首页 > 最新文献

JACC. Heart failure最新文献

英文 中文
Clinical Implications of the P.V142I TTR Variant P.V142I TTR变异的临床意义:来自car的见解。
IF 11.8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-01 DOI: 10.1016/j.jchf.2025.102704
Isabel R. Wees MD , Colby Ayers MS , Frederick L. Ruberg MD , Mathew S. Maurer MD , Yevgeniy Brailovsky DO, MSc , Lily K. Stern MD , Jan M. Griffin MD , Michel G. Khouri MD , Lori R. Roth PA-C , Justin L. Grodin MD, MPH
{"title":"Clinical Implications of the P.V142I TTR Variant","authors":"Isabel R. Wees MD , Colby Ayers MS , Frederick L. Ruberg MD , Mathew S. Maurer MD , Yevgeniy Brailovsky DO, MSc , Lily K. Stern MD , Jan M. Griffin MD , Michel G. Khouri MD , Lori R. Roth PA-C , Justin L. Grodin MD, MPH","doi":"10.1016/j.jchf.2025.102704","DOIUrl":"10.1016/j.jchf.2025.102704","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 2","pages":"Article 102704"},"PeriodicalIF":11.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145261212","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
Evolutionary History of the Comorbidity-Driven Coronary Microvascular Endothelial Inflammation Hypothesis and Its Metamorphosis to the Adipokine Hypothesis of Heart Failure With a Preserved Ejection Fraction 由合并症驱动的冠状动脉微血管内皮炎症假说的进化史及其向脂肪因子假说的转变。
IF 11.8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-01 DOI: 10.1016/j.jchf.2025.102822
Milton Packer MD
For the past decade, the prevailing paradigm to explain heart failure with preserved ejection fraction (HFpEF) has assumed that multiple comorbidities act in concert to trigger a systemic inflammatory state that causes coronary microvascular dysfunction, nitric oxide/cyclic guanosine monophosphate (cGMP) deficiency–dependent titin abnormalities, and load-dependent cellular inflammation and fibrosis of the myocardium. By contrast, the recently proposed adipokine hypothesis elevates one comorbidity—visceral adiposity—to explain the coexistence of systemic inflammation, multiple comorbidities, and HFpEF and identifies a specific proximal causal mechanism (ie, the secretion of a proinflammatory suite of signaling molecules from dysfunctional fat). Excess visceral adiposity and adipokine imbalances have been shown not only to produce HFpEF experimentally but also to directly cause hypertension, insulin resistance and type 2 diabetes, and chronic kidney disease. Visceral adiposity and proinflammatory adipokines can also explain features of HFpEF that are not addressed by the coronary microvascular inflammation hypothesis (eg, atrial fibrillation, skeletal muscle and pulmonary abnormalities, and renal sodium retention and plasma volume expansion). Adipokine imbalances can also cause microvascular dysfunction and defects in cGMP signaling and in titin phosphorylation, and they can directly cause cardiac hypertrophy and fibrosis independently of an effect on the microvasculature. The comorbidity-driven microvascular inflammation hypothesis did not identify a blood-borne molecular mediator that selectively targets the heart, and phenomapping based on the clustering of comorbidities has not yielded reproducible groupings. By contrast, selective silencing of specific proinflammatory adipokines only in adipose tissue causes distant effects on the heart to modulate cardiac structure and the evolution of HFpEF. Clinical trials of drugs that enhance nitric oxide/cGMP signaling or have nonspecific anti-inflammatory effects have not produced favorable effects in clinical HFpEF whereas drugs that produce benefits in HFpEF (eg, glucagon-like peptide 1 receptor agonists, sodium-glucose cotransporter 2 inhibitors) act to normalize the adipokine secretory profile. Finally, whereas coronary microvascular dysfunction is present in 60% to 70% of patients with HFpEF (with endothelium-dependent dysfunction being seen in only 30%), central obesity (assessed by an increased waist-to-height ratio) or visceral adiposity (as by mesenteric or epicardial fat) is present in >85% to 95% of patients with the disorder. Therefore, when compared with the comorbidity-driven coronary microvascular endothelial inflammation hypothesis, the adipokine hypothesis provides an explanatory framework with a stronger evidentiary support and applicable to a broader range of patients with HFpEF. Further work is needed to support these observations.
