{"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 , Ferdinando Carlo Sasso MD , 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}
Pub Date : 2026-01-29DOI: 10.1016/j.jchf.2026.102941
Wendy McCallum
{"title":"Navigating the Intersection of HFmrEF/HFpEF and CKD: High-Risk With Gaps in Evidence.","authors":"Wendy McCallum","doi":"10.1016/j.jchf.2026.102941","DOIUrl":"https://doi.org/10.1016/j.jchf.2026.102941","url":null,"abstract":"","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"110 6 1","pages":"102941"},"PeriodicalIF":13.0,"publicationDate":"2026-01-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146073213","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-22DOI: 10.1016/j.jchf.2025.102849
Elise L Shalowitz,Pardeep Jhund,Mitchell A Psotka,Abhinav Sharma,Matthew Dimond,Trejeeve Martyn,Martin Cowie,Yasbanoo Moayedi,Nathaniel M Hawkins,Justin Ezekowitz,Offer Amir,Maurizio Volterrani,Mona Fiuzat,Christopher O'Connor,David P Kao,
BACKGROUNDNoninvasive remote patient monitoring (RPM) captures and transmits physiological (eg, weight) and symptom data to the patient's care team for monitoring outside of the clinic, creating opportunities for early intervention (eg, medical therapy optimization) to avoid decompensation events. Mixed results in studies of noninvasive RPM may stem from the complex design of heart failure programs. In current RPM study reports, many workflow components including data review and clinical responses are reported ambiguously or not at all. Opaque workflows prevent robust evaluation, replication in other studies, and community implementation of heart failure RPM programs.OBJECTIVESThe purpose of this study was to create a set of recommendations and a template for reporting workflow design in the publication of noninvasive RPM studies.METHODSThe Heart Failure Collaboratory, Canadian Heart Failure Society, and members of the European Society of Cardiology formed a multidisciplinary working group. Through an extensive consensus-building process, the authors reviewed existing workflows and data reporting practices and developed "the 6 Rs" of RPM Reporting.RESULTSThe authors created a set of recommendations and a template for reporting workflows that is organized around 6 Rs: patient Representativeness, ambulatory data Recording, data Relay to clinicians, clinician data Review, Response, and Recommendations from patients and providers.CONCLUSIONSSystematic use of the 6 Rs of RPM Reporting template will improve the completeness and transparency of workflow reporting of RPM studies. The authors encourage investigators to use this framework and accompanying template during noninvasive RPM trial planning and include completed templates in study publications or as supplemental materials.
{"title":"Standardized Reporting in Heart Failure Noninvasive Remote Monitoring Trials: Interventions to Catalyze Data Into Action.","authors":"Elise L Shalowitz,Pardeep Jhund,Mitchell A Psotka,Abhinav Sharma,Matthew Dimond,Trejeeve Martyn,Martin Cowie,Yasbanoo Moayedi,Nathaniel M Hawkins,Justin Ezekowitz,Offer Amir,Maurizio Volterrani,Mona Fiuzat,Christopher O'Connor,David P Kao, ","doi":"10.1016/j.jchf.2025.102849","DOIUrl":"https://doi.org/10.1016/j.jchf.2025.102849","url":null,"abstract":"BACKGROUNDNoninvasive remote patient monitoring (RPM) captures and transmits physiological (eg, weight) and symptom data to the patient's care team for monitoring outside of the clinic, creating opportunities for early intervention (eg, medical therapy optimization) to avoid decompensation events. Mixed results in studies of noninvasive RPM may stem from the complex design of heart failure programs. In current RPM study reports, many workflow components including data review and clinical responses are reported ambiguously or not at all. Opaque workflows prevent robust evaluation, replication in other studies, and community implementation of heart failure RPM programs.OBJECTIVESThe purpose of this study was to create a set of recommendations and