JACC. Heart failure最新文献

英文中文

The Evaluation of New-Onset Heart Failure With Reduced Ejection Fraction

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-03-01 DOI: 10.1016/j.jchf.2024.12.003

Michelle Dimza DO, Cliff Pruett MD, Mark H. Drazner MD, MSc

引用次数: 0

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IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-03-01 DOI: 10.1016/S2213-1779(25)00092-7

引用次数: 0

Outcomes of KDIGO-Defined CKD in U.S. Veterans With HFpEF, HFmrEF, and HFrEF

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-03-01 DOI: 10.1016/j.jchf.2024.11.007

Samir Patel MD , Venkatesh K. Raman MD , Charles Faselis MD , Gregg C. Fonarow MD , Phillip H. Lam MD , Amiya A. Ahmed MD , Paul A. Heidenreich MD, MS , Stefan D. Anker MD, PhD , Prakash Deedwania MD , Charity J. Morgan PhD , Sijian Zhang MB, MS , Hans Moore MD , Janani Rangaswami MD , George Bakris MD , Javed Butler MD, MPH, MBA , Helen M. Sheriff MD , Richard M. Allman MD , Qing Zeng-Treitler PhD , Wen-Chih Wu MD, MPH , Ali Ahmed MD, MPH

Background

Chronic kidney disease (CKD) is defined by the KDIGO (Kidney Disease: Improving Global Outcomes) guideline as abnormal kidney structure or function, present for >3 months, with implications for health. KDIGO-defined CKD is associated with poor outcomes in patients with heart failure (HF). Less is known about whether these associations vary by left ventricular ejection fraction.

Objectives

This study aims to determine the prevalence and outcomes of KDIGO-defined CKD in heart failure with preserved ejection fraction (HFpEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF).

Methods

Of the 1,446,053 veterans with an HF diagnosis (1991-2017) in the national Veterans Affairs electronic health record data, 365,000 with data on EF had KDIGO-defined CKD or normal kidney function (NKF). CKD was defined as 2 values measured 90 days apart of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m² (categorized into 4 eGFR stages based on the last eGFR: 45-59 mL/min/1.73 m², 30-44 mL/min/1.73 m², 15-29 mL/min/1.73 m², and <15 mL/min/1.73 m²) or urinary albumin-to-creatinine ratio (uACR) >30 mg/g (albuminuria). NKF was defined as 2 values measured >90 days apart of eGFR ≥60 mL/min/1.73 m², without eGFR <60 mL/min/1.73 m² or albuminuria for 3 years before HF diagnosis. Patients were categorized into HFpEF (EF ≥50%, n = 85,855), HFmrEF (EF 41%-49%, n = 39,397), and HFrEF (EF ≤40%, n = 139,748). HRs and 95% CIs for 5-year all-cause mortality and HF hospitalization through December 31, 2022, associated with the 5 CKD groups (vs NKF) were estimated using Cox regression.

Results

Among patients with HF and NKF, mortality occurred in 39%, 37%. and 41%, and HF hospitalization occurred in 12%, 15%, and 21% of those with HFpEF, HFmrEF. and HFrEF, respectively. Compared with NKF, CKD was associated with 16%, 19%, and 26% higher multivariable-adjusted risks for death in patients with HFpEF, HFmrEF, and HFrEF, respectively. Respective risks for HF hospitalization were 31%, 33%, and 32% higher. The eGFR-associated risks were incrementally higher with decreasing eGFR, except for eGFR <15 mL/min/1.73 m², likely because of the initiation of dialysis during follow-up. Albuminuria was associated with 16%, 10%, and 12% higher multivariable-adjusted risks for death and 29, 30%, and 24% for HF hospitalization in HFpEF, HFmrEF, and HFrEF, respectively. All associations were statistically significant.

Conclusions

These findings based on KDIGO-defined CKD and NKF provide new information about the best estimates of true prevalence and outcomes of CKD in HFpEF, HFmrEF, and HFrEF.

