JACC. Heart failure最新文献

英文中文

Ending the Fear Depriving Patients With HFpEF and CKD of Lifesaving Therapies 消除剥夺HFpEF和CKD患者生命治疗的恐惧。

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-01-01 DOI: 10.1016/j.jchf.2024.09.020

Maria Rosa Costanzo MD

引用次数: 0

Angiotensin Receptor Neprilysin Inhibition and Cardiovascular Outcomes Across the Kidney Function Spectrum 血管紧张素受体肾素抑制剂与肾功能范围内的心血管预后：PARAGON-HF 试验

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-01-01 DOI: 10.1016/j.jchf.2024.08.022

Finnian R. Mc Causland MBBCh, MMSc , Muthiah Vaduganathan MD, MPH , Brian Claggett PhD , Mauro Gori MD , Pardeep S. Jhund MBBCh, PhD , Martina M. McGrath MBBCh , Brendon L. Neuen MBBS, PhD , Milton Packer MD , Marc A. Pfeffer MD, PhD , Jean L. Rouleau MD , Michele Senni MD , Karl Swedberg MD , Faiez Zannad MD , Michael Zile MD , Martin P. Lefkowitz MD , John J.V. McMurray MD , Scott D. Solomon MD

Background

Lower estimated glomerular filtration rate (eGFR) may be one of the major reasons for hesitation or failure to initiate potentially beneficial therapies in patients with heart failure (HF).

Objectives

This study sought to assess if the effects of sacubitril/valsartan (vs valsartan) on cardiovascular outcomes differ according to baseline kidney function in patients with HF with preserved ejection fraction.

Methods

The PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HF with Preserved Ejection Fraction) trial was global clinical trial of 4,796 patients with chronic HF and left ventricular ejection fraction (LVEF) ≥45% randomly assigned to sacubitril/valsartan or valsartan. We examined the effect of treatment on cardiovascular outcomes using Cox regression models, stratified by region, and assessed for differential treatment effects according to the baseline eGFR and ejection fraction.

Results

At randomization, mean eGFR was 67 ± 19 mL/min/1.73 m²; 1,955 (41%) participants had an eGFR <60 mL/min/1.73 m². Compared with valsartan, sacubitril/valsartan reduced the primary cardiovascular outcome (cardiovascular death and total HF hospitalizations) to a greater extent among those with lower baseline eGFR (P interaction = 0.07 for continuous eGFR), and was most pronounced for those with eGFR ≤45 mL/min/1.73 m² (RR: 0.69; 95% CI: 0.51-0.94). The influence of eGFR on the treatment effect for cardiovascular death was nonlinear, with the most pronounced treatment effect for those with baseline eGFR <45 mL/min/1.73 m² (HR: 0.65; 95% CI: 0.43-0.97). In further subgroup analyses according to LVEF and eGFR, the treatment effect for the primary outcome was most pronounced among those with LVEF ≤57% and eGFR ≤45 mL/min/1.73 m² (HR: 0.66; 95% CI: 0.45-0.97).

Conclusions

In the PARAGON-HF trial, the benefits of sacubitril/valsartan to reduce the frequency of HF hospitalizations and cardiovascular death were most apparent in patients with lower baseline eGFR and lower ejection fraction. (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711)

背景：较低的估计肾小球滤过率（eGFR）可能是心力衰竭（HF）患者犹豫不决或无法开始潜在有益治疗的主要原因之一：本研究旨在评估射血分数保留的心力衰竭患者的基线肾功能不同，沙库比特利/缬沙坦（vs 缬沙坦）对心血管预后的影响是否不同：PARAGON-HF（前瞻性比较ARNI与ARB对射血分数保留型心房颤动患者的总体疗效）试验是一项全球性临床试验，共有4796名左心室射血分数（LVEF）≥45%的慢性心房颤动患者随机分配接受了沙格列普利/缬沙坦或缬沙坦治疗。我们使用Cox回归模型研究了治疗对心血管预后的影响，按地区进行了分层，并根据基线eGFR和射血分数评估了不同的治疗效果：随机化时，平均 eGFR 为 67 ± 19 mL/min/1.73 m2；1,955 名参与者（41%）的 eGFR 为 2。与缬沙坦相比，在基线 eGFR 较低的参与者中，沙库比曲/缬沙坦能更大程度地降低主要心血管结局（心血管死亡和 HF 住院总次数）（连续 eGFR 的 P 交互作用 = 0.07），在 eGFR ≤45 mL/min/1.73 m2 的参与者中效果最明显（RR：0.69；95% CI：0.51-0.94）。eGFR对心血管死亡的治疗效果的影响是非线性的，基线eGFR为2的患者治疗效果最明显（HR：0.65；95% CI：0.43-0.97）。在根据 LVEF 和 eGFR 进行的进一步亚组分析中，LVEF ≤57% 和 eGFR ≤45 mL/min/1.73 m2 的患者对主要结局的治疗效果最为显著（HR：0.66；95% CI：0.45-0.97）：在PARAGON-HF试验中，在基线eGFR较低和射血分数较低的患者中，沙库比妥/缬沙坦对降低HF住院频率和心血管死亡的益处最为明显。(LCZ696与缬沙坦相比对射血分数保留的心衰患者发病率和死亡率的有效性和安全性[PARAGON-HF]；NCT01920711）。

