Pub Date : 2024-12-01DOI: 10.1016/j.jchf.2024.07.013
Samuel F. Sears PhD , Elizabeth Jordan BA , JoAnn Lindenfeld MD , William T. Abraham MD , Fred A. Weaver MD , Faiez Zannad MD , Tyson Rogers MS , Fares Yared MD , Seth J. Wilks PhD , Michael R. Zile MD
{"title":"Long-Term Quality of Life Response Observed in the Baroreflex Activation Therapy for Heart Failure Trial","authors":"Samuel F. Sears PhD , Elizabeth Jordan BA , JoAnn Lindenfeld MD , William T. Abraham MD , Fred A. Weaver MD , Faiez Zannad MD , Tyson Rogers MS , Fares Yared MD , Seth J. Wilks PhD , Michael R. Zile MD","doi":"10.1016/j.jchf.2024.07.013","DOIUrl":"10.1016/j.jchf.2024.07.013","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 12","pages":"Pages 2110-2112"},"PeriodicalIF":10.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142107494","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 : 2024-12-01DOI: 10.1016/j.jchf.2024.08.007
Joycie Chang BA , Andrew P. Ambrosy MD , Orly Vardeny PharmD, MS , Harriette G.C. Van Spall MD, MPH , Robert J. Mentz MD , Andrew J. Sauer MD
The pathophysiology of heart failure (HF) is related to the overactivation of the mineralocorticoid receptor, leading to fluid retention and adverse myocardial remodeling. Although mineralocorticoid receptor antagonists (MRAs) are recommended for the treatment of heart failure with reduced ejection fraction (HFrEF), they remain underused due to adverse effects such as hyperkalemia; and their efficacy is controversial in heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). Recent trials in people with diabetes and kidney disease have supported the use of nonsteroidal MRAs in reducing HF-related morbidity and mortality and have fewer side effects than their steroidal counterparts. The efficacy and safety of nonsteroidal MRAs have not been tested in HF and are currently being evaluated in additional clinical trials. This review comprehensively examines the current data regarding MRAs for HF and the future direction of nonsteroidal MRA research while exploring the causes of MRA underutilization.
{"title":"Mineralocorticoid Antagonism in Heart Failure","authors":"Joycie Chang BA , Andrew P. Ambrosy MD , Orly Vardeny PharmD, MS , Harriette G.C. Van Spall MD, MPH , Robert J. Mentz MD , Andrew J. Sauer MD","doi":"10.1016/j.jchf.2024.08.007","DOIUrl":"10.1016/j.jchf.2024.08.007","url":null,"abstract":"<div><div>The pathophysiology of heart failure (HF) is related to the overactivation of the mineralocorticoid receptor, leading to fluid retention and adverse myocardial remodeling. Although mineralocorticoid receptor antagonists (MRAs) are recommended for the treatment of heart failure with reduced ejection fraction (HFrEF), they remain underused due to adverse effects such as hyperkalemia; and their efficacy is controversial in heart failure with mildly reduced ejection fraction (HFmrEF) and heart failure with preserved ejection fraction (HFpEF). Recent trials in people with diabetes and kidney disease have supported the use of nonsteroidal MRAs in reducing HF-related morbidity and mortality and have fewer side effects than their steroidal counterparts. The efficacy and safety of nonsteroidal MRAs have not been tested in HF and are currently being evaluated in additional clinical trials. This review comprehensively examines the current data regarding MRAs for HF and the future direction of nonsteroidal MRA research while exploring the causes of MRA underutilization.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 12","pages":"Pages 1979-1993"},"PeriodicalIF":10.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145666","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 : 2024-12-01DOI: 10.1016/j.jchf.2024.07.014
Kannu Bansal MD , Mohak Gupta MD , Mohil Garg MD , Neel Patel MD , Alexander G. Truesdell MD , Mir Babar Basir DO , Syed Tanveer Rab MD , Tariq Ahmad MD, MPH , Navin K. Kapur MD , Nihar Desai MD, MPH , Saraschandra Vallabhajosyula MD, MSc
Background
There are limited data on volume-outcome relationships in acute myocardial infarction (AMI) with cardiogenic shock (CS).
