Journal of Cardiac Failure最新文献

{"title":"Feasibility Of A Novel Implantable Device To Provide Heart Failure Therapy And Left Atrial Pressure Monitoring In A Chronic Animal Study","authors":"Shuchen Ge,&nbsp;Hui Yu,&nbsp;Haiyang Xu,&nbsp;Bo Li,&nbsp;Eva Yu,&nbsp;Kun Liu,&nbsp;Tao Zhang,&nbsp;Jing Zhang,&nbsp;Min Jiang,&nbsp;Qingyi Sun,&nbsp;Li Wang","doi":"10.1016/j.cardfail.2025.11.060","DOIUrl":"10.1016/j.cardfail.2025.11.060","url":null,"abstract":"<div><h3>Introduction</h3><div>Pulmonary Artery Pressure Monitoring has been shown to reduce rehospitalization in HF patients. Interatrial Shunting (IS) is in clinical studies for similar purposes. However, none of the currently available devices provide both at the same time.</div></div><div><h3>Hypothesis</h3><div>A novel implantable system has been developed to provide IS and LAP monitoring. It consists of an implant device, a delivery system, and an external Monitoring Unit (MU). The MU works with the device’s MEMS pressure sensor to provide the measured LAP. This study aims to assess the feasibility of the system and accuracy of measured LAP in a chronic canine study.</div></div><div><h3>Methods</h3><div>The device was implanted in 10 healthy dogs (Labrador, 30-35 Kg), with 4 observed for 1 month and 6 for 3 months. Procedure success, safety outcome, shunt patency (via TEE) and pressure accuracy were evaluated. To achieve various pressure levels, phenylephrine (0.05-2.00 mg) was injected during implant and at the end of each follow up (FU) before termination. Waveforms of PCWP from Swan Ganz and LAP from the device were recorded for more than 10 seconds by PowerLab (PLC01) and MU respectively. Correlation and agreement between LAP and PCWP were assessed with Pearson’s correlation analysis and Bland-Altman plots.</div></div><div><h3>Results</h3><div>The implant was successful in all dogs with shunt patent at 1 or 3 months. No device related adverse event was observed. Pressure points were obtained for each dog, with a total of 42 pairs of pressure measurements ranging from 0 to 22 mmHg from all dogs. <strong>Fig. 1a</strong> shows an example of the device encapsulation by a thin layer of endothelium at 3 months. Simultaneous pressure waveform recordings, correlation and Bland-Altman plot are shown in <strong>Fig.1b-d</strong>. The PCWP and LAP measurements correlated well (<strong><em>R²</em>=0.87</strong>), with an average difference of 0.33±1.80 mmHg. In the Bland-Altman plot, 40 of 42 pairs fell inside the 95% limit of agreement, indicating good agreement between PCWP measured by Swan-Ganz and LAP by the device.</div></div><div><h3>Conclusions</h3><div>This preliminary chronic animal study demonstrated the feasibility of this implantable device and the accuracy of device-based LAP as compared to PCWP. Further studies are warranted. This novel device with interatrial shunting therapy and hemodynamic monitoring has the potential to provide clinicians with more options for managing HF patients.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 197"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950347","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":"Temporal Trends In Gender, Racial, And Geographic Disparities Of Heart Failure And Pulmonary Embolism-related Mortality Among Adults In The United States: A Retrospective Analysis","authors":"Suhayya Batool ,&nbsp;Daniya Naveed ,&nbsp;Ahmed Sanan ,&nbsp;Rutaba Siddiqui ,&nbsp;Abdul Hannan ,&nbsp;Qura Tul Ain","doi":"10.1016/j.cardfail.2025.11.050","DOIUrl":"10.1016/j.cardfail.2025.11.050","url":null,"abstract":"<div><h3>Background</h3><div>Heart Failure (HF) and Pulmonary Embolism (PE)-related mortality rates are increasing annually in the United States. This study aims to analyze mortality trends of HF and PE-related deaths in the adult population of the United States (1999-2000).