Pub Date : 2025-04-09DOI: 10.1016/j.jchf.2025.01.019
Paul R. Kalra MA MB BChir MD, Irakli Gogorishvili MD, George Khabeishvili MD, Filip Málek MD PhD MBA, Ondřej Toman PhD MHA, Chris Critoph BM MD, Andrew S. Flett MBBS MD CCDS, Peter J. Cowburn MD, Mandeep R. Mehra MD MSc, William S. Sheridan PhD, John R. Britton PhD MBA, Teresa Buxo MSc, Robyn M. Kealy MSc, Annette Kent PhD, Barry R. Greene PhD, Kaushik Guha MD, Roy S. Gardner MBChB MD, Ian Loke MBChB MD, Ali Vazir PhD MBBS, Jasper J. Brugts MD PhD MSc, Alastair Gray MBChB MD, Jeffrey M. Testani MD MTR, Kevin Damman MD PhD
Variations of inferior vena cava (IVC) area and collapsibility serve as early markers of congestion and predict risk for heart failure (HF) events.
{"title":"First-in-Human Implantable Inferior Vena Cava Sensor for Remote Care in Heart Failure: FUTURE-HF","authors":"Paul R. Kalra MA MB BChir MD, Irakli Gogorishvili MD, George Khabeishvili MD, Filip Málek MD PhD MBA, Ondřej Toman PhD MHA, Chris Critoph BM MD, Andrew S. Flett MBBS MD CCDS, Peter J. Cowburn MD, Mandeep R. Mehra MD MSc, William S. Sheridan PhD, John R. Britton PhD MBA, Teresa Buxo MSc, Robyn M. Kealy MSc, Annette Kent PhD, Barry R. Greene PhD, Kaushik Guha MD, Roy S. Gardner MBChB MD, Ian Loke MBChB MD, Ali Vazir PhD MBBS, Jasper J. Brugts MD PhD MSc, Alastair Gray MBChB MD, Jeffrey M. Testani MD MTR, Kevin Damman MD PhD","doi":"10.1016/j.jchf.2025.01.019","DOIUrl":"https://doi.org/10.1016/j.jchf.2025.01.019","url":null,"abstract":"Variations of inferior vena cava (IVC) area and collapsibility serve as early markers of congestion and predict risk for heart failure (HF) events.","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"5 1","pages":""},"PeriodicalIF":13.0,"publicationDate":"2025-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143824979","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.jchf.2025.02.007
Nandan Kodur BS , W.H. Wilson Tang MD
Heart failure with improved ejection fraction (HFimpEF) is defined by improved left ventricular ejection fraction (LVEF) among patients who previously had reduced LVEF. HFimpEF is associated with improved prognosis, albeit with persistent risk of relapse and adverse events in some patients. Current guidelines thus recommend sustained and indefinite guideline-directed medical therapy (GDMT) for all patients with HFimpEF. Emerging clinical experience suggests that heart failure arising from acute etiologies that fully resolve along with complete LVEF recovery may have a favorable prognosis with lower risk of relapse. Indeed, cohort and case series studies have demonstrated the feasibility of safe de-escalation of GDMT in select patients with specific etiologies, with multiple small trials ongoing. Future studies should investigate whether advanced imaging or blood biomarkers could aid in risk stratifying patients with recovered LVEF, whether partial de-escalation of GDMT could be safe and feasible, and whether implantable cardioverter-defibrillator therapy can be safely discontinued.