Objectives
In this study, the authors sought to evaluate the association between hospital percutaneous coronary intervention (PCI) volume and readmission after AMI-CS.
Methods
Adult AMI-CS patients were identified from the Nationwide Readmissions Database for 2016-2019 and were categorized into hospital quartiles (Q1 lowest volume to Q4 highest) based on annual inpatient PCI volume. Outcomes of interest included 30-day all-cause, cardiac, noncardiac, and heart-failure (HF) readmissions.
Results
There were 49,558 AMI-CS admissions at 3,954 PCI-performing hospitals. Median annual PCI volume was 174 (Q1-Q3: 70-316). Patients treated at Q1 hospitals were on average older, female, and with higher comorbidity burden. Patients at Q4 hospitals had higher rates of noncardiac organ dysfunction, complications, and use of cardiac support therapies. Overall, 30-day readmission rate was 18.5% (n = 9,179), of which cardiac, noncardiac, and HF readmissions constituted 56.2%, 43.8%, and 25.8%, respectively. From Q1 to Q4, there were no differences in 30-day all-cause (17.6%, 18.4%, 18.2%, 18.7%; P = 0.55), cardiac (10.9%, 11.0%, 10.6%, 10.2%; P = 0.29), and HF (5.0%, 4.8%, 4.8%, 4.8%; P = 0.99) readmissions. Noncardiac readmissions were noted more commonly in higher quartiles (6.7%, 7.4%, 7.7%, 8.5%; P = 0.001) but was not significant after multivariable adjustment. No relationship was noted between hospital PCI volume as a continuous variable and readmissions.
Conclusions
In AMI-CS, there was no association between hospital annual PCI volume and 30-day readmissions despite higher acuity in the higher volume PCI centers suggestive of better care pathways for CS at higher volume centers.
{"title":"Impact of Inpatient Percutaneous Coronary Intervention Volume on 30-Day Readmissions After Acute Myocardial Infarction-Cardiogenic Shock","authors":"Kannu Bansal MD , Mohak Gupta MD , Mohil Garg MD , Neel Patel MD , Alexander G. Truesdell MD , Mir Babar Basir DO , Syed Tanveer Rab MD , Tariq Ahmad MD, MPH , Navin K. Kapur MD , Nihar Desai MD, MPH , Saraschandra Vallabhajosyula MD, MSc","doi":"10.1016/j.jchf.2024.07.014","DOIUrl":"10.1016/j.jchf.2024.07.014","url":null,"abstract":"<div><h3>Background</h3><div>There are limited data on volume-outcome relationships in acute myocardial infarction (AMI) with cardiogenic shock (CS).</div></div><div><h3>Objectives</h3><div>In this study, the authors sought to evaluate the association between hospital percutaneous coronary intervention (PCI) volume and readmission after AMI-CS.</div></div><div><h3>Methods</h3><div>Adult AMI-CS patients were identified from the Nationwide Readmissions Database for 2016-2019 and were categorized into hospital quartiles (Q1 lowest volume to Q4 highest) based on annual inpatient PCI volume. Outcomes of interest included 30-day all-cause, cardiac, noncardiac, and heart-failure (HF) readmissions.</div></div><div><h3>Results</h3><div>There were 49,558 AMI-CS admissions at 3,954 PCI-performing hospitals. Median annual PCI volume was 174 (Q1-Q3: 70-316). Patients treated at Q1 hospitals were on average older, female, and with higher comorbidity burden. Patients at Q4 hospitals had higher rates of noncardiac organ dysfunction, complications, and use of cardiac support therapies. Overall, 30-day readmission rate was 18.5% (n = 9,179), of which cardiac, noncardiac, and HF readmissions constituted 56.2%, 43.8%, and 25.8%, respectively. From Q1 to Q4, there were no differences in 30-day all-cause (17.6%, 18.4%, 18.2%, 18.7%; <em>P =</em> 0.55), cardiac (10.9%, 11.0%, 10.6%, 10.2%; <em>P =</em> 0.29), and HF (5.0%, 4.8%, 4.8%, 4.8%; <em>P =</em> 0.99) readmissions. Noncardiac readmissions were noted more commonly in higher quartiles (6.7%, 7.4%, 7.7%, 8.5%; <em>P =</em> 0.001) but was not significant after multivariable adjustment. No relationship was noted between hospital PCI volume as a continuous variable and readmissions.</div></div><div><h3>Conclusions</h3><div>In AMI-CS, there was no association between hospital annual PCI volume and 30-day readmissions despite higher acuity in the higher volume PCI centers suggestive of better care pathways for CS at higher volume centers.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 12","pages":"Pages 2087-2097"},"PeriodicalIF":10.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142145665","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 : 2024-12-01DOI: 10.1016/j.jchf.2024.07.020