{"title":"Angiotensin Receptor Neprilysin Inhibition and Cardiovascular Outcomes Across the Kidney Function Spectrum","authors":"Finnian R. Mc Causland MBBCh, MMSc , Muthiah Vaduganathan MD, MPH , Brian Claggett PhD , Mauro Gori MD , Pardeep S. Jhund MBBCh, PhD , Martina M. McGrath MBBCh , Brendon L. Neuen MBBS, PhD , Milton Packer MD , Marc A. Pfeffer MD, PhD , Jean L. Rouleau MD , Michele Senni MD , Karl Swedberg MD , Faiez Zannad MD , Michael Zile MD , Martin P. Lefkowitz MD , John J.V. McMurray MD , Scott D. Solomon MD","doi":"10.1016/j.jchf.2024.08.022","DOIUrl":"10.1016/j.jchf.2024.08.022","url":null,"abstract":"<div><h3>Background</h3><div>Lower estimated glomerular filtration rate (eGFR) may be one of the major reasons for hesitation or failure to initiate potentially beneficial therapies in patients with heart failure (HF).</div></div><div><h3>Objectives</h3><div>This study sought to assess if the effects of sacubitril/valsartan (vs valsartan) on cardiovascular outcomes differ according to baseline kidney function in patients with HF with preserved ejection fraction.</div></div><div><h3>Methods</h3><div>The PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HF with Preserved Ejection Fraction) trial was global clinical trial of 4,796 patients with chronic HF and left ventricular ejection fraction (LVEF) ≥45% randomly assigned to sacubitril/valsartan or valsartan. We examined the effect of treatment on cardiovascular outcomes using Cox regression models, stratified by region, and assessed for differential treatment effects according to the baseline eGFR and ejection fraction.</div></div><div><h3>Results</h3><div>At randomization, mean eGFR was 67 ± 19 mL/min/1.73 m<sup>2</sup>; 1,955 (41%) participants had an eGFR <60 mL/min/1.73 m<sup>2</sup>. Compared with valsartan, sacubitril/valsartan reduced the primary cardiovascular outcome (cardiovascular death and total HF hospitalizations) to a greater extent among those with lower baseline eGFR (<em>P</em> interaction = 0.07 for continuous eGFR), and was most pronounced for those with eGFR ≤45 mL/min/1.73 m<sup>2</sup> (RR: 0.69; 95% CI: 0.51-0.94). The influence of eGFR on the treatment effect for cardiovascular death was nonlinear, with the most pronounced treatment effect for those with baseline eGFR <45 mL/min/1.73 m<sup>2</sup> (HR: 0.65; 95% CI: 0.43-0.97). In further subgroup analyses according to LVEF and eGFR, the treatment effect for the primary outcome was most pronounced among those with LVEF ≤57% and eGFR ≤45 mL/min/1.73 m<sup>2</sup> (HR: 0.66; 95% CI: 0.45-0.97).</div></div><div><h3>Conclusions</h3><div>In the PARAGON-HF trial, the benefits of sacubitril/valsartan to reduce the frequency of HF hospitalizations and cardiovascular death were most apparent in patients with lower baseline eGFR and lower ejection fraction. (Efficacy and Safety of LCZ696 Compared to Valsartan, on Morbidity and Mortality in Heart Failure Patients With Preserved Ejection Fraction [PARAGON-HF]; <span><span>NCT01920711</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 1","pages":"Pages 105-114"},"PeriodicalIF":10.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142681995","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}

引用次数: 0

Association of Fatigue Subtype With Outcomes in Adults with Prevalent Heart Failure 疲劳亚型与成人普遍心力衰竭预后的关系：ARIC研究

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-01-01 DOI: 10.1016/j.jchf.2024.10.008

Noelle V. Pavlovic PhD, RN , Martha Abshire Saylor PhD, RN , Jeannie-Marie Leoutsakos PhD , Cheryl R. Himmelfarb PhD, RN , Christopher S. Lee PhD, RN , Amil M. Shah MD, PhD , Patricia P. Chang MD, MHS , Yvonne Commodore-Mensah PhD, MHS, RN , Kunihiro Matsushita MD, PhD , Chiadi E. Ndumele MD, PhD

引用次数: 0

The Art of Prediction 预测的艺术。

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-01-01 DOI: 10.1016/j.jchf.2024.10.010

Evan P. Kransdorf MD, PhD, Michelle M. Kittleson MD, PhD

引用次数: 0

We Need to Stop Telling Heart Failure Patients to Restrict Their Salt Intake 我们需要停止告诉心力衰竭患者限制盐的摄入量。

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-01-01 DOI: 10.1016/j.jchf.2024.10.011

Tariq Ahmad MD, MPH

引用次数: 0

Diuretic Potentiation Strategies in Acute Heart Failure 急性心力衰竭的利尿增强策略。

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-01-01 DOI: 10.1016/j.jchf.2024.09.017

Tariq Jamal Siddiqi MD , Milton Packer MD , Justin A. Ezekowitz MBBCh, MSc , Gregg C. Fonarow MD , Stephen J. Greene MD , Michelle Kittleson MD , Muhammad Shahzeb Khan MD, MSc , Robert J. Mentz MD , Jeffrey Testani MD , Adriaan A. Voors MD , Javed Butler MD, MPH, MBA

