Journal of Cardiac Failure最新文献

{"title":"The Heartmate 3 Device In Severely Obese Patients","authors":"Benjamin N. French ,&nbsp;Anudeep S. Nakirikanti ,&nbsp;Kris Wittersheim ,&nbsp;David Vega ,&nbsp;Mani Daneshmand ,&nbsp;Divya Gupta","doi":"10.1016/j.cardfail.2024.10.030","DOIUrl":"10.1016/j.cardfail.2024.10.030","url":null,"abstract":"<div><h3>Introduction</h3><div>Left ventricular assist devices (LVADs) are a lifesaving therapy for patients with severe heart failure. The only currently commercially available LVAD is the HeartMate 3, which features an intrathoracic, fully magnetically levitated, centrifugal-flow pump. Currently, there is an extremely limited body of evidence on outcomes for patients with severe (class III) obesity, defined as a BMI of 40 or more, who receive a HeartMate 3 device for circulatory support. LVAD therapy carries the risk of significant morbidity. Thus, the ability to recognize which patients will benefit most from an LVAD will assist in shared decision making when patients are ill enough to consider mechanical circulatory support.</div></div><div><h3>Hypothesis</h3><div>Increased perioperative risk in morbidly obese patients has been well-documented; however, we hypothesize severely obese patients can still demonstrate significant benefit from the HeartMate 3 LVAD.</div></div><div><h3>Methods</h3><div>193 patients received a HeartMate 3 LVAD between July 1^st, 2016 and July 1^st, 2023. Patients with a BMI of less than 40 were classified as our control group (n = 166) and had an average BMI of 27.4. Those with a BMI of 40 or greater were classified as severely obese (n = 27) and had an average BMI of 45.0. This was a retrospective cohort study conducted via review of patient charts.</div></div><div><h3>Results</h3><div><u>Mortality</u>: We found no significant difference in mortality at 30 days (p = 0.3), 1 year (p = 0.8), or 2 years (p = 0.9). (Figure 1). <u>Length of stay</u>: Length of ICU stay post-implantation was 11.6 days for controls and 10.1 days for severely obese patients (p = 0.5). Length of total hospitalization was 24.2 days for controls and 22.9 days for severely obese patients (p = 0.7). <u>Readmission rate</u>: Controls were readmitted 1.9 times per year while severely obese patients were readmitted 1.6 times per year (p = 0.5). <u>Driveline Infections</u>: We found no significant difference in the rate of new driveline infections between groups after 2 years (p = 0.14).</div></div><div><h3>Conclusion</h3><div>We found no significant difference in any measured outcome for severely obese patients when compared to controls. Our evidence suggests that the HeartMate 3 LVAD offers lifesaving therapy to patients with severe obesity and should be considered in all severely obese patients who have no contraindications to LVAD implantation.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 189"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142614","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":"Win Ratio Sensitivity Analysis Using A Modified Hierarchical Composite Outcome: Insights From The Paraglide-hf","authors":"Satoshi Shoji ,&nbsp;Derek Cyr ,&nbsp;Adrian Hernandez ,&nbsp;David Morrow ,&nbsp;Eric Velazquez ,&nbsp;Jonathan Ward ,&nbsp;Kristin Williamson ,&nbsp;Samiha Sarwat ,&nbsp;Randall Starling ,&nbsp;Akshay Desai ,&nbsp;Shelley Zieroth ,&nbsp;Scott Solomon ,&nbsp;Eugene Braunwald ,&nbsp;Robert Mentz","doi":"10.1016/j.cardfail.2024.10.011","DOIUrl":"10.1016/j.cardfail.2024.10.011","url":null,"abstract":"<div><h3>Introduction</h3><div>The win ratio (WR) is a promising alternative for reporting composite outcomes, prioritizing clinically significant events (e.g., mortality), while incorporating morbidity and surrogate measures. However, its benefits could be offset by limitations, mainly due to the large influence of lower hierarchical outcomes, such as biomarker outcome s. This secondary analysis of the PARAGLIDE-HF trial, which presented the WR in the primary paper, performed a WR sensitivity analysis using a modified hierarchical composite outcome to evaluate the utility of WR sensitivity analysis and assess the efficacy of sacubitril/valsartan (sac/val) vs. valsartan (val).