Pub Date : 2026-03-19DOI: 10.1016/j.jchf.2026.103013
Zachary R McCaw,Stephanie Armbruster,Lu Tian,Brian L Claggett,Garrett Fitzmaurice,Alberto Foà,Marc A Pfeffer,Lee-Jen Wei
{"title":"Using Days Alive and Out of Hospital as the Study Endpoint in Cardiovascular Heart Failure Clinical Trials.","authors":"Zachary R McCaw,Stephanie Armbruster,Lu Tian,Brian L Claggett,Garrett Fitzmaurice,Alberto Foà,Marc A Pfeffer,Lee-Jen Wei","doi":"10.1016/j.jchf.2026.103013","DOIUrl":"https://doi.org/10.1016/j.jchf.2026.103013","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"27 1","pages":"103013"},"PeriodicalIF":13.0,"publicationDate":"2026-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147483779","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 : 2026-03-12DOI: 10.1016/j.jchf.2026.103007
Leslie T Cooper, Cristina Basso, Marc K Halushka, Joseph J Maleszewski, Katarzyna Michaud, Enrico Ammirati
{"title":"The Seaport Criteria: A New Histologic Standard to Diagnose Myocarditis.","authors":"Leslie T Cooper, Cristina Basso, Marc K Halushka, Joseph J Maleszewski, Katarzyna Michaud, Enrico Ammirati","doi":"10.1016/j.jchf.2026.103007","DOIUrl":"https://doi.org/10.1016/j.jchf.2026.103007","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":"103007"},"PeriodicalIF":11.8,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433052","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 : 2026-03-12DOI: 10.1016/j.jchf.2026.103004
Karl-Philipp Rommel, Mark N Belkin
{"title":"Exercise-Induced Versus Resting Left Atrial Hypertension: 2 Phases or 2 Faces of HFpEF?","authors":"Karl-Philipp Rommel, Mark N Belkin","doi":"10.1016/j.jchf.2026.103004","DOIUrl":"https://doi.org/10.1016/j.jchf.2026.103004","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":"103004"},"PeriodicalIF":11.8,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147432976","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 : 2026-03-12DOI: 10.1016/j.jchf.2026.103003
Sebastiaan Dhont, Philippe B Bertrand, Alessandro Malagoli
{"title":"The Left Atrium: Heart Failure's Silent \"Memory\" Across the Spectrum of Functional Mitral Regurgitation.","authors":"Sebastiaan Dhont, Philippe B Bertrand, Alessandro Malagoli","doi":"10.1016/j.jchf.2026.103003","DOIUrl":"https://doi.org/10.1016/j.jchf.2026.103003","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":"103003"},"PeriodicalIF":11.8,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147433071","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}
BACKGROUNDSecondary mitral regurgitation (SMR) frequently accompanies heart failure with reduced ejection fraction (HFrEF) and may regress with guideline-directed medical therapy (GDMT). However, real-world data on SMR trajectories and prognostic implications remain scarce.OBJECTIVESThe purpose of this study was to characterize 12-month trajectories of SMR under optimized GDMT in ambulatory patients with HFrEF and to evaluate the long-term prognostic impact.METHODSThe authors prospectively studied 2,254 ambulatory HFrEF patients who underwent baseline and 12-month transthoracic echocardiography (TTE), excluding those with mitral valve interventions. The primary endpoint was all-cause mortality, and the secondary endpoint was a composite of all-cause mortality or heart failure hospitalization (HFH) over a median follow-up period of 4.5 years after the 12-month TTE.RESULTSAt baseline, 67.6% of patients had none or mild (nonsignificant) SMR, 25.2% had moderate SMR, and 7.3% had severe SMR. After 12 months of optimized GDMT, the distribution shifted (P < 0.001): 79.5%, 16.5%, and 4.2% had nonsignificant, moderate, and severe SMR, respectively. Among the 731 patients with significant SMR (moderate/severe) at baseline, 57.5% improved to nonsignificant SMR. Improvement from significant to nonsignificant SMR within 12 months was associated with a favorable long-term prognosis, comparable to patients who consistently had nonsignificant SMR. Conversely, patients with persistent significant SMR had a higher risk of all-cause mortality (HR: 1.60; 95% CI: 1.36-1.89; P < 0.001) and the composite outcome of mortality or HFH (HR: 1.59; 95% CI: 1.36-1.85; P < 0.001).CONCLUSIONSIn this real-world HFrEF cohort, optimizing GDMT use led to SMR improvement in over half of patients with moderate or severe SMR. Nevertheless, both persistent moderate and severe SMR were associated with poor outcomes, underscoring the known benefit of mitral intervention in severe SMR and its potential in moderate SMR.
