Journal of Cardiac Failure最新文献

Background: The HEART-FID trial (Randomized Placebo-Controlled Trial of Ferric Carboxymaltose [FCM] as Treatment for Heart Failure with Iron Deficiency) is the largest trial to test intravenous iron (ferric carboxymaltose [FCM]) vs placebo in patients with heart failure and iron deficiency. The results showed a modest but nonstatistically significant reduction in important clinical outcomes, including all-cause mortality.

Objectives: We sought to understand the factors associated with all-cause mortality.

Methods: Data concerning patients enrolled in the HEART-FID trial were used to determine factors associated with all-cause mortality via multivariable models. The models included key clinical characteristics, including treatment interactions identified in the primary analysis (age by sex and country of enrollment). All-cause mortality at 12 months and over the full duration of follow-up (median 23.1 months) was evaluated by using Cox proportional hazard regression.

Results: A total of 3065 patients had 737 all-cause mortality events over the duration of the trial, with 289 events occurring in the first 12 months. Fewer patients randomized to FCM died by 12 months compared with the placebo group (131 receiving FCM vs 158 receiving placebo; hazard ratio 0.82 [95% confidence interval: 0.65-1.04]). Patients who died were more likely to be older and to have diabetes, atrial fibrillation, lower ejection fractions and estimated glomerular filtration rates and higher N-Terminal pro B-type natriuretic peptide (NT-proBNP) levels. The 3 multivariable factors most strongly associated with all-cause mortality at 12 months were NT-proBNP level, country of enrollment and 6-minute walk test distance. Similar results were seen for predicting all-cause mortality over the entire follow-up; the addition of an age × sex × FCM interaction yielded statistically significant results, with greater association of benefit from FCM found in older women than in other subgroups of patients.

Conclusion: FCM, compared with placebo, was associated with a potentially clinically meaningful (but not statistically significant) reduction in all-cause mortality, with key predictors of mortality being natriuretic peptide level, country of enrollment and 6-minute walk test distance.

Heart failure (HF) is associated with poor prognosis, especially when it progresses to cardiogenic shock (CS), where survival rates substantially decline. A key area of interest is the role of blood lactate as a biomarker in these conditions. Lactate is produced under normal physiological conditions but increases with impaired tissue perfusion, a hallmark of HF and CS. Elevated lactate levels result from increased production, reduced clearance or both and are often associated with worse outcomes. Traditionally considered a byproduct of anaerobic metabolism, lactate is now recognized as an important energy substrate, particularly in myocardial tissue during periods of metabolic stress. Recent studies suggest that dynamic lactate monitoring, including lactate clearance (LC), may provide critical insights into patients' prognoses and responses to therapy. Serial measurements of lactate have been shown to predict survival in critically ill patients, including those with HF and CS. In CS, elevated lactate levels correlate with increased mortality risk, and LC is emerging as an important parameter in treatment protocols. Despite growing evidence of lactate's clinical relevance, research is needed to establish standardized thresholds and optimal monitoring timelines. Understanding the complexities of lactate metabolism and its role in HF and CS could lead to improved risk stratification and more personalized treatment approaches.

The author describes her personal experience with a cardiac diagnosis to demonstrate how wellness disparities are often rooted in historical constructions of "ideal" physical presentation that are both racialized and gendered. Her experiential analysis contends that failure to contextualize patients and divorce them from these historically problematic constructions is used to justify their profound disability and death.

The main function of the implantable cardioverter-defibrillator (ICD) is to protect against sudden cardiac death (SCD) due to ventricular tachyarrhythmia (VTA). Current guidelines provide a recommendation to implant a prophylactic ICD for the primary prevention of SCD in individuals having heart failure with reduced ejection fraction (HFrEF) who never experienced a previous sustained VTA. However, these recommendations are based on clinical trials conducted more than 20 years ago and may not be applicable to contemporary patients with HFrEF who have a lower arrhythmic risk as a result of advances in heart failure medical therapies. Thus, there is an unmet need for more appropriate selection of contemporary patients with HFrEF for a primary prevention ICD. In this article, we review data underlying the current clinical equipoise on the need for routine implantation of a primary prevention ICD in patients with HFrEF and the rationale for conducting clinical trials that aim to reassess the role of the ICD in this population.

