ESC Heart Failure最新文献

Introduction: Novel bioimpedance analysis (BIA) devices may improve the precision of fluid overload assessment, potentially offering additional prognostic information beyond clinical parameters in patients with HF. This study aimed to evaluate the association between fluid overload indexes obtained with a novel bioelectrical impedance device (BioScan touch i8 IVF, MALTRON®) and the risk of cardiovascular events in ambulatory patients with HF.

Methods: Volume excess was assessed using BioScan Touch i8 IVF (MALTRON), which differentiates fluid distribution across body compartments. Volume-excess variables (total, intravascular, and tissue) were analysed both as quartiles (Q) and as continuous measures. Their independent associations with the composite of all-cause death or worsening HF were adjusted for established prognostic markers, including a clinical congestion score (CCS) and N-terminal pro-B-type natriuretic peptide.

Results: Among 386 ambulatory patients with stage C chronic HF, median total, intravascular, and tissue fluid excess were 1.3 L (Q1-Q3: 0.5, 2.3), 0.1 L (Q1-Q3: -0.1, 0.4), and 1.9 L (Q1-Q3: 1.1, 2.8), respectively. Total and tissue fluid excess had the strongest correlation with the CCS (Total fluid excess rho = 0.31; P < .001, tissue fluid excess rho = 0.33; P < .001). In adjusted analyses, patients in the highest quartile had significantly higher risk of the composite outcome compared with Q1: total fluid excess hazard ratio (HR) 2.11 [95% confidence interval (CI) 1.21-4.05, P = .010], intravascular fluid excess HR 2.16 (1.19-3.90, P = .011), and tissue fluid excess HR 2.81 (1.49-5.32, P = .001).

Conclusion: Compartment-specific estimates of fluid overload obtained with the BioScan Touch i8 IVF were independently associated with adverse outcomes in ambulatory patients with chronic HF, beyond NT-proBNP and clinical surrogates of congestion. These findings support the potential role of BIA-derived indexes, particularly tissue fluid excess, as complementary tools for risk stratification in this population.

Introduction: This study aimed to evaluate the diagnostic value of lipocalin 2 (LCN2) and microRNA-8078 (miR-8078) in congenital heart disease-associated pulmonary arterial hypertension (CHD-PAH).

Methods: Seventy-six patients were diagnosed with CHD-PAH according to established clinical guidelines (including mean pulmonary arterial pressure (mPAP), pulmonary artery wedge pressure, and pulmonary vascular resistance) via right heart catheterization. Based on their mPAP, they were stratified into non-PAH (mPAP < 25 mm Hg; n = 28), mild PAH (25 ≤ mPAP < 35 mm Hg; n = 21), and moderate-to-severe PAH (mPAP ≥ 35 mm Hg; n = 27) groups. Plasma LCN2 levels and miR-8078 expression were quantified using Enzyme-linked immunosorbent assay and RT-qPCR, respectively. The diagnostic value was analysed using receiver operating characteristic curves. Correlation analysis assessed associations between biomarkers and hemodynamic parameters. Multi-variate logistic regression identified independent predictors of CHD-PAH.

Results: Plasma LCN2 (135.1 [40.2] vs 67.7 [17.7] ng/ml; P < .05) and relative miR-8078 expression (4.2 ± 1.1 vs 2.3 ± 1.3 fold; P < .05) were significantly elevated in the moderate-to-severe PAH group compared with the non-PAH group. Both markers showed positive correlations with mPAP (LCN2: r = 0.691, P < .001; miR-8078: r = 0.481, P < .001) and pulmonary artery systolic pressure (LCN2: r = 0.579, P < .001; miR-8078: r = 0.391, P < .001). Notably, LCN2 levels positively correlated with miR-8078 expression (r = 0.407, P < .001). For diagnosing moderate-to-severe PAH, the area under the curve (AUC) was 0.883 for LCN2 and 0.749 for miR-8078. The combined model yielded a numerically higher AUC of 0.896, but did not significantly differ from LCN2 alone. Univariate regression analysis identified both LCN2 and miR-8078 as significant predictors of CHD-PAH. LCN2 was identified as an independent risk factor for CHD-PAH.

