{"title":"Inflammation and the Need for Biology-Driven Care in Heart Failure.","authors":"Abhinav Sharma,Virginia Anagnostopoulou,Anique Ducharme","doi":"10.1016/j.jchf.2025.102834","DOIUrl":"https://doi.org/10.1016/j.jchf.2025.102834","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"138 1","pages":"102834"},"PeriodicalIF":13.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680592","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 : 2025-12-05DOI: 10.1016/j.jchf.2025.102833
Cindy M Martin,Ezequiel J Molina
{"title":"When the Exception Becomes the Rule: Rethinking Heart Allocation in the Era of Status Inflation.","authors":"Cindy M Martin,Ezequiel J Molina","doi":"10.1016/j.jchf.2025.102833","DOIUrl":"https://doi.org/10.1016/j.jchf.2025.102833","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 1","pages":"102833"},"PeriodicalIF":13.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145718015","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 : 2025-12-05DOI: 10.1016/j.jchf.2025.102781
Kimberly Lamberti,Jonathan Grinstein
{"title":"Practical Application of Pressure-Volume Loops and Cardiac Energetics to Improve Care Delivery in Pulmonary Hypertension: Have We Finally Found the \"RIGHT\" Toolbox?","authors":"Kimberly Lamberti,Jonathan Grinstein","doi":"10.1016/j.jchf.2025.102781","DOIUrl":"https://doi.org/10.1016/j.jchf.2025.102781","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"128 1","pages":"102781"},"PeriodicalIF":13.0,"publicationDate":"2025-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145680600","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 : 2025-12-01DOI: 10.1016/j.jchf.2025.04.003
John O. Louca MB BChir , Marco Öchsner MB BChir , Sai Bhagra MRCP , Ashish Shah MD , Kelly Schlendorf MD, MHS , Brian Lima MD , Chen Chia Wang BSc , Hasan Siddiqi MD, MSCR , Ali Irshad MD , Jacob Schroder MD , Sarah Casalinova BSc , Carmelo Milano MD , Kiran Khush MD, MAS , Anette Skoda MPH , Helen Luikart MSN , Euan Ashley PhD , Nader Moazami MD , Les James MD, MPH , Owais Dar MD , Mailen Konicoff MD , Stephen Large MD
Background
As donation after circulatory determination of death (DCD) heart transplantation (HT) becomes more widely adopted, there is a need to establish the most clinically effective method of organ procurement.
Objectives
This international, multicenter study compares outcomes of DCD HT across Europe and the United States between recipients whose donor hearts were retrieved using thoraco-abdominal normothermic regional perfusion (taNRP) with those whose hearts were recovered using direct procurement and perfusion (DPP).
Methods
This was a retrospective observational study across 22 heart transplant centers in Belgium, Spain, the United Kingdom, and the United States. This study included all patients undergoing DCD HT at participating centers, from the start of each center’s DCD program through January 1, 2023. DCD HT with recovery using either taNRP or DPP were compared with one another. Posttransplant outcomes included: 1) survival at 1 year; 2) incidence of severe primary graft dysfunction (PGD); and 3) episodes of treated, biopsy-proven acute-cellular rejection (ACR) in the first year following transplantation.
Results
A total of 504 DCD HTs took place in the study period. Survival at 1 year was similar for taNRP and DPP recipients (91% vs 88%; P = 0.100). taNRP recipients had a lower rate of severe PGD (7.6% vs 19.2%; P < 0.001) and fewer episodes of biopsy-proven, ACR requiring treatment in the first year post-transplantation (13% vs 25%; P < 0.001).
Conclusions
In an international study of DCD HT, recipients of hearts retrieved by taNRP technique had lower rates of severe PGD and fewer episodes of biopsy-proven ACR in the first year when compared with those retrieved by using DPP. These results should be further investigated with randomized control trials.
