Heart Failure Reviews最新文献

The gap between maximally tolerated medical therapy and consideration for permanent mechanical circulatory support and/or cardiac transplant or palliative treatment of moderate to severe heart failure represents an underserved patient population. New therapies are evolving which may not only improve quality of life for these patients but also improve hemodynamics and potentially reverse the progression of the disease. This review is focused on one such therapy, synchronized diaphragmatic stimulation. Current clinical results suggest that patients experience improved exercise tolerance, quality of life, and hemodynamic function over 6-12 months of therapy which can be safely implemented through a minimally invasive laparoscopic procedure, often as an outpatient. This technology has been granted breakthrough device designation and is being evaluated for a double-blinded, randomized controlled trial by the US FDA.

Globally, heart failure (HF) is a leading cause of hospitalization and mortality, primarily among the elderly, and is estimated to affect more than 64 million individuals. Hospitalization for HF represents the largest part of overall medical care expenditures for HF, and hospitalization for HF is associated with high rates of in-hospital and post-discharge morbidity and mortality. Patients discharged from the hospital with a diagnosis of acute decompensated HF have an increased risk for clinical worsening, rehospitalization, and mortality. A major goal for patients with HF is to detect and prevent both first and recurrent hospitalizations. However, detecting and preventing worsening HF events requiring hospitalization and/or pharmacotherapy remains an unmet medical need. Artificial intelligence (AI) is helping us meet this clinical challenge. An example leverages speech processing for the assessment of HF clinical status. In the acute setting, changes in speech measures (SM) can identify the decompensated from the compensated state. A remote monitoring system (HearO™), which includes a mobile speech application (App) to detect worsening HF prior to decompensation events is undergoing evaluation in ambulatory HF patients for reducing the rate of hospitalization. This App is readily downloadable on a smartphone and is user-friendly, and presents an example of how AI-assisted speech signal processing system development may enhance diagnostic accuracy. Preliminary results from clinical trials indicate high rates of sensitivity for detecting HF events along with high rates of adherence. Further elucidation of the effectiveness of this system will be provided by ongoing and planned studies in patients with chronic HF.

Functional mitral regurgitation (MR) is a common complication in heart failure (HF) and remains a major contributor to adverse outcomes despite advances in pharmacologic therapy. Guideline-directed medical therapy (GDMT) can lead to reverse remodeling and reduce MR severity in some patients, but many continue to experience symptomatic, moderate-to-severe MR. Transcatheter edge-to-edge repair (TEER) with the MitraClip® device has emerged as an important therapeutic option, particularly in patients who remain symptomatic despite optimized GDMT. Recent randomized trials-most notably RESHAPE-HF2 and MATTERHORN-have expanded the evidence base supporting TEER. RESHAPE-HF2 demonstrated that TEER significantly reduces heart failure hospitalizations and cardiovascular death in well-selected patients with moderate-to-severe functional MR, especially those with recent decompensation and favorable anatomy. MATTERHORN confirmed the noninferiority of TEER compared to surgery in high-risk patients, with a markedly better safety profile. These findings, alongside robust data on post-procedural GDMT intensification and functional improvement, support earlier integration of TEER into clinical practice. Collectively, the evidence suggests a paradigm shift: from reserving TEER as a last-resort therapy to incorporating it as an early intervention for appropriately selected patients with functional MR and persistent symptoms or incomplete reverse remodeling on optimal medical therapy.

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RA) have shown promising effects on heart failure (HF) outcomes, particularly in phenotype-specific populations. However, their impact on cardiac structure and function in HF with preserved ejection fraction (HFpEF) and reduced ejection fraction (HFrEF) remains unclear.

Methods: Medline, Cochrane Library, and Scopus were queried through December 2024 for primary and secondary analyses of randomized controlled trials comparing GLP-1RA with placebo in HF patients. Outcomes included changes in left ventricular ejection fraction (LVEF), end-diastolic volume (LVEDV), end-systolic volume (LVESV), global longitudinal strain (GLS), left ventricular mass, left atrial volume (LAV), and NT-proBNP levels. Random-effects models were used to calculate weighted mean differences (WMDs) or hazard ratios (HRs).

