Adam Piasecki, Adam Rdzanek, Piotr Scisło, Ewa Pędzich, Agnieszka Kapłon-Cieślicka, Mariusz Tomaniak
Severe tricuspid regurgitation is a prevalent condition with a poor prognosis. Recent advances in transcatheter techniques resulted in a growing population of patients who are qualified for transcatheter edge-to-edge repair of tricuspid regurgitation. There is evidence that these procedures result in an improvement in heart failure symptoms and patient-reported quality of life; however, the data guiding the qualification process are scarce. The increasing volume of patients that undergo qualification for interventional TR treatment creates the need to improve the tools for risk stratification and outcome prediction. TAPSE/SPAP ratio is an echocardiographic parameter that has been recently proposed as a predictive factor for adverse outcome in various clinical settings including patients undergoing transcatheter procedures. In this systematic review, we gathered the data on the utility of this parameter in patients with significant tricuspid regurgitation. We identified five studies fulfilling the search criteria. In all of the studies, a low TAPSE/SPAP ratio was associated with worse prognosis, but the exact cutoff value remains difficult to define. In available studies, it ranged from 0.26 to 0.49 mm/mmHg. Moreover, greater severity of tricuspid regurgitation results in an underestimation of SPAP potentially reducing the usefulness of TAPSE/SPAP ratio in patients with massive and torrential TR.
{"title":"Right ventricle to pulmonary artery coupling as a prognostic factor in tricuspid regurgitation: A systematic review","authors":"Adam Piasecki, Adam Rdzanek, Piotr Scisło, Ewa Pędzich, Agnieszka Kapłon-Cieślicka, Mariusz Tomaniak","doi":"10.1002/ehf2.15352","DOIUrl":"10.1002/ehf2.15352","url":null,"abstract":"<p>Severe tricuspid regurgitation is a prevalent condition with a poor prognosis. Recent advances in transcatheter techniques resulted in a growing population of patients who are qualified for transcatheter edge-to-edge repair of tricuspid regurgitation. There is evidence that these procedures result in an improvement in heart failure symptoms and patient-reported quality of life; however, the data guiding the qualification process are scarce. The increasing volume of patients that undergo qualification for interventional TR treatment creates the need to improve the tools for risk stratification and outcome prediction. TAPSE/SPAP ratio is an echocardiographic parameter that has been recently proposed as a predictive factor for adverse outcome in various clinical settings including patients undergoing transcatheter procedures. In this systematic review, we gathered the data on the utility of this parameter in patients with significant tricuspid regurgitation. We identified five studies fulfilling the search criteria. In all of the studies, a low TAPSE/SPAP ratio was associated with worse prognosis, but the exact cutoff value remains difficult to define. In available studies, it ranged from 0.26 to 0.49 mm/mmHg. Moreover, greater severity of tricuspid regurgitation results in an underestimation of SPAP potentially reducing the usefulness of TAPSE/SPAP ratio in patients with massive and torrential TR.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 6","pages":"4033-4040"},"PeriodicalIF":3.7,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274089","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Janine Beezer, Andrew L. Clark, Adam Todd, Andrew Kingston, Andrew Husband
<div> <section> <h3> Aims</h3> <p>Mortality remains high in heart failure despite advances in heart failure therapy. Heart failure patients are generally older, with multiple long-term conditions, and polypharmacy is common. This study explores the association between polypharmacy and mortality.</p> </section> <section> <h3> Methods</h3> <p>This retrospective longitudinal observational cohort study collected medication data on admission and discharge from the first heart failure hospitalisation. Association with mortality was explored using Cox proportional hazard models and inverse probability weighting regression analysis.</p> </section> <section> <h3> Results</h3> <p>A total of 660 patients were included, 367 (56%) male, mean age 76.1 (SD ±12.3) and almost 60% (338/660) had died at study end. Median follow-up time was 2.9 years (25th and 75th quartiles 1.6 and 4.5). It was rare to be discharged from hospital with no polypharmacy (5%, <i>n</i> = 31). Heart failure with preserved ejection fraction (HFpEF) was associated with a 32% (HR 1.32, CI 1.08–1.61, <i>P</i> = 0.007) higher mortality compared to HFrEF.</p> <p>In those with heart failure with reduced ejection fraction (HFrEF), univariable analysis showed hyperpolypharmacy was associated with twice the mortality compared to polypharmacy (HR 1.95, CI 1.36–2.82, <i>P</i> < 0.001). In multivariable analysis, the association between polypharmacy and mortality was lost. The average treatment effect for hyperpolypharmacy was associated with 26% (Coeff. −0.26, CI −0.43 to −0.09, <i>P</i> = 0.003) higher mortality than polypharmacy. The chance of survival to the end of follow-up was 80% (Coeff. 0.80, CI 0.64–0.95, <i>P</i> < 0.01) for those with polypharmacy, and 54% (Coeff. 0.54, CI 0.46–0.61, <i>P</i> < 0.01) for those with hyperpolypharmacy.</p> <p>In HFpEF, hyperpolypharmacy, univariable analysis was not associated with mortality (HR 0.93, CI 0.70–1.24, <i>P</i> = 0.63). Average treatment effect also showed that hyperpolypharmacy was not associated with mortality (Coeff. −0.03, CI −0.15 to 0.08, <i>P</i> = 0.55). The chance of survival to the end of follow-up was 67% (Coeff. 0.67, CI 0.58–0.77, <i>P</i> < 0.01) with polypharmacy and 64% (Coeff. 0.64, CI 0.57–0.71, <i>P</i> < 0.01) with hyperpolypharmacy.</p> </section> <section> <h3> Conclusions</h3> <p>Age, sex, CCI, and CFS are strong mortality predictors for HF irrespective of HF subgroup. Rigorous confounding adjustment suggests polypharmacy is associated with mortalit
