Pub Date : 2026-01-01DOI: 10.1016/j.cardfail.2025.06.013
ANURADHA LALA MD , CRAIG BEAVERS PharmD , VANESSA BLUMER MD , LAPRINCESS BREWER MD , DIANA DE OLIVEIRA-GOMES MD , SANDRA B. DUNBAR PhD RN , HANNAH EVERY MD , RICHARD FERRARO MD , BONNIE KY MD, MSCE , JAMES L. JANUZZI MD , FRANCOISE MARVEL MD , ROBERT J. MENTZ MD , ERIN MICHOS MD , JAGAT NARULA MD , KHURAM NASIR MD , PRADEEP NATARAJAN MD , LORI ANN PETERSON NP , FATIMA RODRIGUEZ MD , MICHAEL D. SHAPIRO DO MCR , JENNA SKOWRONSKI MD , MARTHA GULATI MD
Heart disease is the leading cause of death worldwide, with heart failure (HF) recognized as its most severe and debilitating manifestation. Though remarkable advancements have led to the establishment of life-saving and quality-of-life-enhancing medical and device-based therapies for HF, HF-related mortality trends have increased over the past decade. To combat this worldwide epidemic, care must evolve so that preventive recommendations are not siloed from HF management. Prevention must be prioritized more broadly, not only in the early detection and deterrence of HF but across a patient’s lifespan in conjunction with therapeutic intervention. Members of the Heart Failure Society of America and the American Society for Preventive Cardiology created this joint Societal Scientific Statement on the Prevention of Heart Failure to emphasize the links between cardiovascular disease prevention and HF and offer a conceptual roadmap along which to consider all aspects of preventive care. This includes primary prevention to reduce the burden of HF, secondary prevention to reduce the impact of HF among those with an established diagnosis of HF, and tertiary prevention, which encompasses the management of risk factors in patients who require advanced therapies, including durable mechanical circulatory support and heart transplantation.
{"title":"The Continuum of Prevention and Heart Failure in Cardiovascular Medicine: A Joint Scientific Statement from the Heart Failure Society of America and The American Society for Preventive Cardiology","authors":"ANURADHA LALA MD , CRAIG BEAVERS PharmD , VANESSA BLUMER MD , LAPRINCESS BREWER MD , DIANA DE OLIVEIRA-GOMES MD , SANDRA B. DUNBAR PhD RN , HANNAH EVERY MD , RICHARD FERRARO MD , BONNIE KY MD, MSCE , JAMES L. JANUZZI MD , FRANCOISE MARVEL MD , ROBERT J. MENTZ MD , ERIN MICHOS MD , JAGAT NARULA MD , KHURAM NASIR MD , PRADEEP NATARAJAN MD , LORI ANN PETERSON NP , FATIMA RODRIGUEZ MD , MICHAEL D. SHAPIRO DO MCR , JENNA SKOWRONSKI MD , MARTHA GULATI MD","doi":"10.1016/j.cardfail.2025.06.013","DOIUrl":"10.1016/j.cardfail.2025.06.013","url":null,"abstract":"<div><div>Heart disease is the leading cause of death worldwide, with heart failure (HF) recognized as its most severe and debilitating manifestation. Though remarkable advancements have led to the establishment of life-saving and quality-of-life-enhancing medical and device-based therapies for HF, HF-related mortality trends have increased over the past decade. To combat this worldwide epidemic, care must evolve so that preventive recommendations are not siloed from HF management. Prevention must be prioritized more broadly, not only in the early detection and deterrence of HF but across a patient’s lifespan in conjunction with therapeutic intervention. Members of the Heart Failure Society of America and the American Society for Preventive Cardiology created this joint Societal Scientific Statement on the Prevention of Heart Failure to emphasize the links between cardiovascular disease prevention and HF and offer a conceptual roadmap along which to consider all aspects of preventive care. This includes primary prevention to reduce the burden of HF, secondary prevention to reduce the impact of HF among those with an established diagnosis of HF, and tertiary prevention, which encompasses the management of risk factors in patients who require advanced therapies, including durable mechanical circulatory support and heart transplantation.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Pages 75-105"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144859245","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}
Pub Date : 2026-01-01DOI: 10.1016/j.cardfail.2025.11.003
Ibrahim A. Miyanoorwala , Madeline Czeck , Fernando Santiago , Kevin Burns , Evan Walser-Kuntz , Alan J. Bank
Introduction
We have previously demonstrated that CRT optimization of nonresponders using a novel technology called electrical dyssynchrony mapping (EDM) improves LV size and systolic function. However, it is unknown whether this approach can be used as part of routine clinical care in a clinical disease management program.