在过去的十年中,解释具有保留射血分数(HFpEF)的心力衰竭的主流范式假设多种合并症协同作用,引发全身炎症状态,导致冠状动脉微血管功能障碍,一氧化氮/环鸟苷单磷酸(cGMP)缺乏依赖性的titin异常,以及负荷依赖性的细胞炎症和心肌纤维化。相比之下,最近提出的脂肪因子假说提出了一种合并症——内脏脂肪——来解释全身性炎症、多种合并症和HFpEF的共存,并确定了一种特定的近因机制(即,来自功能失调脂肪的促炎信号分子的分泌)。内脏过度肥胖和脂肪因子失衡不仅可以产生HFpEF,而且可以直接导致高血压、胰岛素抵抗和2型糖尿病以及慢性肾脏疾病。内脏脂肪和促炎脂肪因子也可以解释冠状动脉微血管炎症假说无法解释的HFpEF特征(如心房颤动、骨骼肌和肺部异常、肾钠潴存和血浆容量扩张)。脂肪因子失衡还可引起微血管功能障碍和cGMP信号通路和titin磷酸化缺陷,并可独立于对微血管的影响而直接引起心脏肥大和纤维化。合并症驱动的微血管炎症假说并没有确定一种选择性靶向心脏的血源性分子介质,基于合并症聚类的现象图谱也没有产生可重复的分组。相比之下,仅在脂肪组织中选择性沉默特异性促炎脂肪因子会对心脏产生遥远的影响,从而调节心脏结构和HFpEF的进化。增强一氧化氮/cGMP信号或具有非特异性抗炎作用的药物的临床试验并未对临床HFpEF产生有利作用,而对HFpEF产生有益作用的药物(如胰高血糖素样肽1受体激动剂、钠-葡萄糖共转运蛋白2抑制剂)可使脂肪因子分泌谱正常化。最后,尽管60% - 70%的HFpEF患者存在冠状动脉微血管功能障碍(内皮依赖性功能障碍仅见于30%),但85% - 95%的HFpEF患者存在中心性肥胖(通过腰高比增加来评估)或内脏脂肪(如肠系膜或心外膜脂肪)。因此,与合并症驱动的冠状动脉微血管内皮炎症假说相比,脂肪因子假说提供了一个证据支持更强的解释框架,适用于更广泛的HFpEF患者。需要进一步的工作来支持这些观察结果。
{"title":"Evolutionary History of the Comorbidity-Driven Coronary Microvascular Endothelial Inflammation Hypothesis and Its Metamorphosis to the Adipokine Hypothesis of Heart Failure With a Preserved Ejection Fraction","authors":"Milton Packer MD","doi":"10.1016/j.jchf.2025.102822","DOIUrl":"10.1016/j.jchf.2025.102822","url":null,"abstract":"<div><div>For the past decade, the prevailing paradigm to explain heart failure with preserved ejection fraction (HFpEF) has assumed that multiple comorbidities act in concert to trigger a systemic inflammatory state that causes coronary microvascular dysfunction, nitric oxide/cyclic guanosine monophosphate (cGMP) deficiency–dependent titin abnormalities, and load-dependent cellular inflammation and fibrosis of the myocardium. By contrast, the recently proposed adipokine hypothesis elevates one comorbidity—visceral adiposity—to explain the coexistence of systemic inflammation, multiple comorbidities, and HFpEF and identifies a specific proximal causal mechanism (ie, the secretion of a proinflammatory suite of signaling molecules from dysfunctional fat). Excess visceral adiposity and adipokine imbalances have been shown not only to produce HFpEF experimentally but also to directly cause hypertension, insulin resistance and type 2 diabetes, and chronic kidney disease. Visceral adiposity and proinflammatory adipokines can also explain features of HFpEF that are not addressed by the coronary microvascular inflammation hypothesis (eg, atrial fibrillation, skeletal muscle and pulmonary abnormalities, and renal sodium retention and plasma volume expansion). Adipokine imbalances can also cause microvascular dysfunction and defects in cGMP signaling and in titin phosphorylation, and they can directly cause cardiac hypertrophy and fibrosis independently of an effect on the microvasculature. The comorbidity-driven microvascular inflammation hypothesis did not identify a blood-borne molecular mediator that selectively targets the heart, and phenomapping based on the clustering of comorbidities has not yielded reproducible groupings. By contrast, selective silencing of specific proinflammatory adipokines only in adipose tissue causes distant effects on the heart to modulate cardiac