背景随着血液循环确定死亡（DCD）后捐献的心脏移植（HT）被越来越广泛地采用，有必要建立临床上最有效的器官获取方法。目的：这项国际、多中心研究比较了欧洲和美国（US）使用胸腹恒温区域灌注（taNRP）回收供体心脏的受者与使用直接获取和灌注（DPP）恢复心脏的受者之间的DCD-HT结果。方法：本研究是一项回顾性观察性研究，涉及比利时、西班牙、英国和美国的20个心脏移植中心。本研究包括所有在参与中心接受DCD- ht治疗的患者，从每个中心的DCD项目开始到2023年1月1日。DCD-HT与taNRP或DPP的恢复进行了相互比较。移植后结果包括(i) 1年生存率，（ii）严重原发性移植物功能障碍（PGD）发生率，（iii）移植后第一年经活检证实的经治疗的急性细胞排斥反应（ACR）发生率。结果研究期间共发生DCD-HT 504例。taNRP和DPP患者的1年生存率相似（91% vs 88%, p=0.1）。taNRP接受者的严重PGD发生率较低（7.6% vs 19.2%, p<0.001），移植后第一年活检证实的ACR需要治疗的发作较少（13% vs 25%,p<0.001）。在一项关于DCD-HT的国际研究中，与使用DPP的受者相比，采用taNRP技术的受者在第一年发生严重PGD的几率更低，活检证实的ACR发作次数更少。这些结果应该通过随机对照试验进一步研究。
{"title":"Outcomes After Donation After Circulatory Determination of Death Cardiac Transplantation","authors":"John O. Louca MB BChir , Marco Öchsner MB BChir , Sai Bhagra MRCP , Ashish Shah MD , Kelly Schlendorf MD, MHS , Brian Lima MD , Chen Chia Wang BSc , Hasan Siddiqi MD, MSCR , Ali Irshad MD , Jacob Schroder MD , Sarah Casalinova BSc , Carmelo Milano MD , Kiran Khush MD, MAS , Anette Skoda MPH , Helen Luikart MSN , Euan Ashley PhD , Nader Moazami MD , Les James MD, MPH , Owais Dar MD , Mailen Konicoff MD , Stephen Large MD","doi":"10.1016/j.jchf.2025.04.003","DOIUrl":"10.1016/j.jchf.2025.04.003","url":null,"abstract":"<div><h3>Background</h3><div>As donation after circulatory determination of death (DCD) heart transplantation (HT) becomes more widely adopted, there is a need to establish the most clinically effective method of organ procurement.</div></div><div><h3>Objectives</h3><div>This international, multicenter study compares outcomes of DCD HT across Europe and the United States between recipients whose donor hearts were retrieved using thoraco-abdominal normothermic regional perfusion (taNRP) with those whose hearts were recovered using direct procurement and perfusion (DPP).</div></div><div><h3>Methods</h3><div>This was a retrospective observational study across 22 heart transplant centers in Belgium, Spain, the United Kingdom, and the United States. This study included all patients undergoing DCD HT at participating centers, from the start of each center’s DCD program through January 1, 2023. DCD HT with recovery using either taNRP or DPP were compared with one another. Posttransplant outcomes included: 1) survival at 1 year; 2) incidence of severe primary graft dysfunction (PGD); and 3) episodes of treated, biopsy-proven acute-cellular rejection (ACR) in the first year following transplantation.</div></div><div><h3>Results</h3><div>A total of 504 DCD HTs took place in the study period. Survival at 1 year was similar for taNRP and DPP recipients (91% vs 88%; <em>P =</em> 0.100). taNRP recipients had a lower rate of severe PGD (7.6% vs 19.2%; <em>P</em> < 0.001) and fewer episodes of biopsy-proven, ACR requiring treatment in the first year post-transplantation (13% vs 25%; <em>P</em> < 0.001).</div></div><div><h3>Conclusions</h3><div>In an international study of DCD HT, recipients of hearts retrieved by taNRP technique had lower rates of severe PGD and fewer episodes of biopsy-proven ACR in the first year when compared with those retrieved by using DPP. These results should be further investigated with randomized control trials.</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 12","pages":"Article 102473"},"PeriodicalIF":11.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143889260","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 : 2025-12-01DOI: 10.1016/j.jchf.2025.03.028