Hypothesis
CRT optimization of nonresponders (EF improvement with CRT < 5%) and incomplete responders (EF improvement >5% but final EF ≤ 50%) can be performed as part of routine clinical care in a CRT device clinic and results in significant improvement in LV ejection fraction (EF).
Methods
We developed a clinical pathway to manage all newly implanted CRT patients. We performed an ECG and echo at least 3 months after implantation and again 4 - 6 months after EDM optimization. EDM is a novel technology that quantifies electrical synchrony expressed as cardiac resynchronization index (CRI, a number between 0 and 100%), using a proprietary algorithm that calculates the percent change in the QRS area between all combinations of 6 anterior and 3 posterior electrograms at multiple different atrial-ventricular (AV) and ventricular-ventricular (VV) delays. CRT optimization was performed during routine 1-hour device checks. Echos were read in a blinded fashion.
Results
We studied 41 patients 5.6 ± 2.5 months post CRT implantation with EF ≤ 50% and underlying LBBB, IVCD, or RV pacing. Patient age at implant was 76 ± 10.8 years, and 80.5% of patients were male. Pre-CRT QRS duration was 169 ± 26 ms, and EF was 37.4 ± 6.8%. Among the patients studied, 22 (55%) were nonresponders, and 18 (45%) were incomplete responders. The Figure shows an electrical dyssynchrony map of a CRT nonresponder changed from biventricular pacing at an AV delay of 120 ms and a VV delay of 0 ms to LV-only pacing at an AV delay of 90 ms. This resulted in an improvement in CRI from 21% to 94% and in EF from 24% to 35%. CRI in the entire group improved significantly (p < 0.0001) from 57.5 ± 20.5% at baseline to 86.8 ± 10.9% after optimization. EF improved significantly from 33.2 ± 9.0% pre-CRT to 37.4 ± 6.8% post-CRT (p < 0.0018) to 42.3 ± 7.6% post-optimization (p < 0.0001). LVESV decreased non-significantly (p = 0.2214) from 70.6 ± 30.2 ml to 67.1 ± 31.9 ml.
Conclusions
EDM can be performed as part of a routine clinical care CRT management pathway. Optimization of device programming results in a 5% improvement in EF in CRT nonresponders and incomplete responders.
{"title":"Improvement In LV Systolic Function In Cardiac Resynchronization Therapy Nonresponders: Results From A Clinical Optimization Program","authors":"Ibrahim A. Miyanoorwala , Madeline Czeck , Fernando Santiago , Kevin Burns , Evan Walser-Kuntz , Alan J. Bank","doi":"10.1016/j.cardfail.2025.11.003","DOIUrl":"10.1016/j.cardfail.2025.11.003","url":null,"abstract":"<div><h3>Introduction</h3><div>We have previously demonstrated that CRT optimization of nonresponders using a novel technology called electrical dyssynchrony mapping (EDM) improves LV size and systolic function. However, it is unknown whether this approach can be used as part of routine clinical care in a clinical disease management program.</div></div><div><h3>Hypothesis</h3><div>CRT optimization of nonresponders (EF improvement with CRT < 5%) and incomplete responders (EF improvement >5% but final EF ≤ 50%) can be performed as part of routine clinical care in a CRT device clinic and results in significant improvement in LV ejection fraction (EF).</div></div><div><h3>Methods</h3><div>We developed a clinical pathway to manage all newly implanted CRT patients. We performed an ECG and echo at least 3 months after implantation and again 4 - 6 months after EDM optimization. EDM is a novel technology that quantifies electrical synchrony expressed as cardiac resynchronization index (CRI, a number between 0 and 100%), using a proprietary algorithm that calculates the percent change in the QRS area between all combinations of 6 anterior and 3 posterior electrograms at multiple different atrial-ventricular (AV) and ventricular-ventricular (VV) delays. CRT optimization was performed during routine 1-hour device checks. Echos were read in a blinded fashion.</div></div><div><h3>Results</h3><div>We studied 41 patients 5.6 ± 2.5 months post CRT implantation with EF ≤ 50% and underlying LBBB, IVCD, or RV pacing. Patient age at implant was 76 ± 10.8 years, and 80.5% of patients were male. Pre-CRT QRS duration was 169 ± 26 ms, and EF was 37.4 ± 6.8%. Among the patients studied, 22 (55%) were nonresponders, and 18 (45%) were incomplete responders. The Figure shows an electrical dyssynchrony map of a CRT nonresponder changed from biventricular pacing at an AV delay of 120 ms and a VV delay of 0 ms to LV-only pacing at an AV delay of 90 ms. This resulted in an improvement in CRI from 21% to 94% and in EF from 24% to 35%. CRI in the entire group improved significantly (p < 0.0001) from 57.5 ± 20.5% at baseline to 86.8 ± 10.9% after optimization. EF improved significantly from 33.2 ± 9.0% pre-CRT to 37.4 ± 6.8% post-CRT (p < 0.0018) to 42.3 ± 7.6% post-optimization (p < 0.0001). LVESV decreased non-significantly (p = 0.2214) from 70.6 ± 30.2 ml to 67.1 ± 31.9 ml.</div></div><div><h3>Conclusions</h3><div>EDM can be performed as part of a routine clinical care CRT management pathway. Optimization of device programming results in a 5% improvement in EF in CRT nonresponders and incomplete responders.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 170"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950421","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}
Pub Date : 2026-01-01DOI: 10.1016/j.cardfail.2025.11.062
Selim Krim , Scott Lundgren , Orvar Jonsson , Sam Taimourzadeh , Tianru Zhang , Fei San Lee , Allison T. Connolly
Introduction
Heart failure (HF) remains a significant cause of morbidity and mortality. Ambulatory hemodynamic monitoring has been shown to reduce HF hospitalization rates, and mortality[[i]] in the first year after implant.