{"title":"Management of Heart Failure With Improved Ejection Fraction","authors":"Nandan Kodur BS , W.H. Wilson Tang MD","doi":"10.1016/j.jchf.2025.02.007","DOIUrl":"10.1016/j.jchf.2025.02.007","url":null,"abstract":"<div><div>Heart failure with improved ejection fraction (HFimpEF) is defined by improved left ventricular ejection fraction (LVEF) among patients who previously had reduced LVEF. HFimpEF is associated with improved prognosis, albeit with persistent risk of relapse and adverse events in some patients. Current guidelines thus recommend sustained and indefinite guideline-directed medical therapy (GDMT) for all patients with HFimpEF. Emerging clinical experience suggests that heart failure arising from acute etiologies that fully resolve along with complete LVEF recovery may have a favorable prognosis with lower risk of relapse. Indeed, cohort and case series studies have demonstrated the feasibility of safe de-escalation of GDMT in select patients with specific etiologies, with multiple small trials ongoing. Future studies should investigate whether advanced imaging or blood biomarkers could aid in risk stratifying patients with recovered LVEF, whether partial de-escalation of GDMT could be safe and feasible, and whether implantable cardioverter-defibrillator therapy can be safely discontinued.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 4","pages":"Pages 537-553"},"PeriodicalIF":10.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143790922","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.jchf.2024.11.018
Sean P. Pinney MD , Maria V. DeVita MD , Bjorn Redfors MD, PhD , Lak N. Kotinkaduwa PhD , Megan Cotts BS , Jennifer Cowger MD, MS , Maria Rosa Costanzo MD
{"title":"Ultrafiltration for Management of Decompensated Heart Failure","authors":"Sean P. Pinney MD , Maria V. DeVita MD , Bjorn Redfors MD, PhD , Lak N. Kotinkaduwa PhD , Megan Cotts BS , Jennifer Cowger MD, MS , Maria Rosa Costanzo MD","doi":"10.1016/j.jchf.2024.11.018","DOIUrl":"10.1016/j.jchf.2024.11.018","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 4","pages":"Pages 657-659"},"PeriodicalIF":10.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.jchf.2024.10.006
Shada Jadam MD, Andrew Gaballa MD, Alaa Alashi MD, Bo Xu MD, Maran Thamilarasan MD, E. Rene Rodriguez MD, Carmela D. Tan MD, Susan Ospina NP, Nicholas Smedira MD, Zoran B. Popovic MD, PhD, Milind Y. Desai MD, MBA
Background
In hypertrophic cardiomyopathy, histologic findings like myocyte hypertrophy and disarray, interstitial fibrosis (IF), and small intramural coronary artery dysplasia (SICAD) result in left ventricular hypertrophy, diastolic dysfunction, arrhythmogenicity, and microvascular ischemia.
Objectives
The authors sought to evaluate the association between histology and outcomes in obstructive hypertrophic cardiomyopathy (oHCM) patients undergoing surgical myectomy (SM).
Methods
The study included 1,722 symptomatic oHCM patients (mean age: 56 ± 14 years; 948 [55%] men) who underwent SM at a tertiary center between 2005 and 2018. The SM specimen was analyzed for presence and severity of: 1) myocyte hypertrophy; 2) myocyte disarray; 3) IF; and 4) SICAD. Histologic findings were graded as 0-3 (none, mild, moderate, and severe) and a score from 0-12 was calculated. Primary endpoint was a composite of death, appropriate defibrillator discharge, or cardiac transplantation during follow-up.
Results
Moderate and severe histologic findings were distributed as follows: myocyte hypertrophy (1,341 [78%]); disarray (237 [14%]); IF (448 [26%]); and SICAD (258 [15%]). The mean total histologic score was 5.1 ± 1.4. At 5.1 ± 5.2 years, there were 352 (20%) primary events (317 [18%] deaths). On spline analysis, a total histology score of >5 was associated with primary events. On Kaplan-Meier analysis, patients with a histology score >5 had greater events vs those with a score ≤5 (147/598 [25%] vs 205/1124 [18%]; log-rank P = 0.002). On multivariable Cox analysis, total histology score >5 (HR: 1.24 [95% CI: 1.03-1.54]; P = 0.03) was independently associated with higher primary events.
Conclusions
In symptomatic oHCM patients undergoing SM, a higher histologic score was independently associated with long-term outcomes.