{"title":"Outcomes of KDIGO-Defined CKD in U.S. Veterans With HFpEF, HFmrEF, and HFrEF","authors":"Samir Patel MD , Venkatesh K. Raman MD , Charles Faselis MD , Gregg C. Fonarow MD , Phillip H. Lam MD , Amiya A. Ahmed MD , Paul A. Heidenreich MD, MS , Stefan D. Anker MD, PhD , Prakash Deedwania MD , Charity J. Morgan PhD , Sijian Zhang MB, MS , Hans Moore MD , Janani Rangaswami MD , George Bakris MD , Javed Butler MD, MPH, MBA , Helen M. Sheriff MD , Richard M. Allman MD , Qing Zeng-Treitler PhD , Wen-Chih Wu MD, MPH , Ali Ahmed MD, MPH","doi":"10.1016/j.jchf.2024.11.007","DOIUrl":"10.1016/j.jchf.2024.11.007","url":null,"abstract":"<div><h3>Background</h3><div>Chronic kidney disease (CKD) is defined by the KDIGO (Kidney Disease: Improving Global Outcomes) guideline as abnormal kidney structure or function, present for >3 months, with implications for health. KDIGO-defined CKD is associated with poor outcomes in patients with heart failure (HF). Less is known about whether these associations vary by left ventricular ejection fraction.</div></div><div><h3>Objectives</h3><div>This study aims to determine the prevalence and outcomes of KDIGO-defined CKD in heart failure with preserved ejection fraction (HFpEF), heart failure with mildly reduced ejection fraction (HFmrEF), and heart failure with reduced ejection fraction (HFrEF).</div></div><div><h3>Methods</h3><div>Of the 1,446,053 veterans with an HF diagnosis (1991-2017) in the national Veterans Affairs electronic health record data, 365,000 with data on EF had KDIGO-defined CKD or normal kidney function (NKF). CKD was defined as 2 values measured 90 days apart of estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m<sup>2</sup> (categorized into 4 eGFR stages based on the last eGFR: 45-59 mL/min/1.73 m<sup>2</sup>, 30-44 mL/min/1.73 m<sup>2</sup>, 15-29 mL/min/1.73 m<sup>2</sup>, and <15 mL/min/1.73 m<sup>2</sup>) or urinary albumin-to-creatinine ratio (uACR) >30 mg/g (albuminuria). NKF was defined as 2 values measured >90 days apart of eGFR ≥60 mL/min/1.73 m<sup>2</sup>, without eGFR <60 mL/min/1.73 m<sup>2</sup> or albuminuria for 3 years before HF diagnosis. Patients were categorized into HFpEF (EF ≥50%, n = 85,855), HFmrEF (EF 41%-49%, n = 39,397), and HFrEF (EF ≤40%, n = 139,748). HRs and 95% CIs for 5-year all-cause mortality and HF hospitalization through December 31, 2022, associated with the 5 CKD groups (vs NKF) were estimated using Cox regression.</div></div><div><h3>Results</h3><div>Among patients with HF and NKF, mortality occurred in 39%, 37%. and 41%, and HF hospitalization occurred in 12%, 15%, and 21% of those with HFpEF, HFmrEF. and HFrEF, respectively. Compared with NKF, CKD was associated with 16%, 19%, and 26% higher multivariable-adjusted risks for death in patients with HFpEF, HFmrEF, and HFrEF, respectively. Respective risks for HF hospitalization were 31%, 33%, and 32% higher. The eGFR-associated risks were incrementally higher with decreasing eGFR, except for eGFR <15 mL/min/1.73 m<sup>2</sup>, likely because of the initiation of dialysis during follow-up. Albuminuria was associated with 16%, 10%, and 12% higher multivariable-adjusted risks for death and 29, 30%, and 24% for HF hospitalization in HFpEF, HFmrEF, and HFrEF, respectively. All associations were statistically significant.</div></div><div><h3>Conclusions</h3><div>These findings based on KDIGO-defined CKD and NKF provide new information about the best estimates of true prevalence and outcomes of CKD in HFpEF, HFmrEF, and HFrEF.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 3","pages":"Pages 467-479"},"PeriodicalIF":10.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143364502","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

Heart Transplant and Pregnancy

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-03-01 DOI: 10.1016/j.jchf.2024.11.016

Vanessa Kirschner BS , Ophelia Yin MD , Lisa Coscia RN, BSN , Prisca C. Diala MD , Negeen Shahandeh MD , Roxanna A. Irani MD, PhD , Serban Constantinescu MD, PhD , Michael J. Moritz MD , Yalda Afshar MD, PhD

Background

Heart transplant recipients (HTRs) during pregnancy are at greater risk for maternal and obstetrical complications and hypertensive disease of pregnancy exacerbates these risks. The impact of preeclampsia on HTRs is unknown.