a template for reporting workflow design in the publication of noninvasive RPM studies.METHODSThe Heart Failure Collaboratory, Canadian Heart Failure Society, and members of the European Society of Cardiology formed a multidisciplinary working group. Through an extensive consensus-building process, the authors reviewed existing workflows and data reporting practices and developed \"the 6 Rs\" of RPM Reporting.RESULTSThe authors created a set of recommendations and a template for reporting workflows that is organized around 6 Rs: patient Representativeness, ambulatory data Recording, data Relay to clinicians, clinician data Review, Response, and Recommendations from patients and providers.CONCLUSIONSSystematic use of the 6 Rs of RPM Reporting template will improve the completeness and transparency of workflow reporting of RPM studies. The authors encourage investigators to use this framework and accompanying template during noninvasive RPM trial planning and include completed templates in study publications or as supplemental materials.","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"22 1","pages":"102849"},"PeriodicalIF":13.0,"publicationDate":"2026-01-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146021678","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.jchf.2025.102899
Nicholas P Bergeron,Alexander C Egbe,William R Miranda,Rajiv Gulati,Ryan T Demmer,Varun Sundaram,Barry A Borlaug,Yogesh N V Reddy
BACKGROUNDAlthough patients with heart failure with preserved ejection fraction (HFpEF) have poor quality of life (QOL) and a high coronary artery disease (CAD) burden, there remains limited evidence guiding revascularization in these patients, in part related to complexity in diagnosis.OBJECTIVESThis study aims to determine the prevalence of likely undiagnosed HFpEF in patients with CAD and a positive stress test result, as well as its therapeutic interaction with an invasive strategy on QOL.METHODSPatients without known heart failure (HF) from the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial were stratified by the Rose Dyspnea Scale questionnaire and HFpEF-ABA (heart failure with preserved ejection fraction algorithm using age, body mass index, and history of atrial fibrillation) probability into 3 groups: 1) probable HFpEF (dyspnea and HFpEF-ABA ≥75%); 2) possible HFpEF (dyspnea and HFpEF-ABA <75%); and 3) no HFpEF (no dyspnea). The effect of an invasive strategy on health status was determined using mixed models. The study independently tested the prevalence of HFpEF by using exercise right-sided heart catheterization in a validation cohort of patients with dyspnea, stress testing, and angiography.RESULTSAmong 4,986 participants, 53.4% had dyspnea and were at risk for HFpEF: 9.0% (n = 450) with probable HFpEF and 44.4% (n = 2,213) with possible HFpEF. Patients in the probable HFpEF group had the worst exercise capacity, angina, dyspnea, and QOL, despite having less obstructive CAD (P < 0.0001 for all). An invasive strategy improved Rose Dyspnea Scale, SAQ (Seattle Angina Questionnaire) QOL, and Euro-QoL-5D results consistently across the 3 groups (P = 0.009; P < 0.0001, and P = 0.05, respectively; interaction P > 0.20 for all), with greater benefits on physical limitation and angina in the probable HFpEF group (SAQ Summary, SAQ Physical Limitation, and SAQ Angina Frequency score interaction P = 0.01; P = 0.01, and P = 0.08, respectively). The probable HFpEF group demonstrated an increased risk of HF hospitalization (HR: 7.2 [95% CI: 3.7-13.8]; P < 0.0001) vs no HFpEF (HR: 5.0 [95% CI: 2.7-9.0]; P < 0.0001) vs possible HFpEF), but an invasive strategy did not mitigate this risk (HR: 1.5 [95% CI: 0.7-3.5]; P = 0.34). In the validation cohort (n = 237), of those patients with positive stress test results and dyspnea, 85% had HFpEF, and 68% of these patients had elevated left-sided heart filling pressures even at rest.CONCLUSIONSMore than one-half of patients with CAD and ischemia have dyspnea, with a high risk of undiagnosed HFpEF in one-tenth of these patients. In this study, patients with a high HFpEF probability had the greatest risk for HF hospitalization, the poorest exercise tolerance, and the most severe symptoms, and they derived the greatest benefit from an invasive strategy for physical limitation and angina. However, despite these improvements, residual dyspnea, QOL impa