</div></div><div><h3>Methods</h3><div>The study analyzed HF and PE-related mortality rates from 1999 to 2020 using death certificate data from the Centers for Disease Control and Prevention Wide-Ranging OnLine Data for Epidemiologic Research (CDC WONDER). The Age-Adjusted Mortality Rates (AAMR), per 100 000 people, Annual Percent Changes (APCs) and corresponding Confidence Intervals (CIs) were calculated. Data was further stratified by year, sex, race, and geographic region (state and census regions).</div></div><div><h3>Results</h3><div>This study examines 60,072 deaths related to HF and PE among U.S. adults aged 25-85+ years from 1999 to 2020. The age-adjusted mortality rate (AAMR) increased from 1.1 (95% CI: 1.05-1.15) in 1999 to 1.88 (95% CI: 1.83-1.93) in 2020, with a particularly sharp rise from 2018 to 2020 with an APC of 12.14%. The total number of deaths increased from 1,980 in 1999 to a peak of 5,026 in 2020. Mortality was higher among females accounting for 56.07% than males with just 43.93% of total deaths, although men exhibited higher AAMRs 1.35 than that of females of 1.2, AAMRs among men increased from 1.15 in 1999 to 2.14 in 2020 with an APC of 7.21%, while females' AAMR had a significant rise from 1.3 in 2018 to 1.66 in 2020 having an APC of 12.16%. Racial disparities were evident, with non-Hispanic Black individuals having the highest AAMR of 2.10, followed by non-Hispanic Whites with AAMR of 1.24, non-Hispanic American Indian or Alaska Natives had AAMR of 1.13, Hispanics with 0.41 AAMR, and non-Hispanic Asian or Pacific Islanders had an AAMR of 0.38 The AAMR for non-Hispanic Black individuals rose significantly after 2016 all the way to 2020 with a staggering APC of 11.48%. Geographic differences were also notable, with the Southern region accounting for the highest proportion of deaths,37.50% of the total deaths where Wyoming recorded the highest AAMR of 2.05, while Hawaii had the lowest of 0.65. States like Texas and California contributed the highest total deaths with an AAMR of 1.55 and AAMR of 1.12 respectively.</div></div><div><h3>Conclusion</h3><div>Heart failure and pulmonary embolism-related AAMR inclined in the US from 1999 to 2020, with an obvious rise seen in the last year of our study period. This trend was seen more in men, NH black Africans, and southern regions of the country. Further prospective research with larger sample sizes and controlling for potential confounding factors is critical to better elucidate these correlations.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 192"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950368","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":"CRRL 101, A Novel Bispecific Biologic Targeting The Glucagon-like Peptide-1 (glp-1) Receptor And Guanylyl Cyclase A (gca) Receptor, Demonstrates Beneficial Cardiometabolic Effects In Vitro","authors":"Jasraj Singh,&nbsp;Fadi Adel,&nbsp;Xiaoyu Ma,&nbsp;Ye Zheng,&nbsp;Shuchong Pan,&nbsp;JC Malsawmzuali,&nbsp;Dante Moroni,&nbsp;Horng Chen","doi":"10.1016/j.cardfail.2025.11.005","DOIUrl":"10.1016/j.cardfail.2025.11.005","url":null,"abstract":"<div><h3>Introduction</h3><div>The increasing prevalence of cardiometabolic diseases which, via insulin resistance, cellular apoptosis, and myocardial fibrosis, lead to heart failure with preserved ejection fraction.</div></div><div><h3>Hypothesis</h3><div>Our novel bispecific biologic (CRRL 101) mitigates these processes by targeting both the GLP-1 and GCA pathways.</div></div><div><h3>Methods</h3><div>We evaluated CRRL 101 (10 µM) in vitro using transfected human embryonic kidney (HEK) cells, INS-1 rat pancreatic beta cells, human cardiac fibroblasts (HCF), AC16 human cardiomyocytes, and human preadipocytes-visceral(HPA-vis). Data was analyzed using GraphPad Prism 9.4.1 and are presented as mean ± SEM.