Several trials have evaluated diuretic-based strategies to improve symptoms and outcomes in patients with acute heart failure (AHF). The authors sought to summarize the effect of different combination strategies on symptoms, physical signs, physiological variables, and outcomes in patients with AHF. Twelve trials were identified that assessed the addition of thiazide diuretics, sodium-glucose cotransporter 2 inhibitors, mineralocorticoid receptor antagonists, vasopressin receptor antagonists, carbonic anhydrase inhibitors, or loop diuretic intensification to conventional therapy for AHF. The trials evaluated short-term markers of congestion and symptoms, and none were powered for clinical outcomes. Short-term responses (such as relief from dyspnea, physical signs of congestion, and weight change) varied greatly across studies; all diuretic strategies were accompanied by short-term increases in serum creatinine and did not demonstrate benefits on mortality or recurrent heart failure events. The available evidence suggests that intensification of loop diuretic agents produces relief of physical signs of decongestion, but the importance of different strategies for short-term decongestion strategy for health status and long-term outcomes has not been established.

一些试验评估了以利尿剂为基础的策略来改善急性心力衰竭（AHF）患者的症状和预后。作者试图总结不同的联合策略对AHF患者的症状、体征、生理变量和结局的影响。12项试验评估了在AHF常规治疗中加入噻嗪类利尿剂、钠-葡萄糖共转运蛋白2抑制剂、矿皮质激素受体拮抗剂、抗利尿素受体拮抗剂、碳酸酐酶抑制剂或循环利尿剂强化的效果。这些试验评估了充血和症状的短期标志，没有一项试验为临床结果提供动力。短期反应（如呼吸困难缓解、身体充血症状和体重变化）在不同研究中差异很大；所有利尿剂策略都伴有血清肌酐的短期升高，并且没有显示出对死亡率或复发性心力衰竭事件的益处。现有证据表明，循环利尿剂的强化可以缓解身体充血的迹象，但不同的短期充血策略对健康状况和长期结果的重要性尚未确定。

{"title":"Diuretic Potentiation Strategies in Acute Heart Failure","authors":"Tariq Jamal Siddiqi MD , Milton Packer MD , Justin A. Ezekowitz MBBCh, MSc , Gregg C. Fonarow MD , Stephen J. Greene MD , Michelle Kittleson MD , Muhammad Shahzeb Khan MD, MSc , Robert J. Mentz MD , Jeffrey Testani MD , Adriaan A. Voors MD , Javed Butler MD, MPH, MBA","doi":"10.1016/j.jchf.2024.09.017","DOIUrl":"10.1016/j.jchf.2024.09.017","url":null,"abstract":"<div><div>Several trials have evaluated diuretic-based strategies to improve symptoms and outcomes in patients with acute heart failure (AHF). The authors sought to summarize the effect of different combination strategies on symptoms, physical signs, physiological variables, and outcomes in patients with AHF. Twelve trials were identified that assessed the addition of thiazide diuretics, sodium-glucose cotransporter 2 inhibitors, mineralocorticoid receptor antagonists, vasopressin receptor antagonists, carbonic anhydrase inhibitors, or loop diuretic intensification to conventional therapy for AHF. The trials evaluated short-term markers of congestion and symptoms, and none were powered for clinical outcomes. Short-term responses (such as relief from dyspnea, physical signs of congestion, and weight change) varied greatly across studies; all diuretic strategies were accompanied by short-term increases in serum creatinine and did not demonstrate benefits on mortality or recurrent heart failure events. The available evidence suggests that intensification of loop diuretic agents produces relief of physical signs of decongestion, but the importance of different strategies for short-term decongestion strategy for health status and long-term outcomes has not been established.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 1","pages":"Pages 14-27"},"PeriodicalIF":10.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142949066","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}

引用次数: 0

Race in Heart Failure 心力衰竭患者的种族：对全球 PARADIGM-HF 和 PARAGON-HF 试验参与者水平的汇总分析

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-01-01 DOI: 10.1016/j.jchf.2024.08.008

Henri Lu MD , Brian L. Claggett PhD , Milton Packer MD , Maria A. Pabon MD , Marc A. Pfeffer MD, PhD , Eldrin F. Lewis MD, MPH , Carolyn S.P. Lam MBBS, PhD , Jean Rouleau MD , Michael R. Zile MD , Martin Lefkowitz MD , Akshay S. Desai MD, MPH , Pardeep S. Jhund MBChB, MS, PhD , John J.V. McMurray MD , Scott D. Solomon MD , Muthiah Vaduganathan MD, MPH

Background

Mechanisms of disease pathobiology, prognosis, and potentially treatment responses might vary by race in patients with heart failure (HF).

Objectives

The authors aimed to examine the safety and efficacy of sacubitril/valsartan among patients with HF by self-reported race.

Methods

PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HF With Preserved Ejection Fraction) were global, randomized clinical trials testing sacubitril/valsartan against a renin-angiotensin system inhibitor (RASi) (enalapril or valsartan, respectively) in patients with HF and left ventricular ejection fraction ≤40% (PARADIGM-HF) or left ventricular ejection fraction ≥45% (PARAGON-HF). Patients with self-reported race were categorized as White, Asian, or Black. We assessed the composite of first HF hospitalization or cardiovascular death, its components, and angioedema across races.

