Current Heart Failure Reports最新文献

Purpose of review: To position relative fat mass (RFM) as a more accurate, physiologically grounded, and clinically useful alternative to body mass index (BMI) for assessing adiposity and predicting cardiometabolic risk, including heart failure.  RECENT FINDINGS: RFM estimates body fat percentage using a sex-specific formula based on waist circumference and height. RFM not only correlates more strongly with fat mass than BMI, but also shows a weaker correlation with muscle mass. This distinction helps reduce lean mass-related confounding in the assessment of adiposity. In clinical studies, RFM has emerged as a robust predictor of incident heart failure, cardiometabolic disease, and all-cause mortality.  RFM avoids misclassification of adiposity in individuals with high muscle mass and better reflects abdominal adiposity than BMI. As the prevalence of heart failure and other obesity-related diseases continues to rise, RFM offers a practical and intuitive tool for assessment of adiposity and heart failure risk - challenging the long-standing dominance of BMI.

Purpose of review: Cardiac Implantable Electronic Device (CIED)-based remote monitoring has been proposed to improve heart failure (HF) management by enabling early detection of decompensation. This systematic review evaluates the effectiveness of multisensor CIED-based monitoring in reducing mortality, HF hospitalizations, and unplanned HF outpatient visits.

Recent findings: Earlier CIED-based remote monitoring strategies were mainly based on single-sensor impedance-based algorithms, and showed limited clinical benefits. Newer multisensor CIED-based algorithms have shown promise in initial studies. However, their impact on clinical outcomes remains uncertain, and therefore current HF guidelines provide limited recommendations. Multisensor CIED-based algorithms reliably identify high-risk HF patients and their use leads to reductions in HF hospitalizations and unplanned outpatient HF visits, although prospective validation in RCTs is lacking for any of the algorithms. Standardized response strategies are needed to enhance clinical integration and generalizability. If validated, multisensor monitoring could become a key tool in HF management.

Purpose of review: There is a growing need for palliative care (PC) among patients with cardiovascular disease (CVD), as population ageing and technological progress bolster the numbers of patients living with chronic forms of CVD.

Recent findings: PC can provide support and benefits in areas that are not necessarily addressed by medical therapy. However, many healthcare providers, and cardiologists in particular, struggle with identifying the right time to introduce PC in the care trajectory of patients with CVD, especially in heart failure, where the clinical course is punctuated by highs and lows, with periods of stability that may last several months to years. The use of validated assessment tools to recognize PC needs of people living with CVD is recommended, but clinicians may be unaware of existing instruments and criteria for PC referral, or when and how to use them. We report here a narrative review of the literature, with the aim of providing an overview of useful tools for the identification and assessment of palliative care needs among patients suffering from cardiovascular disease with a view to improving their care process. We further discuss the overall suitability of available tools, as well as issues specifically related to implantable cardiac devices at the end-of-life.

Purpose of review: This review aims to elucidate the complex interplay between cardiogenic shock (CS) and renal function, detailing the mechanisms of kidney injury, identifying risk factors, and providing a framework for the diagnosis and management of acute kidney injury (AKI) in CS. We evaluate evidence supporting medical interventions, including vasopressors, inotropes, and mechanical circulatory support (MCS), in relation to renal outcomes.

Recent findings: AKI affects up to 80% of patients with CS and is associated with higher mortality, especially when Renal Replacement Therapy (RRT) is required. Mechanisms include impaired perfusion, venous congestion, and systemic inflammation. Invasive hemodynamic assessment improves diagnostic accuracy. Continuous RRT is preferred in unstable patients, although early initiation has not been shown to provide a survival benefit. Emerging tools such as novel biomarkers and machine learning may aid in early detection and risk stratification. AKI in CS is common and multifactorial, with significant prognostic impact. Early recognition, hemodynamic optimization, and a multidisciplinary strategy remain essential. Future work should focus on individualized management approaches to improve outcomes.

Purpose of review: Heart failure (HF) is a complex, multifactorial syndrome resulting from impaired heart function. When medical management of HF is ineffective, mechanical circulatory support with a left-ventricular assist device (LVAD) or heart transplantation are the only options for significantly extending patients' lives. Patients with HF experience various emotional reactions, including fears, which may impact their well-being44444 and disease management. Understanding how fears may differentially influence patients with HF depending on the stage of the disease is thus essential for delivering personalized care.

Recent findings: Among patients with advanced HF, disease-related and existential fears were associated with anxiety, depression, sleeplessness, loss of dignity, feelings of abandonment, uncertainty about the future, and restricted physical and social activities. The fears of patients with LVAD can be categorized into device-related, transplant-related, and psychological/emotional fears. Device-related fears involved maintaining the device in optimal condition, transplant-related fears included not surviving until transplantation or not receiving an organ, and psychological/emotional fears related to sexuality and disease progression, correlating with anxiety and depression. The fears experienced by heart transplant recipients fall into three main categories: avoidance, existential, and psychological fears. Avoidance fears lead to lower exercise motivation and higher anxiety, existential fears involved the fear of death leading to poor psychological well-being, and psychological fears included concerns about non-compliance repercussions, hypochondriacal responses, and appearing ungrateful. Each stage of HF disease presents unique fears with distinct implications, emphasizing the need for stage-specific psychological support and interventions. Further studies are required to understand the impact of fears in different stages of HF disease.

Purpose of review: Heart failure with preserved ejection fraction (HFpEF) is increasingly prevalent among individuals with obesity, primarily due to metabolic dysfunction and structural cardiac remodeling. This review explores the emerging therapeutic role of glucagon-like peptide-1 receptor agonists (GLP-1 RAs) in managing HFpEF in obese populations.