Conclusion: Plasma LCN2 and miR-8078 are significantly elevated in patients with CHD-PAH and correlate positively with hemodynamic severity. LCN2, in particular, serves as a robust independent biomarker for the diagnosis and severity assessment of CHD-PAH. Consequently, LCN2 and miR-8078 hold promise as potential non-invasive biomarkers for the diagnosis and severity assessment of CHD-PAH.

Introduction: The majority of clinical studies investigating patients with heart failure and a reduced ejection fraction (HFrEF) exclusively included patients with symptomatic heart failure. There is a paucity of information concerning the clinical characteristics, progression to symptomatic heart failure, heart failure hospitalization rates and survival in patients with asymptomatic systolic left ventricular dysfunction (ASLVD). We address this knowledge gap by describing the baseline characteristics of participants in the prospective observational TransitionCHF study of patients with reduced left ventricular Function in New York Heart Association (NYHA) functional Class I and comparing them to those of other recent trials in HFrEF.

Methods: In total, 1005 individuals with ASLVD NYHA I with an ejection fraction ≤ 40% were recruited. Patient characteristics were compared with other studies involving patients with symptomatic heart failure. Multivariable linear regression and Pearson coefficients were used to determine the association between quality of life, mental health, markers of organ function, N-terminal prohormone of brain natriuretic peptide (NT-proBNP) plasma levels, and exercise performance.

Results: The mean age of participants was 60 ± 14 years and 18% were women. The mean ejection fraction was 36% and the mean left ventricular end-diastolic diameter was 59 mm. When compared with studies involving patients with symptomatic heart failure, the age was ≈ 5 years younger and the frequency of comorbidities was lower. The Short Form Health Survey-36 physical functioning score was moderately correlated with the Maastricht Vital Exhaustion Questionnaire (MQ; r = -0.44 and weakly with 6-min walking distance (r = 0.32), peak VO2 at ergospirometry (r = 0.28), and Heart Focus Anxiety (HAF17; r = -0.34). NT-proBNP levels showed a weak association with peak VO2 (r = -0.29) and the 6-min walk distance (r = -0.21).

Conclusions: Patients included in the TransitionCHF study are younger and suffer from fewer comorbidities as compared with symptomatic heart failure patients. Associations between NT-proBNP levels and markers of exercise performance were weak.

Introduction: Pulmonary capillary wedge pressure (PCWP) and right atrial pressure (RAP) are key haemodynamic indicators of cardiac congestion. Atrial fibrillation (AF) often coexists with several heart diseases, making it challenging to determine AF's independent contribution to atrial pressure elevation. Therefore, the impact of AF on PCWP and RAP requires clarification. We sought to quantify the contribution of AF on PCWP and RAP within patients with various chronic heart diseases.

Methods: We performed a single-center retrospective analysis on 1452 patients (age: 68.0 ± 13.6 years, 58.7% male, 26% AF) with chronic heart diseases undergoing right heart catheterization (RHC). PCWP and RAP were measured during RHC, and the underlying AF or sinus rhythm (SR) was annotated. To isolate AF effect from clinical, haemodynamic, and echocardiographic confounders, two propensity score matching analyses yielded two balanced cohorts for PCWP (n = 496) and RAP (n = 494) analysis.

Results: After matching, PCWP was higher in the AF than the SR group (18.4 ± 0.49 mmHg vs 15.7 ± 0.49 mmHg; P < .001). Similarly, RAP was higher in the AF than the SR group (8.7 ± 0.34 mmHg vs 7.5 ± 0.34 mmHg; P = .02). The findings were highly robust for PCWP (E-value = 10.8) and moderately robust for RAP (E-value = 2.78) to unmeasured confounders. Additionally, patients in the SR cohort with a prior history of AF had significantly higher PCWP and RAP compared to patients with no AF history.