{"title":"Association of Histologic Findings With Long-Term Outcomes in Symptomatic Obstructive Hypertrophic Cardiomyopathy Patients Undergoing Surgical Myectomy","authors":"Shada Jadam MD, Andrew Gaballa MD, Alaa Alashi MD, Bo Xu MD, Maran Thamilarasan MD, E. Rene Rodriguez MD, Carmela D. Tan MD, Susan Ospina NP, Nicholas Smedira MD, Zoran B. Popovic MD, PhD, Milind Y. Desai MD, MBA","doi":"10.1016/j.jchf.2024.10.006","DOIUrl":"10.1016/j.jchf.2024.10.006","url":null,"abstract":"<div><h3>Background</h3><div>In hypertrophic cardiomyopathy, histologic findings like myocyte hypertrophy and disarray, interstitial fibrosis (IF), and small intramural coronary artery dysplasia (SICAD) result in left ventricular hypertrophy, diastolic dysfunction, arrhythmogenicity, and microvascular ischemia.</div></div><div><h3>Objectives</h3><div>The authors sought to evaluate the association between histology and outcomes in obstructive hypertrophic cardiomyopathy (oHCM) patients undergoing surgical myectomy (SM).</div></div><div><h3>Methods</h3><div>The study included 1,722 symptomatic oHCM patients (mean age: 56 ± 14 years; 948 [55%] men) who underwent SM at a tertiary center between 2005 and 2018. The SM specimen was analyzed for presence and severity of: 1) myocyte hypertrophy; 2) myocyte disarray; 3) IF; and 4) SICAD. Histologic findings were graded as 0-3 (none, mild, moderate, and severe) and a score from 0-12 was calculated. Primary endpoint was a composite of death, appropriate defibrillator discharge, or cardiac transplantation during follow-up.</div></div><div><h3>Results</h3><div>Moderate and severe histologic findings were distributed as follows: myocyte hypertrophy (1,341 [78%]); disarray (237 [14%]); IF (448 [26%]); and SICAD (258 [15%]). The mean total histologic score was 5.1 ± 1.4. At 5.1 ± 5.2 years, there were 352 (20%) primary events (317 [18%] deaths). On spline analysis, a total histology score of >5 was associated with primary events. On Kaplan-Meier analysis, patients with a histology score >5 had greater events vs those with a score ≤5 (147/598 [25%] vs 205/1124 [18%]; log-rank <em>P</em> = 0.002). On multivariable Cox analysis, total histology score >5 (HR: 1.24 [95% CI: 1.03-1.54]; <em>P =</em> 0.03) was independently associated with higher primary events.</div></div><div><h3>Conclusions</h3><div>In symptomatic oHCM patients undergoing SM, a higher histologic score was independently associated with long-term outcomes.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 4","pages":"Pages 631-640"},"PeriodicalIF":10.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142638974","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.jchf.2024.11.017
Alberto Maria Marra MD, PhD , Roberta D’Assante PhD , Mariarosaria De Luca MD , Michele Arcopinto MD, PhD , Paola Gargiulo MD, PhD , Valeria Valente MD , Giulia Crisci MD , Carmen Rainone MD , Michele Modestino MD , Federica Giardino MD , Stefania Paolillo MD, PhD , Francesco Cacciatore MD, PhD , Lavinia Saldamarco MD , Dario Bruzzese PhD , Donatella Scarpa MD , Pasquale Perrone Filardi MD, PhD , Giovanni Esposito MD , Luigi Saccà MD , Eduardo Bossone MD, PhD , Andrea Salzano MD, PhD , Antonio Cittadini MD
<div><h3>Background</h3><div>Growing evidence suggests that reduced activity of the growth hormone (GH)/insulin-like growth factor (IGF)-1 axis is common and associated with poor clinical status and outcome in heart failure (HF). In addition, preliminary results of growth hormone deficiency (GHD) correction in HF showed an improvement in quality of life, cardiac structure and function, and cardiovascular performance.</div></div><div><h3>Objectives</h3><div>The aim of the present double-blind, randomized, placebo-controlled trial was to evaluate the cardiovascular effects of 1 year of GH replacement therapy in a cohort of patients with heart failure and reduced ejection fraction (HFrEF).