structure and the evolution of HFpEF. Clinical trials of drugs that enhance nitric oxide/cGMP signaling or have nonspecific anti-inflammatory effects have not produced favorable effects in clinical HFpEF whereas drugs that produce benefits in HFpEF (eg, glucagon-like peptide 1 receptor agonists, sodium-glucose cotransporter 2 inhibitors) act to normalize the adipokine secretory profile. Finally, whereas coronary microvascular dysfunction is present in 60% to 70% of patients with HFpEF (with endothelium-dependent dysfunction being seen in only 30%), central obesity (assessed by an increased waist-to-height ratio) or visceral adiposity (as by mesenteric or epicardial fat) is present in &gt;85% to 95% of patients with the disorder. Therefore, when compared with the comorbidity-driven coronary microvascular endothelial inflammation hypothesis, the adipokine hypothesis provides an explanatory framework with a stronger evidentiary support and applicable to a broader range of patients with HFpEF. Further work is needed to support these observations.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 2","pages":"Article 102822"},"PeriodicalIF":11.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145563975","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
Surveillance Patterns for Allograft Vasculopathy in Heart Transplant Recipients in PET Myocardial Perfusion Imaging Performing Centers in the United States 美国PET心肌灌注显像中心心脏移植受者同种异体移植血管病变的监测模式
IF 11.8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-01 DOI: 10.1016/j.jchf.2025.102718
Attila Feher MD, PhD , Maria Alwan MD , Catherine X. Wright MD , Kevin J. Clerkin MD, MSc , Andrew J. Einstein MD, PhD , Edward J. Miller MD, PhD , Mouaz H. Al-Mallah MD, MSc
{"title":"Surveillance Patterns for Allograft Vasculopathy in Heart Transplant Recipients in PET Myocardial Perfusion Imaging Performing Centers in the United States","authors":"Attila Feher MD, PhD ,&nbsp;Maria Alwan MD ,&nbsp;Catherine X. Wright MD ,&nbsp;Kevin J. Clerkin MD, MSc ,&nbsp;Andrew J. Einstein MD, PhD ,&nbsp;Edward J. Miller MD, PhD ,&nbsp;Mouaz H. Al-Mallah MD, MSc","doi":"10.1016/j.jchf.2025.102718","DOIUrl":"10.1016/j.jchf.2025.102718","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 2","pages":"Article 102718"},"PeriodicalIF":11.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145300907","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
LV Structure and Function in HFrEF With and Without Peak-Flow-Triggered Adaptive Servo-Ventilation-Treated Sleep-Disordered Breathing 有和没有峰值流量触发的自适应伺服通气治疗睡眠呼吸障碍的HFrEF左室结构和功能。
IF 11.8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-01 DOI: 10.1016/j.jchf.2025.02.016
Shoichiro Yatsu MD, PhD , Anna Woo MD , Christian M. Horvath MD , Tomoyuki Tobushi MD , Alexander G. Logan MD , John S. Floras MD, DPhil , George Tomlinson PhD , T. Douglas Bradley MD

Background

Sleep-disordered breathing (SDB), comprising obstructive sleep apnea (OSA) and central sleep apnea (CSA), could promote left ventricular (LV) remodeling and systolic dysfunction.