</div></div><div><h3>Methods</h3><div>PARAGLIDE-HF compared sac/val with val in heart failure (HF) patients with ejection fraction (EF) &gt;40% following a recent worsening HF event. A hierarchical outcome in the primary analysis consisted of 1) cardiovascular death, 2) HF hospitalizations, 3) urgent HF visits, and 4) change in N-terminal pro-B-type natriuretic peptide (NT-proBNP), considering a 25% proportional decrease as a win. In the pre-specified subgroup with EF≤60%, sac/val showed a treatment effect on the hierarchical outcome (WR, 1.46; 95% CI, 1.08-1.97). Sensitivity analyses for this subgroup with modifications to the hierarchy included: 1) excluding NT-proBNP change, 2) substituting the 25% proportion change of NT-proBNP with 10% or 50%, and 3) including the pre-specified renal outcomes within the hierarchical outcome. The WR was calculated as the percentage of the total number of wins over the total numbers of losses, and the win odds (WO) allocated 50% of the ties to both the numerator and denominator of the WR statistic.</div></div><div><h3>Results</h3><div>Among 466 randomized patients, 357 patients with EF 41-60% (median age 70 years, 49.3% women) were included in the analysis. Excluding NT-proBNP from the hierarchy favored treatment with sac/val vs. val (WR, 1.49; 95% CI, 1.00-2.22; WO, 1.12; 95% CI, 1.00-1.26). When adjusting the threshold for proportional change in NT-proBNP from 25% to either 10% or 50%, the win statistics consistently favor sac/val vs. val. Incorporating renal outcomes also favored sac/val vs. val (WR, 1.44; 95% CI: 1.07-1.94; WO, 1.28; 95% CI, 1.05-1.56).</div></div><div><h3>Conclusions</h3><div>Multiple Win Ratio sensitivity analyses support the treatment benefit of sac/val vs. val among HF patients with EF below normal. Future studies should consider prespecifying Win Ratio sensitivity analysis for comprehensive assessment of treatment effects.<!--> </div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 181"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141384","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":"Immunosuppression After Myocarditis Episodes In Patients With Dsp-cardiomyopathy","authors":"Alessio Gasperetti ,&nbsp;Giovanni Peretto ,&nbsp;Steven Muller ,&nbsp;Mikael Laredo ,&nbsp;Richard Carrick ,&nbsp;Babken Asatryan ,&nbsp;Alexandros Protonotarios ,&nbsp;Brittney Murray ,&nbsp;Paul Scheel ,&nbsp;Kalliopi Pilichou ,&nbsp;Petros Syrros ,&nbsp;Pierre-Yves Tarlet ,&nbsp;Max Jason ,&nbsp;Kristen Medo ,&nbsp;Valentina Rossi ,&nbsp;Ardan Saguner ,&nbsp;Firat Duru ,&nbsp;Robyn Hylind ,&nbsp;Dominic Abrams ,&nbsp;Julia Cadrin-Tourigny ,&nbsp;Nisha Gilotra","doi":"10.1016/j.cardfail.2024.10.013","DOIUrl":"10.1016/j.cardfail.2024.10.013","url":null,"abstract":"<div><h3>Introduction</h3><div>Desmoplakin cardiomyopathy (DSP-CMP) is a genetic cardiomyopathy characterized by high risk of ventricular arrhythmias (VAs), heart failure (HF), and recurrent myocarditis. Data regarding the use and impact of immunosuppression on those myocarditis episodes is scarce.</div></div><div><h3>Hypothesis</h3><div>Immunosuppression treatment in DSP-CMP associated myocarditis may improve clinical outcomes.</div></div><div><h3>Methods</h3><div>Patients (pts) with DSP-CMP and 1+ episode of myocarditis in the worldwide DSP-ERADOS Network (26 institutions across 9 countries in 3 continents) were enrolled. For each treated episode, immunosuppressive medication regimen and duration (acute vs chronic immunosuppression) were collected. The primary combined outcome was sustained VA and/or HF episodes during follow up. Outcomes of DSP-CMP patients receiving immunosuppression at the time of first myocarditis episode were compared with DSP-CMP patients with untreated myocarditis using a log-rank test.