Objectives

The authors describe characteristics of HTRs who developed preeclampsia and the effect of preeclampsia on graft and pregnancy outcomes.

Methods

This is a retrospective group study of adult HTRs with subsequent pregnancy outcomes of ≥20 weeks’ gestation enrolled in the Transplant Pregnancy Registry International between 1986 and 2022. The primary outcome was graft loss within 2 years from delivery. Secondary outcomes included maternal and neonatal outcomes.

Results

A total of 146 pregnancies and 149 neonates met inclusion criteria. All were livebirths. Forty-two pregnancies (28.8%) were complicated by preeclampsia. HTRs in the preeclampsia group were more likely to be nulliparous (81.0% vs 54.8%; P < 0.01), and have chronic hypertension (73.8% vs 34.6%; P < 0.01). There was no difference in incidence of graft loss at 2 years with (4.8%) or without (2.9%) preeclampsia (P = 0.72). There was no clinically important difference in graft survival in pregnancies with preeclampsia compared with pregnancies without preeclampsia (adjusted HR: 0.79 [95% CI: 0.37-1.69]; P = 0.54). However, rates of severe maternal morbidity were high in both groups: 16.7% in the preeclampsia group and 10.6% in those without preeclampsia. Furthermore, preeclampsia was associated with earlier gestational age at birth (35.0 vs 37.0 weeks; P < 0.01) and lower birth weight (2,310 vs 2,801 grams; P < 0.01).

Conclusions

There was no difference in graft loss from delivery in HTRs who developed preeclampsia during pregnancy. Regardless of preeclampsia, pregnant HTRs are more likely than the general population to experience severe maternal morbidity. These findings provide pertinent information for counseling heart transplant recipients who pursue pregnancy.

{"title":"Heart Transplant and Pregnancy","authors":"Vanessa Kirschner BS , Ophelia Yin MD , Lisa Coscia RN, BSN , Prisca C. Diala MD , Negeen Shahandeh MD , Roxanna A. Irani MD, PhD , Serban Constantinescu MD, PhD , Michael J. Moritz MD , Yalda Afshar MD, PhD","doi":"10.1016/j.jchf.2024.11.016","DOIUrl":"10.1016/j.jchf.2024.11.016","url":null,"abstract":"<div><h3>Background</h3><div>Heart transplant recipients (HTRs) during pregnancy are at greater risk for maternal and obstetrical complications and hypertensive disease of pregnancy exacerbates these risks. The impact of preeclampsia on HTRs is unknown.</div></div><div><h3>Objectives</h3><div>The authors describe characteristics of HTRs who developed preeclampsia and the effect of preeclampsia on graft and pregnancy outcomes.</div></div><div><h3>Methods</h3><div>This is a retrospective group study of adult HTRs with subsequent pregnancy outcomes of ≥20 weeks’ gestation enrolled in the Transplant Pregnancy Registry International between 1986 and 2022. The primary outcome was graft loss within 2 years from delivery. Secondary outcomes included maternal and neonatal outcomes.</div></div><div><h3>Results</h3><div>A total of 146 pregnancies and 149 neonates met inclusion criteria. All were livebirths. Forty-two pregnancies (28.8%) were complicated by preeclampsia. HTRs in the preeclampsia group were more likely to be nulliparous (81.0% vs 54.8%; <em>P</em> < 0.01), and have chronic hypertension (73.8% vs 34.6%; <em>P</em> < 0.01). There was no difference in incidence of graft loss at 2 years with (4.8%) or without (2.9%) preeclampsia (<em>P =</em> 0.72). There was no clinically important difference in graft survival in pregnancies with preeclampsia compared with pregnancies without preeclampsia (adjusted HR: 0.79 [95% CI: 0.37-1.69]; <em>P =</em> 0.54). However, rates of severe maternal morbidity were high in both groups: 16.7% in the preeclampsia group and 10.6% in those without preeclampsia. Furthermore, preeclampsia was associated with earlier gestational age at birth (35.0 vs 37.0 weeks; <em>P</em> < 0.01) and lower birth weight (2,310 vs 2,801 grams; <em>P</em> < 0.01).</div></div><div><h3>Conclusions</h3><div>There was no difference in graft loss from delivery in HTRs who developed preeclampsia during pregnancy. Regardless of preeclampsia, pregnant HTRs are more likely than the general population to experience severe maternal morbidity. These findings provide pertinent information for counseling heart transplant recipients who pursue pregnancy.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 3","pages":"Pages 498-507"},"PeriodicalIF":10.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143548037","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