背景：尽管保留射血分数（HFpEF）的心力衰竭患者生活质量（QOL）较差，冠状动脉疾病（CAD）负担高，但指导这些患者血运重建术的证据仍然有限，部分原因与诊断的复杂性有关。目的：本研究旨在确定CAD患者中可能未确诊的HFpEF的患病率和应激测试阳性结果，以及其与有创策略对生活质量的治疗相互作用。方法通过Rose呼吸困难量表问卷和HFpEF- aba（基于年龄、体重指数和房颤史的保留射血分数算法）概率对缺血试验中无已知心力衰竭（HF）患者进行分层，分为3组：1)可能的HFpEF（呼吸困难和HFpEF- aba≥75%）；2)可能的HFpEF（呼吸困难和HFpEF- aba均为0.20），可能的HFpEF组对身体限制和心绞痛有更大的益处（SAQ Summary， SAQ physical limitation和SAQ angina Frequency评分交互作用P = 0.01, P = 0.01, P = 0.08）。可能HFpEF组与无HFpEF组相比（HR: 5.0 [95% CI: 2.7-9.0]; P < 0.0001）， HF住院的风险增加（HR: 7.2 [95% CI: 3.7-13.8]; P < 0.0001），但侵入性策略并没有降低这种风险（HR: 1.5 [95% CI: 0.7-3.5]; P = 0.34）。在验证队列（n = 237）中，在应激试验结果阳性且呼吸困难的患者中，85%患有HFpEF，其中68%的患者即使在休息时左侧心脏充盈压力升高。结论：超过一半的冠心病和缺血患者存在呼吸困难，其中十分之一的患者存在未确诊的HFpEF高风险。在本研究中，HFpEF概率高的患者HF住院风险最大，运动耐受性最差，症状最严重，并且他们从身体限制和心绞痛的侵入性策略中获益最大。然而，尽管有这些改善，血运重建术后，残余呼吸困难、生活质量受损和HF住院风险升高仍然存在。这些数据提示了独立评估冠心病合并呼吸困难患者并发HFpEF的潜在作用。
{"title":"Implications of Potential Undiagnosed HFpEF on Symptomatic Response With Coronary Revascularization.","authors":"Nicholas P Bergeron,Alexander C Egbe,William R Miranda,Rajiv Gulati,Ryan T Demmer,Varun Sundaram,Barry A Borlaug,Yogesh N V Reddy","doi":"10.1016/j.jchf.2025.102899","DOIUrl":"https://doi.org/10.1016/j.jchf.2025.102899","url":null,"abstract":"BACKGROUNDAlthough patients with heart failure with preserved ejection fraction (HFpEF) have poor quality of life (QOL) and a high coronary artery disease (CAD) burden, there remains limited evidence guiding revascularization in these patients, in part related to complexity in diagnosis.OBJECTIVESThis study aims to determine the prevalence of likely undiagnosed HFpEF in patients with CAD and a positive stress test result, as well as its therapeutic interaction with an invasive strategy on QOL.METHODSPatients without known heart failure (HF) from the ISCHEMIA (International Study of Comparative Health Effectiveness With Medical and Invasive Approaches) trial were stratified by the Rose Dyspnea Scale questionnaire and HFpEF-ABA (heart failure with preserved ejection fraction algorithm using age, body mass index, and history of atrial fibrillation) probability into 3 groups: 1) probable HFpEF (dyspnea and HFpEF-ABA ≥75%); 2) possible HFpEF (dyspnea and HFpEF-ABA <75%); and 3) no HFpEF (no dyspnea). The effect of an invasive strategy on health status was determined using mixed models. The study independently tested the prevalence of HFpEF by using exercise right-sided heart catheterization in a validation cohort of patients with dyspnea, stress testing, and angiography.RESULTSAmong 4,986 participants, 53.4% had dyspnea and were at risk for HFpEF: 9.0% (n = 450) with probable HFpEF and 44.4% (n = 2,213) with possible HFpEF. Patients in the probable HFpEF group had the worst exercise capacity, angina, dyspnea, and QOL, despite having less obstructive CAD (P < 0.0001 for all). An invasive strategy improved Rose Dyspnea Scale, SAQ (Seattle Angina Questionnaire) QOL, and Euro-QoL-5D results consistently across the 3 groups (P = 0.009; P < 0.0001, and P = 0.05, respectively; interaction P > 0.20 for all), with greater benefits on physical limitation and angina in the probable HFpEF group (SAQ Summary, SAQ Physical Limitation, and SAQ Angina Frequency score interaction P = 0.01; P = 0.01, and P = 0.08, respectively). The probable HFpEF group demonstrated an increased risk of HF hospitalization (HR: 7.2 [95% CI: 3.7-13.8]; P < 0.0001) vs no HFpEF (HR: 5.0 [95% CI: 2.7-9.0]; P < 0.0001) vs possible HFpEF), but an invasive strategy did not mitigate this risk (HR: 1.5 [95% CI: 0.7-3.5]; P = 0.34). In the validation cohort (n = 237), of those patients with positive stress test results and dyspnea, 85% had HFpEF, and 68% of