Hypothesis
The reduction in HF hospitalization rates seen after implantable pulmonary artery pressure sensor (PAPS) are sustained over five-year follow-up.
Methods
A matched cohort study was conducted using Medicare fee-for-service claims data from January1, 2013, to June 30, 2024. Patients who received PAPS implant between June 1, 2014 to March 31, 2016 were identified by procedure codes for PAPS implant (treatment). During this period, CardioMEMS was the only FDA approved PAPS and was indicated for NYHA Class III HF patients with a prior HF hospitalization. A contemporaneous control cohort was formed by propensity-score matching to HF patients without PAPS based on demographics, HF hospitalization history, and comorbidities. Patients were censored at end of Medicare FFS enrollment, death, heart transplant, or durable LVAD implant. Outcomes of HF hospitalization rates and survival free-from-mortality were compared. Survival curves were constructed using Kaplan-Meier estimates and mortality was compared using Cox proportional hazards. The Andersen-Gill model with robust sandwich estimate of variance was used to compare HF hospitalization rates between the treatment and control cohorts. Hazard ratios (HR) are presented with 95% confidence intervals.
Results
The study included 3,564 patients with CardioMEMS and 3,564 matched controls. Both cohorts were matched by age at implant (73 ± 10 years), sex (37% female) and race (85% white). At 5 years post-implant, there were 4,463 HF hospitalizations in the treatment group compared to 4,765 in the control group. Additionally, the treatment cohort had 2121 deaths compared to 2428 in the control cohort. Lower HF hospitalization rates (Figure A, HR 0.85, 95% CI 0.81-0.88; P < 0.005) and lower mortality rates were seen in patients with PAPS when compared to controls (Figure B, HR 0.78, 95% CI 0.73-0.83; P < 0.005).
Conclusions
Medicare beneficiaries with HF who received CardioMEMS experienced fewer HF hospitalizations and higher survival when compared to matched controls. This is the first study to show a long-term benefit of CardioMEMS with 5 years of follow-up.
[i] Abraham J, Bharmi R, Jonsson O, et al. Association of Ambulatory Hemodynamic Monitoring of Heart Failure With Clinical Outcomes in a Concurrent Matched Cohort Analysis. JAMA Cardiol. 2019;4(6):556-563. doi:10.1001/jamacardio.2019.1384
心力衰竭（HF）仍然是发病率和死亡率的重要原因。动态血流动力学监测已被证明可降低心衰住院率和植入后第一年的死亡率[[i]]。假设：植入肺动脉压力传感器（PAPS）后，心衰住院率的降低持续了5年的随访。方法采用2013年1月1日至2024年6月30日的医疗保险按服务收费索赔数据进行匹配队列研究。2014年6月1日至2016年3月31日期间接受PAPS种植体的患者使用PAPS种植体（治疗）程序代码进行识别。在此期间，CardioMEMS是FDA批准的唯一一种PAPS，用于NYHA III级HF患者。根据人口统计学、HF住院史和合并症，通过倾向评分与无PAPS的HF患者进行匹配，形成同期对照队列。患者在医疗保险FFS登记、死亡、心脏移植或持久LVAD植入结束时被审查。比较HF住院率和无死亡生存率的结果。使用Kaplan-Meier估计构建生存曲线，使用Cox比例风险比较死亡率。采用具有稳健夹心方差估计的Andersen-Gill模型比较治疗组和对照组之间的HF住院率。风险比（HR）以95%置信区间表示。结果该研究包括3564例CardioMEMS患者和3564例匹配对照。两个队列根据种植时的年龄（73±10岁）、性别（37%女性）和种族（85%白人）进行匹配。植入后5年，治疗组有4,463例HF住院，对照组为4,765例。此外，治疗组有2121人死亡，而对照组有2428人死亡。与对照组相比，PAPS患者的HF住院率较低（图A， HR 0.85, 95% CI 0.81-0.88; P < 0.005），死亡率较低（图B， HR 0.78, 95% CI 0.73-0.83; P < 0.005）。结论：与对照组相比，接受CardioMEMS治疗的HF医疗保险受益人的HF住院率更低，生存率更高。这是第一个通过5年随访显示CardioMEMS的长期益处的研究。[1]刘建军，刘建军，刘建军，等。心衰动态血流动力学监测与并发匹配队列分析的临床结果的关联。中华医学会心内科杂志，2019;4(6):556-563。doi: 10.1001 / jamacardio.2019.1384