目的：尽管心力衰竭治疗取得进展，但心力衰竭的死亡率仍然很高。心力衰竭患者一般年龄较大，有多种长期病情，多药治疗较为常见。本研究探讨了多药与死亡率之间的关系。方法：本回顾性纵向观察队列研究收集了首次心力衰竭住院患者入院和出院时的用药资料。采用Cox比例风险模型和逆概率加权回归分析探讨与死亡率的关系。结果：共纳入660例患者，其中男性367例（56%），平均年龄76.1 (SD±12.3)，研究结束时死亡近60%（338/660）。中位随访时间为2.9年（25分位数和75分位数分别为1.6年和4.5年）。出院时未出现复方用药的患者极少（5%,n = 31）。与HFrEF相比，保留射血分数（HFpEF）心力衰竭的死亡率高出32% （HR 1.32, CI 1.08-1.61, P = 0.007）。在心力衰竭伴射血分数降低（HFrEF）的患者中，单变量分析显示，与多药治疗相比，多药治疗与两倍的死亡率相关（HR 1.95, CI 1.36-2.82， P）。结论：年龄、性别、CCI和CFS是HF的强死亡率预测因子，与HF亚组无关。严格的混杂校正表明，多药治疗与HFrEF住院后的死亡率相关，但与HFpEF无关。需要进一步的研究来解决多种药物、年龄、合并症和虚弱之间复杂的相互作用。
{"title":"The association between polypharmacy and mortality in patients with heart failure: Results from the PULSE dataset","authors":"Janine Beezer, Andrew L. Clark, Adam Todd, Andrew Kingston, Andrew Husband","doi":"10.1002/ehf2.15445","DOIUrl":"10.1002/ehf2.15445","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Mortality remains high in heart failure despite advances in heart failure therapy. Heart failure patients are generally older, with multiple long-term conditions, and polypharmacy is common. This study explores the association between polypharmacy and mortality.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This retrospective longitudinal observational cohort study collected medication data on admission and discharge from the first heart failure hospitalisation. Association with mortality was explored using Cox proportional hazard models and inverse probability weighting regression analysis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 660 patients were included, 367 (56%) male, mean age 76.1 (SD ±12.3) and almost 60% (338/660) had died at study end. Median follow-up time was 2.9 years (25th and 75th quartiles 1.6 and 4.5). It was rare to be discharged from hospital with no polypharmacy (5%, <i>n</i> = 31). Heart failure with preserved ejection fraction (HFpEF) was associated with a 32% (HR 1.32, CI 1.08–1.61, <i>P</i> = 0.007) higher mortality compared to HFrEF.</p>\u0000 \u0000 <p>In those with heart failure with reduced ejection fraction (HFrEF), univariable analysis showed hyperpolypharmacy was associated with twice the mortality compared to polypharmacy (HR 1.95, CI 1.36–2.82, <i>P</i> < 0.001). In multivariable analysis, the association between polypharmacy and mortality was lost. The average treatment effect for hyperpolypharmacy was associated with 26% (Coeff. −0.26, CI −0.43 to −0.09, <i>P</i> = 0.003) higher mortality than polypharmacy. The chance of survival to the end of follow-up was 80% (Coeff. 0.80, CI 0.64–0.95, <i>P</i> < 0.01) for those with polypharmacy, and 54% (Coeff. 0.54, CI 0.46–0.61, <i>P</i> < 0.01) for those with hyperpolypharmacy.</p>\u0000 \u0000 <p>In HFpEF, hyperpolypharmacy, univariable analysis was not associated with mortality (HR 0.93, CI 0.70–1.24, <i>P</i> = 0.63). Average treatment effect also showed that hyperpolypharmacy was not associated with mortality (Coeff. −0.03, CI −0.15 to 0.08, <i>P</i> = 0.55). The chance of survival to the end of follow-up was 67% (Coeff. 0.67, CI 0.58–0.77, <i>P</i> < 0.01) with polypharmacy and 64% (Coeff. 0.64, CI 0.57–0.71, <i>P</i> < 0.01) with hyperpolypharmacy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Age, sex, CCI, and CFS are strong mortality predictors for HF irrespective of HF subgroup. Rigorous confounding adjustment suggests polypharmacy is associated with mortalit","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 6","pages":"4316-4325"},"PeriodicalIF":3.7,"publicationDate":"2025-10-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719856/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274139","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Christina Paitazoglou, Dominik Jurczyk, Matthias Mezger, Felicitas Lemmer, Bernhard Schwaab, Patricia Grube, Thomas Helms, Bettina Zippel-Schultz, Buntaro Fujita, Roland Tilz, Thomas Stiermaier, Christian Frerker, Stephan Ensminger, Ingo Eitel
Aims
Heart failure (HF) is a major cause of hospitalization, mortality and healthcare costs. Reducing its socioeconomic burden is a key global public health priority. HF networks are recommended to improve screening and management of HF patients. We developed and implemented a multi-sectoral HF network in Northern Germany aimed at optimizing patient outcomes.
Methods and results
A regional HF network was established by integrating 12 pre-existing local networks into a state-wide, multi-sectoral HF network. Data from HF-coded patients were analysed for two time periods: pre-implementation (2018–2020) and post-implementation (2021–2023). Patient trajectories through the healthcare system were examined using both inpatient and outpatient datasets. We report on the network's implementation across urban, island and rural areas, along with associated challenges and benefits. A roadmap of HF patient trajectories was created, identifying key healthcare entry points and informing a three-pillar theory of change to address the national HF burden.
Post-implementation, outpatient treatment cases increased markedly (2018–2020 n = 1237 vs. 2021–2023 n = 2563; +101.3%, P < 0.001), as did referrals from specialists (2018–2020 n = 290 vs. 2021–2023 n = 434, +49.7%, P = 0.013), general practitioners (2018–2020 n = 369 vs. 2021–2023 n = 435, +17.9%, P = 0.26), and inpatient admissions (2018–2020 n = 2342 vs. 2021–2023 n = 2608, +20.7%, P = 0.03). HF rehospitalization rates showed no significant difference yet despite a positive trend (2018–2020 20.3% vs. 2021–2023 17.9%; P = 0.295), while in-hospital mortality remained stable (2018–2020 8.8% vs. 2021–2023 10.2%; P = 0.1).