</div></div><div><h3>Results</h3><div>In HEK cells, CRRL 101 markedly increased cyclic guanosine monophosphate (cGMP) levels (8.9 pmol/mL ± 5.1 vs 457.2 pmol/mL ± 64.9 relative activity 100) in GCA-expressing HEK, with no effect in guanylyl cyclase B (GCB) receptor-expressing HEK cells (3.57 pmol/mL ± 0.53 vs 5.12 pmol/mL ±1.86 relative activity 1.4). Demonstrating its effect via the GLP-1 signaling pathway, it also increased cAMP levels at all doses in a 20 mM glucose medium (16.7 pmol/mL ± 1.47 vs 24.87 pmol/mL ± 2.53 p=0.0041, 22.95 pmol/mL ± 3.95 p=0.0042, and 23.19 pmol/mL ± 1.51 p=0.0036) in INS-1 cells, and doubled insulin secretion independent of the glucose environment (3.8 ng/mL ± 0.74 vs 7.1 ng/mL in 2.8 mM glucose p = 0.0019 and 4.4 ng/mL ± 0.44 vs 9.5 ng/mL ± 0.34 in 20 mM glucose p &lt; 0.0001). In HCF cells, CRRL 101 attenuated alpha smooth muscle actin (α-SMA) activation by both insulin and transforming growth factor beta 1 (TGF-β1). In AC16 cells, CRRL 101 exhibited dose-dependent inhibition of insulin mediated apoptosis and a similar inhibition of TGF-β1 and insulin-mediated collagen secretion (85.11 µg/mL ± 15.32 vs 55.93 µg/mL ± 13.15 p=0.09; and 86.27 µg/mL ± 14.10 vs 48.20µg/mL ± 12.03 p=0.0331, respectively). Finally, CRRL 101 demonstrated marked adipose browning in HPA-vis (Figure 1).</div></div><div><h3>Conclusion</h3><div>CRRL 101 is a GCA-selective and GLP-1 chimeric bispecific biologic with favorable insulinergic, anti-apoptotic, anti-fibrotic, and pro-adipose browning effects uniquely mediated through its activity at the GLP-1 and GCA receptors. Further in vivo studies are in progress to explore its therapeutic potential.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 171"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950423","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":"Time-to-Diuretics in Acute Heart Failure Management: Striking the Balance Between Speed and Accuracy","authors":"SIAMACK ALAM-SHOUSHTARI ,&nbsp;NATHANIEL M. HAWKINS ,&nbsp;ROBERT MCKELVIE ,&nbsp;STEPHANIE POON ,&nbsp;GEORGE HONOS ,&nbsp;SHELLEY ZIEROTH ,&nbsp;JUSTIN EZEKOWITZ ,&nbsp;SEAN A. VIRANI ,&nbsp;NIMA MOGHADDAM MD FRCPC.","doi":"10.1016/j.cardfail.2025.07.011","DOIUrl":"10.1016/j.cardfail.2025.07.011","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Pages 157-159"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144816746","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":"Patient Focus: Teamwork to Make the Heart Work: An Explanation of the Impact of Embedded Interdisciplinary Heart Failure Teams on Achieving Guideline-Directed Medical Therapy in Community-Based Cardiology Practices","authors":"ANAS JAWAID MD ,&nbsp;JENNIFER T. THIBODEAU MD, MSCS","doi":"10.1016/j.cardfail.2025.03.002","DOIUrl":"10.1016/j.cardfail.2025.03.002","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Pages 27-28"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143639618","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":"The JCF 2025 Year-In-Review: Onwards and Upwards!","authors":"ASHISH CORREA MD ,&nbsp;QUIN DENFELD PhD, RN, FAHA, FAAN, FHFSA","doi":"10.1016/j.cardfail.2025.12.001","DOIUrl":"10.1016/j.cardfail.2025.12.001","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Pages 1-4"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950119","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":"Evaluating The Timeliness And Equity Of ATTR-CM Diagnosis In The Medicare Population","authors":"Gabriela Spencer-Bonilla ,&nbsp;Jun Fan ,&nbsp;Anubodh S. Varshney ,&nbsp;Paul Cheng ,&nbsp;Natasha Din ,&nbsp;Fatima Rodriguez ,&nbsp;Marie Davies ,&nbsp;Mia Papas ,&nbsp;John Venditto ,&nbsp;Joanna Huang ,&nbsp;Ronald Witteles ,&nbsp;Paul Heidenreich ,&nbsp;Alexander Sandhu ,&nbsp;Kevin Alexander","doi":"10.1016/j.cardfail.2025.11.006","DOIUrl":"10.1016/j.cardfail.2025.11.006","url":null,"abstract":"<div><h3>Background</h3><div>Timely diagnosis of transthyretin amyloidosis with cardiomyopathy (ATTR-CM) is critical to initiate treatment and reduce subsequent morbidity and mortality for these patients. The contemporary timeline of ATTR-CM diagnosis and patient journey is not well characterized. We describe the time from heart failure (HF) diagnosis to ATTR-CM diagnosis and identify predictors of delayed diagnosis of ATTR-CM in the Medicare population.