Background: The benefit of implantable cardioverter-defibrillators (ICDs) and cardiovascular resynchronization therapy defibrillators (CRT-Ds) in patients supported with a HeartMate 3 left ventricular assist device (LVAD) remains uncertain.

Methods: An analysis was done of the Multicenter Study of MAGLEV Technology in Patients Undergoing Mechanical Circulatory Support Therapy with HeartMate 3 (MOMENTUM 3) randomized clinical trial and the first 1000 patients in the Continued Access Protocol (CAP) trial. Patients were divided into 3 groups based on the presence of an ICD and/or CRT-D: No device (n = 153, 11%), ICD only (n = 699, 50.4%), and CRT-D (n = 535, 38.6%). We assessed the association of ICDs or CRT-Ds with overall mortality, ventricular arrhythmias (VAs), rehospitalization rates, quality of life, and the 6-minute walk test distance at 2 years' follow-up.

Results: Patients with an ICD or CRT-D had similar survival to those without (hazard ratio [HR], 1.3; 95% CI 0.8-2.1, P = .36) with no differences in rehospitalizations, quality of life or 6-minute walk test distance. VA occurred more frequently in patients with an ICD or CRT-D (HR, 2.4; 95% CI 1.3-4.3, P = .006). Compared with an ICD alone, patients with a CRT-D demonstrated similar survival (HR, 1.1; 95% CI 0.9-1.5, P = .36). However, they had increased rates of VA (HR, 1.3; 95% CI 1.0-1.7, P = .03). There were no differences in rate of rehospitalization between those with an ICD or CRT-D and those without (P = .19) or between those with an ICD and those with a CRT-D (P = .32). A propensity-matched sensitivity analysis confirmed these findings.

Conclusions: In this post-hoc analysis of the MOMENTUM 3 trial, the presence of an ICD or CRT-D at the time of HM3 LVAD implantation was associated with an increased incidence of VA but was not associated with survival, quality of life, or functional capacity.

Trial registration: Momentum 3 portfolio, NCT02224755 (Pivotal) and NCT02892955 (CAP).

Background: Data on left ventricular ejection fraction (LVEF) recovery in patients with anthracycline-induced cardiomyopathy (AIC) are limited.

Objectives: To evaluate LVEF recovery rate, its predictors and its association with cardiovascular outcomes in a contemporary and diverse cohort with AIC.

Methods: This retrospective study analyzed patients diagnosed with AIC from 2010-2023 at 2 U.S. university hospitals and an affiliated cancer center. LVEF recovery, defined as ≥ 10% improvement in LVEF to a value ≥ 50% within 3 years of AIC detection, was assessed by using Cox proportional-hazards accounting for competing risks. The association between LVEF recovery and the composite of heart failure (HF) hospitalizations, mechanical circulatory support, heart transplantation, or cardiovascular death was assessed by using Cox regression analysis with LVEF recovery as a time-dependent factor.

Results: Among 167 patients with anthracycline-induced cardiomyopathy (AIC) (median age 67 [Q1, Q3: 53, 74] years, 53% female), the majority had lymphoma (55%) or breast cancer (23%). The median time from first anthracycline exposure to AIC detection was 631 (219, 3569) days, and the median LVEF was 38% (29%, 45%). At the detection of AIC, 69% had symptomatic HF. LVEF recovered in 38% (n = 63) at a median of 349 (137, 691) days from AIC detection. Age ≥ 60 years at anthracycline exposure, non-white race, diabetes mellitus, longer interval between anthracycline exposure and AIC detection, and LV dilation were associated with a lower likelihood of recovery, while statin use and AIC detection after 2022 were associated with a higher likelihood of recovery. LVEF recovery was not associated with cardiovascular outcomes.