{"title":"5-year Clinical Outcomes With Ambulatory Hemodynamic Monitoring In A Concurrent Matched Cohort Analysis Of Medicare Beneficiaries","authors":"Selim Krim , Scott Lundgren , Orvar Jonsson , Sam Taimourzadeh , Tianru Zhang , Fei San Lee , Allison T. Connolly","doi":"10.1016/j.cardfail.2025.11.062","DOIUrl":"10.1016/j.cardfail.2025.11.062","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure (HF) remains a significant cause of morbidity and mortality. Ambulatory hemodynamic monitoring has been shown to reduce HF hospitalization rates, and mortality[[i]] in the first year after implant.</div></div><div><h3>Hypothesis</h3><div>The reduction in HF hospitalization rates seen after implantable pulmonary artery pressure sensor (PAPS) are sustained over five-year follow-up.</div></div><div><h3>Methods</h3><div>A matched cohort study was conducted using Medicare fee-for-service claims data from January1, 2013, to June 30, 2024. Patients who received PAPS implant between June 1, 2014 to March 31, 2016 were identified by procedure codes for PAPS implant (treatment). During this period, CardioMEMS was the only FDA approved PAPS and was indicated for NYHA Class III HF patients with a prior HF hospitalization. A contemporaneous control cohort was formed by propensity-score matching to HF patients without PAPS based on demographics, HF hospitalization history, and comorbidities. Patients were censored at end of Medicare FFS enrollment, death, heart transplant, or durable LVAD implant. Outcomes of HF hospitalization rates and survival free-from-mortality were compared. Survival curves were constructed using Kaplan-Meier estimates and mortality was compared using Cox proportional hazards. The Andersen-Gill model with robust sandwich estimate of variance was used to compare HF hospitalization rates between the treatment and control cohorts. Hazard ratios (HR) are presented with 95% confidence intervals.</div></div><div><h3>Results</h3><div>The study included 3,564 patients with CardioMEMS and 3,564 matched controls. Both cohorts were matched by age at implant (73 ± 10 years), sex (37% female) and race (85% white). At 5 years post-implant, there were 4,463 HF hospitalizations in the treatment group compared to 4,765 in the control group. Additionally, the treatment cohort had 2121 deaths compared to 2428 in the control cohort. Lower HF hospitalization rates (Figure A, HR 0.85, 95% CI 0.81-0.88; P < 0.005) and lower mortality rates were seen in patients with PAPS when compared to controls (Figure B, HR 0.78, 95% CI 0.73-0.83; P < 0.005).</div></div><div><h3>Conclusions</h3><div>Medicare beneficiaries with HF who received CardioMEMS experienced fewer HF hospitalizations and higher survival when compared to matched controls. This is the first study to show a long-term benefit of CardioMEMS with 5 years of follow-up.</div><div>[i] Abraham J, Bharmi R, Jonsson O, et al. Association of Ambulatory Hemodynamic Monitoring of Heart Failure With Clinical Outcomes in a Concurrent Matched Cohort Analysis. <em>JAMA Cardiol.</em> 2019;4(6):556-563. doi:10.1001/jamacardio.2019.1384</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Pages 197-198"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950405","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}
Pub Date : 2026-01-01DOI: 10.1016/j.cardfail.2025.11.015
Devin Mantini, Bana Hadid, Gabriel Dardrik, Jose Fernandez, Boaz Elad, Brian LaBarre, Julia Baranowska, Salwa Rahman, Adi Hertz, Ersilia DeFillipis, Paolo Colombo, Adil Yunis, Dor Lotan, Jayant Raikhelkar, Koji Takeda, Kevin Clerkin, Gabriel Sayer, Nir Uriel
Introduction
The HeartMate 3 (HM3) LVAD is commonly used as bridge to heart transplantation (HT), yet its explantation presents unique surgical challenges due to its proximity to the lung. Previously we showed higher rates of pneumonia (PNA) in patients bridged with HM3, yet data comparing lung imaging findings between HM3-bridged and non-LVAD patients remains limited. This study aims to compare post-HT lung imaging abnormalities in patients with and without prior HM3.