</div></div><div><h3>Results</h3><div>Of 815 patients in the DSP registry, 153 patients (age at first presentation 31.1±8.7 yo, 72.5% female, 71.2% proband, LVEF 46.7±8.6%) experiencing a total of 260 myocarditis episodes (age at first episode 32.5±7.4 yo; n=60/153 had myocarditis as initial DSP-CMP presentation; 1.7 episodes/pt; n=54 pts with 2+ episodes,) were enrolled in the current study (<strong>Table 1</strong>). Of these episodes, 79 (30.4%) were treated with immunosuppression, with 23 treated with multiple agents. Seven (4.6%) patients received chronic immunosuppression. Over a median follow up of 4.6 [1.6-8.2] years, 96 primary outcome events (HF: n=31, VA: n=65) where observed in 73 (47.7%) patients. Patients whose first episode was treated with immunosuppression were less likely to meet the combined endpoint of HF/VA than those whose first episode was not treated (6/31 (19.4%) vs 67/122 (54.9%) p&lt;0.001).</div></div><div><h3>Conclusions</h3><div>In a large, multicenter DSP-CMP registry, we demonstrate that approximately one-third of all myocarditis episodes were treated with immunosuppression, most commonly corticosteroid-based strategies. Patients whose first episode of myocarditis was treated with immunosuppression had a lower rate of subsequent VA and HF events. These findings provide preliminary data to support a prospective trial to confirm the role of immunosuppression in DSP-CMP presenting with myocarditis.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 182"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141386","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":"Experiences Of Discrimination And Health Status Among Black And Hispanic Adults With Heart Failure: The SCAN-MP Study","authors":"Yashika Sharma ,&nbsp;Sergio Teruya ,&nbsp;Margaret Cuomo ,&nbsp;Ruth Masterson-Creber ,&nbsp;Denise Fine ,&nbsp;Sergylensky Fils ,&nbsp;Ikram Ullah ,&nbsp;Frederick Ruberg ,&nbsp;Mathew Maurer","doi":"10.1016/j.cardfail.2024.10.014","DOIUrl":"10.1016/j.cardfail.2024.10.014","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure (HF) disproportionately affects older Black and Hispanic adults. Studies indicate that Black and Hispanic adults report higher levels of physician distrust and experiences of discrimination compared to White adults. Despite knowing these differences, limited studies have examined the relationship between trust in physicians and experiences of perceived discrimination with health status among Black and Hispanic adults with HF.</div></div><div><h3>Methods</h3><div>We used data from the prospective Screening for Cardiac Amyloidosis with Nuclear Imaging in Minority Populations (SCAN-MP) study. Trust was measured using the Trust in Physician Scale, and experiences of discrimination were measured using the Everyday Discrimination Scale. Health status was examined using the Kansas City Cardiomyopathy Questionnaire (KCCQ). We ran linear regression models to examine the associations between trust in physician and experiences of perceived discrimination with health status. Models were adjusted for age, sex, race, ethnicity, education, and insurance status.</div></div><div><h3>Results</h3><div>The sample included 400 participants with a mean age of 72.5 (±8.94) years, of which 49.3% were female, 88.0% identified as Black and 29.0% identified as Hispanic, and 54.5% had New York Heart Association class II. The mean KCCQ overall summary score was 62.9 (±25.1), indicating moderate health status. After adjusting for covariates, higher scores on the Everyday Discrimination Scale (indicative of greater experiences of perceived discrimination) were associated with lower scores across several domains of KCCQ. Similarly, higher scores on the Everyday Discrimination Scale were associated with lower KCCQ summary scores for total symptoms, clinical summary, and overall summary, all of which indicate worse health status. Trust in physician was not significantly associated with overall health status.