Pub Date : 2026-03-05DOI: 10.1016/j.jchf.2026.102996
Alison Brann,James C Fang
{"title":"Bucking Conventional Wisdom: The Experience of Cardiac Myosin Inhibitors in Hypertrophic Cardiomyopathy.","authors":"Alison Brann,James C Fang","doi":"10.1016/j.jchf.2026.102996","DOIUrl":"https://doi.org/10.1016/j.jchf.2026.102996","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"42 1","pages":"102996"},"PeriodicalIF":13.0,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147358992","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 : 2026-03-01Epub Date: 2025-10-31DOI: 10.1016/j.jchf.2025.102753
Gyeongtae S. Moon BS , Paul J. Scheel 3rd MD , Maggie Montovano MD , Milan Kaushik MD , Cole Buchanan MD , Samuel H. Friedman MD , Rebecca Vanderpool PhD , Tess Allan MD , M. Imran Aslam MD , Ryan J. Tedford MD , Monica Mukherjee MD, MHS , Paul M. Hassoun MD , Vivek P. Jani MS , Steven Hsu MD
Background
Load-independent indices of right ventricular (RV) dysfunction aid in the prognosis of patients with pulmonary hypertension (PH), but acquisition of these indices remains difficult. Simpler image-based tools could bring these metrics to everyday practice.
Objectives
This study sought to develop a novel, artificial intelligence-based pipeline that estimates load-independent RV functional indices using a pressure-time waveform and stroke volume from clinical right-sided heart catheterization.
Methods
Clinical data and pressure-volume-time data were collected from 76 patients referred for right-sided heart catheterization for known or suspected PH from 3 centers. A computational pipeline was developed to determine the RV pressure-volume loop and extract load-independent RV indices using computer vision image processing and single-beat analysis. Agreement with gold standard single-beat analysis and prognostic value were evaluated.
Results
Strong concordance was observed between both methods for end-systolic elastance (Ees: R = 0.96; concordance correlation coefficient [CCC] = 0.58), effective arterial elastance (Ea: R = 0.97; CCC = 0.88), end-diastolic elastance (Eed: R = 0.87; CCC = 0.47), and Ees/Ea ratio (R = 0.93; CCC = 0.71) in both the validation and external cohorts. Prognostic analyses showed that calculated Ea (HR: 2.09; 95% CI: 1.04-4.20) and Ees/Ea (HR: 0.27; 95% CI: 0.08-0.87) were significant predictors of clinical outcomes. Cluster analysis using single-beat indices identified 2 RV subphenotypes with distinct hemodynamic features that were more predictive of poor outcomes than analysis using standard clinical features.
Conclusions
Study investigators have developed a novel computational pipeline that digitizes and generates single-beat estimates of RV-pulmonary arterial coupling from an image of the RV pressure waveform and stroke volume. Its output correlates with single-beat methods and predicts clinical outcomes.
