Journal of Cardiac Failure最新文献

{"title":"Are Social Determinants Of Health Related To Physical Frailty In Heart Failure?","authors":"Quin E. Denfeld ,&nbsp;Christopher V. Chien ,&nbsp;Shirin O. Hiatt ,&nbsp;Mary Roberts Davis ,&nbsp;S. Albert Camacho ,&nbsp;Christopher S. Lee","doi":"10.1016/j.cardfail.2024.10.044","DOIUrl":"10.1016/j.cardfail.2024.10.044","url":null,"abstract":"<div><h3>Introduction</h3><div>Physical frailty affects a significant number of adults with heart failure (HF), conferring worse clinical and patient-reported outcomes. While the biological (including sex) and physiological factors contributing to physical frailty in HF are beginning to be understood, the contributing role of social determinants of health have not been studied.</div></div><div><h3>Purpose</h3><div>To identify associations between social determinants of health (SDOH) and physical frailty among adults with HF.</div></div><div><h3>Methods</h3><div>We performed a secondary analysis of combined data from two studies of adults with New York Heart Association (NYHA) functional class I-IV HF. Physical frailty was measured with the Frailty Phenotype Criteria: unintentional weight loss, weakness, slowness, physical exhaustion, and low physical activity. We examined the following SDOH factors: race/ethnicity (Non-Hispanic White vs. all other races/ethnicities), level of education (bachelor's degree or higher vs. some college vs. high school or less), financial status (have enough or more than enough to make ends meet vs. do not have enough to make ends meet), employment status (employed vs. retired/unemployed), marital status (married/living with domestic partner vs. single/divorced/widowed), and having someone to confide in (yes vs. no). Logistic regression (odds ratios (OR) with 95% confidence intervals (CI)), adjusted for the known contributors (age, sex, NYHA class, and comorbidity index), was used to identify SDOH predictors of physical frailty. We also explored the influence of sex on associations between each SDOH factor and physical frailty using interaction testing.</div></div><div><h3>Results</h3><div>The sample (n = 160) was 61.7±14.6 years, 44% female, and 62% were NYHA class III/IV. Physical frailty was identified in 44% of the sample. Significant predictors of physical frailty were female sex (OR 3.67, 95% CI [1.62, 8.33]) and being retired/unemployed (OR 3.86, 95% CI [1.38, 10.80]). A nested logistic regression model demonstrated that the block of SDOH factors significantly predicted physical frailty above and beyond age, sex, NYHA class, and comorbidity index (Wald chi² = 14.09, p &lt; 0.05; Δ pseudo R² = 8%). Finally, lower education was a stronger predictor of physical frailty for women than for men (interaction p &lt; 0.05).</div></div><div><h3>Conclusions</h3><div>SDOH, individually and in combination, are potential significant contributors to physical frailty in HF. Retirement or unemployment was a notable predictor of frailty, indicating that it warrants further research and clinical evaluation as a potential sentinel event for adults with HF. Additionally, female sex continues to be strongly associated with and influences predictors of physical frailty in HF.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 195-196"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141363","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}

{"title":"Exercise Intolerance And Cardiac Dysfunction Following Treatment For Intracranial And Craniospinal Tumors In Childhood","authors":"Alena Novikova ,&nbsp;Maria Poltavskaya ,&nbsp;Ilya Giverts ,&nbsp;Maria Pavlova ,&nbsp;Petr Chomakhidze ,&nbsp;Alexandra Bykova ,&nbsp;Nadegda Potemkina ,&nbsp;Anna Shmeleva ,&nbsp;Afina Bestavashvili ,&nbsp;Dinara Mesitskaya ,&nbsp;Zubeida Kuli-Zade ,&nbsp;Nana Gogiberidze ,&nbsp;Anna Levshina ,&nbsp;Alina Zatsepina ,&nbsp;Natalia Plaksina ,&nbsp;Dmitry Shchekochikhin ,&nbsp;Denis Andreev","doi":"10.1016/j.cardfail.2024.10.061","DOIUrl":"10.1016/j.cardfail.2024.10.061","url":null,"abstract":"<div><h3>Objective</h3><div>State-of-the-art therapy improves the five-year survival rate of patients under the age of 20 with cranial and craniospinal tumors up to 74 %. We aimed to assess echocardiographic parameters and exercise performance in subjects following complex treatment for cranial and craniospinal tumors in childhood.