</div></div><div><h3>Conclusions</h3><div>Our findings indicate an association between experiences of perceived discrimination and worsened reported health status among and quality of life older Black and Hispanic adults with HF. These results underscore the importance of addressing discrimination to improve health outcomes among minority populations with HF.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 182-183"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141387","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":"Reevaluating How We View Renal Dysfunction During Left Ventricular Assist Device Consideration","authors":"Martin Osorio Nader ,&nbsp;Michael S. Debakey ,&nbsp;Kristin Wittersheim ,&nbsp;Mani Daneshmand ,&nbsp;John David Vega ,&nbsp;Divya Gupta","doi":"10.1016/j.cardfail.2024.10.071","DOIUrl":"10.1016/j.cardfail.2024.10.071","url":null,"abstract":"<div><h3>Introduction</h3><div>Renal dysfunction is often seen in patients with advanced heart failure and is the cause of exclusion from LVAD implantation for many. As technology advances, such as with the continuous-flow design of the HeartMate3 (HM3), we must reevaluate how we view comorbidities like renal disease when considering patients for LVADs. We aimed to review patients implanted with an HM3 and examine their survival through the lens of their eGFR to determine if those with a lower eGFR (≤ 30) or on dialysis at the time of implantation had comparable outcomes to patients with higher eGFR.</div></div><div><h3>Methods</h3><div>This is a single-center retrospective review of patients at our institution implanted with an HM3 between 1/1/2021 and 7/1/2023. Patients were sorted into groups by eGFR at the time of implantation as follows: Group A (eGFR ≥ 60), Group B (60 &gt; eGFR &gt; 30), and Group C (eGFR ≤ 30 or on dialysis). We evaluated each group's survival at 6, 12, and 24 months and compared their development or redevelopment of a dialysis requirement post-implant with a chi-squared test. At respective survival calculations, we censored patients who were alive but had not reached or had a transplant before an endpoint.</div></div><div><h3>Results</h3><div>We reviewed a total of 177 patients. Group A consisted of 73 patients (mean age: 49.1, % male: 67.1), Group B of 64 patients (mean age: 56.1, % male: 79.7), and Group C of 40 patients (mean age: 56.5, % male: 77.5). Eleven Group C patients were on dialysis at the time of implantation (1 hemodialysis, 10 CRRT) with three remaining on dialysis indefinitely post-implant. The median length of dialysis requirement for these eleven patients after LVAD implantation was 33 days. Group C patients had a seemingly lower 6-month survival rate; however, they had a similar 12 and 24-month survival compared to higher eGFR groups (Figure, Table). The percentage of patients who developed or redeveloped a dialysis requirement in each group was 12.3%, 12.5%, and 18.9%, respectively (p=0.59).</div></div><div><h3>Conclusion</h3><div>This study demonstrated that an eGFR ≤ 30 or being on dialysis at implantation is likely insufficient to predict a poor outcome post-LVAD in those implanted with an HM3. Additional investigation is needed to improve how we evaluate patients with renal disease for LVADs to provide better access to lifesaving implantations in a population with a common comorbid condition.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Page 208"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141543","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":"Left Atrial Reverse Remodeling In Patients Supported With Durable Left Ventricular Assist Devices And Clinical Implications","authors":"Christos Kyriakopoulos ,&nbsp;Eleni Maneta ,&nbsp;Konstantinos Sideris ,&nbsp;Iosif Taleb ,&nbsp;Eleni Tseliou ,&nbsp;Omar Wever-Pinzon ,&nbsp;Michael Bonios ,&nbsp;Sean McCandless ,&nbsp;Elizabeth Dranow ,&nbsp;Thomas Hanff ,&nbsp;Matthew Goodwin ,&nbsp;Spencer Carter ,&nbsp;James Fang ,&nbsp;Josef Stehlik ,&nbsp;Craig Selzman ,&nbsp;Stavros Drakos","doi":"10.1016/j.cardfail.2024.10.058","DOIUrl":"10.1016/j.cardfail.2024.10.058","url":null,"abstract":"<div><h3>Introduction</h3><div>The left atrium (LA) maintains a dynamic interaction with the left ventricle (LV). LA forward and reverse remodeling affect prognosis in patients with chronic heart failure (HF).