Methods
This retrospective cohort study analyzed all patients who underwent HT at our center between 2016-2022. Patients were categorized into a HM3 bridge to HT group and a non-LVAD group. Patients with congenital heart disease, re-transplantation, or LVAD support besides HM3 were excluded, as well as those lost to follow-up within one year. Chest X-ray and computed tomography findings were assessed during index hospitalization and up to one year post-HT. One year post-HT findings included those following index hospitalization discharge up to one year post-HT. Fisher’s Exact Test and odds ratios (OR) were used to compare findings, with p-values adjusted for multiple comparisons using the False Discovery Rate method.
Results
A total of 220 patients were included (81 HM3, 139 non-LVAD). Average age at HT (56 vs 58 years, p=0.251), sex (83% vs 75% male, p=0.184), and race (52% vs 56% white, p=0.576) were similar between the groups. HM3 patients had more COPD/asthma (30% vs 15%, p=0.015), though rates of diabetes and prior CABG were similar. During the index hospitalization and at one year post-HT, the prevalence of left-sided pleural effusions and opacities was higher in the HM3 group, though the difference was not significant after adjustment. Right-sided opacities were less common in patients with HM3 at both index hospitalization (42% vs 60%, p=0.091) and one year (42% vs 22%, p=0.022). At one year, left-sided hemidiaphragm elevation was significantly more common in the HM3 group (34% vs 12%, OR 3.61, p=0.004). (Figure) Patients with left-sided hemidiaphragm elevation required longer support on mechanical ventilation (median 3 vs 2 days, p=0.074) following HT. They were additionally more likely to have PNA during index hospitalization (OR 2.62, p=0.009) and at one year following HT (OR 3.20, p=0.009).
Conclusions
These findings suggest distinct post-HT pulmonary imaging differences in HM3-bridged patients, with higher rates of left-sided hemidiaphragm elevation potentially linked to explantation-related injury. Further research is needed to determine the clinical impact of these abnormalities and to refine surgical strategies to minimize post-HT pulmonary complications.
HeartMate 3 （HM3）左心室辅助装置通常被用作心脏移植（HT）的桥梁，但由于其靠近肺部，其移植面临独特的手术挑战。先前我们发现HM3桥接患者的肺炎（PNA）发生率较高，但比较HM3桥接和非lvad患者肺部影像学结果的数据仍然有限。本研究旨在比较HM3患者和无HM3患者ht后肺部影像学异常。方法本回顾性队列研究分析了2016-2022年在本中心接受HT治疗的所有患者。患者分为HM3桥至HT组和非lvad组。排除先天性心脏病患者、再移植患者、除HM3外LVAD支持患者以及1年内无随访者。在住院期间和治疗后一年内评估胸部x线和计算机断层扫描结果。治疗后一年的结果包括治疗后一年的住院出院情况。使用Fisher精确检验和比值比（OR）来比较结果，使用错误发现率方法调整p值以进行多次比较。结果共纳入220例患者（HM3 81例，非lvad 139例）。两组患者的平均年龄（56岁vs 58岁，p=0.251）、性别（83% vs 75%男性，p=0.184）和种族（52% vs 56%白人，p=0.576）相似。HM3患者有更多的COPD/哮喘（30% vs 15%, p=0.015），尽管糖尿病和既往冠脉搭桥的发生率相似。指数住院期间及ht后1年，HM3组左侧胸腔积液及混浊发生率较高，但经调整后差异无统计学意义。HM3患者在指数住院期间（42%对60%，p=0.091）和一年内（42%对22%，p=0.022）右侧混浊较少见。一年后，HM3组左侧半膈抬高更为常见（34% vs 12%, OR 3.61, p=0.004）。（图）左侧半膈抬高患者在HT后需要更长时间的机械通气支持（中位3天vs 2天，p=0.074）。此外，在指数住院期间（OR 2.62, p=0.009）和HT后一年（OR 3.20, p=0.009），他们更有可能发生PNA。结论：hm3桥接患者ht后肺部影像学差异明显，左侧半膈抬高率较高可能与解释相关损伤有关。需要进一步的研究来确定这些异常的临床影响，并改进手术策略以减少ht后肺部并发症。
{"title":"Higher Rate Of Left Lung Injury In Heart Transplant Patients Bridged With Heartmate 3 Lvad","authors":"Devin Mantini, Bana Hadid, Gabriel Dardrik, Jose Fernandez, Boaz Elad, Brian LaBarre, Julia Baranowska, Salwa Rahman, Adi Hertz, Ersilia DeFillipis, Paolo Colombo, Adil Yunis, Dor Lotan, Jayant Raikhelkar, Koji Takeda, Kevin Clerkin, Gabriel Sayer, Nir Uriel","doi":"10.1016/j.cardfail.2025.11.015","DOIUrl":"10.1016/j.cardfail.2025.11.015","url":null,"abstract":"<div><h3>Introduction</h3><div>The HeartMate 3 (HM3) LVAD is commonly used as bridge to heart transplantation (HT), yet its explantation presents unique surgical challenges due to its proximity to the lung. Previously we showed higher rates of pneumonia (PNA) in patients bridged with HM3, yet data comparing lung imaging findings between HM3-bridged and non-LVAD patients remains limited. This study aims to compare post-HT lung imaging abnormalities in patients with and without prior HM3.</div></div><div><h3>Methods</h3><div>This retrospective cohort study analyzed all patients who underwent HT at our center between 2016-2022. Patients were categorized into a HM3 bridge to HT group and a non-LVAD group. Patients with congenital heart disease, re-transplantation, or LVAD support besides HM3 were excluded, as well as those lost to follow-up within one year. Chest X-ray and computed tomography findings were assessed during index hospitalization and up to one year post-HT. One year post-HT findings included those following index hospitalization discharge up to one year post-HT. Fisher’s Exact Test and odds ratios (OR) were used to compare findings, with p-values adjusted for multiple comparisons using the False Discovery Rate method.