</div></div><div><h3>Methods</h3><div>This retrospective cohort study used Medicare fee-for-service data. We identified patients with ATTR-CM diagnosed between 2016 and 2022 based on a previously validated algorithm using diagnoses and medication data. The time to diagnosis was defined as the number of days between each patient’s first HF diagnosis and their first amyloid diagnosis. We used multivariable logistic regression to assess demographic, clinical, and socioeconomic predictors of time to ATTR-CM diagnosis using ≥6 months as a clinically meaningful delay.</div></div><div><h3>Results</h3><div>7,770 patients with HF and ATTR-CM were identified. The median age at the time of ATTR-CM diagnosis was 81 years (interquartile range [IQR]: 76-86); 1,775 (22.8%) patients identified as female. Most patients were White (5,789; 75%) or Black (1,522; 20%). The median time from HF diagnosis to ATTR-CM diagnosis was 494 days (IQR: 63, 1340), with 4,992 (64%) of Medicare enrollees having a diagnostic delay (&gt; 6 months). For the 6,175 patients with a loop diuretic prescription before ATTR-CM diagnosis, the median time between initial loop prescription and ATTR-CM diagnosis was 840 days (IQR: 252, 1,768). After adjustment, older age (OR 0.69; CI 0.64-0.74), male sex (OR 0.81; CI 0.72-0.92) and history of carpal tunnel syndrome (OR 0.84; CI 0.73-0.96) were associated with lower odds of delayed diagnosis. Black race (OR 1.14; CI 1.00-1.30), a history of aortic stenosis (OR 1.4; CI 1.2-1.6), chronic obstructive pulmonary disease (COPD) (OR 1.17; CI 1.02-1.33), coronary artery disease (OR 1.22; CI 1.10-1.36), diabetes mellitus (OR 1.24; CI 1.10-1.42), and hypertension (OR 1.26; CI 1.11-1.42) were associated with higher odds of delayed diagnosis.</div></div><div><h3>Conclusions</h3><div>There are significant delays between incident HF and diagnosis of ATTR-CM. Black race, despite being associated with variant ATTR and possibly a more severe disease course, was associated with higher odds of delayed diagnosis. Additionally, having a history of aortic stenosis, coronary artery disease, diabetes or hypertension, which are each associated with elevated risk of cardiomyopathy, was associated with higher odds of delayed diagnosis. These findings highlight the need for targeted interventions to decrease diagnostic delay in the Black population and a need for a heightened index of suspicion for ATTR-CM in patients with possible alternate etiologies of cardiomyopathy or heart failure symptoms.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 172"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950111","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":"Pre-Transplant Peripheral Artery Disease Doubles One-year Mortality Risk After Heart Transplantation","authors":"Bana Hadid ,&nbsp;Sarah Schwartz ,&nbsp;Devin Mantini ,&nbsp;Brian LaBarre ,&nbsp;Julia Baranowska ,&nbsp;Adi Hertz ,&nbsp;Ersilia M. DeFillipis ,&nbsp;Kevin Clerkin ,&nbsp;Jayant Raikhelkar ,&nbsp;Justin Fried ,&nbsp;Kyung Taek Oh ,&nbsp;David Bae ,&nbsp;David Majure ,&nbsp;Melana Yuzefpolskaya ,&nbsp;Paolo Colombo ,&nbsp;Yoshifumi Naka ,&nbsp;Farhana Latif ,&nbsp;Koji Takeda ,&nbsp;Nicholas J. Morrissey ,&nbsp;Nir Uriel ,&nbsp;Gabriel Sayer","doi":"10.1016/j.cardfail.2025.11.022","DOIUrl":"10.1016/j.cardfail.2025.11.022","url":null,"abstract":"<div><h3>Introduction</h3><div>Peripheral artery disease (PAD) is a known risk factor for adverse cardiovascular outcomes and severe PAD has traditionally been considered a relative contraindication to heart transplantation (HT). However, with advancements in PAD management, its impact on post-HT outcomes warrants reevaluation.</div></div><div><h3>Hypothesis</h3><div>We hypothesize that pre-HT PAD is associated with an increased risk of one-year post-HT mortality and stroke.</div></div><div><h3>Methods</h3><div>A retrospective study to evaluate all adult patients who underwent HT at a large, advanced heart failure center from January 2012 to May 2022. PAD was defined as a history of cerebrovascular disease (stroke or transient ischemic attack), claudication, abnormal non-invasive flow studies (ankle-brachial index &lt;1), abnormal carotid dopplers (&gt;50% stenosis), abnormal upper or lower extremity arterial dopplers (&gt;50% stenosis), or stenosis/occlusion of the lower extremity (LE) on computed tomography angiography (CTA). Demographic and clinical characteristics were compared between patients with and without PAD. Analyses included chi-square tests, Kaplan-Meier survival curves, and log-rank tests using R and Python.