</div></div><div><h3>Hypothesis</h3><div>We sought to examine LA reverse remodeling in patients supported with LV assist devices (LVADs) and investigate a potential impact on clinical outcomes.</div></div><div><h3>Methods</h3><div>Consecutive advanced HF patients receiving durable, continuous-flow LVAD were prospectively evaluated (n=263). After excluding patients with unavailable echocardiographic data, 241 patients were studied. Echocardiographic assessment was performed pre- and serially post-LVAD implantation. We assessed LA and LV structure and function and their association, and the impact of LA reverse remodeling on all-cause mortality, LVAD-related adverse events, and atrial fibrillation (AF).</div></div><div><h3>Results</h3><div>Most patients were male, white, with a mean age of 56±15 years. Forty-four percent had underlying ischemic cardiomyopathy, 65% were INTERMACS profile 1-3, with a mean LV ejection fraction of 19±7%, and end-diastolic diameter of 6.7±1.1 cm, pre-LVAD. LA structure and function improved by 1-month on LVAD support and remained improved by 12 months, as evidenced by LA volumes, emptying volumes, and emptying fractions in patients without AF (Figure 1). A similar pattern was observed in patients with AF. LA changes were shown to be associated with LV structural and functional changes. The magnitude of LA reverse remodeling was associated with all-cause mortality, but not cerebrovascular accident/transient ischemic attack, or LVAD thrombosis rates by 12 months on LVAD support. Of 46 patients with AF pre-LVAD, 28 (61%) converted to sinus rhythm, and 18 (39%) remained on AF during serial echocardiographic assessment.</div></div><div><h3>Conclusion</h3><div>LA structure and function improved early during LVAD support, showed stability of improvement during follow-up, and were associated with simultaneous LV changes. Implications on all-cause mortality and AF may inform the care of patients who are considered for advanced HF therapies, as well as the broader population of patients with HF and concomitant AF undergoing pharmacological unloading.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 202-203"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141545","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":"Socioeconomic Deprivation And The Severity Of Newly Diagnosed Transthyretin Cardiac Amyloidosis: Is There A Link?","authors":"Gracia Fahed ,&nbsp;John Isaiah Jimenez ,&nbsp;Marina I. Adrianzen Fonseca ,&nbsp;Gabriella Spencer-Bonilla ,&nbsp;Francois Haddad ,&nbsp;Ronald M. Witteles ,&nbsp;Kevin M. Alexander","doi":"10.1016/j.cardfail.2024.10.037","DOIUrl":"10.1016/j.cardfail.2024.10.037","url":null,"abstract":"<div><h3>Introduction</h3><div>Cardiac amyloidosis is associated with significant morbidity and mortality, and early diagnosis is crucial to improve survival. Despite advancements in diagnosis and treatment, disparities in disease detection persist in many regions. We sought to explore the impact of social determinants of health (SDoH) on timely diagnosis of transthyretin cardiac amyloidosis (ATTR-CM).</div></div><div><h3>Hypothesis</h3><div>Patients from neighborhoods with high social deprivation are diagnosed with ATTR-CM at later-stages compared to those presenting from less deprived areas.</div></div><div><h3>Methods</h3><div>The study cohort included 379 patients referred to the Stanford Amyloid Center for cardiac evaluation from 2009 to 2023. The Columbia staging system was used to classify patients into early, intermediate, and late ATTR-CM disease stages. The score incorporated the National Amyloidosis Center (NAC) staging (NT-proBNP + eGFR), daily furosemide dose equivalents, and NYHA functional class. To quantify SDoH, the neighborhood social deprivation index (SDI) score was tabulated from patients' residential zip-codes <strong>(Figure 1)</strong>. A high SDI, meaning high social deprivation, corresponded to &gt;80th percentile of the SDI scores distribution. Ordinal regression analysis was performed to assess the relationship between high SDI and ATTR-CM Columbia stage at the time of diagnosis.