Miguel Lorenzo MD , Eduardo Núñez MPH , Rafael de la Espriella MD, PhD , Arturo Carratalá MD, PhD , Enrique Rodríguez MD, PhD , Jose Luis Górriz MD, PhD , Neus Valls MD , Antoni Bayés-Genís MD, PhD , Juan Sanchis MD, PhD , Julio Núñez MD, PhD
{"title":"Longitudinal Assessment of Spot Urinary Sodium as Predictor of Clinical Outcomes in Chronic Heart Failure","authors":"Miguel Lorenzo MD , Eduardo Núñez MPH , Rafael de la Espriella MD, PhD , Arturo Carratalá MD, PhD , Enrique Rodríguez MD, PhD , Jose Luis Górriz MD, PhD , Neus Valls MD , Antoni Bayés-Genís MD, PhD , Juan Sanchis MD, PhD , Julio Núñez MD, PhD","doi":"10.1016/j.jchf.2025.03.028","DOIUrl":"10.1016/j.jchf.2025.03.028","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 12","pages":"Article 102467"},"PeriodicalIF":11.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078190","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 : 2025-12-01DOI: 10.1016/j.jchf.2025.03.002
Senthil Selvaraj MD, MS, MA , Antoneta Karaj MS , Julio A. Chirinos MD, PhD , Nicole Denney BS, MS , Gabby Grosso BA , Melissa Fernando BS, MPH , Kishon Chambers BA , Cassandra Demastus CRNP , Ravinder Reddy PhD , Michael Langham PhD , Dushyant Kumar PhD , Hannah Maynard MPH , Bianca Pourmussa BA , Stuart B. Prenner MD , Jordana B. Cohen MD, MSCE , Harry Ischiropoulos PhD , Michael R. Rickels MD, MS , David C. Poole PhD, DSc , David D. Church PhD , Robert R. Wolfe PhD , Payman Zamani MD, MTR
Background
The etiology of exercise intolerance in heart failure with preserved ejection fraction (HFpEF) is multifactorial. Several contributing pathways may be improved by ketone ester (KE).
Objectives
This study aims to determine whether KE improves exercise tolerance in HFpEF.
Methods
KETO-HFpEF (Ketogenic Exogenous Therapies in HFpEF) is a randomized, crossover, placebo-controlled trial of acute KE dosing in 20 symptomatic HFpEF participants. Coprimary endpoints include peak oxygen consumption (VO2) during incremental cardiopulmonary exercise testing and time to exhaustion during an additional constant-intensity exercise (75% peak workload) bout.
Results
The average age was 71 ± 8 years, 60% were women, and 65% were White. KE did not improve peak VO2 (KE: 10.4 ± 3.6 vs placebo: 10.5 ± 4.0 mL/kg/min; P = 0.75). At rest, heart rate, biventricular systolic function, and cardiac output (0.6 L/min [95% CI: 0.3-1.0 L/min]) were greater with KE vs placebo, whereas total peripheral resistance (−3.2 WU [95% CI: −5.2 to −1.2 WU]) and the arteriovenous oxygen content difference (−0.7 mL of O2/dL blood [95% CI: −1.2 to −0.2 mL]) were lower. These differences mostly disappeared during incremental exercise. KE did not improve exercise endurance during the constant-intensity protocol (9.7 ± 7.3 minutes vs 8.7 ± 4.4 minutes; P = 0.51). In 6 participants receiving 6,6-2H2-glucose infusions during constant-intensity exercise, plasma glucose appearance rate before and during exercise was lower with KE (−0.24 mg/kg/min; P < 0.001). During both exercise protocols, KE lowered: 1) respiratory exchange ratios, demonstrating decreased systemic carbohydrate use; 2) nonesterified fatty acids and glucose; and 3) estimated left ventricular filling pressures (E/e′).