Conclusion: In our cohort, AF increased PCWP by 2.6 mmHg and RAP by 1.1 mmHg. Furthermore, a previous history of AF is linked to higher atrial pressures in patients later in SR.

Introduction: Peripartum cardiomyopathy (PPCM) affects previously healthy women commonly of African ancestry resulting into elevated morbidity and mortality rates. The clinical characteristics of PPCM are diverse but there is yet limited data on outcomes for women with PPCM in Uganda. We sought to elucidate the clinical presentation, echocardiographic findings, and 6-month outcomes among women with PPCM in Uganda.

Methods: A prospective cohort study of 80 PPCM women matched for age were monitored over a 6-month period while on goal-directed medical therapy (GDMT) was conducted. All participants underwent a physical examination, 12-lead electrocardiography, echocardiography and biomarkers including NT-pro BNP and Prolactin at baseline and at 6-month follow-up visit. Additionally, 80 matched controls were recruited at baseline as comparison for the biomarkers.

Results: The mean age of cases and controls was 33.6 ± 6.6 and 30.2 ± 5.9 years respectively. Clinical data for cases were as follows: mean left ventricular ejection fraction (LVEF) was 35.7 ± 11.0%, mean LV global longitudinal strain (GLS) was -11.9 ± 4.7%, mean right ventricular GLS was -14.7 ± 10.9%. A total of 22 (27.5%) participants had a LVEF <35% while 6 (7.5%) participants had severe RV systolic dysfunction. 20 (25%) participants were in NYHA IV. 54 (68%) participants received bromocriptine therapy in addition to other GDMT. Clinical data for controls were as follows: mean LVEF was 67.2 ± 4.5%, mean LV GLS was -17.1 ± 4.9%, all controls had normal RV systolic function parameters. After 6-months of follow-up, 6 (7.5%) of the cases had died. Atrial fibrillation occurred in 2 (2.5%) participants and intracardiac thrombus was documented among 8 (10%) participants. 52 (65%) participants were in NYHA I. LV recovery (LVEF ≥ 50%) was observed in 37 (46.3%) cases.

Conclusion: This study shows a high mortality rate of 7.5% aligning with global studies, the observed high thrombus burden and stroke occurred in 10% and 2.5%, respectively which may indicate severity of LV systolic dysfunction at presentation. Two-thirds of patients received Bromocriptine in addition to GDMT which may explain the high rate of LV recovery in this cohort.

Introduction: The aim of this investigation was to establish the clinical characteristics and outcomes of patients with non-dilated left ventricular cardiomyopathy (NDLVC) secondary to chronic Chagas disease (CChD).

Methods: All patients with CChD followed at our institution from January 2000 to January 2010 were included. Patients with a left ventricular ejection fraction (LVEF) <50%, a left ventricular diastolic diameter (LVDD) <55 mm, and segmental wall motion abnormalities (SWMA) on echocardiography were diagnosed with NDLVC secondary to CChD. The remaining patients had dilated cardiomyopathy (DCM) secondary to CChD.

Results: Of the 215 patients, 21 (10%) had NDLVC. In this group, the mean age was 62 ± 9 years, 12 (57%) were male, the median daily dose of metoprolol was 100 (62, 5, 125) mg, the LVDD was 51 ± 29 mm, and the LVEF was 39 ± 6.4%. SWMA were found in 12 (57%) patients. Mean follow-up 50.8 ± 3.8 months, during which 9 (43%) patients died. In a Cox regression model, Beta-blocker therapy was the only independent predictor of all-cause mortality for patients with NDLVC (hazard ratio = 0.16, 95% CI 0.04-0.68; P = .01) Over a 60-month follow-up, Kaplan-Meier survival estimates at 12, 24, 36, 48, and 60 months, were 71%, 71%, 59%, 59%, and 59%, respectively, in patients with NDLVC, and 77%, 61%, 49%, 38%, and 30%, respectively, in those with DCM due to CChD (P = .04).