Objectives

The authors tested the hypothesis, in the ADVENT-HF (Adaptive Servo-ventilation for Sleep-disordered Breathing in Patients with Heart Failure with Reduced Ejection Fraction) trial, that SDB is associated with reversible impairment of LV structure and function.

Methods

Participants underwent echocardiography (ejection fraction ≤45%) and polysomnography. They were classified as no-SDB (apnea-hypopnea index [AHI] <15/h); OSA (AHI ≥15/h with ≥50% of events obstructive), or CSA (AHI ≥15 with >50% of events central). Those with SDB were randomized to a control group or to peak-flow-triggered adaptive servo-ventilation (ASVPF) to treat SDB and, in them, echocardiography was repeated 6 months later.

Results

Subjects with OSA (n = 543) had similar LV structure and function to those without SDB (n = 56). Subjects with CSA (n = 201) had greater LV mass index and lower LV ejection fraction than the other groups. LV volumes were higher in the CSA than in the OSA group (P < 0.05 for all). ASVPF abolished SDB, but had no significant effect, whether evaluated by allocation or adherence, 6 months post-randomization on LV structure or function for the entire cohort (n = 549), or either subgroup.

Conclusions

Among patients with heart failure with reduced ejection fraction, those with OSA had similar LV structure and function to those without SDB. Patients with CSA had greater LV remodeling and systolic dysfunction than those with OSA or without SDB. Six months of SDB suppression of OSA and CSA by ASVPF had no impact on LV structure or function. (Adaptive Servo-ventilation for Sleep-disordered Breathing in Patients with Heart Failure with Reduced Ejection Fraction [ADVENT-HF])
背景:睡眠呼吸障碍(SDB)包括阻塞性睡眠呼吸暂停(OSA)和中枢性睡眠呼吸暂停(CSA),可促进左心室(LV)重构和收缩功能障碍。目的:作者在adap - hf(自适应伺服通气治疗心力衰竭伴射血分数降低患者睡眠呼吸障碍)试验中验证了SDB与左室结构和功能可逆性损害相关的假设。方法:接受超声心动图(射血分数≤45%)和多导睡眠图检查。他们被分类为无sdb(呼吸暂停-低通气指数[AHI]占事件中心的50%)。SDB患者随机分为对照组或峰流量触发自适应伺服通气组(ASVPF)治疗SDB, 6个月后复查超声心动图。结果:OSA患者(n = 543)与非SDB患者(n = 56)的左室结构和功能相似。CSA组(n = 201)左室质量指数高于其他组,左室射血分数低于其他组。CSA组左室容积高于OSA组(P < 0.05)。ASVPF消除了SDB,但无论是通过分配还是依从性来评估,随机化后6个月对整个队列(n = 549)或两个亚组的LV结构或功能都没有显著影响。结论:在心力衰竭伴射血分数降低的患者中,OSA患者的左室结构和功能与无SDB患者相似。CSA患者的左室重构和收缩功能障碍高于OSA患者或无SDB患者。ASVPF对OSA和CSA的SDB抑制6个月对左室结构和功能没有影响。自适应伺服通气治疗心力衰竭伴射血分数降低患者睡眠呼吸障碍[ad - hf]。
{"title":"LV Structure and Function in HFrEF With and Without Peak-Flow-Triggered Adaptive Servo-Ventilation-Treated Sleep-Disordered Breathing","authors":"Shoichiro Yatsu MD, PhD ,&nbsp;Anna Woo MD ,&nbsp;Christian M. Horvath MD ,&nbsp;Tomoyuki Tobushi MD ,&nbsp;Alexander G. Logan MD ,&nbsp;John S. Floras MD, DPhil ,&nbsp;George Tomlinson PhD ,&nbsp;T. Douglas Bradley MD","doi":"10.1016/j.jchf.2025.02.016","DOIUrl":"10.1016/j.jchf.2025.02.016","url":null,"abstract":"<div><h3>Background</h3><div>Sleep-disordered breathing (SDB), comprising obstructive sleep apnea (OSA) and central sleep apnea<span> (CSA), could promote left ventricular (LV) remodeling and systolic dysfunction.