Targeting Inflammation in Heart Failure Prevention

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-03-01 DOI: 10.1016/j.jchf.2025.01.005

W.H. Wilson Tang MD

引用次数: 0

Socioeconomic and Geographic Disparities in the Reported U.S. Amyloidosis Mortality From 2018-2022

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-03-01 DOI: 10.1016/j.jchf.2024.11.021

Gracia Fahed MD , John Isaiah Jimenez BS , Nixuan Cai BS , Xiaokang Wu MD, PhD , Alexis Edmonds BS , Khushali Shah BS, MS , Hiroki Kitakata MD , Francois Haddad MD , Ronald M. Witteles MD , Kevin M. Alexander MD

引用次数: 0

Validation of Guideline Recommendation on Sudden Cardiac Death Prevention in Hypertrophic Cardiomyopathy.

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-03-01 DOI: 10.1016/j.jchf.2024.12.006

Masashi Amano, Hiroaki Kitaoka, Yusuke Yoshikawa, Yasushi Sakata, Kaoru Dohi, Yukichi Tokita, Takao Kato, Shouji Matsushima, Takeshi Kitai, Atsushi Okada, Yutaka Furukawa, Toshihiro Tamura, Akihiro Hayashida, Haruhiko Abe, Kenji Ando, Satoshi Yuda, Moriaki Inoko, Kazushige Kadota, Yukio Abe, Katsuomi Iwakura, Tetsuya Kitamura, Jun Masuda, Takahiro Ohara, Takashi Omura, Takashi Tanigawa, Kenji Nakamura, Kunihiro Nishimura, Chisato Izumi

Background: To prevent sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM), the HCM Risk-SCD calculator and guideline recommendations are used to aid decision making for implantable cardioverter-defibrillator placement.

Objectives: The aim of this study was to assess the clinical profiles and occurrence of SCD by phenotypes of HCM and validate the performance of the current guidelines from a large-scale Japanese multicenter registry.

Methods: This was a retrospective, multicenter, observational, longitudinal cohort study that enrolled 3,611 consecutive patients with HCM. The primary endpoint was a composite of SCD or an equivalent event.

Results: The 5-year cumulative incidence of SCD events was markedly high in patients with end-stage HCM, defined by ejection fraction <50% (18.5%), followed by midventricular obstruction and nonobstructive HCM (6.9% and 4.7%). The 5-year cumulative incidence rates of SCD events for each recommendation class by the 2 guidelines were as follows: with the 2024 ACC (American College of Cardiology)/AHA (American Heart Association) guidelines, 23.8%, 7.2%, 5.7%, and 2.3% for Classes 1, 2a, 2b, and 3, respectively, and with the 2023 ESC (European Society of Cardiology) guidelines, 23.8%, 2.9%, 9.3%, and 2.6%, respectively. The 5-year risk was not well stratified between Classes 2a and 2b with the 2024 ACC/AHA guidelines (P = 0.101), and the event rate was even reversed with the 2023 ESC guidelines (P = 0.545).