</div></div><div><h3>Methods</h3><div>48 subjects who underwent cranial and craniospinal irradiation for CNS tumors in childhood were compared to 20 healthy controls. Examination included cardiopulmonary exercise testing (CPET), hormone studies and echocardiography.</div></div><div><h3>Results</h3><div>According to CPET parameters cancer survivors showed significantly impaired exercise tolerance compared to healthy volunteers resulting in lower peak VO₂ (19.8 vs 30.3 ml*min/kg; p&lt;0.001), lower percent from predicted peak VO₂ (58.6% vs 85.8%; p&lt;0.001) and lower ventilatory efficacy (VE/VCO₂ 29.9 vs 23.6; p=0.044; peak PetCO₂ 36.3 vs 40.6 mm Hg; p=0.009). Poor exercise tolerance was associated with a younger age at the time of treatment initiation. 5 patients from the main group (10.4%) demonstrated abnormal echocardiographic parameters including thickening and calcification of the aortic valve leaflets and diffuse reduction in the systolic LV and RV function. Hormonal derangements like somatotropin insufficiency, hypocorticism, hypothyroidism, hypogonadism in cancer survivors correlated both with exercise intolerance and echocardiographic abnormalities.</div></div><div><h3>Conclusion</h3><div>Exercise intolerance and cardiac dysfunction coupled with hormonal deficits are not uncommon among patients following treatment for intracranial and craniospinal tumors at a young age. Obtained data confirms the importance of regular cardiovascular risk assessment in childhood cancer survivors.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 203-204"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141731","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}

{"title":"Hyperkalemia Risk And The Effect Of Finerenone In Patients With Diabetes And Chronic Kidney Disease: An Analysis From Fidelity","authors":"Joao Pedro P. Ferreira ,&nbsp;Stefan D Anker ,&nbsp;Biff F Palmer ,&nbsp;Bertram Pitt ,&nbsp;Peter Rossing ,&nbsp;Luis M Ruilope ,&nbsp;Christoph Wanner ,&nbsp;Youssef M.K. Farag ,&nbsp;Andrea Horvat-Broecker ,&nbsp;Marc Lambelet ,&nbsp;Meike Brinker ,&nbsp;Katja Rohwedder ,&nbsp;Gerasimos Filippatos ,&nbsp;Marco Lavagnino","doi":"10.1016/j.cardfail.2024.10.033","DOIUrl":"10.1016/j.cardfail.2024.10.033","url":null,"abstract":"<div><h3>Introduction</h3><div>Finerenone (FIN) reduced CV and kidney events in patients (pts) with chronic kidney disease (CKD) and type 2 diabetes (T2D) in FIDELITY, a pooled analysis of the FIDELIO-DKD and FIGARO-DKD trials. Clinically relevant hyperkalemia- (HK-) related AEs were infrequent but the perceived risk may limit FIN use in pts with high risk of increased serum K+. Currently, no incident HK risk models exist in pts with CKD and T2D to identify those at high risk. Using FIDELITY data, we developed a risk prediction model and analyzed FIN efficacy in reducing the incidence of cardiorenal outcomes across pts with different HK risk levels.</div></div><div><h3>Methods</h3><div>Adults with CKD and T2D receiving RASi were randomized to FIN or placebo (PBO). New-onset HK was defined by serum K+ &gt;5.5 mmol/l. Variables independently associated with HK were identified with Cox models with stepwise selection using PBO data and validated with FIN data. An integer risk score was built based on β-coefficients of variables retained in the final model; the score was divided into low, intermediate, and high HK risk categories. FIN efficacy was assessed across HK risk categories tertiles.</div></div><div><h3>Results</h3><div>7 baseline variables were independently associated with incident treatment-emergent serum K+ &gt;5.5 mmol/l (<strong>Table</strong>). Model C-index (SE) was 0.732 (0.012); the model was well-calibrated across HK risk deciles at 2 years. Pts were divided into HK risk categories based on derived integer risk score tertiles: low (0-3 points), intermediate (4-6 points), and high-risk (7-12 points; <strong>Table</strong>). The score ranged from 0-12 points, with a mean (SD) of 4.7 (2.1) points. Treatment-emergent serum K+ &gt;5.5 mmol/l was increased in pts with a higher HK risk category; 2.7%, 7.0%, and 16.7% of pts assigned PBO reported an event in the low-, intermediate- and high-risk group. In the FIN risk groups, this finding was confirmed (<strong>Fig</strong>). FIN reduced major CV and kidney event incidence vs PBO irrespective of HK risk category.</div></div><div><h3>Conclusions</h3><div>Based on FIDELITY data, we developed and validated an easy-to-use integer risk score model for new-onset HK in patients with CKD and T2D. The risk score enables HK risk identification of individual patients, irrespective of FIN treatment. As FIN benefited pts across all HK risk categories, the developed risk score could facilitate tailored follow-up and therapeutic strategies aimed to mitigate HK in high-risk patients with indication for FIN.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 190-191"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142028","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}