</div></div><div><h3>Methods</h3><div>Consecutive patients with HFrEF in NYHA functional class I/II/III and concomitant GHD were recruited. GHD patients were randomized to receive GH (0.012 mg/kg every second day ∼2.5 IU), or placebo, on top of background therapy. The primary endpoint was peak oxygen consumption (VO<sub>2</sub>). Secondary endpoints included hospitalizations, end-systolic left ventricular volumes, N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels, health-related quality of life score, and muscle strength (handgrip).</div></div><div><h3>Results</h3><div>A total of 318 consecutive patients were screened, with 86 (27%) fulfilling the criteria for GHD. Of these, 22 subjects refused to participate in the study. The final study groups consisted of 64 patients, 30 randomized in the active treatment group and 34 in the control group. After 1 year, 45 patients completed the study (21 in the control group and 24 in the active group). A statistically significant improvement of peak VO<sub>2</sub> was reached in the active group (from 12.8 ± 3.4 mL/kg/min to 15.5 ± 3.15 mL/kg/min; <em>P <</em> 0.01; delta peak VO<sub>2</sub> between groups: +3.1 vs −1.8; <em>P <</em> 0.01). Other cardiopulmonary exercise test parameters (ie, peak workload, VO<sub>2</sub> at the aerobic threshold, O<sub>2</sub> pulse and VE/VCO<sub>2</sub> slope; <em>P <</em> 0.05) also improved, paralleled by an increase in 6-minute walking test distance (<em>P <</em> 0.05) and handgrip strength (<em>P <</em> 0.01). GH improved right ventricular function (ie, TAPSE and TAPSE/pulmonary artery systolic pressure ratio; <em>P <</em> 0.01), leading to an amelioration of clinical status (NYHA functional class; <em>P <</em> 0.05) and health-related quality of life (Minnesota Living With Heart Failure Questionnaire; <em>P <</em> 0.05). A significant decrease of NT-proBNP was also found (<em>P <</em> 0.05).</div></div><div><h3>Conclusions</h3><div>This randomized, double-blind, placebo-controlled trial demonstrates that GH replacement therapy in HFrEF patients with GHD improves exercise performance, and left ventricular and right ventricular structure and function, leading to an amelioration of clinical status and health-related quality of life. (Treatment of GHD A
{"title":"Growth Hormone Replacement Therapy in Heart Failure With Reduced Ejection Fraction","authors":"Alberto Maria Marra MD, PhD , Roberta D’Assante PhD , Mariarosaria De Luca MD , Michele Arcopinto MD, PhD , Paola Gargiulo MD, PhD , Valeria Valente MD , Giulia Crisci MD , Carmen Rainone MD , Michele Modestino MD , Federica Giardino MD , Stefania Paolillo MD, PhD , Francesco Cacciatore MD, PhD , Lavinia Saldamarco MD , Dario Bruzzese PhD , Donatella Scarpa MD , Pasquale Perrone Filardi MD, PhD , Giovanni Esposito MD , Luigi Saccà MD , Eduardo Bossone MD, PhD , Andrea Salzano MD, PhD , Antonio Cittadini MD","doi":"10.1016/j.jchf.2024.11.017","DOIUrl":"10.1016/j.jchf.2024.11.017","url":null,"abstract":"<div><h3>Background</h3><div>Growing evidence suggests that reduced activity of the growth hormone (GH)/insulin-like growth factor (IGF)-1 axis is common and associated with poor clinical status and outcome in heart failure (HF). In addition, preliminary results of growth hormone deficiency (GHD) correction in HF showed an improvement in quality of life, cardiac structure and function, and cardiovascular performance.</div></div><div><h3>Objectives</h3><div>The aim of the present double-blind, randomized, placebo-controlled trial was to evaluate the cardiovascular effects of 1 year of GH replacement therapy in a cohort of patients with heart failure and reduced ejection fraction (HFrEF).</div></div><div><h3>Methods</h3><div>Consecutive patients with HFrEF in NYHA functional class I/II/III and concomitant GHD were recruited. GHD patients were randomized to receive GH (0.012 mg/kg every second day ∼2.5 IU), or placebo, on top of background therapy. The primary endpoint was peak oxygen consumption (VO<sub>2</sub>). Secondary endpoints included hospitalizations, end-systolic left ventricular volumes, N-terminal pro–B-type natriuretic peptide (NT-proBNP) levels, health-related quality of life score, and muscle strength (handgrip).