Results: Six trials (n = 1,195) were included, with three each evaluating HFpEF and HFrEF populations. In patients with HFpEF, GLP-1RA significantly reduced the LV mass (WMD: -8.6 g; 95% CI: -14.6, -2.6; p = 0.005) and LAV (WMD: -5.4 ml; 95% CI: -8.8, -2.0; p = 0.002) and lowered NT-proBNP concentration throughout (HR: 0.85; 95% CI: 0.8, 0.9; p < 0.001). A decrease in LAV was observed in the HFrEF population (WMD: -5.4 ml [95% CI: -8.8, -2.0]; p = 0.002). However, no significant improvements were observed in LVEF, LVEDV, LVESV, or GLS. There were significant differences between HFpEF and HFrEF for LVEDV (p = 0.01) and LVESV (p = 0.04).

Conclusions: GLP-1RA demonstrated phenotype-specific benefits, improving structural remodeling in HFpEF but showing limited effects in HFrEF. These findings highlight the importance of targeted therapeutic strategies based on HF phenotypes. Further research is warranted to elucidate underlying mechanisms and optimize patient selection.

The nonsteroidal mineralocorticoid receptor antagonist (MRA) finerenone is indicated in the United States for use in adults with chronic kidney disease (CKD) associated with type 2 diabetes (T2D). Results from the FIDELIO-DKD and FIGARO-DKD Phase 3 clinical trials showed a statistically significant reduction in the risk of CKD progression and cardiovascular events with finerenone versus placebo when added to maximally tolerated dose of an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. The cardiovascular event risk reduction was primarily driven by the reduction in the risk of hospitalization for heart failure (HF). Recent results from the Phase 3 FINEARTS-HF trial in patients with HF with mildly reduced ejection fraction (HFmrEF) or HF with preserved ejection fraction (HFpEF) showed a significantly lower rate of a composite of total worsening HF events and death from cardiovascular causes with finerenone versus placebo. Further Phase 3 trials in additional HF populations are ongoing. The steroidal MRAs spironolactone and eplerenone are included in clinical practice guidelines for the treatment of symptomatic HF, but the highest class (grade 1) recommendations are in HF with reduced ejection fraction only. Based on the available evidence, finerenone presents as a new evidence-based therapy for HFpEF/HFmrEF in addition to its current application in CKD associated with T2D. The aim of our review article is to present the current evidence available on the potential kidney and cardioprotective effects of finerenone to inform healthcare professionals (particularly those who work in cardiology).

Obesity and inflammation have been associated with an increased incidence of heart failure (HF) and death. However, until recent years, no therapy directed towards reducing inflammation and reducing obesity has been shown to reduce those adverse outcomes. Over the past few years, a few small studies have suggested that improving obesity-and in even smaller studies, reducing inflammation-may help improve HF severity, congestion, quality of life, and possibly outcomes. Larger studies that are being planned and executed, which will report their results within the next 2-3 years, should help further clarify the effects of weight and inflammation reduction in patients with HF.

Heart failure (HF) is a leading cause of hospitalizations, with over 1 million admissions annually in the USA and Europe due to signs and symptoms of congestion. Congestion in HF is now understood to result from both an absolute increase in total body fluid volume and a relative redistribution of fluid from capacitance vessels to the effective circulation. While guideline-directed medical therapy (GDMT) has greatly improved the outlook for stable HF patients, there has been little progress in managing acute HF (AHF) over the past 50 years. To address this unmet need, a group of expert clinicians met at the 63rd Annual Romanian Society of Cardiology Meeting on September 20th, 2024. They critically evaluated current evidence and identified knowledge gaps in three key areas of AHF management: (1) enhancing diuresis beyond standard therapy; (2) targeting fluid redistribution with intravenous vasodilators; and (3) applying hemodynamic profiling for personalized care. The first part of the discussion centered on enhanced diuresis strategies, covering contemporary real-world practice patterns, the relationship between residual congestion and hospital readmissions, findings from clinical trials of diuretic strategies, and recent insights into the role of GDMT in the acute setting. The panel also highlighted the limitations of existing evidence and proposed a research roadmap to optimize diuretic strategies in conjunction with GDMT in AHF, with the ultimate goal of facilitating decongestion in order to restore euvolemia and improve post-discharge outcomes.