{"title":"Impact Of HF Etiology On The Sustainability Of Favorable Response After LVAD Weaning: A VAD Wean Registry Analysis","authors":"Eleni Maneta ,&nbsp;Christos Kyriakopoulos ,&nbsp;Elizabeth Dranow ,&nbsp;Thomas Hanff ,&nbsp;Josef Stehlik ,&nbsp;Omar Wever-Pinzon ,&nbsp;Rebecca Cogswell ,&nbsp;Jessica Schultz ,&nbsp;Andrew Schwartzman ,&nbsp;Keyur Shah ,&nbsp;Guy Macgowan ,&nbsp;Stephan Schueler ,&nbsp;Daniel Zimpfer ,&nbsp;Ulrich Jorde ,&nbsp;Craig Selzman ,&nbsp;Snehal Patel ,&nbsp;Stavros Drakos","doi":"10.1016/j.cardfail.2024.10.051","DOIUrl":"10.1016/j.cardfail.2024.10.051","url":null,"abstract":"<div><h3>Introduction</h3><div>A subset of HF patients can experience significant improvement of their cardiac structure and function while on LVAD support.</div></div><div><h3>Hypothesis</h3><div>We sought to investigate the impact of HF etiology on the durability of cardiac improvement and favorable outcomes after LVAD weaning.</div></div><div><h3>Methods</h3><div>We studied 324 HF patients enrolled in the international multicenter VAD Wean Registry who received a durable continuous-flow LVAD and underwent device support weaning (Figure Panel A). Indications for VAD weaning included: structural/functional cardiac improvement meeting institutional criteria for “myocardial recovery” (responders) or LVAD-related complications accompanied by variable degrees of cardiac improvement (partial responders). Patients were divided into seven categories based on HF etiology: ischemic cardiomyopathy (CM) (n=30), post-myocarditis CM (n=65), peripartum CM (n=53), valvular CM (n=12), chemotherapy-induced CM (n=14) and idiopathic CM (n=150). The primary outcome was 2-year survival free of transplant or LVAD re-implantation. The secondary outcome was the LVEF, measured by echocardiography at 3, 6, 12 and 24 months post-LVAD weaning.</div></div><div><h3>Results</h3><div>Patients with idiopathic, peripartum and post-myocarditis CM had higher rate of 2-year survival free of transplant or LVAD re-implantation compared to patients with chemotherapy-induced CM (Figure-Panel B) (p-values: 0.009, 0.004, 0.001, respectively). Patients with post-myocarditis CM were also more likely to achieve the primary outcome compared to those with ischemic CM (ICM) (p-value, 0.009). The LVEF changes over time are depicted in the Figure-Panel C and detailed in the Table.</div></div><div><h3>Conclusions</h3><div>In this multicenter analysis the etiology of HF appears to impact the durability of favorable response after LVAD weaning. The degree of reverse remodeling achieved before VAD weaning and its impact on the durability of response in different HF etiologies warrants further investigation in studies with larger patient population and power.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 199-200"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142293","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}

{"title":"Phase Ib Study Of Hs135, A Novel Activin And Gdf Inhibitor, In Patients With Obesity-related Heart Failure With Preserved Ejection Fraction And Pulmonary Hypertension Leveraging Remote Pulmonary Artery Pressure Monitoring Technology","authors":"Andrew Sauer ,&nbsp;Dan Chiche ,&nbsp;Julia Schoelermann ,&nbsp;Maureen O'Connor-McCourt ,&nbsp;Mikhail Kosiborod","doi":"10.1016/j.cardfail.2024.10.027","DOIUrl":"10.1016/j.cardfail.2024.10.027","url":null,"abstract":"<div><h3>Rationale</h3><div>Heart failure (HF) with preserved ejection fraction (HFpEF) has become the predominant type of HF. Obesity-related HFpEF is the most common phenotype, associated with an especially high burden of symptoms and physical limitations, and a poor quality of life. Pulmonary hypertension (PH) is a common feature of obesity-related HFpEF. HS135 is a novel decoy trap for Activins and Growth Differentiation