Conclusions
Implementation of a novel multi-sectoral HF network enabled the analysis of patient trajectories and identification of areas for improvement in HF care. Observed shifts in referral patterns and increased treatment activity indicate early positive trends that support the potential of such networks in enhancing HF management and reducing disease burden.
目的：心力衰竭（HF）是住院、死亡和医疗费用的主要原因。减轻其社会经济负担是全球公共卫生的一个关键优先事项。心衰网络被推荐用于改善心衰患者的筛查和管理。我们在德国北部开发并实施了一个多部门HF网络，旨在优化患者的预后。方法和结果：通过将12个已有的本地网络整合成一个全国性的多部门高频网络，建立了一个区域性高频网络。对来自hf编码患者的数据进行了两个时间段的分析：实施前（2018-2020）和实施后（2021-2023）。患者轨迹通过医疗保健系统检查使用住院和门诊数据集。我们报告了该网络在城市、岛屿和农村地区的实施情况，以及相关的挑战和利益。创建了心衰患者轨迹路线图，确定了关键的医疗保健切入点，并为解决国家心衰负担的三支柱变革理论提供了信息。实施后，门诊治疗病例显著增加（2018-2020 n = 1237 vs. 2021-2023 n = 2563; +101.3%）。结论：实施新的多部门心衰网络可以分析患者轨迹并确定心衰护理需要改进的领域。观察到的转诊模式的转变和治疗活动的增加表明了早期的积极趋势，支持这种网络在加强心衰管理和减轻疾病负担方面的潜力。
{"title":"A heart failure network model to improve outcome and trans-sectoral guideline-directed medical treatment utilization","authors":"Christina Paitazoglou, Dominik Jurczyk, Matthias Mezger, Felicitas Lemmer, Bernhard Schwaab, Patricia Grube, Thomas Helms, Bettina Zippel-Schultz, Buntaro Fujita, Roland Tilz, Thomas Stiermaier, Christian Frerker, Stephan Ensminger, Ingo Eitel","doi":"10.1002/ehf2.15434","DOIUrl":"10.1002/ehf2.15434","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Heart failure (HF) is a major cause of hospitalization, mortality and healthcare costs. Reducing its socioeconomic burden is a key global public health priority. HF networks are recommended to improve screening and management of HF patients. We developed and implemented a multi-sectoral HF network in Northern Germany aimed at optimizing patient outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>A regional HF network was established by integrating 12 pre-existing local networks into a state-wide, multi-sectoral HF network. Data from HF-coded patients were analysed for two time periods: pre-implementation (2018–2020) and post-implementation (2021–2023). Patient trajectories through the healthcare system were examined using both inpatient and outpatient datasets. We report on the network's implementation across urban, island and rural areas, along with associated challenges and benefits. A roadmap of HF patient trajectories was created, identifying key healthcare entry points and informing a three-pillar theory of change to address the national HF burden.</p>\u0000 \u0000 <p>Post-implementation, outpatient treatment cases increased markedly (2018–2020 <i>n</i> = 1237 vs. 2021–2023 <i>n</i> = 2563; +101.3%, <i>P</i> < 0.001), as did referrals from specialists (2018–2020 <i>n</i> = 290 vs. 2021–2023 <i>n</i> = 434, +49.7%, <i>P</i> = 0.013), general practitioners (2018–2020 <i>n</i> = 369 vs. 2021–2023 <i>n</i> = 435, +17.9%, <i>P</i> = 0.26), and inpatient admissions (2018–2020 <i>n</i> = 2342 vs. 2021–2023 <i>n</i> = 2608, +20.7%, <i>P</i> = 0.03). HF rehospitalization rates showed no significant difference yet despite a positive trend (2018–2020 20.3% vs. 2021–2023 17.9%; <i>P</i> = 0.295), while in-hospital mortality remained stable (2018–2020 8.8% vs. 2021–2023 10.2%; <i>P</i> = 0.1).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Implementation of a novel multi-sectoral HF network enabled the analysis of patient trajectories and identification of areas for improvement in HF care. Observed shifts in referral patterns and increased treatment activity indicate early positive trends that support the potential of such networks in enhancing HF management and reducing disease burden.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 6","pages":"4305-4315"},"PeriodicalIF":3.7,"publicationDate":"2025-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145274043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Giulia Stronati, Michele Alfieri, Niki Tombolesi, Alessandro Barbarossa, Samuele Principi, Federico Gullì, Arianna Massari, Gianmarco Bastianoni, Francesca Roccetti, Michela Casella, Antonio Dello Russo, Federico Guerra
Background and aims
Tachycardia-induced cardiomyopathy (TCM) is a reversible form of heart failure (HF) driven by arrhythmias, often atrial fibrillation (AF). While reversible, TCM's long-term prognosis remains unclear, especially in comparison to HF with reduced ejection fraction (HFrEF). This study examines the prognosis of pure and impure TCM against other causes of HFrEF.
Methods
Prospective, monocentric, observational study of 456 patients hospitalized with de novo, acute decompensated HFrEF, classified into pure TCM, impure TCM, ischaemic HF and non-ischaemic HF. The primary endpoint was all-cause mortality, and the secondary endpoint was the incidence of unplanned cardiovascular hospitalisations. Sensitivity analyses were performed using propensity score matching between the four groups.
Results
During a median follow-up of 3 years (interquartile range 1.5–5.1 years), pure TCM had the highest survival rate, and ischaemic HF had the lowest (pure TCM 78.2%; impure TCM 64.8%; non-ischaemic HF 73.4%; ischaemic HF 58.5%; log-rank P < 0.0001). Pure and impure TCM presented the lowest free-from-readmission estimates over follow-up (pure TCM 43.2%; impure TCM 60.0%; non-ischaemic HF 83.2%; ischaemic HF 69.9%; log-rank P < 0.0001). An initial rhythm control strategy was associated with better overall survival in TCM (79% vs. 63%; log-rank P < 0.0001) but similar rates of unplanned hospitalization.
Conclusions
Pure TCM shows a favourable survival prognosis but high readmission rates, emphasizing the need for early rhythm control and sustained monitoring for arrhythmia recurrence. An initial rhythm control strategy seems associated with an increased survival, highlighting the importance of early recognition of arrhythmias as a culprit of HF worsening.