Results

Among 12,097 participants, 9,451 (78.1%) were White, 2,116 (17.5%) were Asian, and 530 (4.4%) were Black. Over a median follow-up of 2.5 years, Black (adjusted HR: 1.68; 95% CI: 1.42-1.98) and Asian patients (adjusted HR: 1.32; 95% CI: 1.18-1.47) experienced higher risks of the primary outcome compared with White patients. Treatment effects of sacubitril/valsartan vs RASi on the primary endpoint were consistent among White (HR: 0.84; 95% CI: 0.77-0.91), Asian (HR: 0.92; 95% CI: 0.78-1.10), and Black patients (HR: 0.79; 95% CI: 0.58-1.07; P_interaction = 0.58). Rates of severe angioedema were higher with sacubitril/valsartan vs RASi (White: 0.2% vs 0.1%; Black: 1.5% vs 0.0%; Asian: 0.1% vs 0.1%).

Conclusions

In a pooled experience of 2 global trials, Black and Asian patients exhibited a higher risk of cardiovascular events than White patients. The benefits of sacubitril/valsartan were consistent across races. Risks of severe angioedema were low but numerically higher with sacubitril/valsartan. (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF]; NCT01035255; Prospective Comparison of ARNI with ARB Global Outcomes in HF With Preserved Ejection Fraction [PARAGON-HF]; NCT01920711)

心力衰竭（HF）患者的病理生物学机制、预后以及潜在的治疗反应可能因种族而异。作者的目的是根据自我报告的种族，研究心力衰竭患者服用沙库比妥/缬沙坦的安全性和疗效。他们在全球范围内开展了PARADIGM-HF（评估LCZ696与依那普利相比对慢性心力衰竭和射血分数降低患者发病率和死亡率的疗效和安全性的研究）和PARAGON-HF（评估LCZ696与缬沙坦相比对射血分数保留的心力衰竭患者发病率和死亡率的疗效和安全性的研究）、这些随机临床试验针对左室射血分数≤40%（PARADIGM-HF）或左室射血分数≥45%（PARAGON-HF）的心力衰竭患者，测试了沙库比特利/缬沙坦与肾素-血管紧张素系统抑制剂（[RASi]，分别为依那普利或缬沙坦）的对比效果。自报种族的患者被分为白人、亚裔或黑人。我们评估了不同种族的首次心房颤动住院或心血管死亡的复合情况、其组成部分以及血管性水肿。在 12,097 名参与者中，9,451 人（78.1%）为白人，2,116 人（17.5%）为亚裔，530 人（4.4%）为黑人。在中位随访 2.5 年期间，与白人患者相比，黑人患者（调整后 HR：1.68；95% CI：1.42-1.98）和亚裔患者（调整后 HR：1.32；95% CI：1.18-1.47）的主要结局风险更高。在白人患者（HR：0.84；95% CI：0.77-0.91）、亚裔患者（HR：0.92；95% CI：0.78-1.10）和黑人患者（HR：0.79 [95% CI：0.58-1.07]；= 0.58）中，沙库比曲/缬沙坦与 RASi 对主要终点的治疗效果一致。使用沙库比曲/缬沙坦与RASi相比，严重血管性水肿的发生率更高（白人：0.2% vs 0.1%；黑人：1.5% vs 0.0%；亚洲人：0.1% vs 0.1%）。在两项全球试验的汇总经验中，黑人和亚裔患者发生心血管事件的风险高于白人患者。在不同种族中，沙库比妥/缬沙坦的益处是一致的。发生严重血管性水肿的风险较低，但服用沙库比特利/缬沙坦后发生血管性水肿的风险在数量上要高一些。(评估 LCZ696 与依那普利相比对慢性心力衰竭和射血分数降低患者发病率和死亡率的疗效和安全性的多中心、随机、双盲、平行组、主动对照研究 [PARADIGM-HF]；一项多中心、随机、双盲、平行组、主动对照研究，评估 LCZ696 与缬沙坦相比对射血分数保留型心力衰竭患者发病率和死亡率的疗效和安全性 [PARAGON-HF]; )