</div></div><div><h3>Results</h3><div>Of the 595 patients included (mean age 52.7 years, 27.9% female, 26.6% Black), 216 (36.3%) met the criteria for PAD. Patients with PAD had a higher prevalence of pre-HT diabetes (32.4% vs 20.8%, p = 0.002). 120 (55.6%) patients with PAD had a stroke prior to HT. There was no statistically significant difference in sex, race, chronic kidney disease stage, or prior HT between patients with and without PAD. One-year post-HT mortality was more than two times greater for patients with PAD (11.6% vs 5.5%, p=0.013, Figure), with the highest mortality rates observed in patients with abnormal LE dopplers (23.8%), abnormal LE CTA (20.0%), and claudication (16.7%). Importantly, PAD was not associated with an increased risk of post-HT stroke (9.3% vs. 8.4%, p=0.85). Even when considering the composite outcome of death or stroke in PAD vs no PAD (18.1% vs 12.4%, p=0.08), the increased risk was driven solely by mortality, with stroke rates remaining comparable between groups.</div></div><div><h3>Conclusions</h3><div>This analysis found that pre-transplant PAD was associated with an increased one-year mortality following HT, while stroke rates remained unchanged. These findings highlight PAD as a key risk factor in transplant evaluation. The association between PAD and reduced survival underscores the need for enhanced perioperative risk stratification and tailored post-transplant management strategies.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 178"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950171","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":"The Impact Of Race, Status Exception, And Hemodynamic Support On Waitlist Removal Among Heart Transplant Candidates: An Examination Of The Unos Registry","authors":"Quentin R. Youmans ,&nbsp;Cedrick Mutebi ,&nbsp;Abigail S. Baldridge ,&nbsp;Tingqing Wu ,&nbsp;Rebecca Harap ,&nbsp;Sarah Chuzi ,&nbsp;Jane Wilcox ,&nbsp;Benjamin Bryner ,&nbsp;Duc Pham ,&nbsp;Ersilia DeFillipis ,&nbsp;Clyde Yancy MD MSc ,&nbsp;Ike Okwuosa ,&nbsp;Anjan Tibrewala","doi":"10.1016/j.cardfail.2025.11.029","DOIUrl":"10.1016/j.cardfail.2025.11.029","url":null,"abstract":"<div><h3>Objectives</h3><div>UNOS status qualification in heart transplantation directly impacts likelihood to receive a heart transplant (HT). The current US allocation system aims to prioritize patients based on acuity of illness with an emphasis on patients that need temporary mechanical circulatory support (MCS). However, exceptions are often granted. Our study examines differences in HT waitlist removal based on race, levels of support, and status exception.</div></div><div><h3>Methods</h3><div>We examined the UNOS database including patients listed for isolated heart transplant from 10/2018 - 12/2023. We evaluated waitlist removal based on self-reported race -Black, White, or Other. Level of support was defined as either temporary MCS, inotropes, or neither. Participants were additionally separated by whether they had a status exception granted. Cumulative incidence of waitlist removal was compared using Fine-Gray models to account for competing risk of HT.</div></div><div><h3>Results</h3><div>Over the study period, 17,767 patients were listed for isolated HT: 10,574 [60%] White, 4,457 [25%] Black, and 2736 [15%] of other races. Black patients had higher waitlist removal compared to white patients and other races p=0.0002 (Figure 1A)<strong>.</strong> While Black and White patients supported with temporary MCS or inotropes had similar waitlist outcomes (Figures 1C and 1D), Black patients listed with an exception without support from inotropes or MCS had higher waitlist removal compared to White patients without either p=0.0386 (Figure 1B).