{"title":"A Novel Computational Pipeline for Acquiring Pressure-Volume Hemodynamics of the Right Ventricle in Pulmonary Hypertension","authors":"Gyeongtae S. Moon BS , Paul J. Scheel 3rd MD , Maggie Montovano MD , Milan Kaushik MD , Cole Buchanan MD , Samuel H. Friedman MD , Rebecca Vanderpool PhD , Tess Allan MD , M. Imran Aslam MD , Ryan J. Tedford MD , Monica Mukherjee MD, MHS , Paul M. Hassoun MD , Vivek P. Jani MS , Steven Hsu MD","doi":"10.1016/j.jchf.2025.102753","DOIUrl":"10.1016/j.jchf.2025.102753","url":null,"abstract":"<div><h3>Background</h3><div>Load-independent indices of right ventricular (RV) dysfunction aid in the prognosis of patients with pulmonary hypertension (PH), but acquisition of these indices remains difficult. Simpler image-based tools could bring these metrics to everyday practice.</div></div><div><h3>Objectives</h3><div>This study sought to develop a novel, artificial intelligence-based pipeline that estimates load-independent RV functional indices using a pressure-time waveform and stroke volume from clinical right-sided heart catheterization.</div></div><div><h3>Methods</h3><div>Clinical data and pressure-volume-time data were collected from 76 patients referred for right-sided heart catheterization for known or suspected PH from 3 centers. A computational pipeline was developed to determine the RV pressure-volume loop and extract load-independent RV indices using computer vision image processing and single-beat analysis. Agreement with gold standard single-beat analysis and prognostic value were evaluated.</div></div><div><h3>Results</h3><div>Strong concordance was observed between both methods for end-systolic elastance (Ees: <em>R</em> = 0.96; concordance correlation coefficient [CCC] = 0.58), effective arterial elastance (Ea: <em>R</em> = 0.97; CCC = 0.88), end-diastolic elastance (Eed: <em>R</em> = 0.87; CCC = 0.47), and Ees/Ea ratio (<em>R</em> = 0.93; CCC = 0.71) in both the validation and external cohorts. Prognostic analyses showed that calculated Ea (HR: 2.09; 95% CI: 1.04-4.20) and Ees/Ea (HR: 0.27; 95% CI: 0.08-0.87) were significant predictors of clinical outcomes. Cluster analysis using single-beat indices identified 2 RV subphenotypes with distinct hemodynamic features that were more predictive of poor outcomes than analysis using standard clinical features.</div></div><div><h3>Conclusions</h3><div>Study investigators have developed a novel computational pipeline that digitizes and generates single-beat estimates of RV-pulmonary arterial coupling from an image of the RV pressure waveform and stroke volume. Its output correlates with single-beat methods and predicts clinical outcomes.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 3","pages":"Article 102753"},"PeriodicalIF":11.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145411509","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 : 2026-03-01Epub Date: 2025-11-11DOI: 10.1016/j.jchf.2025.102732
Virginia S. Hahn MD , Jelani K. Grant MD, MHS , Chiadi E. Ndumele MD, PhD
{"title":"Looking AHEAD to Heart Failure Prevention","authors":"Virginia S. Hahn MD , Jelani K. Grant MD, MHS , Chiadi E. Ndumele MD, PhD","doi":"10.1016/j.jchf.2025.102732","DOIUrl":"10.1016/j.jchf.2025.102732","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 3","pages":"Article 102732"},"PeriodicalIF":11.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145495494","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 : 2026-03-01Epub Date: 2025-11-19DOI: 10.1016/j.jchf.2025.102768
Josephine Harrington MD , Anna Giczewska MS , Vishal N. Rao MD, MPH , Marat Fudim MD, MHS , Anthony E. Peters MD, MS , Elizabeth Chrischilles PhD , W. Schuyler Jones MD , Heidi May PhD , Benjamin A. Steinberg MD , Jeffrey VanWormer PhD , Derek D. Cyr PhD , G. Michael Felker MD, MHS
Background
Limited data are available on the relationship between body mass index (BMI) and heart failure (HF) physiology or clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF).
Objectives
This study aims to assess the relationship between BMI and echocardiographic and hemodynamic measures as well as the risk of HF hospitalization and death.
Methods
This analysis was performed using a large multicenter registry of patients with diagnosed HFpEF in PCORnet (National Patient-Centered Clinical Research Network) from 2012 to 2018 who had undergone either echocardiography or invasive right heart catheterization.