{"title":"Race in Heart Failure","authors":"Henri Lu MD , Brian L. Claggett PhD , Milton Packer MD , Maria A. Pabon MD , Marc A. Pfeffer MD, PhD , Eldrin F. Lewis MD, MPH , Carolyn S.P. Lam MBBS, PhD , Jean Rouleau MD , Michael R. Zile MD , Martin Lefkowitz MD , Akshay S. Desai MD, MPH , Pardeep S. Jhund MBChB, MS, PhD , John J.V. McMurray MD , Scott D. Solomon MD , Muthiah Vaduganathan MD, MPH","doi":"10.1016/j.jchf.2024.08.008","DOIUrl":"10.1016/j.jchf.2024.08.008","url":null,"abstract":"<div><h3>Background</h3><div>Mechanisms of disease pathobiology, prognosis, and potentially treatment responses might vary by race in patients with heart failure (HF).</div></div><div><h3>Objectives</h3><div>The authors aimed to examine the safety and efficacy of sacubitril/valsartan among patients with HF by self-reported race.</div></div><div><h3>Methods</h3><div>PARADIGM-HF (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure) and PARAGON-HF (Prospective Comparison of ARNI with ARB Global Outcomes in HF With Preserved Ejection Fraction) were global, randomized clinical trials testing sacubitril/valsartan against a renin-angiotensin system inhibitor (RASi) (enalapril or valsartan, respectively) in patients with HF and left ventricular ejection fraction ≤40% (PARADIGM-HF) or left ventricular ejection fraction ≥45% (PARAGON-HF). Patients with self-reported race were categorized as White, Asian, or Black. We assessed the composite of first HF hospitalization or cardiovascular death, its components, and angioedema across races.</div></div><div><h3>Results</h3><div>Among 12,097 participants, 9,451 (78.1%) were White, 2,116 (17.5%) were Asian, and 530 (4.4%) were Black. Over a median follow-up of 2.5 years, Black (adjusted HR: 1.68; 95% CI: 1.42-1.98) and Asian patients (adjusted HR: 1.32; 95% CI: 1.18-1.47) experienced higher risks of the primary outcome compared with White patients. Treatment effects of sacubitril/valsartan vs RASi on the primary endpoint were consistent among White (HR: 0.84; 95% CI: 0.77-0.91), Asian (HR: 0.92; 95% CI: 0.78-1.10), and Black patients (HR: 0.79; 95% CI: 0.58-1.07; <em>P</em><sub>interaction</sub> = 0.58). Rates of severe angioedema were higher with sacubitril/valsartan vs RASi (White: 0.2% vs 0.1%; Black: 1.5% vs 0.0%; Asian: 0.1% vs 0.1%).</div></div><div><h3>Conclusions</h3><div>In a pooled experience of 2 global trials, Black and Asian patients exhibited a higher risk of cardiovascular events than White patients. The benefits of sacubitril/valsartan were consistent across races. Risks of severe angioedema were low but numerically higher with sacubitril/valsartan. (Prospective Comparison of ARNI with ACEI to Determine Impact on Global Mortality and Morbidity in Heart Failure [PARADIGM-HF]; <span><span>NCT01035255</span><svg><path></path></svg></span>; Prospective Comparison of ARNI with ARB Global Outcomes in HF With Preserved Ejection Fraction [PARAGON-HF]; <span><span>NCT01920711</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 1","pages":"Pages 58-71"},"PeriodicalIF":10.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142264028","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}

引用次数: 0

Genetic Landscape of Patients With Dilated Cardiomyopathy and a Systemic Immune-Mediated Disease 扩张型心肌病和系统性免疫相关疾病患者的基因状况

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-01-01 DOI: 10.1016/j.jchf.2024.08.011

Sophie L.V.M. Stroeks MD , Michiel T.H.M. Henkens MD, PhD , Fernando Dominguez MD, PhD , Marco Merlo MD , Debby M.E.I. Hellebrekers PhD , Esther Gonzalez-Lopez MD, PhD , Matteo dal Ferro MD , Juan Pablo Ochoa MD, PhD , Francesco Venturelli MD , Godelieve R.F. Claes PhD , Max F.G.H.M. Venner MD , Ingrid P.C. Krapels MD, PhD , Els K. Vanhoutte MD, PhD , Pieter van Paassen MD, PhD , Arthur van den Wijngaard PhD , Maurits A. Sikking MD , Rick van Leeuwen BSc , Myrurgia Abdul Hamid MD , Xiaofei Li MD, PhD , Han G. Brunner MD, PhD , Job A.J. Verdonschot MD, PhD

Background

Systemic immune-mediated diseases (SIDs) are a well-known cause of dilated cardiomyopathy (DCM), a cardiac phenotype influenced by genetic predispositions and environmental factors.

Objectives

This study sought to examine if an underlying genetic predisposition is present in patients with DCM and SID.

Methods

Genotyped DCM-SID patients (n = 183) were enrolled at 3 European centers. Genetic variants were compared with healthy control subjects (n = 20,917), DCM patients without SID (n = 560), and individuals with a suspicion of an SID (n = 1,333). Clinical outcomes included all-cause mortality, heart failure hospitalization, and life-threatening arrhythmias.

Results

The SID diagnosis preceded the DCM diagnosis by 4.8 months (Q1-Q3: −68.4 to +2.4 months). The prevalence of pathogenic/likely pathogenic (P/LP) variants in DCM patients with an SID from the Maastricht cohort was 17.1%, compared with 1.9% in healthy control subjects (P < 0.001). In the Madrid/Trieste cohort, the prevalence was 20.5% (P < 0.001). Truncating variants showed the strongest enrichment (10.7% [OR: 24.5] (Maastricht) and 16% [OR: 116.6 (Madrid/Trieste); both P < 0.001), with truncating TTN (titin) variant (TTNtv) being the most prevalent. Left ventricular ejection fraction at presentation was reduced in TTNtv-SID patients compared with DCM patients with SID without a P/LP (P = 0.016). The presence of a P/LP variant in DCM-SID had no impact on clinical outcomes over a median follow-up of 8.4 years (Q1-Q3: 4.9-12.1 years).