{"title":"Secondary Mitral Regurgitation Trajectories and Prognosis With Intensification of Guideline-Directed Medical Therapy in Heart Failure.","authors":"Cristina Ferrero,Pau Codina,Josep Lupón,María Ruiz-Cueto,Elisabet Zamora,Andrea Borrellas,Cinta Llibre,Clara Badia-Molins,Andrea Prencipe,Evelyn Santiago-Vacas,Mar Domingo,Javier Santesmases,Elena Ferrer-Sistach,Claudia Escabia,Julio Núñez,Stefan D Anker,Marco Metra,Javed Butler,Gregg W Stone,Victoria Delgado,Antoni Bayes-Genis","doi":"10.1016/j.jchf.2026.103001","DOIUrl":"https://doi.org/10.1016/j.jchf.2026.103001","url":null,"abstract":"BACKGROUNDSecondary mitral regurgitation (SMR) frequently accompanies heart failure with reduced ejection fraction (HFrEF) and may regress with guideline-directed medical therapy (GDMT). However, real-world data on SMR trajectories and prognostic implications remain scarce.OBJECTIVESThe purpose of this study was to characterize 12-month trajectories of SMR under optimized GDMT in ambulatory patients with HFrEF and to evaluate the long-term prognostic impact.METHODSThe authors prospectively studied 2,254 ambulatory HFrEF patients who underwent baseline and 12-month transthoracic echocardiography (TTE), excluding those with mitral valve interventions. The primary endpoint was all-cause mortality, and the secondary endpoint was a composite of all-cause mortality or heart failure hospitalization (HFH) over a median follow-up period of 4.5 years after the 12-month TTE.RESULTSAt baseline, 67.6% of patients had none or mild (nonsignificant) SMR, 25.2% had moderate SMR, and 7.3% had severe SMR. After 12 months of optimized GDMT, the distribution shifted (P < 0.001): 79.5%, 16.5%, and 4.2% had nonsignificant, moderate, and severe SMR, respectively. Among the 731 patients with significant SMR (moderate/severe) at baseline, 57.5% improved to nonsignificant SMR. Improvement from significant to nonsignificant SMR within 12 months was associated with a favorable long-term prognosis, comparable to patients who consistently had nonsignificant SMR. Conversely, patients with persistent significant SMR had a higher risk of all-cause mortality (HR: 1.60; 95% CI: 1.36-1.89; P < 0.001) and the composite outcome of mortality or HFH (HR: 1.59; 95% CI: 1.36-1.85; P < 0.001).CONCLUSIONSIn this real-world HFrEF cohort, optimizing GDMT use led to SMR improvement in over half of patients with moderate or severe SMR. Nevertheless, both persistent moderate and severe SMR were associated with poor outcomes, underscoring the known benefit of mitral intervention in severe SMR and its potential in moderate SMR.","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"56 1","pages":"103001"},"PeriodicalIF":13.0,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147373895","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 : 2026-03-06DOI: 10.1016/j.jchf.2026.102943
Carolyn S P Lam, Biykem Bozkurt, David Z I Cherney, Justin A Ezekowitz, Meg J Jardine, Sadiya S Khan, Magdalena Madero, Mark J Sarnak, Jozine M Ter Maaten, Michael Cheung, Jennifer M King, Morgan E Grams, Michel Jadoul, Nisha Bansal
Heart failure (HF) and chronic kidney disease (CKD) frequently coexist, which elevates the risks of hospitalization, disease progression, and death. Despite advances in treating each condition independently, many challenges remain in diagnosing and managing them in combination. In March 2024, Kidney Disease: Improving Global Outcomes (KDIGO) held the Controversies Conference on Kidney Disease and Heart Failure: Recent Advances and Current Challenges. Discussions highlighted the complex, bidirectional relationship between HF and CKD, including shared risk factors and overlapping pathophysiology as well as nuances in interpreting biomarkers such as natriuretic peptides and serum creatinine. Sodium-glucose cotransporter-2 inhibitors, renin-angiotensin-aldosterone system inhibitors, and emerging agents such as finerenone and glucagon-like peptide-1 receptor agonists can have benefits in both populations of patients with HF and CKD, though evidence in advanced CKD remains limited. Importantly, small declines in kidney function after initiating guideline-directed HF therapies generally do not require discontinuation, as these declines are often hemodynamic in nature and not associated with poor outcomes. The group highlighted the need for CKD-specific HF diagnostic thresholds and refined acute kidney injury definitions in HF. It is important for future cardiovascular and kidney trials to include relevant end points, such as kidney function trajectories, symptom burden, and quality of life. To improve care for individuals with HF and CKD, a more integrated approach to management, rooted in individualization, clinical context, and shared therapeutic goals, is needed.