Factors (GDFs), including myostatin, which are genetically and clinically validated targets in PH, obesity, and HF. HS135 is differentiated from other Activin and GDF targeting mechanisms via its potential for best-in-class multi-specific potency which results in increased therapeutic window and qualitatively differentiated efficacy in PH, HF and body composition in pre-clinical models. Therefore, HS135 holds promise as a potential novel treatment option for patients with obesity-related HFpEF and PH. HS135-003 is a Phase 1b clinical trial to assess the preliminary safety and efficacy of HS135 in patients with PH and HFpEF (PH-HFpEF). The innovative trial design employs remote pulmonary artery (PA) pressure sensor technology which allows for frequent monitoring of PH-related hemodynamics.</div></div><div><h3>Methods</h3><div>This ongoing, randomized, double-blind, placebo-controlled, multiple ascending dose study is actively enrolling up to 40 adult male and female patients diagnosed with PH-HFpEF at centers in the US. Patients with a CardioMEMS™ HF System implanted as a part of standard care and a BMI of ≥30 kg/m² are eligible. Several dose levels of subcutaneous HS135 will be explored in sequential fashion with a primary endpoint of safety. Secondary endpoints will include change from baseline up to week 24 in mean PA pressure and mean PA diastolic pressure measured using CardioMEMS™. Additional assessments of hemodynamics, patient-reported symptoms and physical limitations, exercise function, as well as echocardiographic, morphological, body composition and biomarker measurements will be assessed. Patients who desire and can benefit from HS135 therapy will be offered to enter an open label extension period upon completion of the initial treatment period.</div></div><div><h3>Results</h3><div>In progress.</div></div><div><h3>Conclusion</h3><div>This is a Phase 1b trial in progress to assess the preliminary safety and efficacy of the novel Activin and GDF inhibitor HS135 in obese patients with PH-HFpEF. Ambulatory PA pressure measurements in addition to patient-reported outcomes, measures of exercise function, biomarker and body composition endpoints are expected to provide valuable data to evaluate safety, identify efficacy signals and inform further development.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 188"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142611","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}

{"title":"Emerging Adults: a Group Caught in the Middle","authors":"ELENA M. DONALD MD","doi":"10.1016/j.cardfail.2024.10.450","DOIUrl":"10.1016/j.cardfail.2024.10.450","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 169-171"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142800923","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}

{"title":"Leveraging HF Stats for Enhanced Heart Failure Management: A Guide for Practitioners","authors":"","doi":"10.1016/j.cardfail.2024.12.005","DOIUrl":"10.1016/j.cardfail.2024.12.005","url":null,"abstract":"<div><div>Cardiology providers and healthcare clinicians tackling heart failure (HF) face an escalating challenge: rising prevalence rates and widening disparities among populations. In this context, leveraging up-to-date and specialized data becomes paramount. Although the American Heart Association's (AHA) <em>Heart and Stroke Statistics</em> provides a sweeping overview of cardiovascular health with a few pages dedicated to HF and cardiomyopathy, the Heart Failure Society of America's (HFSA) <em>HF Stats</em> annual publication offers an up-to-date and in-depth look at multiple themes related to HF epidemiology, global trends, outcomes and much more. This article highlights the unique benefits of <em>HF Stats</em>, why providers and clinicians should want to utilize the report and its dedicated website, <span><span>HFStats.org</span><svg><path></path></svg></span>, and how the report contents can enhance clinical practice, research, and patient care.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 178-179"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143006007","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}