these patients had elevated left-sided heart filling pressures even at rest.CONCLUSIONSMore than one-half of patients with CAD and ischemia have dyspnea, with a high risk of undiagnosed HFpEF in one-tenth of these patients. In this study, patients with a high HFpEF probability had the greatest risk for HF hospitalization, the poorest exercise tolerance, and the most severe symptoms, and they derived the greatest benefit from an invasive strategy for physical limitation and angina. However, despite these improvements, residual dyspnea, QOL impa","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"3 1","pages":"102899"},"PeriodicalIF":13.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145955482","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-12DOI: 10.1016/j.jchf.2025.102890
Yousuf Razvi,Janet Gilbertson,Carlos Heras-Palou,Jeremy Bland,Onur Berber,Dominic Furniss,Akira Wiberg,Ryckie G Wade,Grainne Bourke,Maxim D Horwitz,Nicola Botcher,Mariana Mykytow,Zak Vinnicombe,Yueyang Li,Alexandra Wood,Taryn Youngstein,Aldostefano Porcari,Muhammad Rauf,Josephine Mansell,Awais Sheikh,Rishi Patel,Dorota Rowczenio,David Hutt,Mary M Reilly,Helen J Lachmann,Ashutosh D Wechalekar,Lucia Venneri,Carol Whelan,Ana Martinez-Naharro,Marianna Fontana,Julian D Gillmore,Philip N Hawkins,
BACKGROUNDTransthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized but still underdiagnosed cause of heart failure in older people, typically causing substantial and irreversible cardiac damage before diagnosis. Specific therapies have lately become available that slow disease progression, early diagnosis now being a major priority to improving outcomes. Amyloid-associated carpal tunnel syndrome commonly precedes symptomatic cardiomyopathy, but histological examination at surgical decompression is seldom sought. This multicentre prospective study was conducted to determine whether biopsy at carpal tunnel decompression can aid early diagnosis of ATTR-CM.OBJECTIVESThis study sought to determine whether carpal tunnel biopsies obtained at routine surgical decompression can aid early diagnosis of ATTR-CM.METHODSThis prospective, multicenter, cross-sectional United Kingdom study included unselected patients >50 years of age who were undergoing carpal tunnel decompression and who provided biopsies for amyloid histological examination. Exclusion criteria included the inability to consent and an existing diagnosis of amyloidosis. Patients with biopsy-proven amyloid deposition were invited to undergo repurposed bone scintigraphy, echocardiography, and clinical assessments for systemic amyloidosis.RESULTSA total of 555 patients, including 315 women, were studied with a mean ± SD age of 68.7 ± 11.0 years. The majority (60.3%), had bilateral symptoms, and the biopsy procedure proved safe. Amyloid was identified in 216 (39%) cases (51% of male and 30% of female patients), more frequently in tenosynovial than transverse carpal ligament biopsies (82.6% vs 70.2%; P < 0.001). Of 216 biopsy-positive patients, 116 assented to cardiac assessment. This assessment identified myocardial amyloid by using technetium-3,3-diphosphono-1,2-propanodicarboxlyic acid (Tc-DPD) scintigraphy in 32 of 116 (28%) patients: 26 were male, 10 had Perugini grade 2 uptake, and the remainder had grade 1 uptake. Echocardiography and serum biomarkers identified significant ATTR-CM in patients with Perugini grade 2 DPD scans, prompting commencement of disease-modifying therapy. Two further patients received a diagnosis of unsuspected systemic light-chain (AL) amyloidosis, thus enabling timely chemotherapy.CONCLUSIONSTransthyretin amyloid (ATTR) is commonly present in the tenosynovium and transverse carpal ligaments of older people with carpal tunnel syndrome, and more than one quarter of whom have ATTR cardiac amyloid infiltration that is readily identifiable using bone scintigraphy. Biopsies of samples taken at carpal tunnel decompression present a practicable pathway to enable early diagnosis and treatment of ATTR-CM.