{"title":"Long-term prognosis of pure and impure tachycardiomyopathy","authors":"Giulia Stronati, Michele Alfieri, Niki Tombolesi, Alessandro Barbarossa, Samuele Principi, Federico Gullì, Arianna Massari, Gianmarco Bastianoni, Francesca Roccetti, Michela Casella, Antonio Dello Russo, Federico Guerra","doi":"10.1002/ehf2.15444","DOIUrl":"10.1002/ehf2.15444","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background and aims</h3>\u0000 \u0000 <p>Tachycardia-induced cardiomyopathy (TCM) is a reversible form of heart failure (HF) driven by arrhythmias, often atrial fibrillation (AF). While reversible, TCM's long-term prognosis remains unclear, especially in comparison to HF with reduced ejection fraction (HFrEF). This study examines the prognosis of pure and impure TCM against other causes of HFrEF.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Prospective, monocentric, observational study of 456 patients hospitalized with de novo, acute decompensated HFrEF, classified into pure TCM, impure TCM, ischaemic HF and non-ischaemic HF. The primary endpoint was all-cause mortality, and the secondary endpoint was the incidence of unplanned cardiovascular hospitalisations. Sensitivity analyses were performed using propensity score matching between the four groups.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During a median follow-up of 3 years (interquartile range 1.5–5.1 years), pure TCM had the highest survival rate, and ischaemic HF had the lowest (pure TCM 78.2%; impure TCM 64.8%; non-ischaemic HF 73.4%; ischaemic HF 58.5%; log-rank <i>P</i> < 0.0001). Pure and impure TCM presented the lowest free-from-readmission estimates over follow-up (pure TCM 43.2%; impure TCM 60.0%; non-ischaemic HF 83.2%; ischaemic HF 69.9%; log-rank <i>P</i> < 0.0001). An initial rhythm control strategy was associated with better overall survival in TCM (79% vs. 63%; log-rank <i>P</i> < 0.0001) but similar rates of unplanned hospitalization.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Pure TCM shows a favourable survival prognosis but high readmission rates, emphasizing the need for early rhythm control and sustained monitoring for arrhythmia recurrence. An initial rhythm control strategy seems associated with an increased survival, highlighting the importance of early recognition of arrhythmias as a culprit of HF worsening.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 6","pages":"4288-4298"},"PeriodicalIF":3.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719866/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250468","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Judith Rovira-Solé, Evelyn Santiago-Vacas, Pau Codina, Andrea Borrellas, Mar Domingo, Antoni Bayes-Genís
<p>Approximately 50% of patients with chronic heart failure (HF), whether with preserved or reduced left ventricular ejection fraction (LVEF), develop secondary pulmonary hypertension, which is associated with poorer outcomes. Previous studies have shown that sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce cardiovascular mortality and HF-related hospitalizations in patients with HF, regardless of LVEF.<span><sup>1, 2</sup></span></p><p>The primary objective of this study is to evaluate the impact of SGLT2i on pulmonary artery pressure (PAP) in patients with chronic HF who are monitored using a PAP sensor (CardioMEMS HF system). A secondary objective is to assess the effects of SGLT2i in patient subgroups stratified by LVEF.<span><sup>3</sup></span></p><p>This retrospective study included patients with chronic HF and previously implanted PAP sensors from July 2019 to February 2023. SGLT2 inhibitors were added as a fourth-line treatment in patients with reduced LVEF who were already receiving optimal HF treatment. Patients were excluded if they underwent changes in diuretic therapy or baseline neurohormonal treatment during the follow-up period.</p><p>The study compared changes in PAP, renal function, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels between two time intervals: 1 month before and 1 month after the initiation of SGLT2i therapy. Subsequently, patients were categorized into two groups based on LVEF: group 1 (LVEF ≤ 40%) and group 2 (LVEF > 40%), and the same analyses were conducted within each subgroup.</p><p>A total of 1020 pulmonary artery pressure (PAP) measurements were analysed from 17 patients included in the study. The mean age was 71.7 ± 9.6 years, with 64.7% being male. The average left ventricular ejection fraction (LVEF) was 49.4 ± 17.5%, 23.5% of patients had an ischaemic aetiology, and 64.7% were classified as New York Heart Association (NYHA) class III. There was a significantly higher proportion of men in group 1 (LVEF ≤ 40%) compared to group 2 (LVEF > 40%) (<i>P</i> = 0.043); however, no other baseline characteristics differed significantly between the two groups (<i>Table</i> 1). Dapagliflozin (10 mg daily) was initiated in 14 patients (82.4%)—5 in group 1 and 9 in group 2—while empagliflozin (10 mg daily) was initiated in 3 patients (17.6%)—1 in group 1 and 2 in group 2. Prior to the initiation of SGLT2 inhibitor therapy, the mean diastolic PAP (dPAP) was 17.3 ± 5.6 mmHg, and the median NT-proBNP level was 2841.5 pg/mL (interquartile range: 289–10 515 pg/mL).</p><p>SGLT2 inhibitors significantly reduced dPAP; the mean dPAP in the “one month after” period was 1.5 mmHg lower (95% CI, 0.26–2.74; <i>P</i> = 0.021) compared to the “one month before” period (<i>Figure</i> 1). SGLT2 inhibitors also reduced systolic PAP (−2.2 mmHg), mean PAP (−1.7 mmHg), NT-proBNP (−183 pg/mL), and creatinine (−0.2 mg/dL), although these changes were not statistically significant. These improvements were more