Loop diuretics are the cornerstone of managing congestion in heart failure (HF). It is hypothesized that in heavily congested patients, gut edema may lead to lower bioavailability of oral drugs, including diuretics, which, in turn, may lead to insufficient diuresis. Intravenous (IV) loop diuretics are often required to achieve rapid diuresis due to their high plasma concentrations. However, reliance on IV administration limits options in ambulatory settings, where effective rescue therapies are needed. Bumetanide Nasal Spray (BNS) is a novel formulation designed to overcome absorption challenges and provide rapid, high bioavailability through intranasal administration. This mini-review summarizes the results of the recently presented bioavailability study of BNS conducted in healthy individuals, showing its bioequivalence to oral formulations. Lastly, the paper discusses the potential caveats and limitations of the trial and further perspectives.

While there is continued progress in developing therapies for patients with heart failure, the condition results in significant morbidity and a sizeable economic impact on our society. Recent advances in wearable sensors combined with machine learning algorithms give hope that heart failure can be better managed remotely and allow for improved clinical outcomes. This is a focused review of the key findings of the SEISMocardiogram In Cardiovascular Monitoring for Heart Failure I (SEISMIC-HF 1) study, presented at the American Heart Association's Scientific Sessions 2024 in Chicago, Illinois. This study showcased the ability of a machine learning algorithm to estimate pulmonary capillary wedge pressure in patients with heart failure with reduced ejection fraction, utilizing seismocardiography, photoplethysmography, and electrocardiography signals obtained non-invasively through a wearable sensor patch (CardioTag) for model input. The authors showed a significant correlation between model-predicted pulmonary capillary wedge pressure and the gold standard pressure measurement obtained from right heart catheterization. Future investigations should assess the implementation of this technology as a part of a treatment strategy for outpatient heart failure care and explore its performance in additional study populations including those with heart failure with preserved ejection fraction and in patients outside of the clinical environment.

Heart failure (HF) with preserved ejection fraction (HFpEF) is the most common form of HF in older adults. While manifest as distinct clinical phenotypes, almost all patients with HFpEF will present with exercise intolerance or exertional dyspnea. Distinguishing HFpEF from other clinical conditions remains challenging, as the accurate diagnosis of HFpEF involves integrating a diverse array of cardiovascular (CV) structural and physiologic inputs. Owing to its intrinsic ability to characterize the structure and function of the myocardium, cardiac valves, pericardium, and vasculature, echocardiography (TTE) has emerged as an essential modality for diagnosing HFpEF. In contrast to HF with reduced EF, however, no single TTE variable defines HFpEF. Abnormal diastolic function is typically associated with HFpEF, but "diastolic dysfunction" per se is not synonymous with "HFpEF": the pathophysiology of HFpEF is more complex than diastolic dysfunction alone. HFpEF may involve abnormalities at multiple loci within the CV system, including (1) dysfunction of the left ventricle, left atrium, or right ventricle; (2) pulmonary hypertension or pulmonary vascular disease; (3) pericardial restraint; (4) abnormal systemic vascular impedance; (5) coronary or peripheral microcirculatory dysfunction; and (6) defects of tissue oxygen uptake within the periphery. Thus, the accurate diagnosis of HFpEF - and its specific clinical phenotypes - requires diagnostic algorithms that comprise multiple clinical variables, many of which may be derived from TTE data. Refining such algorithms to better discriminate among specific HFpEF phenotypes is the subject of continued investigation.