</div></div><div><h3>Results</h3><div>The mean age was 76±9, 88% were males, and 73% were White. The distribution across early, intermediate and late Columbia stages was 41.2%, 46.7%, and 11.6% of the population, respectively. After adjusting for demographic factors (age, sex, and race), patients from neighborhoods with high SDI were associated with higher Columbia stage [OR 2.03; p&lt;0.01] compared to patients from lower SDI status <strong>(Table 1)</strong>. Notably, Black individuals were also more likely to present with more advanced ATTR-CM [OR 3.36; p&lt;0.01] relative to White individuals. In the adjusted SDI subcomponents analysis, neighborhoods with high poverty had higher odds of having advanced disease at diagnosis [OR 1.69; 95%CI 1.03-2.78; p=0.038].</div></div><div><h3>Conclusion</h3><div>SDoH appear to be related to delayed diagnosis among individuals with ATTR-CM. Public health interventions are essential to identify and effectively manage ATTR-CM in the most vulnerable communities.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 192-193"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143141726","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 Patients With Advanced Chronic Kidney Disease And A Pulmonary Artery Pressure Sensor: Insights From The HF2 Registry","authors":"Mason Sanders ,&nbsp;Elizabeth Volz ,&nbsp;Kartik Munshi ,&nbsp;Terrie Ann Benjamin ,&nbsp;Mosi Bennett ,&nbsp;Pranathi Pilla ,&nbsp;Kunjan Bhatt ,&nbsp;Arvind Bhimaraj ,&nbsp;Timothy Fendler ,&nbsp;Marat Fudim ,&nbsp;Maya Guglin ,&nbsp;Ashrith Guha ,&nbsp;J. Thomas Heywood ,&nbsp;Orvar Jonsson ,&nbsp;Liviu Klein ,&nbsp;Patrick McCann ,&nbsp;Monique Robinson ,&nbsp;Andrew Sauer ,&nbsp;Hsin-Fang Li ,&nbsp;Hirak Shah ,&nbsp;Jacob Abraham","doi":"10.1016/j.cardfail.2024.10.035","DOIUrl":"10.1016/j.cardfail.2024.10.035","url":null,"abstract":"<div><h3>Introduction</h3><div>An implantable pulmonary artery pressure (PAP) sensor is approved to reduce heart failure hospitalizations (HFH) in symptomatic patients. Key trials have excluded those with advanced chronic kidney disease (CKD), or eGFR &lt;25 mL/min per 1.73 m². Real-world use of ambulatory hemodynamic monitoring in advanced CKD has not been well-described.</div></div><div><h3>Methods</h3><div>Hemodynamic Frontiers in Heart Failure (HF²) is an academic consortium of 14 US centers that developed a registry to collect data on patients following implantation with a PAP sensor, including demographics, hemodynamics, and clinical events (ED visits, HFH, or death). We analyzed patients with at least 12 months of hemodynamic monitoring data, comparing events in patients with normal kidney function (eGFR ≥60), mild to moderate CKD (eGFR 30-59), and advanced CKD (eGFR &lt;30). Baseline demographic and implant hemodynamic data were compared using One-Way ANOVA test (IBS SPSS Statistics Version 29.0). In time-to-event analysis, patients who had no events were censored at their 12 month follow up as their last seen date. Those with an event &gt; 12 months from the implant date were censored. The Registry has IRB approval from individual sites and is supported by CTSA Award UL1TR002366.</div></div><div><h3>Results</h3><div>Of 236 total patients, 70 (29.7%) had advanced and 112 (47.5%) had mild to moderate CKD (Table 1A). Those with CKD were more likely to be older, diabetic, and with higher baseline right atrial and pulmonary artery mean pressures. Patients with CKD had more frequent hospitalizations and those with advanced CKD had more frequent death and progression to LVAD/transplant or ESRD/dialysis (Table 1B). Of those with advanced CKD, only 2 (1.5%) progressed to ESRD.