João Pedro Ferreira MD, PhD
{"title":"Patiromer and MRA Doses in Patients With Current or Past Hyperkalemia","authors":"João Pedro Ferreira MD, PhD","doi":"10.1016/j.jchf.2024.07.020","DOIUrl":"10.1016/j.jchf.2024.07.020","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 12","pages":"Pages 2038-2040"},"PeriodicalIF":10.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142346902","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 : 2024-12-01DOI: 10.1016/j.jchf.2024.07.021
John W. Ostrominski MD , Mats C. Højbjerg Lassen MD , Brian L. Claggett PhD , Akshay S. Desai MD , Marc A. Pfeffer MD, PhD , Bertram Pitt MD , Carolyn S.P. Lam MBBS, PhD , John J.V. McMurray MD , Scott D. Solomon MD , Muthiah Vaduganathan MD, MPH
{"title":"Undiagnosed Diabetes in Heart Failure With Preserved Ejection Fraction","authors":"John W. Ostrominski MD , Mats C. Højbjerg Lassen MD , Brian L. Claggett PhD , Akshay S. Desai MD , Marc A. Pfeffer MD, PhD , Bertram Pitt MD , Carolyn S.P. Lam MBBS, PhD , John J.V. McMurray MD , Scott D. Solomon MD , Muthiah Vaduganathan MD, MPH","doi":"10.1016/j.jchf.2024.07.021","DOIUrl":"10.1016/j.jchf.2024.07.021","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 12","pages":"Pages 2116-2119"},"PeriodicalIF":10.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142465738","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 : 2024-12-01DOI: 10.1016/j.jchf.2024.08.020
Wolfram Doehner MD, PhD , Stefan D. Anker MD, PhD , Javed Butler MD, MPH, MBA , Faiez Zannad MD, PhD , Gerasimos Filippatos MD , Andrew J.S. Coats DM , João Pedro Ferreira MD, PhD , Ingrid Henrichmoeller MD , Martina Brueckmann MD , Elke Schueler Dipl Math , Stuart J. Pocock PhD , James L. Januzzi MD , Milton Packer MD
Background
Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve outcome in patients with heart failure (HF) and reduce serum uric acid (SUA). The relevance of this metabolic effect in patients with heart failure with preserved ejection fraction (HFpEF) is unclear.
Objectives
The authors investigated the effect of empagliflozin on SUA levels in relation to the therapeutic efficacy in patients with HFpEF.
Methods
This post hoc analysis of the EMPEROR-Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction; NCT03057951) trial assessed the clinical effect of SUA reduction in relation to the outcome endpoints of the trial (composite primary outcome of cardiovascular mortality or hospitalization for HF, its individual components, and all-cause mortality in patients with HFpEF).
Results
Hyperuricemia (SUA >5.7 mg/dL for women, >7.0 mg/dL for men) was prevalent in 49% of patients. Elevated SUA (highest tertile SUA 8.8 ± 1.4 g/dL) was associated with advanced HF severity and with higher risk of adverse outcome (primary endpoint HR: 1.23 [95% CI: 0.98-1.53]; P = 0.07; HF hospitalization HR: 1.42 [95% CI: 1.08-1.86]; P = 0.01). SUA was reduced early (after 4 weeks vs placebo −0.99 ± 0.03 mg/dL; P < 0.0001) and throughout follow-up, with reduction in all prespecified subgroups. Empagliflozin reduced clinical events of hyperuricemia (acute gout, gouty arthritis, or initiation of antigout therapy) by 38% (HR: 0.62 [95% CI: 0.51-0.76]; P < 0.0001). The treatment benefit on the primary endpoint was not influenced by baseline SUA (HR: 0.79 [95% CI: 0.69-0.90]; P = 0.0004). The change in SUA was an independent correlate of the treatment benefit on the primary endpoint (P = 0.07).