Conclusions
Despite robust ketosis, shifting substrate use away from carbohydrates, and decreasing estimated left ventricular filling pressures, acute KE supplementation did not improve peak VO2 or constant-intensity exercise in HFpEF. (Ketogenic Exogenous Therapies in HFpEF [KETO-HFpEF]; NCT04633460)
{"title":"Crossover Trial of Exogenous Ketones on Cardiometabolic Endpoints in Heart Failure With Preserved Ejection Fraction","authors":"Senthil Selvaraj MD, MS, MA , Antoneta Karaj MS , Julio A. Chirinos MD, PhD , Nicole Denney BS, MS , Gabby Grosso BA , Melissa Fernando BS, MPH , Kishon Chambers BA , Cassandra Demastus CRNP , Ravinder Reddy PhD , Michael Langham PhD , Dushyant Kumar PhD , Hannah Maynard MPH , Bianca Pourmussa BA , Stuart B. Prenner MD , Jordana B. Cohen MD, MSCE , Harry Ischiropoulos PhD , Michael R. Rickels MD, MS , David C. Poole PhD, DSc , David D. Church PhD , Robert R. Wolfe PhD , Payman Zamani MD, MTR","doi":"10.1016/j.jchf.2025.03.002","DOIUrl":"10.1016/j.jchf.2025.03.002","url":null,"abstract":"<div><h3>Background</h3><div>The etiology of exercise intolerance in heart failure with preserved ejection fraction (HFpEF) is multifactorial. Several contributing pathways may be improved by ketone ester (KE).</div></div><div><h3>Objectives</h3><div>This study aims to determine whether KE improves exercise tolerance in HFpEF.</div></div><div><h3>Methods</h3><div>KETO-HFpEF (Ketogenic Exogenous Therapies in HFpEF) is a randomized, crossover, placebo-controlled trial of acute KE dosing in 20 symptomatic HFpEF participants. Coprimary endpoints include peak oxygen consumption (VO<sub>2</sub>) during incremental cardiopulmonary exercise testing and time to exhaustion during an additional constant-intensity exercise (75% peak workload) bout.</div></div><div><h3>Results</h3><div>The average age was 71 ± 8 years, 60% were women, and 65% were White. KE did not improve peak VO<sub>2</sub> (KE: 10.4 ± 3.6 vs placebo: 10.5 ± 4.0 mL/kg/min; <em>P =</em> 0.75). At rest, heart rate, biventricular systolic function, and cardiac output (0.6 L/min [95% CI: 0.3-1.0 L/min]) were greater with KE vs placebo, whereas total peripheral resistance (−3.2 WU [95% CI: −5.2 to −1.2 WU]) and the arteriovenous oxygen content difference (−0.7 mL of O<sub>2</sub>/dL blood [95% CI: −1.2 to −0.2 mL]) were lower. These differences mostly disappeared during incremental exercise. KE did not improve exercise endurance during the constant-intensity protocol (9.7 ± 7.3 minutes vs 8.7 ± 4.4 minutes; <em>P =</em> 0.51). In 6 participants receiving 6,6-<sup>2</sup>H<sub>2</sub>-glucose infusions during constant-intensity exercise, plasma glucose appearance rate before and during exercise was lower with KE (−0.24 mg/kg/min; <em>P <</em> 0.001). During both exercise protocols, KE lowered: 1) respiratory exchange ratios, demonstrating decreased systemic carbohydrate use; 2) nonesterified fatty acids and glucose; and 3) estimated left ventricular filling pressures (E/e′).</div></div><div><h3>Conclusions</h3><div>Despite robust ketosis, shifting substrate use away from carbohydrates, and decreasing estimated left ventricular filling pressures, acute KE supplementation did not improve peak VO<sub>2</sub> or constant-intensity exercise in HFpEF. (Ketogenic Exogenous Therapies in HFpEF [KETO-HFpEF]; <span><span>NCT04633460</span><svg><path></path></svg></span>)</div></div>","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 12","pages":"Article 102435"},"PeriodicalIF":11.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144001181","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 : 2025-12-01DOI: 10.1016/j.jchf.2025.102562
Yogesh N.V. Reddy MBBS, MSc , Sheldon E. Litwin MD
{"title":"Supercharging the Heart With Ketones in Heart Failure With Preserved Ejection Fraction","authors":"Yogesh N.V. Reddy MBBS, MSc , Sheldon E. Litwin MD","doi":"10.1016/j.jchf.2025.102562","DOIUrl":"10.1016/j.jchf.2025.102562","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 12","pages":"Article 102562"},"PeriodicalIF":11.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145206377","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 : 2025-12-01DOI: 10.1016/j.jchf.2025.102710