</div></div><div><h3>Results</h3><div>A total of 220 patients were included (81 HM3, 139 non-LVAD). Average age at HT (56 vs 58 years, p=0.251), sex (83% vs 75% male, p=0.184), and race (52% vs 56% white, p=0.576) were similar between the groups. HM3 patients had more COPD/asthma (30% vs 15%, p=0.015), though rates of diabetes and prior CABG were similar. During the index hospitalization and at one year post-HT, the prevalence of left-sided pleural effusions and opacities was higher in the HM3 group, though the difference was not significant after adjustment. Right-sided opacities were less common in patients with HM3 at both index hospitalization (42% vs 60%, p=0.091) and one year (42% vs 22%, p=0.022). At one year, left-sided hemidiaphragm elevation was significantly more common in the HM3 group (34% vs 12%, OR 3.61, p=0.004). (Figure) Patients with left-sided hemidiaphragm elevation required longer support on mechanical ventilation (median 3 vs 2 days, p=0.074) following HT. They were additionally more likely to have PNA during index hospitalization (OR 2.62, p=0.009) and at one year following HT (OR 3.20, p=0.009).</div></div><div><h3>Conclusions</h3><div>These findings suggest distinct post-HT pulmonary imaging differences in HM3-bridged patients, with higher rates of left-sided hemidiaphragm elevation potentially linked to explantation-related injury. Further research is needed to determine the clinical impact of these abnormalities and to refine surgical strategies to minimize post-HT pulmonary complications.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 175"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950120","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}
Pub Date : 2026-01-01DOI: 10.1016/j.cardfail.2025.11.059
Harnoor Singh , Swaiman Singh , Adhish Beri , Gurbaksh S. Soni , Sukhmandeep S. Dhillon , Rishabh Taneja , Ganeev Singh , Maninder Singh , Apindervir K. Mann , Deepinder Singh , Jaskaran Singh , Ajay A.P. Singh , Kuldeep Randhawa , Udhamgurjot S. Bajwa , Onkardeep Kaur , Prachi Mehmi , Vijay P. Singh
<div><h3>Background</h3><div>Heart failure (HF) is a growing epidemic worldwide, yet it remains underdiagnosed in lower- and middle-income countries (LMICs) like India, where it affects an estimated 8-10 million patients. Less than 10% of these patients receive guideline-directed medical therapy (GDMT), which includes ACEi, ARBs, ARNIs, BB’s, SGLT-2i, and MRAs. The lack of GDMT utilization is attributed to multiple factors like lack of proper healthcare access, limited or no HF specialists, and other socioeconomic barriers. Despite proven mortality benefits, there is significant underutilization of GDMTs which contributing to high hospitalization rates and poor outcomes in HF patients.</div></div><div><h3>Methods</h3><div>our study was a prospective, multicenter cohort study involving 7,532 HF patients (LVEF ≤40%) across 15 Indian cities enrolled between January 2020 and January 2024. A multidisciplinary team of 75 physicians including general cardiologists and primary care physicians implemented a structured intervention (1) patient education via culturally tailored material (videos/pamphlets) (2) simplified once-daily dosing regimens along with fixed dose combination drugs (3) digital reminders (text messages) and (4) community health worker led follow ups. Medication adherence was assessed via pill counts, self-reporting, and prescription renewals while multivariate regression model was used to analyze barriers to adherence (cost, side effects, health literacy).</div></div><div><h3>Results</h3><div>Baseline data revealed only 17.5 % of patients were on greater than or equal to 3 GDMT agents, with compliance rates of only 32.3% (95% CI: 28-36). Post-intervention, compliance improved to 68.4% (95% CI: 64-72; p less than 0.001), with 54.6% achieving greater than or equal to 3 GDMT agents. Key predictors of non-adherence included medication cost (OR=3.2, p=0.01), lack of transportation (OR=2.8, p=0.03), and fear of side effects (OR=2.1, p=0.04). Hospitalizations for acute decompensated HF decreased by 41.6 % (p=0.002) in compliant patients.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that systematic, low-cost interventions significantly improve GDMT adherence in India’s resource-constrained settings. Scaling such strategies leveraging AI, community networks, and provider education could mitigate the HF burden amid a critical shortage of specialists. Policymakers must prioritize HF care integration into primary health systems, subsidize essential therapies, and expand task-sharing models to align with WHO NCD targets. Our study identified critical gaps in the management of heart failure in India, notably the stark underutilization of cardiac resynchronization therapy with defibrillator (CRT-D) devices and the suboptimal prescription rates of angiotensin receptor-neprilysin inhibitors (ARNIs), despite their proven efficacy. Additionally, heart failure with preserved ejection fraction (HFpEF) persists as a significantly underrecog