Conclusions
Hyperuricemia is a common complication in HFpEF and is related to advanced disease severity and adverse outcome. Empagliflozin induced a rapid and sustained reduction of SUA levels and of clinical events related to hyperuricemia.
背景：钠-葡萄糖共转运体 2（SGLT2）抑制剂可改善心力衰竭（HF）患者的预后并降低血清尿酸（SUA）。这种代谢效应与射血分数保留型心力衰竭（HFpEF）患者的相关性尚不清楚：作者研究了 Empagliflozin 对 SUA 水平的影响与 HFpEF 患者疗效的关系：这项对EMPEROR-Preserved（EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction; NCT03057951）试验的事后分析评估了降低SUA与试验结果终点（HFpEF患者的心血管死亡率或HF住院治疗的复合主要结果、其单个组成部分以及全因死亡率）的关系的临床效果：49%的患者患有高尿酸血症（女性 SUA >5.7 mg/dL，男性 >7.0 mg/dL）。SUA升高（SUA最高三分位数为8.8 ± 1.4 g/dL）与晚期心房颤动严重程度和不良预后风险较高有关（主要终点HR：1.23 [95% CI：0.98-1.53]；P = 0.07；心房颤动住院HR：1.42 [95% CI：1.08-1.86]；P = 0.01）。SUA在早期（4周后与安慰剂相比-0.99 ± 0.03 mg/dL；P < 0.0001）和整个随访期间均有所降低，所有预设亚组的SUA均有所降低。恩格列净可将高尿酸血症临床事件（急性痛风、痛风性关节炎或开始抗痛风治疗）减少38%（HR：0.62 [95% CI：0.51-0.76]；P < 0.0001）。主要终点的治疗获益不受基线 SUA 的影响（HR：0.79 [95% CI：0.69-0.90]；P = 0.0004）。SUA的变化是主要终点治疗获益的独立相关因素（P = 0.07）：结论：高尿酸血症是高频血友病的常见并发症，与晚期疾病严重程度和不良预后有关。Empagliflozin能快速、持续地降低SUA水平，减少与高尿酸血症相关的临床事件。
{"title":"Uric Acid and SGLT2 Inhibition With Empagliflozin in Heart Failure With Preserved Ejection Fraction","authors":"Wolfram Doehner MD, PhD , Stefan D. Anker MD, PhD , Javed Butler MD, MPH, MBA , Faiez Zannad MD, PhD , Gerasimos Filippatos MD , Andrew J.S. Coats DM , João Pedro Ferreira MD, PhD , Ingrid Henrichmoeller MD , Martina Brueckmann MD , Elke Schueler Dipl Math , Stuart J. Pocock PhD , James L. Januzzi MD , Milton Packer MD","doi":"10.1016/j.jchf.2024.08.020","DOIUrl":"10.1016/j.jchf.2024.08.020","url":null,"abstract":"<div><h3>Background</h3><div>Sodium-glucose cotransporter 2 (SGLT2) inhibitors improve outcome in patients with heart failure (HF) and reduce serum uric acid (SUA). The relevance of this metabolic effect in patients with heart failure with preserved ejection fraction (HFpEF) is unclear.</div></div><div><h3>Objectives</h3><div>The authors investigated the effect of empagliflozin on SUA levels in relation to the therapeutic efficacy in patients with HFpEF.</div></div><div><h3>Methods</h3><div>This post hoc analysis of the EMPEROR-Preserved (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction; <span><span>NCT03057951</span><svg><path></path></svg></span>) trial assessed the clinical effect of SUA reduction in relation to the outcome endpoints of the trial (composite primary outcome of cardiovascular mortality or hospitalization for HF, its individual components, and all-cause mortality in patients with HFpEF).</div></div><div><h3>Results</h3><div>Hyperuricemia (SUA >5.7 mg/dL for women, >7.0 mg/dL for men) was prevalent in 49% of patients. Elevated SUA (highest tertile SUA 8.8 ± 1.4 g/dL) was associated with advanced HF severity and with higher risk of adverse outcome (primary endpoint HR: 1.23 [95% CI: 0.98-1.53]; <em>P =</em> 0.07; HF hospitalization HR: 1.42 [95% CI: 1.08-1.86]; <em>P =</em> 0.01). SUA was reduced early (after 4 weeks vs placebo −0.99 ± 0.03 mg/dL; <em>P <</em> 0.0001) and throughout follow-up, with reduction in all prespecified subgroups. Empagliflozin reduced clinical events of hyperuricemia (acute gout, gouty arthritis, or initiation of antigout therapy) by 38% (HR: 0.62 [95% CI: 0.51-0.76]; <em>P <</em> 0.0001). The treatment benefit on the primary endpoint was not influenced by baseline SUA (HR: 0.79 [95% CI: 0.69-0.90]; <em>P =</em> 0.0004). The change in SUA was an independent correlate of the treatment benefit on the primary endpoint (<em>P =</em> 0.07).