</div></div><div><h3>Conclusion</h3><div>Waitlist removal was higher for Black patients compared to White patients and other races. Black patients granted an exception may be sicker and under-supported relative to White patients while awaiting HT, contributing to higher waitlist removal. Further analyses are necessary to elucidate the association among race and adverse waitlist outcomes.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 182"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950217","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":"Clinical, Laboratory, And Ultrasonographic Determinants Of Peripheral Lymph Flow In Acute Heart Failure During Decongestion.","authors":"Barbara Ponikowska ,&nbsp;Robert Zymlinski ,&nbsp;Mateusz Guzik ,&nbsp;Gracjan Iwanek ,&nbsp;Beata Ponikowska ,&nbsp;Marat Fudim ,&nbsp;Jan Biegus","doi":"10.1016/j.cardfail.2025.11.070","DOIUrl":"10.1016/j.cardfail.2025.11.070","url":null,"abstract":"<div><h3>Aims</h3><div>The lymphatic system controls fluid homeostasis in the interstitial space, which may modulate the decongestion. The kidneys filter and eliminate volume solely from the plasma; therefore, effective decongestion may necessitate appropriate lymphatic flow to balance the volume loss and replenish the intravascular compartment. We aimed to determine the clinical, laboratory, and ultrasonographic determinants of poor peripheral lymph flow in acute heart failure (AHF) during decongestion and to check if lymph flow is associated with short-term outcomes.</div></div><div><h3>Methods</h3><div>We prospectively studied AHF patients with peripheral congestion who underwent a standardized diuretic regimen. This was followed by evaluating lower limb lymph flow using Indocyanine Green Lymphangiography, a validated method for visualizing lymphatic drainage. The study population was divided into tertiles by lymph flow distance during a 10-minute examination. The patients were followed up for 180 days.</div></div><div><h3>Results</h3><div>Sixty-five AHF patients (mean age: 67±15 years, median [Q1-Q3] NTproBNP: 6901 [4478-12723] pg/ml) were examined. The study population was divided by lymph flow distance tertiles into low (&lt;20), median (20-52), and high (≥52) cm lymph flow. The median [IQR] lymph flow distance in the subgroups was 5 [1.5-10.0], 39.5 [27.5-45.0], and 78 [60.0-85.0] cm, respectively. There was no difference between the groups regarding many biomarkers, like serum sodium, serum creatinine, VEGF-C, Ca125, and NTproBNP, all p&gt;0.05. The low lymph flow group had significantly higher values of aldosterone and renin (18.4 [7.4-33.5] ng/dl and 130 [16.2-750.0] uIU/ml) when compared to median (8.7 [5.6-14.0] ng/dl and 17.4 [2.7-76.5] uIU/ml) and high flow (5.2 [2.6-11.6] ng/dl and 6.5 [2.5-118.4] uIU/ml), respectively, all p&lt;0.05. There was no difference between the groups in ejection fraction (p=0.08); there was a trend for comparison of low (31±12) vs. median lymph flow (42±17) %, p=0.055. There was a significant difference in TAPSE between the groups, with low, median, high lymph flow: 15±2 vs. 16±3 vs. 18±4 mm, respectively, p&lt;0.05. From a clinical perspective, only diuretic response measured at 6h was associated with the lymph flow. The number of patients with good diuretic response was: 7 (35%), 17 (71%), and 19 (91%), respectively, p&lt;0.05. Aldosterone was the only independent predictor of low lymph flow in the multivariable model, with HR (95%CI): 1.07 (1.01-1.14), p=0.017. The event rates during follow-up (death or HF hospitalization) were very high, 42 (65%), and there was no difference in those events between lymph flow groups (all p&gt;0.05).</div></div><div><h3>Conclusions</h3><div>Neurohormonal activation, TAPSE, and diuretic response were associated with poor lymph flow in AHF. Lymph flow was not associated with subsequent HF rehospitalizations and death.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 201"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950336","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}