{"title":"Serotonergic Antidepressants Increase Bleeding Risk In Heart Failure Patients With Left Ventricular Assist Device: A Systematic Review And Meta-analysis","authors":"Omar Almaadawy ,&nbsp;Rahma AbdElfattah Ibrahim ,&nbsp;Obaid Haque ,&nbsp;Mohamed Elnady ,&nbsp;Yakubu Bene-Alhasan ,&nbsp;Ahmad Elashery","doi":"10.1016/j.cardfail.2024.10.057","DOIUrl":"10.1016/j.cardfail.2024.10.057","url":null,"abstract":"<div><h3>Introduction</h3><div>Serotonergic antidepressants (SAs) are the primary pharmacological treatment for depressive symptoms in patients with heart failure (HF). However, concerns have been raised about the potential for bleeding events in patients with left ventricular assist devices (LVADs).</div></div><div><h3>Hypothesis</h3><div>This systematic review and meta-analysis aim to quantify the bleeding risk in patients with heart failure with LVADs who are taking serotonergic antidepressants.</div></div><div><h3>Methods</h3><div>A systematic review and meta-analysis were conducted on clinical trials retrieved from Scopus, Cochrane, PubMed, and Web of Science databases from their inception until March 2024. Studies reporting on the association of bleeding events with the use of SSRI/SNRI therapy were included. The primary outcome was the occurrence of any bleeding events. Data from the studies were pooled using RevMan V5.4, and odds ratios (OR) and confidence intervals (CI) were calculated for the outcome.</div></div><div><h3>Results</h3><div>The meta-analysis included four studies, mainly observational retrospective studies, as the search yielded no randomized controlled trials, with a total of 1006 participants. Among them, 183 of the 408 (44.8%) patients taking SSRIs/SNRIs experienced bleeding, compared to 207 of the 598 (34.6%) patients not taking SSRIs/SNRIs. The increased risk of bleeding was statistically significant (P=0.005), with an odds ratio of 1.45 [95% CI: 1.12, 1.89], favoring the control group (not taking SSRIs/SNRIs). The limitation of this study is the non-availability of randomized data. Also, the bleeding outcome differs across the studies, with two studies reporting the occurrence of any bleeding, two studies reporting gastrointestinal bleeding, and one study reporting hospitalization for any bleeding.</div></div><div><h3>Conclusion</h3><div>The findings suggest that the rate of bleeding is higher in patients with heart failure with LVADs who are treated with serotonergic antidepressants compared to those who are not treated with serotonergic antidepressants. This underscores the need for careful monitoring when prescribing these medications. However, further research is needed to confirm the findings and identify the optimal serotonergic antidepressant associated with less or no bleeding.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 202"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141728","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}

{"title":"Efficacy And Safety Of Vasodilators For The Management Of Persistent Pulmonary Hypertension Of The Newborn: A Systematic Review And Network Meta-analysis","authors":"Amr Elrosasy ,&nbsp;Ahmed Maher ,&nbsp;Nada G Hammam ,&nbsp;Mohamed Soliman ,&nbsp;Ahmed A Ali ,&nbsp;Abdelraouf Ramadan ,&nbsp;Ahmed Fawzy ,&nbsp;Linda Alkassas ,&nbsp;Noha Abdelhadi ,&nbsp;Beshoy Emad ,&nbsp;Menna Kamel ,&nbsp;Wael Abdelmottaleb ,&nbsp;Sameh Nassar","doi":"10.1016/j.cardfail.2024.10.069","DOIUrl":"10.1016/j.cardfail.2024.10.069","url":null,"abstract":"<div><h3>Background</h3><div>Persistent pulmonary hypertension of the newborn (PPHN) is a critical condition characterized by elevated pulmonary vascular resistance (PVR) with subsequent right-to-left shunting. PPHN is associated with significant increase in neonatal morbidity and mortality. While inhaled nitric oxide is the primary treatment, alternative pulmonary vasodilators are currently under investigation due to inhaled nitric oxide limitations. Our study aims to compare the efficacy of various vasodilators as a second-line therapy or adjunctive therapy for management of PPHN.</div></div><div><h3>Methods</h3><div>We conducted a network meta-analysis to analyze nine treatment options, including inhaled nitric oxide, phosphodiesterase inhibitors, and endothelin-1 receptor antagonists. The outcomes analyzed in our study included oxygenation index, length of hospital stay, side effects, treatment failure, and mortality. Statistical analyses were performed using R software with the netmeta package.