</div></div><div><h3>Conclusions</h3><div>Hyperuricemia is a common complication in HFpEF and is related to advanced disease severity and adverse outcome. Empagliflozin induced a rapid and sustained reduction of SUA levels and of clinical events related to hyperuricemia.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 12","pages":"Pages 2057-2070"},"PeriodicalIF":10.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142500655","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}
Pub Date : 2024-12-01DOI: 10.1016/j.jchf.2024.09.007
Thomas S. Metkus MD, PhD
{"title":"Moving the Goalposts to Improve Postdischarge Outcome for Patients With Cardiogenic Shock and Acute MI","authors":"Thomas S. Metkus MD, PhD","doi":"10.1016/j.jchf.2024.09.007","DOIUrl":"10.1016/j.jchf.2024.09.007","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"12 12","pages":"Pages 2098-2100"},"PeriodicalIF":10.3,"publicationDate":"2024-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142545508","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 : 2024-11-21DOI: 10.1016/j.jchf.2024.09.011
Eperke Merkel, Robert Hatala, Mátyás Szigeti, Walter Schwertner, Bálint Lakatos, Anett Behon, Kinga Goscinska-Bis, Goran Milasinovic, Roland Papp, Mihály Ruppert, László Sághy, Marcell Clemens, Scott D Solomon, Valentina Kutyifa, Attila Kovács, Annamária Kosztin, Béla Merkely
Background: In the BUDAPEST (Biventricular Upgrade on left ventricular reverse remodeling and clinical outcomes in patients with left ventricular Dysfunction and intermittent or permanent APical/SepTal right ventricular pacing)-CRT Upgrade randomized trial, the authors have demonstrated improved mortality and morbidity after cardiac resynchronization therapy (CRT) upgrade in patients with heart failure with reduced ejection fraction (HFrEF) with high right ventricular (RV) pacing burden.
Objectives: This substudy sought to examine the impact of CRT upgrade on symptoms, functional outcome, and exercise capacity.
Methods: In the BUDAPEST-CRT Upgrade trial, 360 HFrEF patients with pacemaker or implantable cardioverter-defibrillator (ICD) and ≥20% RV pacing burden were randomly assigned (3:2) to cardiac resynchronization therapy with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145). The prespecified tertiary endpoints were changes in quality of life (QoL) (EQ-5D-3L), NYHA functional class, 6-minute walk test, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels.
Results: Up to 12 months, NYHA functional class improved in the CRT-D upgrade arm compared with ICD only (adjusted OR: 0.50 [95% CI: 0.32-0.80]; P = 0.003). A remarkable decrease was observed in NT-proBNP levels in the CRT-D arm (adjusted difference -1,257 pg/mL [95% CI: -2,287 to -228]; P = 0.017). The progression of age-related worsening of QoL was moderated by CRT-D upgrade (EQ-5D-3L difference by each year: 0.015 [95% CI: 0.005-0.025]; P interaction = 0.003). However, exercise tolerance (6-minute walk test) remained unchanged in both groups.