Results
Of the 149,027 patients with HFpEF, 1.8% were underweight, 20.5% had a normal BMI, 27.9% were overweight, 22.1% had class 1 obesity, 13.3% had class 2, and 14.4% had class 3 obesity. The median follow-up time was 3.5 years. Higher BMI was associated with significant increases in multiple echocardiographic and hemodynamic markers of HF severity, including larger left atrial diameter, left ventricular end-diastolic diameter, and higher mean pulmonary artery pressure and pulmonary capillary wedge pressure (P < 0.001 for all). Higher BMI was associated with a significant and linear increase in the risk of HF hospitalization. In contrast, a sharp L-shaped relationship was observed between BMI and death, such that patients who were underweight had the highest risk of death and increasing BMI >30 kg/m2 was associated with a stable risk of death compared with patients who were overweight.
Conclusions
In these large, real-world, multicenter analyses, higher BMI was associated with adverse hemodynamic and structural cardiac changes, a linear increase in the risk of HF hospitalization, and a stable risk of death.
{"title":"Heart Failure With Preserved Ejection Fraction Across the Spectrum of Body Mass Index","authors":"Josephine Harrington MD , Anna Giczewska MS , Vishal N. Rao MD, MPH , Marat Fudim MD, MHS , Anthony E. Peters MD, MS , Elizabeth Chrischilles PhD , W. Schuyler Jones MD , Heidi May PhD , Benjamin A. Steinberg MD , Jeffrey VanWormer PhD , Derek D. Cyr PhD , G. Michael Felker MD, MHS","doi":"10.1016/j.jchf.2025.102768","DOIUrl":"10.1016/j.jchf.2025.102768","url":null,"abstract":"<div><h3>Background</h3><div>Limited data are available on the relationship between body mass index (BMI) and heart failure (HF) physiology or clinical outcomes in patients with heart failure with preserved ejection fraction (HFpEF).</div></div><div><h3>Objectives</h3><div>This study aims to assess the relationship between BMI and echocardiographic and hemodynamic measures as well as the risk of HF hospitalization and death.</div></div><div><h3>Methods</h3><div>This analysis was performed using a large multicenter registry of patients with diagnosed HFpEF in PCORnet (National Patient-Centered Clinical Research Network) from 2012 to 2018 who had undergone either echocardiography or invasive right heart catheterization.</div></div><div><h3>Results</h3><div>Of the 149,027 patients with HFpEF, 1.8% were underweight, 20.5% had a normal BMI, 27.9% were overweight, 22.1% had class 1 obesity, 13.3% had class 2, and 14.4% had class 3 obesity. The median follow-up time was 3.5 years. Higher BMI was associated with significant increases in multiple echocardiographic and hemodynamic markers of HF severity, including larger left atrial diameter, left ventricular end-diastolic diameter, and higher mean pulmonary artery pressure and pulmonary capillary wedge pressure (<em>P <</em> 0.001 for all). Higher BMI was associated with a significant and linear increase in the risk of HF hospitalization. In contrast, a sharp L-shaped relationship was observed between BMI and death, such that patients who were underweight had the highest risk of death and increasing BMI >30 kg/m<sup>2</sup> was associated with a stable risk of death compared with patients who were overweight.</div></div><div><h3>Conclusions</h3><div>In these large, real-world, multicenter analyses, higher BMI was associated with adverse hemodynamic and structural cardiac changes, a linear increase in the risk of HF hospitalization, and a stable risk of death.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 3","pages":"Article 102768"},"PeriodicalIF":11.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545389","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 : 2026-03-01Epub Date: 2025-10-29DOI: 10.1016/j.jchf.2025.102740