</span></div></div><div><h3>Objectives</h3><div>The authors tested the hypothesis, in the ADVENT-HF (Adaptive Servo-ventilation for Sleep-disordered Breathing in Patients with Heart Failure with Reduced Ejection Fraction) trial, that SDB is associated with reversible impairment of LV structure and function.</div></div><div><h3>Methods</h3><div><span><span>Participants underwent echocardiography (ejection fraction ≤45%) and </span>polysomnography. They were classified as no-SDB (apnea-hypopnea index [AHI] &lt;15/h); OSA (AHI ≥15/h with ≥50% of events obstructive), or CSA (AHI ≥15 with &gt;50% of events central). Those with SDB were randomized to a control group or to peak-flow-triggered adaptive servo-ventilation (ASV</span><sub>PF</sub>) to treat SDB and, in them, echocardiography was repeated 6 months later.</div></div><div><h3>Results</h3><div><span>Subjects with OSA (n = 543) had similar LV structure and function to those without SDB (n = 56). Subjects with CSA (n = 201) had greater LV mass index and lower LV ejection fraction than the other groups. LV volumes were higher in the CSA than in the OSA group (</span><em>P &lt;</em> 0.05 for all). ASV<sub>PF</sub> abolished SDB, but had no significant effect, whether evaluated by allocation or adherence, 6 months post-randomization on LV structure or function for the entire cohort (n = 549), or either subgroup.</div></div><div><h3>Conclusions</h3><div><span>Among patients with heart failure with reduced ejection fraction, those with OSA had similar LV structure and function to those without SDB. Patients with CSA had greater LV remodeling and systolic dysfunction than those with OSA or without SDB. Six months of SDB suppression of OSA and CSA by ASV</span><sub>PF</sub><span> had no impact on LV structure or function. (Adaptive Servo-ventilation for Sleep-disordered Breathing in Patients with Heart Failure with Reduced Ejection Fraction [ADVENT-HF])</span></div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 2","pages":"Article 102434"},"PeriodicalIF":11.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143996640","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
Efficacy and Safety of Omecamtiv Mecarbil in Heart Failure With Reduced Ejection Fraction According to Age 欧美康替对年龄分射血分数降低的心力衰竭的疗效和安全性:GALACTIC-HF试验
IF 11.8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-01 DOI: 10.1016/j.jchf.2025.102703
Henri Lu MD , Brian L. Claggett PhD , G. Michael Felker MD, MHS , John J.V. McMurray MD , John R. Teerlink MD , Riccardo M. Inciardi MD, PhD , Marco Metra MD , Stephen B. Heitner MD , Rafael Diaz MD , Fady Malik MD, PhD , Muthiah Vaduganathan MD, MPH , Scott D. Solomon MD
<div><h3>Background</h3><div>Older age is associated with a high prevalence of comorbidities and worse cardiovascular (CV) outcomes in patients with heart failure (HF) with reduced ejection fraction. Omecamtiv mecarbil, a selective cardiac myosin activator, exerts minimal effects on blood pressure and heart rate and has limited extracardiac activity, and thus it may be well-tolerated in older individuals. The safety profile and clinical benefits of omecamtiv mecarbil across the age spectrum remain uncertain.