Conclusions: HFrEF patients with pacemaker/ICD and ≥20% RV pacing burden receiving CRT upgrade showed a substantial improvement in NYHA functional class and decrease in natriuretic peptide levels, as compared with ICD alone. Moreover, CRT-D upgrade could moderate the progression of worsening of QoL attributed to ageing in this vulnerable, elderly patient population. (Biventricular Upgrade on left ventricular reverse remodeling and clinical outcomes in patients with left ventricular Dysfunction and intermittent or permanent APical/SepTal right ventricular pacing [BUDAPEST]-CRT Upgrade trial).
{"title":"Upgrading Right Ventricular Pacing to Cardiac Resynchronization in HFrEF Patients Improves Symptoms and Functional Outcomes.","authors":"Eperke Merkel, Robert Hatala, Mátyás Szigeti, Walter Schwertner, Bálint Lakatos, Anett Behon, Kinga Goscinska-Bis, Goran Milasinovic, Roland Papp, Mihály Ruppert, László Sághy, Marcell Clemens, Scott D Solomon, Valentina Kutyifa, Attila Kovács, Annamária Kosztin, Béla Merkely","doi":"10.1016/j.jchf.2024.09.011","DOIUrl":"https://doi.org/10.1016/j.jchf.2024.09.011","url":null,"abstract":"<p><strong>Background: </strong>In the BUDAPEST (Biventricular Upgrade on left ventricular reverse remodeling and clinical outcomes in patients with left ventricular Dysfunction and intermittent or permanent APical/SepTal right ventricular pacing)-CRT Upgrade randomized trial, the authors have demonstrated improved mortality and morbidity after cardiac resynchronization therapy (CRT) upgrade in patients with heart failure with reduced ejection fraction (HFrEF) with high right ventricular (RV) pacing burden.</p><p><strong>Objectives: </strong>This substudy sought to examine the impact of CRT upgrade on symptoms, functional outcome, and exercise capacity.</p><p><strong>Methods: </strong>In the BUDAPEST-CRT Upgrade trial, 360 HFrEF patients with pacemaker or implantable cardioverter-defibrillator (ICD) and ≥20% RV pacing burden were randomly assigned (3:2) to cardiac resynchronization therapy with defibrillator (CRT-D) upgrade (n = 215) or ICD (n = 145). The prespecified tertiary endpoints were changes in quality of life (QoL) (EQ-5D-3L), NYHA functional class, 6-minute walk test, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels.</p><p><strong>Results: </strong>Up to 12 months, NYHA functional class improved in the CRT-D upgrade arm compared with ICD only (adjusted OR: 0.50 [95% CI: 0.32-0.80]; P = 0.003). A remarkable decrease was observed in NT-proBNP levels in the CRT-D arm (adjusted difference -1,257 pg/mL [95% CI: -2,287 to -228]; P = 0.017). The progression of age-related worsening of QoL was moderated by CRT-D upgrade (EQ-5D-3L difference by each year: 0.015 [95% CI: 0.005-0.025]; P interaction = 0.003). However, exercise tolerance (6-minute walk test) remained unchanged in both groups.</p><p><strong>Conclusions: </strong>HFrEF patients with pacemaker/ICD and ≥20% RV pacing burden receiving CRT upgrade showed a substantial improvement in NYHA functional class and decrease in natriuretic peptide levels, as compared with ICD alone. Moreover, CRT-D upgrade could moderate the progression of worsening of QoL attributed to ageing in this vulnerable, elderly patient population. (Biventricular Upgrade on left ventricular reverse remodeling and clinical outcomes in patients with left ventricular Dysfunction and intermittent or permanent APical/SepTal right ventricular pacing [BUDAPEST]-CRT Upgrade trial).</p>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":" ","pages":""},"PeriodicalIF":10.3,"publicationDate":"2024-11-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142768942","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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