{"title":"Kidney Disease and Heart Failure: Recent Advances and Current Challenges: Conclusions From a Kidney Disease: Improving Global Outcomes (KDIGO) Controversies Conference.","authors":"Carolyn S P Lam, Biykem Bozkurt, David Z I Cherney, Justin A Ezekowitz, Meg J Jardine, Sadiya S Khan, Magdalena Madero, Mark J Sarnak, Jozine M Ter Maaten, Michael Cheung, Jennifer M King, Morgan E Grams, Michel Jadoul, Nisha Bansal","doi":"10.1016/j.jchf.2026.102943","DOIUrl":"https://doi.org/10.1016/j.jchf.2026.102943","url":null,"abstract":"<p><p>Heart failure (HF) and chronic kidney disease (CKD) frequently coexist, which elevates the risks of hospitalization, disease progression, and death. Despite advances in treating each condition independently, many challenges remain in diagnosing and managing them in combination. In March 2024, Kidney Disease: Improving Global Outcomes (KDIGO) held the Controversies Conference on Kidney Disease and Heart Failure: Recent Advances and Current Challenges. Discussions highlighted the complex, bidirectional relationship between HF and CKD, including shared risk factors and overlapping pathophysiology as well as nuances in interpreting biomarkers such as natriuretic peptides and serum creatinine. Sodium-glucose cotransporter-2 inhibitors, renin-angiotensin-aldosterone system inhibitors, and emerging agents such as finerenone and glucagon-like peptide-1 receptor agonists can have benefits in both populations of patients with HF and CKD, though evidence in advanced CKD remains limited. Importantly, small declines in kidney function after initiating guideline-directed HF therapies generally do not require discontinuation, as these declines are often hemodynamic in nature and not associated with poor outcomes. The group highlighted the need for CKD-specific HF diagnostic thresholds and refined acute kidney injury definitions in HF. It is important for future cardiovascular and kidney trials to include relevant end points, such as kidney function trajectories, symptom burden, and quality of life. To improve care for individuals with HF and CKD, a more integrated approach to management, rooted in individualization, clinical context, and shared therapeutic goals, is needed.</p>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":"102943"},"PeriodicalIF":11.8,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147372480","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 : 2026-03-06DOI: 10.1016/j.jchf.2026.102999
Christiane E Angermann,Teresa Gerhardt,Jonathan P Blatchford,Jan Biegus,Sean P Collins,Mikhail Kosiborod,Joao Pedro Ferreira,Michael E Nassif,Mitchell A Psotka,Jasper Tromp,Bettina J Kraus,Piotr Ponikowski,John R Teerlink,Adriaan A Voors
BACKGROUNDIn EMPULSE (A Study to Test the Effect of Empagliflozin in Patients Who Are in Hospital for Acute Heart Failure), the sodium-glucose cotransporter 2 inhibitor empagliflozin improved clinical outcomes in patients hospitalized for heart failure (HF).OBJECTIVESThis prespecified analysis examined efficacy, safety, and tolerability of empagliflozin in subgroups with de novo heart failure (NHF) vs acute decompensated heart failure (ADHF).METHODSAfter stabilization, participants were randomized 1:1 to empagliflozin 10 mg/d or placebo, stratified by HF status (NHF: n = 175; ADHF: n = 355). The primary endpoint was a hierarchical composite of death, worsening HF, or ≥5-point difference in Kansas City Cardiomyopathy Questionnaire-Total Symptom Score (KCCQ-TSS) change at day 90, assessed using a win ratio.RESULTSParticipants with NHF were younger, had fewer comorbidities, had higher blood pressure and heart rate, and better KCCQ-TSS. Prescription of diuretic agents was similar between subgroups. The win ratio was 1.29 (95% CI: 0.89-1.89) for NHF