Conclusions

One in 6 DCM patients with an SID has an underlying P/LP variant in a DCM-associated gene. This highlights the role of genetic testing in those patients with immune-mediated DCM, and supports the concept that autoimmunity may play a role in unveiling a DCM phenotype in genotype-positive individuals.

背景：众所周知，全身性免疫介导疾病（SID）是扩张型心肌病（DCM）的病因，而扩张型心肌病是一种受遗传倾向和环境因素影响的心脏表型：本研究旨在探讨 DCM 和 SID 患者是否存在潜在的遗传易感性：方法：欧洲 3 个中心招募了基因分型的 DCM-SID 患者（n = 183）。遗传变异与健康对照受试者（n = 20,917）、无 SID 的 DCM 患者（n = 560）和怀疑有 SID 的个体（n = 1,333）进行了比较。临床结果包括全因死亡率、心衰住院率和危及生命的心律失常：结果：SID诊断比DCM诊断早4.8个月（Q1-Q3：-68.4至+2.4个月）。在马斯特里赫特队列中，患有 SID 的 DCM 患者中致病性/可能致病性（P/LP）变异的发生率为 17.1%，而在健康对照组中为 1.9%（P < 0.001）。在马德里/特里亚斯特队列中，发病率为 20.5%（P < 0.001）。截短变异表现出最强的富集性（10.7% [OR: 24.5]（马斯特里赫特）和 16% [OR: 116.6（马德里/特里亚斯特）；P 均<0.001），其中截短 TTN（钛蛋白）变异（TTNtv）最为普遍。与不存在 P/LP 的 SID DCM 患者相比，TTNtv-SID 患者发病时的左心室射血分数降低（P = 0.016）。在中位随访8.4年（Q1-Q3：4.9-12.1年）期间，DCM-SID患者出现P/LP变异对临床结果没有影响：结论：每 6 名患有 SID 的 DCM 患者中，就有一人的 DCM 相关基因存在潜在的 P/LP 变异。这凸显了基因检测在免疫介导的 DCM 患者中的作用，并支持了自身免疫可能在基因型阳性个体中揭示 DCM 表型的概念。

{"title":"Genetic Landscape of Patients With Dilated Cardiomyopathy and a Systemic Immune-Mediated Disease","authors":"Sophie L.V.M. Stroeks MD , Michiel T.H.M. Henkens MD, PhD , Fernando Dominguez MD, PhD , Marco Merlo MD , Debby M.E.I. Hellebrekers PhD , Esther Gonzalez-Lopez MD, PhD , Matteo dal Ferro MD , Juan Pablo Ochoa MD, PhD , Francesco Venturelli MD , Godelieve R.F. Claes PhD , Max F.G.H.M. Venner MD , Ingrid P.C. Krapels MD, PhD , Els K. Vanhoutte MD, PhD , Pieter van Paassen MD, PhD , Arthur van den Wijngaard PhD , Maurits A. Sikking MD , Rick van Leeuwen BSc , Myrurgia Abdul Hamid MD , Xiaofei Li MD, PhD , Han G. Brunner MD, PhD , Job A.J. Verdonschot MD, PhD","doi":"10.1016/j.jchf.2024.08.011","DOIUrl":"10.1016/j.jchf.2024.08.011","url":null,"abstract":"<div><h3>Background</h3><div>Systemic immune-mediated diseases (SIDs) are a well-known cause of dilated cardiomyopathy (DCM), a cardiac phenotype influenced by genetic predispositions and environmental factors.</div></div><div><h3>Objectives</h3><div>This study sought to examine if an underlying genetic predisposition is present in patients with DCM and SID.</div></div><div><h3>Methods</h3><div>Genotyped DCM-SID patients (n = 183) were enrolled at 3 European centers. Genetic variants were compared with healthy control subjects (n = 20,917), DCM patients without SID (n = 560), and individuals with a suspicion of an SID (n = 1,333). Clinical outcomes included all-cause mortality, heart failure hospitalization, and life-threatening arrhythmias.</div></div><div><h3>Results</h3><div>The SID diagnosis preceded the DCM diagnosis by 4.8 months (Q1-Q3: −68.4 to +2.4 months). The prevalence of pathogenic/likely pathogenic (P/LP) variants in DCM patients with an SID from the Maastricht cohort was 17.1%, compared with 1.9% in healthy control subjects (<em>P <</em> 0.001). In the Madrid/Trieste cohort, the prevalence was 20.5% (<em>P <</em> 0.001). Truncating variants showed the strongest enrichment (10.7% [OR: 24.5] (Maastricht) and 16% [OR: 116.6 (Madrid/Trieste); both <em>P <</em> 0.001), with truncating <em>TTN</em> (titin) variant (TTNtv) being the most prevalent. Left ventricular ejection fraction at presentation was reduced in TTNtv-SID patients compared with DCM patients with SID without a P/LP (<em>P =</em> 0.016). The presence of a P/LP variant in DCM-SID had no impact on clinical outcomes over a median follow-up of 8.4 years (Q1-Q3: 4.9-12.1 years).</div></div><div><h3>Conclusions</h3><div>One in 6 DCM patients with an SID has an underlying P/LP variant in a DCM-associated gene. This highlights the role of genetic testing in those patients with immune-mediated DCM, and supports the concept that autoimmunity may play a role in unveiling a DCM phenotype in genotype-positive individuals.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 1","pages":"Pages 133-145"},"PeriodicalIF":10.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465733","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}