</div></div><div><h3>Results</h3><div>A total of 318 consecutive patients were screened, with 86 (27%) fulfilling the criteria for GHD. Of these, 22 subjects refused to participate in the study. The final study groups consisted of 64 patients, 30 randomized in the active treatment group and 34 in the control group. After 1 year, 45 patients completed the study (21 in the control group and 24 in the active group). A statistically significant improvement of peak VO<sub>2</sub> was reached in the active group (from 12.8 ± 3.4 mL/kg/min to 15.5 ± 3.15 mL/kg/min; <em>P <</em> 0.01; delta peak VO<sub>2</sub> between groups: +3.1 vs −1.8; <em>P <</em> 0.01). Other cardiopulmonary exercise test parameters (ie, peak workload, VO<sub>2</sub> at the aerobic threshold, O<sub>2</sub> pulse and VE/VCO<sub>2</sub> slope; <em>P <</em> 0.05) also improved, paralleled by an increase in 6-minute walking test distance (<em>P <</em> 0.05) and handgrip strength (<em>P <</em> 0.01). GH improved right ventricular function (ie, TAPSE and TAPSE/pulmonary artery systolic pressure ratio; <em>P <</em> 0.01), leading to an amelioration of clinical status (NYHA functional class; <em>P <</em> 0.05) and health-related quality of life (Minnesota Living With Heart Failure Questionnaire; <em>P <</em> 0.05). A significant decrease of NT-proBNP was also found (<em>P <</em> 0.05).</div></div><div><h3>Conclusions</h3><div>This randomized, double-blind, placebo-controlled trial demonstrates that GH replacement therapy in HFrEF patients with GHD improves exercise performance, and left ventricular and right ventricular structure and function, leading to an amelioration of clinical status and health-related quality of life. (Treatment of GHD A","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 4","pages":"Pages 602-614"},"PeriodicalIF":10.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143567154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adverse pregnancy outcomes, such as preterm delivery and hypertensive disorders of pregnancy, may be associated with higher future risks of heart failure (HF). However, the comparative effects of different adverse pregnancy outcomes on long-term risk of HF, and their potential causality, are unclear.
OBJECTIVES
The authors sought to examine 5 major adverse pregnancy outcomes in relation to long-term risk of HF in a large population-based cohort.
Methods
A national cohort study was conducted of all 2,201,638 women with a singleton delivery in Sweden in 1973-2015, followed up for HF identified from nationwide outpatient and inpatient diagnoses through 2018. Cox regression was used to compute HRs for HF associated with preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders of pregnancy, and gestational diabetes, while adjusting for other adverse pregnancy outcomes and maternal factors. Co-sibling analyses assessed for potential confounding by shared familial (genetic or environmental) factors.
Results
In 48 million person-years of follow-up, 667,774 women (30%) experienced an adverse pregnancy outcome, and 19,922 women (0.9%) were diagnosed with HF (median age, 61 years). All 5 adverse pregnancy outcomes were independently associated with long-term increased risk of HF. With up to 46 years of follow-up after delivery, adjusted HRs for HF associated with specific adverse pregnancy outcomes were: gestational diabetes, 2.19 (95% CI: 1.95-2.45); preterm delivery, 1.68 (95% CI: 1.61-1.75); other hypertensive disorders, 1.68 (95% CI: 1.48-1.90); preeclampsia, 1.59 (95% CI: 1.53-1.66); and small for gestational age, 1.35 (95% CI: 1.31-1.40). All HRs remained significantly elevated (1.3- to 3.0-fold) even 30 to 46 years after delivery. These findings were only partially explained by shared familial factors. Women with multiple adverse pregnancy outcomes had further increases in risk (eg, up to 46 years after delivery, adjusted HRs associated with 1, 2, or ≥3 adverse pregnancy outcomes were 1.51 [95% CI: 1.47-1.56], 2.31 [95% CI: 2.19-2.45], and 3.18 [95% CI: 2.85-3.56], respectively).