{"title":"Effects of sodium-glucose cotransporter 2 inhibitors on pulmonary artery pressure in patients with chronic heart failure","authors":"Judith Rovira-Solé, Evelyn Santiago-Vacas, Pau Codina, Andrea Borrellas, Mar Domingo, Antoni Bayes-Genís","doi":"10.1002/ehf2.70002","DOIUrl":"10.1002/ehf2.70002","url":null,"abstract":"<p>Approximately 50% of patients with chronic heart failure (HF), whether with preserved or reduced left ventricular ejection fraction (LVEF), develop secondary pulmonary hypertension, which is associated with poorer outcomes. Previous studies have shown that sodium-glucose cotransporter 2 inhibitors (SGLT2i) reduce cardiovascular mortality and HF-related hospitalizations in patients with HF, regardless of LVEF.<span><sup>1, 2</sup></span></p><p>The primary objective of this study is to evaluate the impact of SGLT2i on pulmonary artery pressure (PAP) in patients with chronic HF who are monitored using a PAP sensor (CardioMEMS HF system). A secondary objective is to assess the effects of SGLT2i in patient subgroups stratified by LVEF.<span><sup>3</sup></span></p><p>This retrospective study included patients with chronic HF and previously implanted PAP sensors from July 2019 to February 2023. SGLT2 inhibitors were added as a fourth-line treatment in patients with reduced LVEF who were already receiving optimal HF treatment. Patients were excluded if they underwent changes in diuretic therapy or baseline neurohormonal treatment during the follow-up period.</p><p>The study compared changes in PAP, renal function, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels between two time intervals: 1 month before and 1 month after the initiation of SGLT2i therapy. Subsequently, patients were categorized into two groups based on LVEF: group 1 (LVEF ≤ 40%) and group 2 (LVEF > 40%), and the same analyses were conducted within each subgroup.</p><p>A total of 1020 pulmonary artery pressure (PAP) measurements were analysed from 17 patients included in the study. The mean age was 71.7 ± 9.6 years, with 64.7% being male. The average left ventricular ejection fraction (LVEF) was 49.4 ± 17.5%, 23.5% of patients had an ischaemic aetiology, and 64.7% were classified as New York Heart Association (NYHA) class III. There was a significantly higher proportion of men in group 1 (LVEF ≤ 40%) compared to group 2 (LVEF > 40%) (<i>P</i> = 0.043); however, no other baseline characteristics differed significantly between the two groups (<i>Table</i> 1). Dapagliflozin (10 mg daily) was initiated in 14 patients (82.4%)—5 in group 1 and 9 in group 2—while empagliflozin (10 mg daily) was initiated in 3 patients (17.6%)—1 in group 1 and 2 in group 2. Prior to the initiation of SGLT2 inhibitor therapy, the mean diastolic PAP (dPAP) was 17.3 ± 5.6 mmHg, and the median NT-proBNP level was 2841.5 pg/mL (interquartile range: 289–10 515 pg/mL).</p><p>SGLT2 inhibitors significantly reduced dPAP; the mean dPAP in the “one month after” period was 1.5 mmHg lower (95% CI, 0.26–2.74; <i>P</i> = 0.021) compared to the “one month before” period (<i>Figure</i> 1). SGLT2 inhibitors also reduced systolic PAP (−2.2 mmHg), mean PAP (−1.7 mmHg), NT-proBNP (−183 pg/mL), and creatinine (−0.2 mg/dL), although these changes were not statistically significant. These improvements were more ","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 6","pages":"4535-4537"},"PeriodicalIF":3.7,"publicationDate":"2025-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719850/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145250403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Micha T. Maeder, Laura A. Rechsteiner, Philipp K. Haager, Hans Rickli
{"title":"Reply to letter to the editor","authors":"Micha T. Maeder, Laura A. Rechsteiner, Philipp K. Haager, Hans Rickli","doi":"10.1002/ehf2.15421","DOIUrl":"10.1002/ehf2.15421","url":null,"abstract":"","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 6","pages":"4543-4545"},"PeriodicalIF":3.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719801/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Heart failure with preserved ejection fraction (HFpEF) is often underdiagnosed. This study evaluates the HFpEF-ABA score's ability to identify high-risk, undiagnosed HFpEF subgroups with elevated cardiovascular event rates and assesses the impact of intensive blood pressure control in these populations.
Methods
A post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) was performed. The HFpEF-ABA score identified high-risk individuals with undiagnosed HFpEF. Cox proportional hazards regression was used to examine interactions between HFpEF-ABA score groups and intensive blood pressure control on major cardiovascular outcomes. The primary outcome was a composite of myocardial infarction (MI), acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure and cardiovascular disease death.
Results
Among 9265 patients (mean age, 67.9 ± 9.4 years; 35.5% females), 559 primary outcomes occurred during a median follow-up of 3.2 years. An HFpEF-ABA score ≥ 90% was associated with a higher risk of the primary outcome [adjusted hazard ratio (aHR), 1.96 (1.57–2.44); P < 0.001]. When treated as a continuous variable, higher HFpEF-ABA scores were independently associated with an increased risk of the primary composite outcome (P = 0.001), with a modest non-linear relationship observed (P for non-linearity = 0.040). In the intensive treatment group, the absolute reduction in primary outcomes was 5.0 per 1000 patient-years for scores < 90% and 11.2 per 1000 patient-years for ≥ 90%. Intensive blood pressure control reduced primary outcomes in both groups [<90%: aHR, 0.75 (0.62–0.90); ≥90%: aHR, 0.76 (0.51–1.13)] with no significant heterogeneity (P for interaction = 0.944). Serious adverse events did not increase in either group [<90%: aHR, 1.04 (0.96–1.11); ≥90%: aHR, 1.06 (0.88–1.28); P for interaction = 0.801].
Conclusions
The HFpEF-ABA score identifies high-risk patients with undiagnosed HFpEF who have elevated cardiovascular event rates and benefit from intensive blood pressure control without an increased risk of serious adverse events.