</div></div><div><h3>Objectives</h3><div>This study aims to assess CV outcomes, treatment response, and tolerability to omecamtiv mecarbil according to age in patients enrolled in the GALACTIC-HF (Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure) trial.</div></div><div><h3>Methods</h3><div>GALACTIC-HF was a randomized, global, double-blind clinical trial testing omecamtiv mecarbil vs placebo in patients with symptomatic HF with reduced ejection fraction. Key eligibility criteria included an age between 18-85 years, elevated natriuretic peptides, and a left ventricular ejection fraction (LVEF) ≤35%. We examined the treatment effect of omecamtiv mecarbil vs placebo for the primary endpoint of CV death or first HF event (hospitalization or urgent visit for HF) in both the overall population and the severe HF subgroup (LVEF ≤30%, NYHA functional class III/IV, HF hospitalization within 6 months), as well as safety outcomes according to prespecified age groups (<65 or ≥65 years).</div></div><div><h3>Results</h3><div>A total of 8,232 patients (age 64.5 ± 11.4 years, 54.5% ≥65 years, 21% female) were included. The rate of the primary outcome was 21.4 per 100 patient years (py) in those <65 years of age and 28.8 per 100 py in those ≥65 years of age. The treatment effect of omecamtiv mecarbil for the primary outcome (HR: 0.92 [95% CI: 0.86-0.99]; <em>P =</em> 0.03) was consistent in age groups (<em>P</em><sub>interaction</sub> = 0.76) and irrespective of age as a continuous variable (<em>P</em><sub>interaction</sub> = 0.19, after adjusting for treatment interactions with known modifiers of the effects of omecamtiv mecarbil: LVEF and baseline atrial fibrillation status). In patients with severe HF, omecamtiv mecarbil significantly reduced the risk of the primary outcome in both patients <65 years of age (HR: 0.77 [95% CI: 0.64-0.92]) and those ≥65 years of age (HR: 0.83 [95% CI: 0.71-0.97]; <em>P</em><sub>interaction</sub> = 0.47). The safety profile of omecamtiv mecarbil was consistent irrespective of age (<em>P</em><sub>interaction</sub> > 0.05 for all).</div></div><div><h3>Conclusions</h3><div>In GALACTIC-HF, older individuals were well-represented and faced higher risks of CV events. Treatment with omecamtiv mecarbil was safe irrespective of age and reduced the risk of CV death or first HF event across the age spectrum, especially in those with severe HF. (Global Approach to Lowering Ad
背景:年龄越大,伴射血分数降低的心力衰竭(HF)患者的合并症患病率越高,心血管(CV)预后越差。Omecamtiv mecarbil是一种选择性心肌肌球蛋白激活剂,对血压和心率的影响很小,心外活动有限,因此在老年人中耐受性良好。在不同年龄的人群中,奥米康维的安全性和临床益处仍不确定。目的:本研究旨在评估参加GALACTIC-HF(通过改善心力衰竭收缩性降低不良心脏结局的全球方法)试验的患者的CV结局、治疗反应和对欧美康替的耐受性。方法:sgalactic -HF是一项随机、全球、双盲临床试验,测试奥美康替与安慰剂对伴有射血分数降低的症状性HF患者的疗效。主要入选标准包括年龄在18-85岁之间,利钠肽升高,左心室射血分数(LVEF)≤35%。我们在总体人群和严重HF亚组(LVEF≤30%,NYHA功能等级III/IV, HF住院6个月内)中检测了奥美康替与安慰剂在CV死亡或首次HF事件(因HF住院或紧急就诊)的主要终点的治疗效果,以及根据预先指定年龄组的安全性结局(所有0.05)。结论:在GALACTIC-HF中,年龄较大的个体具有代表性,并且面临更高的心血管事件风险。无论年龄大小,用奥美康替治疗都是安全的,并降低了CV死亡或首次HF事件的风险,特别是在严重HF患者中。通过改善心力衰竭患者的收缩力来降低不良心脏结局的全球方法[GALACTIC-HF]; NCT02929329.)