引用次数: 0

Left Ventricular Dimensions and Clinical Outcomes With a Fully Magnetically Levitated Left Ventricular Assist Device. 全磁悬浮左心室辅助装置的左心室尺寸和临床结果。

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2024-12-05 DOI: 10.1016/j.jchf.2024.09.019

Ezequiel J Molina, Mustafa M Ahmed, Farooq H Sheikh, Joseph C Cleveland, Daniel J Goldstein, Nir Y Uriel, AiJia Wang, Jordan J Revis, Mandeep R Mehra

Background: Prior analyses have suggested that a smaller left ventricular end-diastolic diameter (LVEDD) is associated with reduced survival following HeartMate 3 left ventricular assist device implantation.

Objectives: In this trial-based comprehensive analysis, the authors sought to examine clinical characteristics and association with the outcome of this specific relationship.

Methods: The authors analyzed the presence of LVEDD <55 mm among 1,921 analyzable HeartMate 3 patients within the MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3) trial portfolio, on endpoints of overall survival and adverse events at 2 years. Adverse events included hemocompatibility-related (stroke, bleeding, and pump thrombosis) and non-hemocompatibility-related (right heart failure, infection) outcomes.

Results: Those with a smaller LVEDD (<55 mm) (n = 108) were older (age 63 ± 11 years vs 60 ± 12 years; P = 0.005), were more often female (31% vs 20%; P = 0.096), and had more ischemic cardiomyopathy (60.2% vs 42.6%; P = 0.0004) compared with the LVEDD ≥55 mm group (n = 1,813). Death during implant hospitalization was higher (14.8 vs 5.7%; P = 0.0007) and survival at 2 years was lower (63.3% vs 81.8%; HR: 1.97 [95% CI: 1.39-2.79]; P = 0.0002) in the LVEDD <55 mm group. The LVEDD <55 mm group experienced more deaths due to hemocompatibility-related adverse events (2.8% vs 0.6%; HR: 4.61 [95% CI: 1.29-16.45]; P = 0.018) and right heart failure, both early (0-30 days; 7.4% vs 2.0%; HR: 3.70 [95% CI: 1.73-7.91]; P = 0.001) and late (>30 days; 12.0 vs 4.8%; HR: 2.58 [95% CI: 1.37-4.84]; P = 0.003). Low-flow alarms rehospitalizations were higher in the LVEDD <55 mm cohort (17.4 vs 8.3%; HR: 2.39 [95% CI: 1.59-3.59]; P < 0.001).

Conclusions: Although infrequent in occurrence, smaller LVEDD (<55 mm) is associated with increased risk for early and late mortality, a consequence of hemocompatibility-related and right heart failure-related deaths. Rehospitalizations due to low-flow alarms are also more frequent. (MOMENTUM 3 IDE Clinical Study Protocol [HM3™]; NCT02224755; MOMENTUM 3 Continued Access Protocol [MOMENTUM 3 CAP]; NCT02892955).

背景：先前的分析表明，心脏伴侣3型左室辅助装置植入后，较小的左室舒张末期直径（LVEDD）与生存率降低有关。目的：在这项基于试验的综合分析中，作者试图检查临床特征及其与这种特定关系的结果的关联。方法：作者分析了LVEDD的存在结果：LVEDD较小的患者(30天；12.0 vs 4.8%；Hr: 2.58 [95% ci: 1.37-4.84]；P = 0.003)。结论：虽然低流量警报在LVEDD中的发生率较高，但较小的LVEDD (

