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Mitigating Post-operative Right Ventricular Dysfunction After Left Ventricular Assist Device: The RV Protection Study.
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-13 DOI: 10.1016/j.cardfail.2025.01.017
Anthony J Kanelidis, Leo Gozdecki, Mark N Belkin, Sara Kalantari, Ann Nguyen, Ben B Chung, Stanley Swat, Nitasha Sarswat, Gene Kim, Krystina Chickerillo, Justin Okray, Annalyse Hubbell, Shana K Creighton, Christine Y Jung, Indra Bole, Seyed Ehsan Saffari, Michael O'Connor, Takeyoshi Ota, Valluvan Jeevanandam, Christopher Salerno, Jonathan Grinstein

Background: Despite improvements in hemocompatibility-related adverse events (HRAEs) with the HeartMate 3 left ventricular assist device (LVAD), hemodynamic-related events (HDREs), such as right ventricular failure (RVF) and aortic insufficiency, still result in considerable morbidity and mortality. We investigated a comprehensive, upfront RV protection strategy combining hemodynamic, ventilatory and pharmaceutical optimization to mitigate the risk of RVF.

Methods/results: Participants were prospectively randomized in a 1:1 fashion to either the RV-protection strategy or usual care for post-operative LVAD management. The RV-protection strategy targeted RV afterload (inhaled NO ≥ 48 hrs, PCWP < 18), RV preload (CVP 8-14), RV perfusion (MAP 70-90, Hgb > 8), RV contractility (IV inotropes), rate/rhythm control (HR >100, normal sinus), ventilatory management (SpO2 >95, PaCO2 < 50, plateau pressure < 30, PEEP ≤ 5), and RV geometry (echo-guided septal position). The primary outcome was survival free from any HDREs or HRAEs at 24 weeks. Secondary outcomes included severe RVF, according to INTERMACS and ARC definitions. Twenty participants were randomized: 10 to the RV-protection strategy and 10 to usual care. The median age was 60 years (IQR 54-69), 50% were Black, and 50% had ischemia. At 24 weeks, the RV-protection strategy showed significantly greater survival rates free from HDREs or HRAEs compared to usual care (80% vs 40%; P = 0.04). Event-free survival for HRAEs resulted in similar findings. No HDREs occurred with the RV protection strategy vs 3 (30%) with usual care (P = 0.067). Similarly, severe RVF according to INTERMACS or ARC did not occur in the RV protection strategy vs 3 (30%) in the usual-care cohort (P = 0.20).

Conclusions: Participants receiving a novel, comprehensive, upfront RV protection strategy post-LVAD implantation had significantly greater survival rates free from HDREs or HRAEs at 24 weeks.

背景:尽管 HeartMate 3 左心室辅助装置(LVAD)在血液相容性相关不良事件(HRAEs)方面有所改善,但右心室衰竭(RVF)和主动脉瓣关闭不全等血液动力学相关事件(HDREs)仍会导致相当高的发病率和死亡率。我们研究了一种结合血流动力学、通气和药物优化的综合前期 RV 保护策略,以降低 RVF 风险:参与者以 1:1 的方式被随机分配到 RV 保护策略或术后 LVAD 管理的常规护理中。RV保护策略针对RV后负荷(吸入NO≥48小时,PCWP 8)、RV收缩力(静脉注射肌注)、心率/节律控制(HR>100,正常窦性)、通气管理(SpO2>95,PaCO2>10)、RVF管理(SpO2>10,PaCO2>10):在植入 LVAD 后接受新颖、全面的前期 RV 保护策略的参试者在 24 周后无 HDRE 或 HRAE 的存活率明显更高。
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引用次数: 0
Changes in Stressed Blood Volume With Endovascular Ablation of the Right Greater Splanchnic Nerve in Heart Failure With Preserved Ejection Fraction: The REBALANCE-HF Trial.
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-13 DOI: 10.1016/j.cardfail.2025.01.016
Husam M Salah, Marat Fudim, Barry A Borlaug, Sheldon E Litwin, Matthew Stark, Sanjiv J Shah, Daniel Burkhoff
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引用次数: 0
Acute Heart Failure: Transitioning From Symptom-Based Care to Remission.
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-12 DOI: 10.1016/j.cardfail.2024.12.016
Gad Cotter, Beth A Davison, Douglas L Mann, Jan Biegus, Jozine M Termaaten, Matteo Pagnesi, Yonathan Freund, Adriaan A Voors, Piotr Ponikowski, Marco Metra, Alexandre Mebazaa