{"title":"Efficacy and Safety of Omecamtiv Mecarbil in Heart Failure With Reduced Ejection Fraction According to Age","authors":"Henri Lu MD ,&nbsp;Brian L. Claggett PhD ,&nbsp;G. Michael Felker MD, MHS ,&nbsp;John J.V. McMurray MD ,&nbsp;John R. Teerlink MD ,&nbsp;Riccardo M. Inciardi MD, PhD ,&nbsp;Marco Metra MD ,&nbsp;Stephen B. Heitner MD ,&nbsp;Rafael Diaz MD ,&nbsp;Fady Malik MD, PhD ,&nbsp;Muthiah Vaduganathan MD, MPH ,&nbsp;Scott D. Solomon MD","doi":"10.1016/j.jchf.2025.102703","DOIUrl":"10.1016/j.jchf.2025.102703","url":null,"abstract":"&lt;div&gt;&lt;h3&gt;Background&lt;/h3&gt;&lt;div&gt;Older age is associated with a high prevalence of comorbidities and worse cardiovascular (CV) outcomes in patients with heart failure (HF) with reduced ejection fraction. Omecamtiv mecarbil, a selective cardiac myosin activator, exerts minimal effects on blood pressure and heart rate and has limited extracardiac activity, and thus it may be well-tolerated in older individuals. The safety profile and clinical benefits of omecamtiv mecarbil across the age spectrum remain uncertain.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Objectives&lt;/h3&gt;&lt;div&gt;This study aims to assess CV outcomes, treatment response, and tolerability to omecamtiv mecarbil according to age in patients enrolled in the GALACTIC-HF (Global Approach to Lowering Adverse Cardiac Outcomes Through Improving Contractility in Heart Failure) trial.&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Methods&lt;/h3&gt;&lt;div&gt;GALACTIC-HF was a randomized, global, double-blind clinical trial testing omecamtiv mecarbil vs placebo in patients with symptomatic HF with reduced ejection fraction. Key eligibility criteria included an age between 18-85 years, elevated natriuretic peptides, and a left ventricular ejection fraction (LVEF) ≤35%. We examined the treatment effect of omecamtiv mecarbil vs placebo for the primary endpoint of CV death or first HF event (hospitalization or urgent visit for HF) in both the overall population and the severe HF subgroup (LVEF ≤30%, NYHA functional class III/IV, HF hospitalization within 6 months), as well as safety outcomes according to prespecified age groups (&lt;65 or ≥65 years).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Results&lt;/h3&gt;&lt;div&gt;A total of 8,232 patients (age 64.5 ± 11.4 years, 54.5% ≥65 years, 21% female) were included. The rate of the primary outcome was 21.4 per 100 patient years (py) in those &lt;65 years of age and 28.8 per 100 py in those ≥65 years of age. The treatment effect of omecamtiv mecarbil for the primary outcome (HR: 0.92 [95% CI: 0.86-0.99]; &lt;em&gt;P =&lt;/em&gt; 0.03) was consistent in age groups (&lt;em&gt;P&lt;/em&gt;&lt;sub&gt;interaction&lt;/sub&gt; = 0.76) and irrespective of age as a continuous variable (&lt;em&gt;P&lt;/em&gt;&lt;sub&gt;interaction&lt;/sub&gt; = 0.19, after adjusting for treatment interactions with known modifiers of the effects of omecamtiv mecarbil: LVEF and baseline atrial fibrillation status). In patients with severe HF, omecamtiv mecarbil significantly reduced the risk of the primary outcome in both patients &lt;65 years of age (HR: 0.77 [95% CI: 0.64-0.92]) and those ≥65 years of age (HR: 0.83 [95% CI: 0.71-0.97]; &lt;em&gt;P&lt;/em&gt;&lt;sub&gt;interaction&lt;/sub&gt; = 0.47). The safety profile of omecamtiv mecarbil was consistent irrespective of age (&lt;em&gt;P&lt;/em&gt;&lt;sub&gt;interaction&lt;/sub&gt; &gt; 0.05 for all).&lt;/div&gt;&lt;/div&gt;&lt;div&gt;&lt;h3&gt;Conclusions&lt;/h3&gt;&lt;div&gt;In GALACTIC-HF, older individuals were well-represented and faced higher risks of CV events. Treatment with omecamtiv mecarbil was safe irrespective of age and reduced the risk of CV death or first HF event across the age spectrum, especially in those with severe HF. (Global Approach to Lowering Ad","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 2","pages":"Article 102703"},"PeriodicalIF":11.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338757","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