Aanchel Gupta BA, MD, Sunjidatul Islam MBBS, MSc, Douglas C. Dover PhD, Padma Kaul PhD, Finlay McAlister MD, MSc, Justin A. Ezekowitz MBBCh, MSc
{"title":"Hyperkalemia-Related Heart Failure Therapy Discontinuation and the Association With Outcomes in Patients With Heart Failure","authors":"Aanchel Gupta BA, MD, Sunjidatul Islam MBBS, MSc, Douglas C. Dover PhD, Padma Kaul PhD, Finlay McAlister MD, MSc, Justin A. Ezekowitz MBBCh, MSc","doi":"10.1016/j.jchf.2025.102740","DOIUrl":"10.1016/j.jchf.2025.102740","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 3","pages":"Article 102740"},"PeriodicalIF":11.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145382710","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 : 2026-03-01Epub Date: 2025-11-11DOI: 10.1016/j.jchf.2025.102755
Anand Shah MD , Jaime McDermott DNP , Vishal N. Rao MD , Megha Gupta BA , Stephanie G. Barnes DNP , Cynthia L. Green PhD , Harjeet Caberwal PharmD , Robert J. Mentz MD , Stephen J. Greene MD
{"title":"In-Hospital Virtual Consultation to Implement Guideline-Directed Medical Therapy for Cardiovascular-Kidney-Metabolic Disease","authors":"Anand Shah MD , Jaime McDermott DNP , Vishal N. Rao MD , Megha Gupta BA , Stephanie G. Barnes DNP , Cynthia L. Green PhD , Harjeet Caberwal PharmD , Robert J. Mentz MD , Stephen J. Greene MD","doi":"10.1016/j.jchf.2025.102755","DOIUrl":"10.1016/j.jchf.2025.102755","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 3","pages":"Article 102755"},"PeriodicalIF":11.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145491683","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 : 2026-03-01Epub Date: 2025-11-19DOI: 10.1016/j.jchf.2025.102769
Jason N. Katz MD, MHS , Jean M. Connors MD , Francis D. Pagani MD, PhD , Ulrich P. Jorde MD , Finn Gustafsson MD, PhD , Nir Uriel MD, MSc , Ivan Netuka MD, PhD , Mirnela Byku MD, PhD , Anelechi Anyanwu MD , Mary Keebler MD , Sriram Nathan MD , Craig H. Selzman MD , Jeffrey D. Alexis MD , Nasir Sulemanjee MD , Pavan Atluri MD , David D’Allesandro MD , Sydney Porter PhD , Fei San Lee PhD , Mandeep R. Mehra MD, MSc , ARIES Investigators
Background
The ARIES-HM3 (Antiplatelet Removal and Hemocompatibility Events With the HeartMate 3 Pump) trial demonstrated safety and decreased bleeding in eliminating aspirin from the antithrombotic regimen of patients implanted with a HM3 left ventricular assist device (LVAD). Whether pharmacologic therapies impact hemocompatibility-related adverse events (HRAEs) remains uncertain.
Objectives
In this trial analysis, the authors investigated associations between pharmacologic therapy and hemocompatibility outcomes.
Methods
Among 547 of 589 randomized patients who were discharged, non-inotrope-dependent, and completed 1-month of follow-up, the study explored the influence of pharmacotherapy (renin-angiotensin-aldosterone system [RAAS] inhibitors, heart failure [HF]-related and other cardiovascular drugs) on blood pressure control and on survival free of major nonsurgical HRAEs (stroke, pump thrombosis, bleeding, and arterial thromboembolism) at 12 months.
Results
In 547 eligible patients, 65% received RAAS inhibitors, 89% received other HF-related therapy, and 82% received another cardiovascular drug at 1 month. No statistically significant interaction between RAAS inhibitors (P = 0.08), other HF-related therapies (P = 0.65), or other cardiovascular drugs (P = 0.92) on aspirin use and primary endpoint success was observed. Patients receiving RAAS inhibitors at 1 month had greater primary endpoint success (78.9% vs 69.3%, HR: 0.61 [95% CI: 0.37-1.01]; P = 0.14). Other HF-related therapies and cardiovascular drugs were not associated with primary event success either on or off prescription (HF-related therapy: 75.4% vs 76.7%; other cardiovascular drugs: 74.3% vs 81.3%). Pharmacologic therapy did not have a significant interaction with blood pressure control (RAAS inhibitors: P = 0.69; other HF-related therapy: P = 0.40).