During the past century, the characteristics of patients with heart failure (HF) and acute HF (AHF) have shifted from patients with severe pump failure due to rheumatic, hypertensive and ischemic heart disease to older and more obese patients with multiple severe comorbidities. The pathophysiology of AHF has shifted, in parallel, from that of advanced, end-stage pump failure caused by severe left ventricular dysfunction to age, obesity and comorbidity-related cardiovascular dysfunction combined with neurohormonal and inflammatory dysregulation or "inflammaging." With the advent of neurohormonal blockers leading to improved outcomes of patients with chronic HF, the focus of AHF therapy has also changed from care directed at early symptom improvement to therapies directed toward longer-term improvements in quality of life and outcomes. Studies conducted in the past 5 years suggest that the beneficial effects seen with the 4 pillars of guideline-directed medical therapy for HF, mostly comprising neurohormonal blockade, can be extended to AHF when these therapies are initiated and rapidly uptitrated during admission and after discharge. A recent pilot study, CORTAHF (Effect of Short-Term Prednisone Therapy on CRP Change in Emergency Department Patients With Acute Heart Failure and Elevated Inflammatory Markers), has suggested that these benefits can be extended by treating patients with AHF and markers of inflammatory activation with anti-inflammatory therapies. Future studies should further examine whether combined anti-inflammatory therapy and neurohormonal blockade can lead to the reversal of disrupted underlying pathophysiology and remission in patients with AHF.

在上个世纪,心力衰竭(HF)和急性心力衰竭(AHF)患者的特征已从风湿性、高血压和缺血性心脏病导致的严重泵衰竭患者转变为年龄更大、更肥胖且患有多种严重并发症的患者。与此同时,急性心力衰竭的病理生理学也从严重左心室功能障碍导致的晚期、终末期泵衰竭转变为年龄、肥胖和合并症相关的心血管功能障碍以及神经激素和炎症失调或 "炎症衰老"。随着神经激素阻滞剂的出现,慢性心房颤动患者的预后得到改善,心房颤动治疗的重点也从针对早期症状改善的治疗转变为针对长期生活质量和预后改善的治疗。过去 5 年进行的研究表明,如果在入院期间和出院后开始使用并迅速增加这些疗法,那么高血压医疗指南指导的四大支柱疗法(主要包括神经激素阻滞剂)所产生的有益效果可扩展至心房颤动。最近的一项试验性研究(CORTAHF)表明,用抗炎疗法治疗心房颤动和炎症激活标记物患者,可以扩大这些疗效。未来的研究应进一步探讨联合抗炎疗法和神经激素阻断是否能逆转 AHF 患者紊乱的潜在病理生理学并使病情得到缓解。
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引用次数: 0
Transcatheter Left Ventricular Restoration System: Ancora Heart Inc.
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-12 DOI: 10.1016/j.cardfail.2025.02.004
Yogita Rochlani, Enklajd Marsela, Ulrich P Jorde
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引用次数: 0
Real-World Analysis of Health Care Utilization With Baroreflex Activation Therapy for Heart Failure.
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-12 DOI: 10.1016/j.cardfail.2025.02.003
Jacob Abraham, Amarinder S Bindra, Marat Fudim, Pujan P Patel, Nirav Y Raval, Dmitry Yaranov, Fares Yared, Seth J Wilks, Stefanie Busgang, Philip B Adamson
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引用次数: 0
Increasing Evidence Supports the Benefits of Rapid Uptitration of the Neurohormonal Blockade in HFmrEF/HFpEF Patients With AHF.
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-11 DOI: 10.1016/j.cardfail.2024.12.015
Gad Cotter, Beth Davison, Jan Biegus, Matteo Pagnesi, Marco Metra, Javed Butler, Ovidiu Chioncel, Piotr Ponikowski, Alexandre Mebazaa
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引用次数: 0
Changes in Seated Pulmonary Artery Pressure in Response to Titration of Heart Failure Medications During Ambulatory Monitoring.
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-11 DOI: 10.1016/j.cardfail.2025.02.001
Sandip K Zalawadiya, Michael Kiernan, Barry A Borlaug, Lynne Warner Stevenson, Akshay S Desai, Mosi Bennett, Wilfried Mullens, Nicholas J Hiivala, Max M Owens, Liviu Klein