{"title":"Improving Guideline-directed Medical Therapy (GDMT) Adherence In Heart Failure: Results From A Multicenter Intervention Study In India","authors":"Harnoor Singh , Swaiman Singh , Adhish Beri , Gurbaksh S. Soni , Sukhmandeep S. Dhillon , Rishabh Taneja , Ganeev Singh , Maninder Singh , Apindervir K. Mann , Deepinder Singh , Jaskaran Singh , Ajay A.P. Singh , Kuldeep Randhawa , Udhamgurjot S. Bajwa , Onkardeep Kaur , Prachi Mehmi , Vijay P. Singh","doi":"10.1016/j.cardfail.2025.11.059","DOIUrl":"10.1016/j.cardfail.2025.11.059","url":null,"abstract":"<div><h3>Background</h3><div>Heart failure (HF) is a growing epidemic worldwide, yet it remains underdiagnosed in lower- and middle-income countries (LMICs) like India, where it affects an estimated 8-10 million patients. Less than 10% of these patients receive guideline-directed medical therapy (GDMT), which includes ACEi, ARBs, ARNIs, BB’s, SGLT-2i, and MRAs. The lack of GDMT utilization is attributed to multiple factors like lack of proper healthcare access, limited or no HF specialists, and other socioeconomic barriers. Despite proven mortality benefits, there is significant underutilization of GDMTs which contributing to high hospitalization rates and poor outcomes in HF patients.</div></div><div><h3>Methods</h3><div>our study was a prospective, multicenter cohort study involving 7,532 HF patients (LVEF ≤40%) across 15 Indian cities enrolled between January 2020 and January 2024. A multidisciplinary team of 75 physicians including general cardiologists and primary care physicians implemented a structured intervention (1) patient education via culturally tailored material (videos/pamphlets) (2) simplified once-daily dosing regimens along with fixed dose combination drugs (3) digital reminders (text messages) and (4) community health worker led follow ups. Medication adherence was assessed via pill counts, self-reporting, and prescription renewals while multivariate regression model was used to analyze barriers to adherence (cost, side effects, health literacy).</div></div><div><h3>Results</h3><div>Baseline data revealed only 17.5 % of patients were on greater than or equal to 3 GDMT agents, with compliance rates of only 32.3% (95% CI: 28-36). Post-intervention, compliance improved to 68.4% (95% CI: 64-72; p less than 0.001), with 54.6% achieving greater than or equal to 3 GDMT agents. Key predictors of non-adherence included medication cost (OR=3.2, p=0.01), lack of transportation (OR=2.8, p=0.03), and fear of side effects (OR=2.1, p=0.04). Hospitalizations for acute decompensated HF decreased by 41.6 % (p=0.002) in compliant patients.</div></div><div><h3>Conclusion</h3><div>This study demonstrates that systematic, low-cost interventions significantly improve GDMT adherence in India’s resource-constrained settings. Scaling such strategies leveraging AI, community networks, and provider education could mitigate the HF burden amid a critical shortage of specialists. Policymakers must prioritize HF care integration into primary health systems, subsidize essential therapies, and expand task-sharing models to align with WHO NCD targets. Our study identified critical gaps in the management of heart failure in India, notably the stark underutilization of cardiac resynchronization therapy with defibrillator (CRT-D) devices and the suboptimal prescription rates of angiotensin receptor-neprilysin inhibitors (ARNIs), despite their proven efficacy. Additionally, heart failure with preserved ejection fraction (HFpEF) persists as a significantly underrecog","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Pages 196-197"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950346","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}
Pub Date : 2026-01-01DOI: 10.1016/j.cardfail.2025.11.053
Samantha L. Yeung, Mengxi Wang, Mimi Lou, Tien Ng
Introduction
Substance use and kidney disease are both associated with substantial morbidity and mortality in heart failure (HF). Many illicit substances can cause renal injury, but whether they contribute to greater risk for development of kidney disease in HF is unknown.