Michael R. Bristow, MD, PhD 迈克尔·r·布里斯托,医学博士
IF 11.8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-01 DOI: 10.1016/j.jchf.2026.102936
Douglas L. Mann MD , Arthur M. Feldman MD, PhD , Mona Fiuzat PharmD , Chrisopher M. O’Connor MD , J. David Port PhD
{"title":"Michael R. Bristow, MD, PhD","authors":"Douglas L. Mann MD ,&nbsp;Arthur M. Feldman MD, PhD ,&nbsp;Mona Fiuzat PharmD ,&nbsp;Chrisopher M. O’Connor MD ,&nbsp;J. David Port PhD","doi":"10.1016/j.jchf.2026.102936","DOIUrl":"10.1016/j.jchf.2026.102936","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 2","pages":"Article 102936"},"PeriodicalIF":11.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098684","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
The AHFTC Fellowship Match in an Era of Declining Interest 在兴趣下降的时代AHFTC奖学金匹配:哪些项目填补和为什么。
IF 11.8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-01 DOI: 10.1016/j.jchf.2025.102680
Eiran Z. Gorodeski MD, MPH , Shashank Shekhar MD , Chantal ElAmm MD , Michelle M. Kittleson MD , Robert A. Montgomery MD
{"title":"The AHFTC Fellowship Match in an Era of Declining Interest","authors":"Eiran Z. Gorodeski MD, MPH ,&nbsp;Shashank Shekhar MD ,&nbsp;Chantal ElAmm MD ,&nbsp;Michelle M. Kittleson MD ,&nbsp;Robert A. Montgomery MD","doi":"10.1016/j.jchf.2025.102680","DOIUrl":"10.1016/j.jchf.2025.102680","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 2","pages":"Article 102680"},"PeriodicalIF":11.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145140319","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
Beyond the IVC 超越IVC
IF 11.8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-01 DOI: 10.1016/j.jchf.2025.102832
Abhilash Koratala MD , Amir Kazory MD
{"title":"Beyond the IVC","authors":"Abhilash Koratala MD ,&nbsp;Amir Kazory MD","doi":"10.1016/j.jchf.2025.102832","DOIUrl":"10.1016/j.jchf.2025.102832","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 2","pages":"Article 102832"},"PeriodicalIF":11.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098439","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
Effects of GLP-1 RA Initiation in Patients With HFrEF and Implantable Cardiac Devices Divided for BMI Values GLP-1对HFrEF和植入式心脏装置患者RA起始的影响
IF 11.8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-01 DOI: 10.1016/j.jchf.2025.102839
Celestino Sardu MD, MSc, PhD , Ferdinando Carlo Sasso MD , Raffaele Marfella MD, PhD
{"title":"Effects of GLP-1 RA Initiation in Patients With HFrEF and Implantable Cardiac Devices Divided for BMI Values","authors":"Celestino Sardu MD, MSc, PhD ,&nbsp;Ferdinando Carlo Sasso MD ,&nbsp;Raffaele Marfella MD, PhD","doi":"10.1016/j.jchf.2025.102839","DOIUrl":"10.1016/j.jchf.2025.102839","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 2","pages":"Article 102839"},"PeriodicalIF":11.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098444","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
CMR-First in Newly Diagnosed HFrEF cmr首先用于新诊断的HFrEF
IF 11.8 1区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2026-02-01 DOI: 10.1016/j.jchf.2025.102827
Louis-Marie Desroche MD , Arthur Darmon MD , Charles Burdet MD, PhD , Guillaume Jondeau MD, PhD
{"title":"CMR-First in Newly Diagnosed HFrEF","authors":"Louis-Marie Desroche MD ,&nbsp;Arthur Darmon MD ,&nbsp;Charles Burdet MD, PhD ,&nbsp;Guillaume Jondeau MD, PhD","doi":"10.1016/j.jchf.2025.102827","DOIUrl":"10.1016/j.jchf.2025.102827","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"14 2","pages":"Article 102827"},"PeriodicalIF":11.8,"publicationDate":"2026-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146098685","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
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.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1