</div></div><div><h3>Conclusion</h3><div>Longitudinal real-world data from the HF² Registry demonstrates use of PAP sensors in patients with a broad range of kidney function. Although ambulatory hemodynamic monitoring has been shown to reduce HFH, the same may not be true for those with advanced CKD. More research is needed in this high-risk population.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 191-192"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142030","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-reported Outcomes In Heart Failure: Insights From A Simplified Kccq In Heartmate 3 Lvad Recipients","authors":"Jennifer Cowger ,&nbsp;Nourdine Chakouri","doi":"10.1016/j.cardfail.2024.10.053","DOIUrl":"10.1016/j.cardfail.2024.10.053","url":null,"abstract":"<div><h3>Background</h3><div>Patient-reported outcomes, such as the Kansas City Cardiomyopathy Questionnaire (KCCQ), are pivotal in assessing the impact of left ventricular assist device (LVAD) support on patients’ heart failure-related quality of life (hf-QOL) as part of hierarchical outcomes. However, translating improvements in composite KCCQ scores into a meaningful message for patients and referring providers remains challenging. In registries, incompleteness of KCCQ scores is also common after 1 year, perhaps due to questionnaire length.</div></div><div><h3>Purpose</h3><div>This study aims to a) evaluate the utility of a simplified KCCQ score in describing the LVAD patient journey and b) to generate a patient-friendly graphic on hf-QOL trajectory for use during shared decision making encounters.</div></div><div><h3>Methods</h3><div>Question-level KCCQ responses were analyzed in HeartMate 3 LVAD recipients from the MOMENTUM 3 studies (2,200 patients) preoperatively and at 6- 12-, and 24-months after implant. Patients had to complete one preoperative and ≥1 postoperative KCCQ assessment for inclusion. The simplified LVAD-KCCQ is as follows: 23 KCCQ questions from 5 domains were simplified into 5 questions, 1 from each domain. Response options were consolidated into severely, moderately and minimal/none from 5-7 prior options. The trajectories of within patient changes in the simplified KCCQ domains were evaluated at each time point.</div></div><div><h3>Results</h3><div>There were sustained improvements from baseline in the summary standard and simplified KCCQ scores and within each simplified domain, beginning 6 months postoperatively (table 1, figure 1). Intra-patient improvements occurred rapidly in each domain and were sustained to two years. Of those who were severely limited in their enjoyment of life (blue) prior to LVAD (n=1133), &lt;17.8% (n=202) and &lt;8.2% (n=93) had persistently severe limitations at 6 months and 1 year, respectively. Overall, 63% of patients has no/minimal limitations at 2 years (Fig 1A, Fig 2). Similar rapid and sustained improvements were noted for response to the other simplified KCCQ domains (Fig 1B-C).</div></div><div><h3>Conclusion</h3><div>An assessment of individual simplified KCCQ domain responses allows for a succinct assessment of the patient journey after HM3. These data may assist in improving KCCQ data compliance with registries and in conveying average changes in hf-QOL after LVAD to patients.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 200-201"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143142295","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":"Feasibility and Reproducibility of Performing Maximal Incremental Exercise With the Addition of Invasive Hemodynamic Measurements","authors":"ISABELA LANDSTEINER MD,&nbsp;CHLOE ELIZABETH NEWLANDS MS,&nbsp;JOSEPH CAMPAIN MD,&nbsp;TAKENORI IKOMA MD,&nbsp;RAJEEV MALHOTRA MD,&nbsp;GREGORY D. LEWIS MD","doi":"10.1016/j.cardfail.2024.08.052","DOIUrl":"10.1016/j.cardfail.2024.08.052","url":null,"abstract":"","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"31 1","pages":"Pages 163-165"},"PeriodicalIF":6.7,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142288083","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}