Introduction: Ambulatory hemodynamic monitoring (AHM) of heart failure (HF) using pulmonary artery pressure (PAP) is marked by frequent changes in HF medications. We are beginning to learn how medication titrations during AHM affect mean PAP (mPAP) measured in the seated position, which reflects most waking hours.

Method: We analyzed the 12-month data from the PROACTIVE-HF trial of the Cordella Cordella, Endotronix Inc, Naperville, Illinois, United States) PAP sensor system. Seated mPAP was examined in the 14-days before and after isolated changes in medications; only those medications with ≥10 titrations were analyzed. Dependent sample Wilcoxon-signed rank test was used to compare changes in mPAP with titrations.

Results: We analyzed 456 subjects (age: 64 years, females: 40%, Black: 18%, HF with reduced ejection fraction: 46%). Loop diuretics (LD) were up-titrated 176 times in 133 patients and down-titrated 113 times in 96 patients. Before LD up-titration, mPAP increased by 1.6 ± 1.0 mm Hg; afterwards, it decreased by 2.3 ± 1.0 mm Hg (P < 0.001), with most reduction occurring within 1 week. Down-titration of LD was followed by an increase of 1.8 ± 1.3 mm Hg (P = 0.004) over the next several days. Similar trends were observed across categories of ejection fraction (≤40% and >40%). Angiotensin receptor neprilysin inhibitor (ARNI) up-titration decreased mPAP by 1.8 ± 1.9 mm Hg (P = 0.042), whereas down-titration increased mPAP by 1.5 ± 1.4 (P = 0.094). Mineralocorticoid receptor antagonist (MRA) up-titration tended to decrease mPAP (1.6 ± 2.5 mm Hg, P = 0.286,) whereas down-titration was followed by a significant increase in mPAP of 3.2 ± 1.6 mm Hg (P = 0.001).

Conclusion: The AHM platform using seated mPAP data provided valuable insights into its short-term responses to isolated changes in HF medications. The seated mPAP changed expectedly in response to the titration of LD, whereas the degree of response varied for ARNI and MRA. Ongoing investigation will further characterize the timing and variability of responses to inform algorithms for ambulatory management of PAP.

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引用次数: 0
A Question in the Era of Multiple Effective Therapies for Transthyretin Amyloid Cardiomyopathy (ATTR-CM): Is Transthyretin Biology a Driver of Disease Progression?
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-11 DOI: 10.1016/j.cardfail.2025.01.015
Mathew S Maurer
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引用次数: 0
Is Peak Exercise Performance Relevant to Trials of Patients With HFpEF?
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-11 DOI: 10.1016/j.cardfail.2025.01.018
Yogesh N V Reddy
{"title":"Is Peak Exercise Performance Relevant to Trials of Patients With HFpEF?","authors":"Yogesh N V Reddy","doi":"10.1016/j.cardfail.2025.01.018","DOIUrl":"10.1016/j.cardfail.2025.01.018","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":" ","pages":""},"PeriodicalIF":6.7,"publicationDate":"2025-02-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143414417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"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
PCWL: A Compelling Hemodynamic Metric in Advancing HFpEF Diagnosis.
IF 6.7 2区 医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2025-02-11 DOI: 10.1016/j.cardfail.2025.02.005
Molly K Silkowski, Ryan J Tedford, Javed Butler, Brian A Houston
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Journal of Cardiac Failure
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