{"title":"Left Ventricular Dimensions and Clinical Outcomes With a Fully Magnetically Levitated Left Ventricular Assist Device.","authors":"Ezequiel J Molina, Mustafa M Ahmed, Farooq H Sheikh, Joseph C Cleveland, Daniel J Goldstein, Nir Y Uriel, AiJia Wang, Jordan J Revis, Mandeep R Mehra","doi":"10.1016/j.jchf.2024.09.019","DOIUrl":"https://doi.org/10.1016/j.jchf.2024.09.019","url":null,"abstract":"<p><strong>Background: </strong>Prior analyses have suggested that a smaller left ventricular end-diastolic diameter (LVEDD) is associated with reduced survival following HeartMate 3 left ventricular assist device implantation.</p><p><strong>Objectives: </strong>In this trial-based comprehensive analysis, the authors sought to examine clinical characteristics and association with the outcome of this specific relationship.</p><p><strong>Methods: </strong>The authors analyzed the presence of LVEDD <55 mm among 1,921 analyzable HeartMate 3 patients within the MOMENTUM 3 (Multicenter Study of MagLev Technology in Patients Undergoing Mechanical Circulatory Support Therapy With HeartMate 3) trial portfolio, on endpoints of overall survival and adverse events at 2 years. Adverse events included hemocompatibility-related (stroke, bleeding, and pump thrombosis) and non-hemocompatibility-related (right heart failure, infection) outcomes.</p><p><strong>Results: </strong>Those with a smaller LVEDD (<55 mm) (n = 108) were older (age 63 ± 11 years vs 60 ± 12 years; P = 0.005), were more often female (31% vs 20%; P = 0.096), and had more ischemic cardiomyopathy (60.2% vs 42.6%; P = 0.0004) compared with the LVEDD ≥55 mm group (n = 1,813). Death during implant hospitalization was higher (14.8 vs 5.7%; P = 0.0007) and survival at 2 years was lower (63.3% vs 81.8%; HR: 1.97 [95% CI: 1.39-2.79]; P = 0.0002) in the LVEDD <55 mm group. The LVEDD <55 mm group experienced more deaths due to hemocompatibility-related adverse events (2.8% vs 0.6%; HR: 4.61 [95% CI: 1.29-16.45]; P = 0.018) and right heart failure, both early (0-30 days; 7.4% vs 2.0%; HR: 3.70 [95% CI: 1.73-7.91]; P = 0.001) and late (>30 days; 12.0 vs 4.8%; HR: 2.58 [95% CI: 1.37-4.84]; P = 0.003). Low-flow alarms rehospitalizations were higher in the LVEDD <55 mm cohort (17.4 vs 8.3%; HR: 2.39 [95% CI: 1.59-3.59]; P < 0.001).</p><p><strong>Conclusions: </strong>Although infrequent in occurrence, smaller LVEDD (<55 mm) is associated with increased risk for early and late mortality, a consequence of hemocompatibility-related and right heart failure-related deaths. Rehospitalizations due to low-flow alarms are also more frequent. (MOMENTUM 3 IDE Clinical Study Protocol [HM3™]; NCT02224755; MOMENTUM 3 Continued Access Protocol [MOMENTUM 3 CAP]; NCT02892955).</p>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142872113","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}

引用次数: 0

Choosing the Appropriate Combination of Diuretics for Patients With Heart Failure and Congestion 心力衰竭和充血患者选择合适的利尿剂组合

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2024-12-01 DOI: 10.1016/j.jchf.2024.09.015

Edgar Francisco Carrizales-Sepúlveda MD, Alejandro Ordaz-Farías MD, Raymundo Vera-Pineda MD, Ramiro Flores-Ramírez MD, PhD

引用次数: 0

首页上一页

类型

全部化学•材料生命科学医学物理工程技术环境•农林材料科学地球科学法学管理学化学环境科学与生态学计算机科学教育学经济学农林科学人文科学生物学数学物理与天体物理心理学综合性期刊其他工业工程理学历史学农学文学信息工程

数据库

全部 ACS Publications Elsevier ieeexplore Springer The Royal Society of Chemistry Wiley

期刊

JACC. Heart failure

全部 Acc. Chem. Res. ACS Applied Bio Materials ACS Appl. Electron. Mater. ACS Appl. Energy Mater. ACS Appl. Mater. Interfaces ACS Appl. Nano Mater. ACS Appl. Polym. Mater. ACS BIOMATER-SCI ENG ACS Catal. ACS Cent. Sci. ACS Chem. Biol. ACS Chemical Health & Safety ACS Chem. Neurosci. ACS Comb. Sci. ACS Earth Space Chem. ACS Energy Lett. ACS Infect. Dis. ACS Macro Lett. ACS Mater. Lett. ACS Med. Chem. Lett. ACS Nano ACS Omega ACS Photonics ACS Sens. ACS Sustainable Chem. Eng. ACS Synth. Biol. Anal. Chem. BIOCHEMISTRY-US Bioconjugate Chem. BIOMACROMOLECULES Chem. Res. Toxicol. Chem. Rev. Chem. Mater. CRYST GROWTH DES ENERG FUEL Environ. Sci. Technol. Environ. Sci. Technol. Lett. Eur. J. Inorg. Chem. IND ENG CHEM RES Inorg. Chem. J. Agric. Food. Chem. J. Chem. Eng. Data J. Chem. Educ. J. Chem. Inf. Model. J. Chem. Theory Comput. J. Med. Chem. J. Nat. Prod. J PROTEOME RES J. Am. Chem. Soc. LANGMUIR MACROMOLECULES Mol. Pharmaceutics Nano Lett. Org. Lett. ORG PROCESS RES DEV ORGANOMETALLICS J. Org. Chem. J. Phys. Chem. J. Phys. Chem. A J. Phys. Chem. B J. Phys. Chem. C J. Phys. Chem. Lett. Analyst Anal. Methods Biomater. Sci. Catal. Sci. Technol. Chem. Commun. Chem. Soc. Rev. CHEM EDUC RES PRACT CRYSTENGCOMM Dalton Trans. Energy Environ. Sci. ENVIRON SCI-NANO ENVIRON SCI-PROC IMP ENVIRON SCI-WAT RES Faraday Discuss. Food Funct. Green Chem. Inorg. Chem. Front. Integr. Biol. J. Anal. At. Spectrom. J. Mater. Chem. A J. Mater. Chem. B J. Mater. Chem. C Lab Chip Mater. Chem. Front. Mater. Horiz. MEDCHEMCOMM Metallomics Mol. Biosyst. Mol. Syst. Des. Eng. Nanoscale Nanoscale Horiz. Nat. Prod. Rep. New J. Chem. Org. Biomol. Chem. Org. Chem. Front. PHOTOCH PHOTOBIO SCI PCCP Polym. Chem.

﹀