Shi Huang PhD , Jaclyn Tamaroff MD, MSCI , Eric Farber-Eger BS , Nelson Chow BS , Hasan K. Siddiqi MD , D. Marshall Brinkley MD , Jonathan N. Menachem MD , Aniket S. Rali MD , JoAnn Lindenfeld MD , Henry Ooi MD , Lynn Punnoose MD , Stacy Tsai MD , Dawn Pedrotty MD, PhD , Sandip Zalawadiya MD , Suzanne Sacks MD , Mark Wigger MD , Rochelle Prokupets MD , Aaron M. Williams MD , Swaroop Bommareddi MD , Brian Lima MD , Kaushik Amancherla MD, MSCI
<div><h3>Background</h3><div>Heart transplantation (HT) is the definitive therapy for end-stage heart failure. However, with improving post-HT survival in the modern era, recipients are increasingly cumulatively exposed to unique risk factors for cardiovascular-kidney-metabolic (CKM) dysfunction. An expanded understanding of the incidence and prevalence of CKM dysfunction post-HT may inform screening and therapeutic strategies to mitigate adverse events.</div></div><div><h3>Objectives</h3><div>The aim of this study was to characterize the incidence and prevalence of CKM risk factors in adult and pediatric HT recipients and to define their association with cardiac allograft vasculopathy (CAV) and mortality.</div></div><div><h3>Methods</h3><div>A single-center retrospective observational study was conducted in adults and children who underwent HT between January 1, 2015, and June 30, 2024. Longitudinal clinical and laboratory data were extracted from the electronic health record. Incidence rates (IRs) of type 2 diabetes mellitus (DM2), overweight or obesity, hypertension, chronic kidney disease (CKD), and dyslipidemia were calculated. longitudinal trajectories of CKM dysfunction were constructed, and the impact of sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP1RAs) on CKD and body mass index, respectively, was evaluated. Finally, immunologic and CKM comorbidities were linked with clinical outcomes by using time-varying Cox regression models.</div></div><div><h3>Results</h3><div>During the study period, 860 adults and 84 children underwent HT. Among adults, the IRs (reported as cases per 100 person-years) of DM2, overweight or obesity, dyslipidemia, and CKD were 28.6, 77.3, 139.1, and 69.7, respectively. Among children, the IRs of DM2, overweight or obesity, dyslipidemia, and CKD were 2.8, 26.9, 5.5, and 3.6. Within 12 months post-HT, 99% of adults developed stage 1 or 2 hypertension, and 22.1% of all adults developed hemoglobin A<sub>1c</sub> levels ≥6.5%, regardless of a preexisting diagnosis of DM2. Similarly, 37.5% of adults developed moderate to severe hypertriglyceridemia and 31.1% manifested worsened low-density lipoprotein cholesterol control. Among adults with an estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73 m<sup>2</sup> pre-HT, 86.2% displayed worsening renal function (eGFR <45 mL/min/1.73 m<sup>2</sup>) within 12 months post-HT. In adults initiated on SGLT2 inhibitor post-HT (n = 242), there was a nonlinear improvement in eGFR during the ensuing 12 months; for individuals initiated on GLP1RAs (n = 168), there was a predominantly linear reduction in body mass index. Among CKM comorbidities, none was significantly associated with CAV, whereas DM2 was associated with increased post-HT mortality (HR: 1.84; 95% CI: 1.04-3.25).</div></div><div><h3>Conclusions</h3><div>A significant proportion of HT recipients experience new-onset or worsening CKM dysfunction after HT. Furth