Conclusions: Non-dilated left ventricular cardiomyopathy affects one in 10 patients with CHF due to CChD, and the 5-year survival rate is 59%.

Introduction: The global burden of heart failure (HF) is rising, with a shift towards more cases of heart failure with preserved ejection fraction (HFpEF). Given evolving epidemiology, an updated assessment of outcome differences between HFpEF and heart failure with reduced ejection fraction (HFrEF) is needed. This systematic review and meta-analysis aimed to provide a contemporary, large-scale comparison of clinical outcomes between HFpEF and HFrEF.

Methods: A systematic review and meta-analysis were conducted to compare all-cause mortality, cardiovascular (CV) mortality, and HF hospitalizations in HFpEF (EF: >50%) and HFrEF (EF: <40%). Risk ratios (RR) and maximally adjusted hazard ratios (HR) with 95% confidence intervals (CI) were pooled using random-effects models. Additional analyses included prior HF hospital admissions, in-hospital mortality, and length of hospital stay.

Results: A total of 101 studies were included. HFpEF patients had lower all-cause mortality [RR: 0.78; 95% CI: 0.69-0.88; P < .001; adjusted HR: 0.71; 95% CI: 0.62-0.80; P < .001; 112 vs 148 per 1000 patient-years (PY)], CV mortality [RR: 0.64; 95% CI: 0.53-0.79; P < .001; adjusted HR: 0.65; 95% CI: 0.56-0.75; P < .001; 73 vs 110 per 1000 PY], and HF hospitalizations [RR: 0.75; 95% CI: 0.63-0.91; P = .003; adjusted HR: 0.87; 95% CI: 0.78-0.98; P = .02; 171 vs 225 per 1000 PY] compared to HFrEF.

Conclusion: HFpEF patients experience lower mortality and hospitalization risks than HFrEF patients, even after adjustment for confounders. However, high absolute event rates in HFpEF highlight the need for effective treatment strategies to improve outcomes.PROSPERO registration ID: CRD42024619499.

Introduction: Heart failure with preserved ejection fraction (HFpEF) represents approximately 50% of all heart failure cases and lacks effective treatments. Chronotropic incompetence contributes to exercise intolerance in these patients. This study evaluated the safety and efficacy of blood pressure-adaptive atrial pacing (BPAP) vs standard bradycardia pacing (STD) in hypertensive patients with HFpEF.

Methods: In this prospective, double-blind, randomized, self-controlled crossover study, 16 patients (mean age: 62.7 ± 10.9 years; 6% female; left ventricular ejection fraction 55.3 ± 3.8%) with treated hypertension and implanted dual-chamber pacemakers underwent two 3-week treatment phases (BPAP and STD) in random order. The BPAP algorithm-modulated atrial pacing rate in response to home blood pressure readings. Endpoints included the Minnesota Living With Heart Failure (MLWHF) score, New York Heart Association (NYHA) class, 6-minute walk test (6MWT), and modified Bruce treadmill test.

Results: BPAP improved MLWHF score by an additional 15% from baseline (P = .0288), whereas STD showed a non-significant 3% worsening. Exercise time increased significantly during BPAP (+83.2 ± 55.6 s, P = .005) but not during STD (+70.8 ± 84.4 s, P = .095). The 6MWT distance rose by 35.8 ± 29.9 m during BPAP (P = .003) vs minimal change with STD (+8.2 ± 40.1 m, P = .6). NYHA class improved in 55.6% of BPAP patients vs 11% with STD (P = .0455). Mean heart rate was higher during BPAP (83.8 ± 8.3 bpm) than STD (72.9 ± 12.0 bpm, P < .0001), with no difference in systolic blood pressure (137.5 ± 14.9 vs 138.6 ± 14.0 mmHg, P = .68). No adverse events occurred.

Conclusion: In hypertensive patients with HFpEF and implanted pacemakers, BPAP safely improved exercise capacity and functional status compared to standard pacing. The approach demonstrates feasibility of home-based blood pressure-modulated pacing for physiologic rate adaptation. (NCT06036186).