Conclusion: In this contemporary and diverse AIC cohort, 38% achieved LVEF recovery. Routine screening for AIC and statin therapy may improve recovery rates.

Introduction: Effective communication and understanding are imperative for heart transplant (HT) recipients who require lifelong adherence to treatment plans and medications. Whether non-native English speaking (NNES) recipients have inferior outcomes compared to native English-speaking recipients (NES) has not been studied post-HT.

Methods: We reviewed adult HT recipients at Columbia University Irving Medical Center from January 2005-December 2022; primary language was determined by chart review. Baseline characteristics and patient-level zip codes, which were used to derive the socioeconomic status (SES) index by using data from the Agency for Healthcare Research and Quality (AHRQ), were included. Mortality at 1 year and 5 years was compared between NNES and NES recipients. Survival curves were estimated using the Kaplan-Meier method, and log-rank testing was used to compare survival between groups. Secondary outcomes, including all-cause hospitalization, hospitalization for infection and rejection at 1 year, as well as rejection and cardiac allograft vasculopathy at 5 years, were analyzed using cumulative incidence functions with Gray testing to detect differences between groups. Multivariable Cox proportional hazard models were used to determine whether there was an association between NNES and primary and secondary outcomes.

Results: Of 1066 HT recipients, 103 (10%) were NNES. NNES recipients were more likely to identify as non-White, to have Medicaid as the primary payer and to have lower educational attainment. On average, NNES recipients resided in zip codes with higher levels of unemployment and lower household incomes. Overall, NNES had lower median AHRQ SES indices (51 vs 55; P < 0.001). After adjustment for clinical factors, including socioeconomic status, race/ethnicity and education level, mortality at 1 and 5 years for NNES and NES recipients were not significantly different, although there was a trend toward improved survival rates in the NNES group (1-year adjusted hazard ratio (HR) 0.24, 95% CI 0.06-1.01; P = 0.05; 5-year adjusted HR 0.48, 95% CI 0.22-1.03; P = 0.06). Similarly, there were no differences in need for rehospitalization, infection requiring hospitalization or rejection at 1 year.

Conclusions: There were no significant differences in outcomes at 1 year and 5 years post-HT between NNES and NES. Availability of interpreter services and educational resources in multiple languages are paramount to maintaining effective communication and equitable outcomes.

Background: Inflammation plays a key role in the development of heart failure (HF), and diet is a known modifiable factor that modulates systemic inflammation. The dietary inflammatory score (DIS) is a tool that quantifies the inflammatory components of diet. We sought to determine whether the DIS is associated with incident HF events.

Methods: We examined a total of 17,975 participants without HF at baseline who were in the REasons for Geographic and Racial Differences in Stroke (REGARDS) cohort. The main exposure variable was the DIS quartile, which was derived from the Food Frequency Questionnaire obtained at baseline study enrollment. The main outcome was an incident HF event, defined as hospitalization due to HF or death. To examine the association between the DIS and incident HF events, we conducted Cox proportional hazard regression modeling, adjusting for total energy intake, sociodemographic factors and pro-inflammatory lifestyle behaviors.

Results: The sample mean age was 64 + 9.2 years, 55.8% were female, and 32.3% were Black. Over a median follow-up of 11.1 years, we observed 900 incident HF events, including 752 hospitalizations and 148 deaths due to HF. In an adjusted model, the highest DIS quartile (Q4) was associated with incident HF (HR 1.26 95% CI 1.03-1.54). Of note, these findings remained, even after adjusting for comorbid conditions and physiological parameters. In an age-stratified analysis, the association was present only in those aged < 65 years (Q4: HR 1.65 95% CI 1.08-2.51). Moreover, the association was present for heart failure with reserved ejection fraction (Q4: HR 1.44 95% CI 1.07-1.94) but not for heart failure with preserved ejection fraction.

Conclusion: The highest DIS quartile was associated with incident HF events. These findings indicate the potential value of specific dietary patterns to prevent HF.