Conclusions
Background pharmacologic therapy did not modify the effect of aspirin on HRAE; however, the use of a RAAS inhibitor was independently associated with a reduction in HRAE. These exploratory observations may potentially point to opportunity for enhancing hemocompatibility in patients receiving LVAD therapy. (Antiplatelet Removal and Hemocompatibility Events With the HeartMate 3 Pump [ARIES-HM3]; NCT04069156)
{"title":"Hemocompatibility Outcomes With Pharmacological Therapy Following LVAD Implantation","authors":"Jason N. Katz MD, MHS , Jean M. Connors MD , Francis D. Pagani MD, PhD , Ulrich P. Jorde MD , Finn Gustafsson MD, PhD , Nir Uriel MD, MSc , Ivan Netuka MD, PhD , Mirnela Byku MD, PhD , Anelechi Anyanwu MD , Mary Keebler MD , Sriram Nathan MD , Craig H. Selzman MD , Jeffrey D. Alexis MD , Nasir Sulemanjee MD , Pavan Atluri MD , David D’Allesandro MD , Sydney Porter PhD , Fei San Lee PhD , Mandeep R. Mehra MD, MSc , ARIES Investigators","doi":"10.1016/j.jchf.2025.102769","DOIUrl":"10.1016/j.jchf.2025.102769","url":null,"abstract":"<div><h3>Background</h3><div>The ARIES-HM3 (Antiplatelet Removal and Hemocompatibility Events With the HeartMate 3 Pump) trial demonstrated safety and decreased bleeding in eliminating aspirin from the antithrombotic regimen of patients implanted with a HM3 left ventricular assist device (LVAD). Whether pharmacologic therapies impact hemocompatibility-related adverse events (HRAEs) remains uncertain.</div></div><div><h3>Objectives</h3><div>In this trial analysis, the authors investigated associations between pharmacologic therapy and hemocompatibility outcomes.</div></div><div><h3>Methods</h3><div>Among 547 of 589 randomized patients who were discharged, non-inotrope-dependent, and completed 1-month of follow-up, the study explored the influence of pharmacotherapy (renin-angiotensin-aldosterone system [RAAS] inhibitors, heart failure [HF]-related and other cardiovascular drugs) on blood pressure control and on survival free of major nonsurgical HRAEs (stroke, pump thrombosis, bleeding, and arterial thromboembolism) at 12 months.</div></div><div><h3>Results</h3><div>In 547 eligible patients, 65% received RAAS inhibitors, 89% received other HF-related therapy, and 82% received another cardiovascular drug at 1 month. No statistically significant interaction between RAAS inhibitors (<em>P</em> = 0.08), other HF-related therapies (<em>P</em> = 0.65), or other cardiovascular drugs (<em>P</em> = 0.92) on aspirin use and primary endpoint success was observed. Patients receiving RAAS inhibitors at 1 month had greater primary endpoint success (78.9% vs 69.3%, HR: 0.61 [95% CI: 0.37-1.01]; <em>P</em> = 0.14). Other HF-related therapies and cardiovascular drugs were not associated with primary event success either on or off prescription (HF-related therapy: 75.4% vs 76.7%; other cardiovascular drugs: 74.3% vs 81.3%). Pharmacologic therapy did not have a significant interaction with blood pressure control (RAAS inhibitors: <em>P</em> = 0.69; other HF-related therapy: <em>P</em> = 0.40).</div></div><div><h3>Conclusions</h3><div>Background pharmacologic therapy did not modify the effect of aspirin on HRAE; however, the use of a RAAS inhibitor was independently associated with a reduction in HRAE. These exploratory observations may potentially point to opportunity for enhancing hemocompatibility in patients receiving LVAD therapy. (Antiplatelet Removal and Hemocompatibility Events With the HeartMate 3 Pump [ARIES-HM3]; <span><span>NCT04069156</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 3","pages":"Article 102769"},"PeriodicalIF":11.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145545387","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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