Conclusions: Among HCM phenotypes, the prognosis of patients with end-stage HCM was markedly worse. The 2024 ACC/AHA and 2023 ESC guidelines well stratified SCD risk in patients with HCM; the 2024 ACC/AHA guidelines seemed to better stratify SCD risk between Classes 2a and 2b compared with the 2023 ESC guidelines.

{"title":"Validation of Guideline Recommendation on Sudden Cardiac Death Prevention in Hypertrophic Cardiomyopathy.","authors":"Masashi Amano, Hiroaki Kitaoka, Yusuke Yoshikawa, Yasushi Sakata, Kaoru Dohi, Yukichi Tokita, Takao Kato, Shouji Matsushima, Takeshi Kitai, Atsushi Okada, Yutaka Furukawa, Toshihiro Tamura, Akihiro Hayashida, Haruhiko Abe, Kenji Ando, Satoshi Yuda, Moriaki Inoko, Kazushige Kadota, Yukio Abe, Katsuomi Iwakura, Tetsuya Kitamura, Jun Masuda, Takahiro Ohara, Takashi Omura, Takashi Tanigawa, Kenji Nakamura, Kunihiro Nishimura, Chisato Izumi","doi":"10.1016/j.jchf.2024.12.006","DOIUrl":"https://doi.org/10.1016/j.jchf.2024.12.006","url":null,"abstract":"<p><strong>Background: </strong>To prevent sudden cardiac death (SCD) in patients with hypertrophic cardiomyopathy (HCM), the HCM Risk-SCD calculator and guideline recommendations are used to aid decision making for implantable cardioverter-defibrillator placement.</p><p><strong>Objectives: </strong>The aim of this study was to assess the clinical profiles and occurrence of SCD by phenotypes of HCM and validate the performance of the current guidelines from a large-scale Japanese multicenter registry.</p><p><strong>Methods: </strong>This was a retrospective, multicenter, observational, longitudinal cohort study that enrolled 3,611 consecutive patients with HCM. The primary endpoint was a composite of SCD or an equivalent event.</p><p><strong>Results: </strong>The 5-year cumulative incidence of SCD events was markedly high in patients with end-stage HCM, defined by ejection fraction <50% (18.5%), followed by midventricular obstruction and nonobstructive HCM (6.9% and 4.7%). The 5-year cumulative incidence rates of SCD events for each recommendation class by the 2 guidelines were as follows: with the 2024 ACC (American College of Cardiology)/AHA (American Heart Association) guidelines, 23.8%, 7.2%, 5.7%, and 2.3% for Classes 1, 2a, 2b, and 3, respectively, and with the 2023 ESC (European Society of Cardiology) guidelines, 23.8%, 2.9%, 9.3%, and 2.6%, respectively. The 5-year risk was not well stratified between Classes 2a and 2b with the 2024 ACC/AHA guidelines (P = 0.101), and the event rate was even reversed with the 2023 ESC guidelines (P = 0.545).</p><p><strong>Conclusions: </strong>Among HCM phenotypes, the prognosis of patients with end-stage HCM was markedly worse. The 2024 ACC/AHA and 2023 ESC guidelines well stratified SCD risk in patients with HCM; the 2024 ACC/AHA guidelines seemed to better stratify SCD risk between Classes 2a and 2b compared with the 2023 ESC guidelines.</p>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143633903","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

Desire for Prognostic Information Among Persons With Advanced Heart Failure 晚期心力衰竭患者对预后信息的渴望。

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-03-01 DOI: 10.1016/j.jchf.2024.06.017

Moritz Blum MD , Laura P. Gelfman MD, MPH , Terri R. Fried MD , Karen McKendrick MPH , Felix Schoenrath MD , Nathan E. Goldstein MD

引用次数: 0

Challenges Addressing Prognosis in Advanced Heart Failure

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-03-01 DOI: 10.1016/j.jchf.2025.01.002

Larry A. Allen MD, MHS , Lynne W. Stevenson MD

引用次数: 0

Leveraging Cohort Creation in Datasets

IF 10.3 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

JACC. Heart failure

Pub Date : 2025-03-01 DOI: 10.1016/j.jchf.2025.01.003

Tae Won Yi MD, PhD , Adeera Levin MD

引用次数: 0

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