and 1.39 (95% CI: 1.07-1.81) for ADHF (Pinteraction = 0.759). There were no interactions between NHF and ADHF for the primary endpoint, its components, or secondary endpoints, except diuretic response, which was greater with empagliflozin in NHF than in ADHF from day 15 (mean difference vs placebo: -5.11 [Q1-Q3: -7.89 to -2.32] vs -0.97 [Q1-Q3: -2.91 to 0.96] kg per mean daily loop diuretic dose, Pinteraction = 0.017), with even greater between-group differences at days 30 and 90. Frequencies of adverse events were consistently lower with empagliflozin vs placebo.CONCLUSIONSIn-hospital initiation of empagliflozin produced similar clinical benefits in NHF and ADHF despite the reduced diuretic response in participants with ADHF and was well tolerated. This supports in-hospital initiation of empagliflozin in all patients with acute HF (A Study to Test the Effect of Empagliflozin in Patients Who Are in Hospital for Acute Heart Failure [EMPULSE]; NCT04157751).
{"title":"Empagliflozin in De Novo vs Acute Decompensated Chronic Heart Failure: A Prespecified Analysis From EMPULSE.","authors":"Christiane E Angermann,Teresa Gerhardt,Jonathan P Blatchford,Jan Biegus,Sean P Collins,Mikhail Kosiborod,Joao Pedro Ferreira,Michael E Nassif,Mitchell A Psotka,Jasper Tromp,Bettina J Kraus,Piotr Ponikowski,John R Teerlink,Adriaan A Voors","doi":"10.1016/j.jchf.2026.102999","DOIUrl":"https://doi.org/10.1016/j.jchf.2026.102999","url":null,"abstract":"BACKGROUNDIn EMPULSE (A Study to Test the Effect of Empagliflozin in Patients Who Are in Hospital for Acute Heart Failure), the sodium-glucose cotransporter 2 inhibitor empagliflozin improved clinical outcomes in patients hospitalized for heart failure (HF).OBJECTIVESThis prespecified analysis examined efficacy, safety, and tolerability of empagliflozin in subgroups with de novo heart failure (NHF) vs acute decompensated heart failure (ADHF).METHODSAfter stabilization, participants were randomized 1:1 to empagliflozin 10 mg/d or placebo, stratified by HF status (NHF: n = 175; ADHF: n = 355). The primary endpoint was a hierarchical composite of death, worsening HF, or ≥5-point difference in Kansas City Cardiomyopathy Questionnaire-Total Symptom Score (KCCQ-TSS) change at day 90, assessed using a win ratio.RESULTSParticipants with NHF were younger, had fewer comorbidities, had higher blood pressure and heart rate, and better KCCQ-TSS. Prescription of diuretic agents was similar between subgroups. The win ratio was 1.29 (95% CI: 0.89-1.89) for NHF and 1.39 (95% CI: 1.07-1.81) for ADHF (Pinteraction = 0.759). There were no interactions between NHF and ADHF for the primary endpoint, its components, or secondary endpoints, except diuretic response, which was greater with empagliflozin in NHF than in ADHF from day 15 (mean difference vs placebo: -5.11 [Q1-Q3: -7.89 to -2.32] vs -0.97 [Q1-Q3: -2.91 to 0.96] kg per mean daily loop diuretic dose, Pinteraction = 0.017), with even greater between-group differences at days 30 and 90. Frequencies of adverse events were consistently lower with empagliflozin vs placebo.CONCLUSIONSIn-hospital initiation of empagliflozin produced similar clinical benefits in NHF and ADHF despite the reduced diuretic response in participants with ADHF and was well tolerated. This supports in-hospital initiation of empagliflozin in all patients with acute HF (A Study to Test the Effect of Empagliflozin in Patients Who Are in Hospital for Acute Heart Failure [EMPULSE]; NCT04157751).","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"4 1","pages":"102999"},"PeriodicalIF":13.0,"publicationDate":"2026-03-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147371020","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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