Conclusions
In this large national cohort, women who experienced any of 5 major adverse pregnancy outcomes had increased risk for HF up to 46 years later. Women with adverse pregnancy outcomes need early preventive actions and long-term clinical care to reduce the risk of HF.
{"title":"Adverse Pregnancy Outcomes and Long-Term Risk of Heart Failure in Women","authors":"Casey Crump MD, PhD , Jan Sundquist MD, PhD , Kristina Sundquist MD, PhD","doi":"10.1016/j.jchf.2024.11.004","DOIUrl":"10.1016/j.jchf.2024.11.004","url":null,"abstract":"<div><h3>Background</h3><div>Adverse pregnancy outcomes, such as preterm delivery and hypertensive disorders of pregnancy, may be associated with higher future risks of heart failure (HF). However, the comparative effects of different adverse pregnancy outcomes on long-term risk of HF, and their potential causality, are unclear.</div></div><div><h3>OBJECTIVES</h3><div>The authors sought to examine 5 major adverse pregnancy outcomes in relation to long-term risk of HF in a large population-based cohort.</div></div><div><h3>Methods</h3><div>A national cohort study was conducted of all 2,201,638 women with a singleton delivery in Sweden in 1973-2015, followed up for HF identified from nationwide outpatient and inpatient diagnoses through 2018. Cox regression was used to compute HRs for HF associated with preterm delivery, small for gestational age, preeclampsia, other hypertensive disorders of pregnancy, and gestational diabetes, while adjusting for other adverse pregnancy outcomes and maternal factors. Co-sibling analyses assessed for potential confounding by shared familial (genetic or environmental) factors.</div></div><div><h3>Results</h3><div>In 48 million person-years of follow-up, 667,774 women (30%) experienced an adverse pregnancy outcome, and 19,922 women (0.9%) were diagnosed with HF (median age, 61 years). All 5 adverse pregnancy outcomes were independently associated with long-term increased risk of HF. With up to 46 years of follow-up after delivery, adjusted HRs for HF associated with specific adverse pregnancy outcomes were: gestational diabetes, 2.19 (95% CI: 1.95-2.45); preterm delivery, 1.68 (95% CI: 1.61-1.75); other hypertensive disorders, 1.68 (95% CI: 1.48-1.90); preeclampsia, 1.59 (95% CI: 1.53-1.66); and small for gestational age, 1.35 (95% CI: 1.31-1.40). All HRs remained significantly elevated (1.3- to 3.0-fold) even 30 to 46 years after delivery. These findings were only partially explained by shared familial factors. Women with multiple adverse pregnancy outcomes had further increases in risk (eg, up to 46 years after delivery, adjusted HRs associated with 1, 2, or ≥3 adverse pregnancy outcomes were 1.51 [95% CI: 1.47-1.56], 2.31 [95% CI: 2.19-2.45], and 3.18 [95% CI: 2.85-3.56], respectively).</div></div><div><h3>Conclusions</h3><div>In this large national cohort, women who experienced any of 5 major adverse pregnancy outcomes had increased risk for HF up to 46 years later. Women with adverse pregnancy outcomes need early preventive actions and long-term clinical care to reduce the risk of HF.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 4","pages":"Pages 589-598"},"PeriodicalIF":10.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143023510","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-04-01DOI: 10.1016/j.jchf.2024.05.025
Ajay Kerai MD , Ritika Gadodia MBBS , Tsion Aberra MD , Omar Shakhtour MD , Jiling Chou MA , Ingy Mahana MD , Puja Patel DO , Diego Medvedofsky MD , Rachel Marcus MD
{"title":"Seroprevalence of Chagas Cardiomyopathy Among Hospitalized Latin American Immigrants Within a Washington, DC, Hospital","authors":"Ajay Kerai MD , Ritika Gadodia MBBS , Tsion Aberra MD , Omar Shakhtour MD , Jiling Chou MA , Ingy Mahana MD , Puja Patel DO , Diego Medvedofsky MD , Rachel Marcus MD","doi":"10.1016/j.jchf.2024.05.025","DOIUrl":"10.1016/j.jchf.2024.05.025","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 4","pages":"Pages 651-652"},"PeriodicalIF":10.3,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141633536","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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