{"title":"Assessing cardiovascular benefits of intensive blood pressure lowering in high-risk undiagnosed HFpEF patients","authors":"Xinru Liu, Zhiyan Wang, Chang Hua, Yanfang Wu, Yangyang Tang, Yuling Xiong, Jingwei Liu, Jiaqi Zhang, Qiang Lv, Chao Jiang, Jianzeng Dong, Xin Du","doi":"10.1002/ehf2.15435","DOIUrl":"10.1002/ehf2.15435","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Heart failure with preserved ejection fraction (HFpEF) is often underdiagnosed. This study evaluates the HFpEF-ABA score's ability to identify high-risk, undiagnosed HFpEF subgroups with elevated cardiovascular event rates and assesses the impact of intensive blood pressure control in these populations.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A post-hoc analysis of the Systolic Blood Pressure Intervention Trial (SPRINT) was performed. The HFpEF-ABA score identified high-risk individuals with undiagnosed HFpEF. Cox proportional hazards regression was used to examine interactions between HFpEF-ABA score groups and intensive blood pressure control on major cardiovascular outcomes. The primary outcome was a composite of myocardial infarction (MI), acute coronary syndrome not resulting in MI, stroke, acute decompensated heart failure and cardiovascular disease death.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Among 9265 patients (mean age, 67.9 ± 9.4 years; 35.5% females), 559 primary outcomes occurred during a median follow-up of 3.2 years. An HFpEF-ABA score ≥ 90% was associated with a higher risk of the primary outcome [adjusted hazard ratio (aHR), 1.96 (1.57–2.44); <i>P</i> < 0.001]. When treated as a continuous variable, higher HFpEF-ABA scores were independently associated with an increased risk of the primary composite outcome (<i>P</i> = 0.001), with a modest non-linear relationship observed (<i>P</i> for non-linearity = 0.040). In the intensive treatment group, the absolute reduction in primary outcomes was 5.0 per 1000 patient-years for scores < 90% and 11.2 per 1000 patient-years for ≥ 90%. Intensive blood pressure control reduced primary outcomes in both groups [<90%: aHR, 0.75 (0.62–0.90); ≥90%: aHR, 0.76 (0.51–1.13)] with no significant heterogeneity (<i>P</i> for interaction = 0.944). Serious adverse events did not increase in either group [<90%: aHR, 1.04 (0.96–1.11); ≥90%: aHR, 1.06 (0.88–1.28); <i>P</i> for interaction = 0.801].</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The HFpEF-ABA score identifies high-risk patients with undiagnosed HFpEF who have elevated cardiovascular event rates and benefit from intensive blood pressure control without an increased risk of serious adverse events.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 6","pages":"4277-4287"},"PeriodicalIF":3.7,"publicationDate":"2025-10-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719812/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145238030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alberto Palazzuoli, Marco Giuseppe Del Buono, Giulia La Vecchia, Stephen J. Greene, Andrew P. Ambrosy, Ovidiu Chioncel, Finn Gustafsson, Selim R. Krim, Carl J. Lavie, Marianna Adamo, Tuvia Ben Gal, Oliviana Geavlete, Laura Antohi, Giuseppe Rosano, Sean Collins, Filippo Crea
Heart failure (HF) is a progressive condition marked by recurrent episodes of symptom exacerbation, leading to worsening cardiac function, increased hospitalization and mortality risk. Worsening HF (WHF) and advanced HF (AdvHF) represent two distinct stages in this progression, each with unique clinical features and therapeutic needs. WHF is characterized by a deterioration of pre-existing symptoms requiring intensified treatment, such as diuretic escalation, which often reflects disease progression. Conversely, AdvHF involves severe cardiac dysfunction with persistent symptoms despite optimal medical management, requiring advanced interventions such as inotropic support or heart transplant. Although both stages share some pathophysiological and clinical features, they differ significantly in haemodynamic profiles, disease severity and response to treatment. This review argues that recognizing the transition from WHF to AdvHF is a pivotal issue in patient care. We explore the distinct natural histories, clinical presentations and diagnostic markers of WHF and AdvHF to provide a framework for earlier, more targeted interventions aimed at altering the disease trajectory and preventing the decline associated with the advanced stage. While WHF symptoms are typically reversible with appropriate interventions, AdvHF represents the end stage of HF with often irreversible dysfunction and multi-organ involvement. A clearer understanding and standardized definition of these phenotypes are essential for improving patient outcomes and guiding future clinical research.
{"title":"Worsening versus advanced heart failure: Management and challenges","authors":"Alberto Palazzuoli, Marco Giuseppe Del Buono, Giulia La Vecchia, Stephen J. Greene, Andrew P. Ambrosy, Ovidiu Chioncel, Finn Gustafsson, Selim R. Krim, Carl J. Lavie, Marianna Adamo, Tuvia Ben Gal, Oliviana Geavlete, Laura Antohi, Giuseppe Rosano, Sean Collins, Filippo Crea","doi":"10.1002/ehf2.15437","DOIUrl":"10.1002/ehf2.15437","url":null,"abstract":"<p>Heart failure (HF) is a progressive condition marked by recurrent episodes of symptom exacerbation, leading to worsening cardiac function, increased hospitalization and mortality risk. Worsening HF (WHF) and advanced HF (AdvHF) represent two distinct stages in this progression, each with unique clinical features and therapeutic needs. WHF is characterized by a deterioration of pre-existing symptoms requiring intensified treatment, such as diuretic escalation, which often reflects disease progression. Conversely, AdvHF involves severe cardiac dysfunction with persistent symptoms despite optimal medical management, requiring advanced interventions such as inotropic support or heart transplant. Although both stages share some pathophysiological and clinical features, they differ significantly in haemodynamic profiles, disease severity and response to treatment. This review argues that recognizing the transition from WHF to AdvHF is a pivotal issue in patient care. We explore the distinct natural histories, clinical presentations and diagnostic markers of WHF and AdvHF to provide a framework for earlier, more targeted interventions aimed at altering the disease trajectory and preventing the decline associated with the advanced stage. While WHF symptoms are typically reversible with appropriate interventions, AdvHF represents the end stage of HF with often irreversible dysfunction and multi-organ involvement. A clearer understanding and standardized definition of these phenotypes are essential for improving patient outcomes and guiding future clinical research.</p>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 6","pages":"3856-3868"},"PeriodicalIF":3.7,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719834/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225278","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Bo Wang, Shuo Wang, Chao Gao, D. Scott Lim, Rutao Wang, Xin Meng, Ying Liu, Cun-jun Zhu, Yoshinobu Onuma, Yunbing Wang, Patrick W.J.C. Serruys, Runlin Gao, Randall J. Lee, Ling Tao
Aims
Despite the potential of alginate hydrogel intramyocardial injections in the treatment of heart failure (HF), minimally invasive implantation techniques remain scarce. This study evaluated the safety and feasibility of percutaneous transcatheter endocardial alginate hydrogel injection (TEAi), facilitated by novel implants and a dedicated catheter-based device, in patients with HF with reduced ejection fraction (HFrEF).