{"title":"Cardiovascular-Kidney-Metabolic Disease Burden in Children and Adults Following Heart Transplantation","authors":"Shi Huang PhD , Jaclyn Tamaroff MD, MSCI , Eric Farber-Eger BS , Nelson Chow BS , Hasan K. Siddiqi MD , D. Marshall Brinkley MD , Jonathan N. Menachem MD , Aniket S. Rali MD , JoAnn Lindenfeld MD , Henry Ooi MD , Lynn Punnoose MD , Stacy Tsai MD , Dawn Pedrotty MD, PhD , Sandip Zalawadiya MD , Suzanne Sacks MD , Mark Wigger MD , Rochelle Prokupets MD , Aaron M. Williams MD , Swaroop Bommareddi MD , Brian Lima MD , Kaushik Amancherla MD, MSCI","doi":"10.1016/j.jchf.2025.102710","DOIUrl":"10.1016/j.jchf.2025.102710","url":null,"abstract":"<div><h3>Background</h3><div>Heart transplantation (HT) is the definitive therapy for end-stage heart failure. However, with improving post-HT survival in the modern era, recipients are increasingly cumulatively exposed to unique risk factors for cardiovascular-kidney-metabolic (CKM) dysfunction. An expanded understanding of the incidence and prevalence of CKM dysfunction post-HT may inform screening and therapeutic strategies to mitigate adverse events.</div></div><div><h3>Objectives</h3><div>The aim of this study was to characterize the incidence and prevalence of CKM risk factors in adult and pediatric HT recipients and to define their association with cardiac allograft vasculopathy (CAV) and mortality.</div></div><div><h3>Methods</h3><div>A single-center retrospective observational study was conducted in adults and children who underwent HT between January 1, 2015, and June 30, 2024. Longitudinal clinical and laboratory data were extracted from the electronic health record. Incidence rates (IRs) of type 2 diabetes mellitus (DM2), overweight or obesity, hypertension, chronic kidney disease (CKD), and dyslipidemia were calculated. longitudinal trajectories of CKM dysfunction were constructed, and the impact of sodium-glucose cotransporter 2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP1RAs) on CKD and body mass index, respectively, was evaluated. Finally, immunologic and CKM comorbidities were linked with clinical outcomes by using time-varying Cox regression models.</div></div><div><h3>Results</h3><div>During the study period, 860 adults and 84 children underwent HT. Among adults, the IRs (reported as cases per 100 person-years) of DM2, overweight or obesity, dyslipidemia, and CKD were 28.6, 77.3, 139.1, and 69.7, respectively. Among children, the IRs of DM2, overweight or obesity, dyslipidemia, and CKD were 2.8, 26.9, 5.5, and 3.6. Within 12 months post-HT, 99% of adults developed stage 1 or 2 hypertension, and 22.1% of all adults developed hemoglobin A<sub>1c</sub> levels ≥6.5%, regardless of a preexisting diagnosis of DM2. Similarly, 37.5% of adults developed moderate to severe hypertriglyceridemia and 31.1% manifested worsened low-density lipoprotein cholesterol control. Among adults with an estimated glomerular filtration rate (eGFR) ≥45 mL/min/1.73 m<sup>2</sup> pre-HT, 86.2% displayed worsening renal function (eGFR <45 mL/min/1.73 m<sup>2</sup>) within 12 months post-HT. In adults initiated on SGLT2 inhibitor post-HT (n = 242), there was a nonlinear improvement in eGFR during the ensuing 12 months; for individuals initiated on GLP1RAs (n = 168), there was a predominantly linear reduction in body mass index. Among CKM comorbidities, none was significantly associated with CAV, whereas DM2 was associated with increased post-HT mortality (HR: 1.84; 95% CI: 1.04-3.25).</div></div><div><h3>Conclusions</h3><div>A significant proportion of HT recipients experience new-onset or worsening CKM dysfunction after HT. Furth","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 12","pages":"Article 102710"},"PeriodicalIF":11.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145337119","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 : 2025-12-01DOI: 10.1016/j.jchf.2025.03.004
Eiran Z. Gorodeski MD, MPH , Parampreet K. Singh MD , Shashank Shekhar MD , Vincent D. Salvador MD , Andrew J. Lenneman MD , Brett W. Sperry MD , Michael P. Zacharias DO , Robert A. Montgomery MD
{"title":"Heart Failure Internists","authors":"Eiran Z. Gorodeski MD, MPH , Parampreet K. Singh MD , Shashank Shekhar MD , Vincent D. Salvador MD , Andrew J. Lenneman MD , Brett W. Sperry MD , Michael P. Zacharias DO , Robert A. Montgomery MD","doi":"10.1016/j.jchf.2025.03.004","DOIUrl":"10.1016/j.jchf.2025.03.004","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"13 12","pages":"Article 102437"},"PeriodicalIF":11.8,"publicationDate":"2025-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020647","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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