</div></div><div><h3>Results</h3><div>We included 12 randomized controlled trials involving 2,911 patients. Milrinone and sildenafil demonstrated statistically significant reduction in thge length of hospital stay in the treatment group when compared to the placebo group, with mean difference (MD) of -6.9 days (95% confidence interval (CI): -12.7 to -1.36) and -6.3 days (95% CI: -12.0 to -0.6), respectively. While surfactant and nitric oxide were the most effective in reducing treatment failure, with statistically significant MDs of -0.734 (95% CI: -1.30; -0.17) and -0.6 (95% CI: -0.81; -0.38) respectively. There were no statistically significant difference among the treatment group when compared to the control group in improving oxygenation index, lowering side effects or improving mortality.</div></div><div><h3>Conclusion</h3><div>This network meta-analysis provides insights into the comparative efficacy of various pulmonary vasodilators for PPHN management. While some treatment options showed promising results in particular outcomes, further research is needed to confirm these findings and identify optimal strategies for improving neonatal outcomes in PPHN.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 207"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142053","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}

{"title":"Outcomes Of Axillary-first Approach For Impella 5.5 Placement:Insights For Successful Support","authors":"Ameesh Isath ,&nbsp;Vasiliki Gregory ,&nbsp;Shazli Khan ,&nbsp;Guy Elgar ,&nbsp;Gregg Lanier ,&nbsp;Chhaya Aggarwal ,&nbsp;Junichi Shimamura ,&nbsp;Stephen Pan ,&nbsp;Avi Levine ,&nbsp;Alan Gass ,&nbsp;Suguru Ohira","doi":"10.1016/j.cardfail.2024.10.048","DOIUrl":"10.1016/j.cardfail.2024.10.048","url":null,"abstract":"<div><h3>Background</h3><div>Axillary artery (AA) insertion of Impella 5.5, often placed from the right side, can present unique challenges due to the need for AA diameter &gt;7mm to accommodate the device's size (21 Fr). Left AA insertion involves crossing the aortic arch and more anatomical turns to reach the aortic valve. No data exists on the impact of small AA diameter and the laterality on Impella insertion.</div></div><div><h3>Methods</h3><div>We retrospectively reviewed consecutive Impella 5.5 placement patients from June 2020 to Jan 2024 at our institution (N=75), classifying patients by AA diameter (small, &lt;7 mm vs. normal, ≥7 mm) and access laterality (left vs. right).</div></div><div><h3>Results</h3><div>The AA approach was attempted in all (N=74) but one requiring innominate access, with a technical success rate of 95.9% (N=71/74). The mean age was 58.8±13.3 years, with 81.1% males. Indication for Impella placement is shown in Figure. The median delivery time was 7.0 (25^th, 75^thpercentiles: 4.0,11.5) minutes with a median support duration of 13 (7.7,24) days.</div><div>Ten patients (10.6%) had a small AA, with a mean diameter of 6.3±0.5 mm and was more likely to be younger compared to normal AA with diameter of 8.7±1.2 mm. The smallest AA attempted with successful insertion measured 5.5 mm in 2 young patients. Despite the differences, the delivery time was similar (small, 5.4 [3.5,10.9]) vs. normal, 7 [4.0,12.1] min, P=0.59).</div><div>Regarding laterality of access, 59 patients (79.7%) underwent right AA implantation. The median delivery time was comparable (left, 6 [3.7,10.4) vs. right, 10.4 [5.3,15.2] min, P=0.35). Delivery failures in 3 female patients (mean age 66±3 years and AA diameter, 7.2±0.5 mm) were due to arterial calcification and tortuosity at subclavian to innominate artery or aortic arch on computed tomography, necessitating Impella CP device (N=2) or abandonment (N=1). The overall postoperative outcomes including stroke, vascular complications, infection, and hospital mortality was similar between either groups with respect to diameter as well as laterality (Table).</div></div><div><h3>Conclusion</h3><div>Axillary Impella 5.5 placement can be safely inserted in most patients, with adaptability in AAs &lt;7 mm, potentially due to underestimation of diameters in shock patients and lower atherosclerosis in younger individuals. Challenges exist for older female patients with significant calcifications and tortuosity near bifurcation. Laterality of access also does not seem to influence outcomes.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 198"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142290","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}