{"title":"Early Diagnosis of ATTR-CM Using Carpal Tunnel Biopsy Examination: EDUCATE: A United Kingdom Prospective Multicenter Study.","authors":"Yousuf Razvi,Janet Gilbertson,Carlos Heras-Palou,Jeremy Bland,Onur Berber,Dominic Furniss,Akira Wiberg,Ryckie G Wade,Grainne Bourke,Maxim D Horwitz,Nicola Botcher,Mariana Mykytow,Zak Vinnicombe,Yueyang Li,Alexandra Wood,Taryn Youngstein,Aldostefano Porcari,Muhammad Rauf,Josephine Mansell,Awais Sheikh,Rishi Patel,Dorota Rowczenio,David Hutt,Mary M Reilly,Helen J Lachmann,Ashutosh D Wechalekar,Lucia Venneri,Carol Whelan,Ana Martinez-Naharro,Marianna Fontana,Julian D Gillmore,Philip N Hawkins, ","doi":"10.1016/j.jchf.2025.102890","DOIUrl":"https://doi.org/10.1016/j.jchf.2025.102890","url":null,"abstract":"BACKGROUNDTransthyretin amyloid cardiomyopathy (ATTR-CM) is an increasingly recognized but still underdiagnosed cause of heart failure in older people, typically causing substantial and irreversible cardiac damage before diagnosis. Specific therapies have lately become available that slow disease progression, early diagnosis now being a major priority to improving outcomes. Amyloid-associated carpal tunnel syndrome commonly precedes symptomatic cardiomyopathy, but histological examination at surgical decompression is seldom sought. This multicentre prospective study was conducted to determine whether biopsy at carpal tunnel decompression can aid early diagnosis of ATTR-CM.OBJECTIVESThis study sought to determine whether carpal tunnel biopsies obtained at routine surgical decompression can aid early diagnosis of ATTR-CM.METHODSThis prospective, multicenter, cross-sectional United Kingdom study included unselected patients >50 years of age who were undergoing carpal tunnel decompression and who provided biopsies for amyloid histological examination. Exclusion criteria included the inability to consent and an existing diagnosis of amyloidosis. Patients with biopsy-proven amyloid deposition were invited to undergo repurposed bone scintigraphy, echocardiography, and clinical assessments for systemic amyloidosis.RESULTSA total of 555 patients, including 315 women, were studied with a mean ± SD age of 68.7 ± 11.0 years. The majority (60.3%), had bilateral symptoms, and the biopsy procedure proved safe. Amyloid was identified in 216 (39%) cases (51% of male and 30% of female patients), more frequently in tenosynovial than transverse carpal ligament biopsies (82.6% vs 70.2%; P < 0.001). Of 216 biopsy-positive patients, 116 assented to cardiac assessment. This assessment identified myocardial amyloid by using technetium-3,3-diphosphono-1,2-propanodicarboxlyic acid (Tc-DPD) scintigraphy in 32 of 116 (28%) patients: 26 were male, 10 had Perugini grade 2 uptake, and the remainder had grade 1 uptake. Echocardiography and serum biomarkers identified significant ATTR-CM in patients with Perugini grade 2 DPD scans, prompting commencement of disease-modifying therapy. Two further patients received a diagnosis of unsuspected systemic light-chain (AL) amyloidosis, thus enabling timely chemotherapy.CONCLUSIONSTransthyretin amyloid (ATTR) is commonly present in the tenosynovium and transverse carpal ligaments of older people with carpal tunnel syndrome, and more than one quarter of whom have ATTR cardiac amyloid infiltration that is readily identifiable using bone scintigraphy. Biopsies of samples taken at carpal tunnel decompression present a practicable pathway to enable early diagnosis and treatment of ATTR-CM.","PeriodicalId":14687,"journal":{"name":"JACC. Heart failure","volume":"9 1","pages":"102890"},"PeriodicalIF":13.0,"publicationDate":"2026-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145955933","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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