Methods and Results
This first-in-human study enrolled HFrEF patients [New York Heart Association (NYHA) Class III–IV and left ventricular ejection fraction (LVEF) ≤35%]. The primary endpoint was the incidence of procedure- or device-related serious adverse events (SADEs) at 30 days. Secondary endpoints included the device success rate, HF hospitalization at 6 months, and change from baseline to 6 months post-procedure in the following parameters: LVEF as assessed by MRI; NYHA functional class; 6 min walk test distance (6MWT); the quality of life assessed by the Kansas City Cardiomyopathy Heart Failure Questionnaire (KCCQ); and serum N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) level. Pre- and post-procedural biomechanical analysis was also evaluated. Ten patients successfully underwent TEAi with no SADEs at 30 days. There was one death and two HF hospitalizations at 6 months. At 6 months, LVEF improved from 17.7% ± 3.8% to 24.9% ± 11.2% (P = 0.021), end-systolic volume decreased from 297.5 ± 67.9 mL to 264.8 ± 101.4 mL (P = 0.029), and KCCQ scores increased from 49.7 ± 3.9 to 79.0 ± 8.07 (P = 0.008). No statistically significant changes were observed in end-diastolic volume, NT-proBNP and 6MWT at six months compared with the baseline. Biomechanical analysis revealed a reduction in peak left ventricular end-diastolic wall stress (6.5 ± 1.1 kPa vs. 5.9 ± 1.3 kPa, P = 0.043).
Conclusions
TEAi is feasible and safe for the treatment of HFrEF, warranting further randomized, efficacy clinical trials.
目的：尽管海藻酸盐水凝胶在心肌内注射治疗心力衰竭（HF）方面具有潜力，但微创植入技术仍然很少。本研究评估了经皮经导管心内膜内海藻酸盐水凝胶注射（TEAi）的安全性和可行性，通过新型植入物和专用导管装置，促进了心力衰竭伴射血分数降低（HFrEF）患者的治疗。方法和结果：这项首次人体研究纳入了HFrEF患者[纽约心脏协会（NYHA） III-IV级，左室射血分数(LVEF)≤35%]。主要终点是30天内手术或器械相关严重不良事件（SADEs）的发生率。次要终点包括器械成功率、6个月HF住院率，以及以下参数从基线到术后6个月的变化：MRI评估的LVEF；NYHA功能类；6分钟步行测试距离（6MWT）；通过堪萨斯城心肌病心力衰竭问卷（KCCQ）评估的生活质量；血清b型利钠肽n端激素原（NT-proBNP）水平。术前和术后生物力学分析也进行了评估。10例患者成功接受TEAi治疗，30天无不良反应。6个月时有1例死亡和2例心衰住院。6个月时LVEF由17.7%±3.8%改善至24.9%±11.2% (P = 0.021)，收缩期末期容积由297.5±67.9 mL降至264.8±101.4 mL (P = 0.029)， KCCQ评分由49.7±3.9升至79.0±8.07 （P = 0.008）。与基线相比，6个月时舒张末期容积、NT-proBNP和6MWT无统计学意义变化。生物力学分析显示左室舒张末期壁应力峰值降低（6.5±1.1 kPa比5.9±1.3 kPa, P = 0.043）。结论：TEAi治疗HFrEF是可行且安全的，值得进一步进行随机、有效的临床试验。
{"title":"Percutaneous endocardial alginate–hydrogel injection in the treatment of heart failure: First-in-human study","authors":"Bo Wang, Shuo Wang, Chao Gao, D. Scott Lim, Rutao Wang, Xin Meng, Ying Liu, Cun-jun Zhu, Yoshinobu Onuma, Yunbing Wang, Patrick W.J.C. Serruys, Runlin Gao, Randall J. Lee, Ling Tao","doi":"10.1002/ehf2.15417","DOIUrl":"10.1002/ehf2.15417","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>Despite the potential of alginate hydrogel intramyocardial injections in the treatment of heart failure (HF), minimally invasive implantation techniques remain scarce. This study evaluated the safety and feasibility of percutaneous transcatheter endocardial alginate hydrogel injection (TEAi), facilitated by novel implants and a dedicated catheter-based device, in patients with HF with reduced ejection fraction (HFrEF).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and Results</h3>\u0000 \u0000 <p>This first-in-human study enrolled HFrEF patients [New York Heart Association (NYHA) Class III–IV and left ventricular ejection fraction (LVEF) ≤35%]. The primary endpoint was the incidence of procedure- or device-related serious adverse events (SADEs) at 30 days. Secondary endpoints included the device success rate, HF hospitalization at 6 months, and change from baseline to 6 months post-procedure in the following parameters: LVEF as assessed by MRI; NYHA functional class; 6 min walk test distance (6MWT); the quality of life assessed by the Kansas City Cardiomyopathy Heart Failure Questionnaire (KCCQ); and serum N-terminal prohormone of B-type natriuretic peptide (NT-proBNP) level. Pre- and post-procedural biomechanical analysis was also evaluated. Ten patients successfully underwent TEAi with no SADEs at 30 days. There was one death and two HF hospitalizations at 6 months. At 6 months, LVEF improved from 17.7% ± 3.8% to 24.9% ± 11.2% (<i>P</i> = 0.021), end-systolic volume decreased from 297.5 ± 67.9 mL to 264.8 ± 101.4 mL (<i>P</i> = 0.029), and KCCQ scores increased from 49.7 ± 3.9 to 79.0 ± 8.07 (<i>P</i> = 0.008). No statistically significant changes were observed in end-diastolic volume, NT-proBNP and 6MWT at six months compared with the baseline. Biomechanical analysis revealed a reduction in peak left ventricular end-diastolic wall stress (6.5 ± 1.1 kPa vs. 5.9 ± 1.3 kPa, <i>P</i> = 0.043).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>TEAi is feasible and safe for the treatment of HFrEF, warranting further randomized, efficacy clinical trials.</p>\u0000 </section>\u0000 </div>","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 6","pages":"4266-4276"},"PeriodicalIF":3.7,"publicationDate":"2025-10-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719817/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145225272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>The recently published article by Imiela et al.<span><sup>1</sup></span> in <i>ESC Heart Failure (2025)</i> provides valuable insights into the underexplored association between acute pulmonary embolism, right ventricular dysfunction and the risk of acute kidney injury (AKI) following computed tomography pulmonary angiography (CTPA). The authors are to be commended for addressing this clinically relevant topic with a well-structured analysis and for highlighting the prognostic value of BOVA scores and N-terminal pro b-type natriuretic peptide (NT-proBNP) levels in identifying at-risk patients. Their contribution adds important evidence to a field where data are limited and clinical guidance is much needed. However, despite the strengths of this study, it also has the following limitations …</p><p>First, this study lacks a non-CTPA control group. Without a comparison to patients with Pulmonary embolism (PE) diagnosed by alternative imaging [e.g., ventilation perfusion (V/Q) scan and echocardiography], it is impossible to separate the effect of contrast-induced nephropathy from haemodynamic kidney injury due to PE. This limits causal inference. Cho et al.