ESC Heart Failure最新文献

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: 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 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).

Introduction: Conventional risk scoring systems for patients with heart failure are insufficient for accurately predicting outcomes in older patients. In this study, we aimed to develop a prognostic prediction model specifically for this population.

Methods: A total of 5690 patients aged ≥80 years (median age: 86 years, 41.8% were men) from the JROADHF (The Japanese Registry of Acute Decompensated Heart Failure) were followed up for 3 years. A randomly selected 70% of the cohort (derivation cohort, n = 3983) was used to develop the risk prediction model, while the remaining 30% (validation cohort, n = 1707) was employed to evaluate its discriminative ability and calibration. Hazard ratios were estimated using the Cox proportional hazards model. Variables were selected using the backward elimination method (threshold: P < .001). The discrimination of the model was assessed by Harrell's C statistic, and the calibration was assessed by a calibration plot.

Results: During the follow-up period, a total of 2382 patients died. In the multivariable model, 11 variables, i.e. age, male sex, Barthel index, history of heart failure, systolic blood pressure, haemoglobin, albumin, blood urea nitrogen, b-type natriuretic peptide, sodium levels, and use of renin-angiotensin system inhibitors were selected from 31 potential risk factors. The developed model for predicting mortality at 3 years demonstrated acceptable discriminative ability (Harrell's C-statistic = 0.68, 95% confidence interval: 0.66-0.70) and calibration (Greenwood-Nam-D'Agostino test, P = .30).

Conclusion: The prognostic model developed in this study (JROADHF over 80 Score) demonstrated satisfactory performance in predicting mortality in a cohort of older Japanese patients with heart failure. Estimating prognosis based on factors obtainable in routine clinical practice has the potential for widespread implementation in clinical settings.

Immune checkpoint inhibitors (ICIs), such as PD-1, PD-L1, and CTLA-4 inhibitors, enhance immune function by targeting T-cell surface receptors, overcoming natural immune inhibition. These drugs activate the immune system to detect and target cancer cells, providing an alternative therapeutic approach, particularly in cases where conventional treatments fail. However, the growing use of ICIs has highlighted several defence-related adverse events, particularly cardiac toxicity, including acute myocarditis, atherosclerosis, and heart failure unrelated to myocarditis. These complications present significant challenges, limiting the broader use of ICIs. Research into the cardiac toxicity of ICIs is still in its early stages, and the underlying mechanisms remain unclear. This review consolidates current findings on ICI-associated heart damage, explores potential factors contributing to ICI-induced cardiac injury, and evaluates preventive and therapeutic strategies. This work aims to provide a theoretical foundation for medical intervention and prevention of ICI-related cardiac damage.