Recent findings: Recent clinical trials, including the STEP-HFpEF and SUMMIT studies, have shown that GLP-1 RAs such as semaglutide and tirzepatide significantly reduce body weight (13.3% and 13.9%, respectively), enhance exercise capacity (increases of 21.5m and 26m in 6-minute walk distance), and improve quality of life (19.5 and 16.6-point increases in KCCQ-CSS scores). Additionally, both agents demonstrated marked reductions in systemic inflammation, with C-reactive protein levels decreasing by 38.8% and 43.5%, respectively. GLP-1 RAs represent a promising class of agents targeting the cardiometabolic axis in HFpEF, offering meaningful improvements in functional capacity and symptom burden among obese patients. However, current evidence is limited by short trial durations, lack of population diversity, and insufficient long-term data. Future research should focus on more inclusive cohorts and extended outcomes such as hospitalization rates and cardiovascular events to fully define the long-term safety and efficacy of GLP-1 RAs in HFpEF management.

Purpose of review: Cardiac amyloidosis (CA) is a condition caused by interstitial infiltration of misfolded proteins structured into amyloid fibrils. Transthyretin (ATTR) and immunoglobulin light chain (AL) amyloidosis represent the most common forms of CA. CA was traditionally perceived as a rare and incurable disease, but diagnostic and therapeutic advances have undermined the conventional paradigm.

Recent findings: The standard of care for ATTR-CA include agents capable of selectively stabilizing the precursor protein (e.g., tafamidis), whereas the plasma cell clone is the main target of chemotherapy for AL-CA. For long, tafamidis represented the only drug approved for patients with ATTR-CA. Recent data from ATTRibute-CM led to the approval of acoramidis, whereas patisiran received refusal based on the APOLLO-B trial. Novel CRISPR-Cas9-based drugs (i.e., NTLA-2001) hold great potential in the setting of ATTR-CA. Several hematological regimens are available to treat AL-CA. The main limit of current therapies is their inability to trigger removal of amyloid from tissues. However, the investigation of monoclonal antibodies targeting misfolded ATTR (e.g., PRX004, NI301A) or AL (e.g., birtamimab, anselamimab) has led to encouraging results. Various cutting-edge strategies are being tested for treatment of CA and may change the prognostic landscape of this condition in the next years.

Purpose of review: Many countries prioritise the implementation of person-centred care. This study examines the progression of research in person-centred care, specifically focusing on using complex interventions within intricate contexts. It aims to explore how previous experiences can inform and shape subsequent projects. The review was based on five studies from our research group, encompassing 1099 patients, resulting in 41 peer-reviewed scientific publications. Most studies focused on patients suffering from chronic heart failure, as well as patients with chronic obstructive pulmonary disease. Additionally, interventions for acute coronary syndrome and common mental disorders were also considered. Analyses included the development of a logical model for person-centred care, an overview of partnership operationalisation, and the establishment of evaluation criteria for the trials. The analyses involved creating a coherent model for person-centred care, examining partnership operationalisation, and establishing trial evaluation criteria.

Recent findings: Sequential trials build upon their predecessors and add new elements. The studies conducted by clinicians in usual care and in-house by research staff were complementary, providing a deeper understanding of the efficacy and effectiveness of person-centred care. Initiating, working, and safeguarding a partnership between patient and staff was possible, whether through in-person or remote communication. Evaluations followed modern research standards and incorporated past study insights for a more thorough approach. This study highlights how the cumulative experience from previous research in person-centred care informs the design and analyses of subsequent projects through an iterative learning process, particularly important for complex interventions in various health care contexts.

Purpose of review: To summarize articles describing how to personalize care for heart failure (HF) informal caregivers on the basis of the literature review results. We also describe informal caregivers' preferences and wishes regarding personalized care.

Recent findings: Recent interventions to support informal caregivers were delivered face-to-face or online in group or individual sessions. The sessions embraced various elements, including coaching on setting personalized goals and developing problem-solving strategies. The interventions improved a range of variables, such as caregiver burden, quality of life, depression, stress and anxiety. Informal caregivers described personalized care as being in a partnership, clear communication and coordination of care. Several intervention studies reported positive caregiver effects; however, they were small, and sometimes, the interventions were only briefly described. A deeper and more comprehensive understanding of the experiences and needs of informal caregivers is essential before new tailored interventions can be developed.

Purpose of review: Cardiovascular effects of obesity may be driven, in part, by the distribution of fat. More recently, epicardial adipose tissue (EAT) has gained recognition as an adverse visceral fat impacting cardiac dysfunction in heart failure with preserved ejection fraction (HFpEF).

Recent findings: EAT can be identified and measured using several non-invasive imaging techniques, including transthoracic echocardiography, computed tomography, and cardiac magnetic resonance. The presence of EAT is associated with increased risk of HFpEF and worse clinical outcomes among patients with established HFpEF, independent of total adiposity. EAT may serve a pivotal role in the pathogenesis of HFpEF by worsening volume distribution, enhancing pericardial restraint and ventricular interaction, worsening right ventricular dysfunction, and diminishing exercise tolerance. No large trials have tested the effects of reducing fat in specific areas of the body on cardiovascular outcomes, but some studies that followed people in communities and trials over time have suggested that drug and non-drug treatments that lower EAT could improve the risk factors for heart problems in patients with HFpEF. Further understanding the role that pathogenic fat depots play in HFpEF incidence and progression may provide future therapeutic targets in treating the obese-HFpEF phenotype.