<span><sup>2</sup></span> showed that contrast exposure during CTPA itself can increase the risk of post-contrast acute kidney injury (AKI), highlighting the importance of having comparator groups to distinguish contrast-related effects. Second, there is no standardization of hydration or nephroprotective measures. Variability in pre- and post-CTPA hydration status or nephroprotective interventions (saline and N-acetylcysteine) could confound AKI outcomes. Lack of this control makes it unclear whether outcomes were due to PE severity or differences in supportive care. Ho and Harahsheh et al.<span><sup>3</sup></span> reported hydration protocols significantly modify AKI risk after CTPA in critically ill patients. Third, this study uses single-timepoint biomarkers (NT-proBNP and creatinine). Using only admission NT-proBNP and creatinine may not capture dynamic changes in renal and cardiac function. This reduces sensitivity to detect early or transient AKI. Wang et al.<span><sup>4</sup></span> demonstrated that serial renal markers and early anticoagulation timing better predicted AKI in normotensive PE. Fourth, there is a lack of external validation or multi-centre data. Being single-centre, findings may not generalize to different populations with varied comorbidity patterns, contrast protocols or treatment strategies. Elias and Aronson et al.<span><sup>5</sup></span> highlighted that AKI risk estimates vary substantially across cohorts and require multi-centre validation to ensure reliability. Fifth, there is an absence of machine learning (ML) or multimodal risk stratification. Reliance on conventional regression with a few predictors (BOVA, NT-proBNP) may oversimplify risk. Machine learning models combining clinical, imaging and laboratory data could capture nonlinear interactions missed in th
{"title":"Letter to the Editor, ‘Haemodynamic consequences of acute pulmonary embolism predict risk of CTPA-related acute kidney injury’","authors":"Ahmed Raza, Shahzadi Gulfishan","doi":"10.1002/ehf2.15441","DOIUrl":"10.1002/ehf2.15441","url":null,"abstract":"<p>The recently published article by Imiela et al.<span><sup>1</sup></span> in <i>ESC Heart Failure (2025)</i> provides valuable insights into the underexplored association between acute pulmonary embolism, right ventricular dysfunction and the risk of acute kidney injury (AKI) following computed tomography pulmonary angiography (CTPA). The authors are to be commended for addressing this clinically relevant topic with a well-structured analysis and for highlighting the prognostic value of BOVA scores and N-terminal pro b-type natriuretic peptide (NT-proBNP) levels in identifying at-risk patients. Their contribution adds important evidence to a field where data are limited and clinical guidance is much needed. However, despite the strengths of this study, it also has the following limitations …</p><p>First, this study lacks a non-CTPA control group. Without a comparison to patients with Pulmonary embolism (PE) diagnosed by alternative imaging [e.g., ventilation perfusion (V/Q) scan and echocardiography], it is impossible to separate the effect of contrast-induced nephropathy from haemodynamic kidney injury due to PE. This limits causal inference. Cho et al.<span><sup>2</sup></span> showed that contrast exposure during CTPA itself can increase the risk of post-contrast acute kidney injury (AKI), highlighting the importance of having comparator groups to distinguish contrast-related effects. Second, there is no standardization of hydration or nephroprotective measures. Variability in pre- and post-CTPA hydration status or nephroprotective interventions (saline and N-acetylcysteine) could confound AKI outcomes. Lack of this control makes it unclear whether outcomes were due to PE severity or differences in supportive care. Ho and Harahsheh et al.<span><sup>3</sup></span> reported hydration protocols significantly modify AKI risk after CTPA in critically ill patients. Third, this study uses single-timepoint biomarkers (NT-proBNP and creatinine). Using only admission NT-proBNP and creatinine may not capture dynamic changes in renal and cardiac function. This reduces sensitivity to detect early or transient AKI. Wang et al.<span><sup>4</sup></span> demonstrated that serial renal markers and early anticoagulation timing better predicted AKI in normotensive PE. Fourth, there is a lack of external validation or multi-centre data. Being single-centre, findings may not generalize to different populations with varied comorbidity patterns, contrast protocols or treatment strategies. Elias and Aronson et al.<span><sup>5</sup></span> highlighted that AKI risk estimates vary substantially across cohorts and require multi-centre validation to ensure reliability. Fifth, there is an absence of machine learning (ML) or multimodal risk stratification. Reliance on conventional regression with a few predictors (BOVA, NT-proBNP) may oversimplify risk. Machine learning models combining clinical, imaging and laboratory data could capture nonlinear interactions missed in th","PeriodicalId":11864,"journal":{"name":"ESC Heart Failure","volume":"12 6","pages":"4533-4534"},"PeriodicalIF":3.7,"publicationDate":"2025-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12719794/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145211910","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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