Hypothesis
Substance use will be independently associated with the development of acute and chronic kidney disease in patients with HF.
Methods
A retrospective, cohort study of patients with a primary diagnosis of HF in the Optum Clinformatics Data Mart (2010 - 2020). Demographics and renal outcomes were obtained by ICD-9/10 codes. Patients with pre-existing renal conditions were excluded. For comparison, patients were stratified based on those with or without a history of substance use. A logistic regression analysis was conducted for the propensity-score 1:1 matched cohort. Renal outcomes were reported for both acute renal failure and advanced chronic kidney disease (≥ stage 3) as total incidence and time to diagnosis. Cox proportional hazard regression model was used to estimate the association between time to event and outcomes.
Results
A total of 184,508 patients were included; 11,611 (6.3%) with documented substance use. Prior to matching, patients with substance use were younger, more often male, and with fewer comorbidities. In the matched cohort, patients with substance use were more likely to develop acute renal failure (71.7% vs 64.8%, p<0.0001) and advanced chronic renal disease (64.2% vs 61.4%, p<0.0001).
Conclusions
In patients with HF, substance use was independently associated with a higher likelihood of developing acute and chronic kidney disease.
药物使用和肾脏疾病都与心力衰竭（HF）的大量发病率和死亡率相关。许多非法药物可引起肾脏损伤，但它们是否会增加心衰患者肾脏疾病发展的风险尚不清楚。假设药物使用与心衰患者急性和慢性肾脏疾病的发展独立相关。方法对2010 - 2020年在Optum临床数据集市（Optum Clinformatics Data Mart）中初步诊断为HF的患者进行回顾性队列研究。通过ICD-9/10代码获得人口统计学和肾脏结局。排除已有肾脏疾病的患者。为了进行比较，患者根据有无药物使用史进行分层。对倾向评分为1:1匹配的队列进行logistic回归分析。报告了急性肾衰竭和晚期慢性肾病（≥3期）的肾脏结局，包括总发病率和诊断时间。采用Cox比例风险回归模型估计事件发生时间与结果之间的相关性。结果共纳入184,508例患者；11,611人（6.3%）有物质使用记录。在配对之前，使用药物的患者更年轻，更多的是男性，合并症更少。在匹配的队列中，使用药物的患者更容易发生急性肾功能衰竭（71.7% vs 64.8%, 0.0001）和晚期慢性肾脏疾病（64.2% vs 61.4%, 0.0001）。结论在HF患者中，药物使用与发生急性和慢性肾脏疾病的可能性较高独立相关。
{"title":"Prior Or Current Substance Use Is Associated With Increased Risk Of Developing Acute And Chronic Kidney Disease In Heart Failure","authors":"Samantha L. Yeung, Mengxi Wang, Mimi Lou, Tien Ng","doi":"10.1016/j.cardfail.2025.11.053","DOIUrl":"10.1016/j.cardfail.2025.11.053","url":null,"abstract":"<div><h3>Introduction</h3><div>Substance use and kidney disease are both associated with substantial morbidity and mortality in heart failure (HF). Many illicit substances can cause renal injury, but whether they contribute to greater risk for development of kidney disease in HF is unknown.</div></div><div><h3>Hypothesis</h3><div>Substance use will be independently associated with the development of acute and chronic kidney disease in patients with HF.</div></div><div><h3>Methods</h3><div>A retrospective, cohort study of patients with a primary diagnosis of HF in the Optum Clinformatics Data Mart (2010 - 2020). Demographics and renal outcomes were obtained by ICD-9/10 codes. Patients with pre-existing renal conditions were excluded. For comparison, patients were stratified based on those with or without a history of substance use. A logistic regression analysis was conducted for the propensity-score 1:1 matched cohort. Renal outcomes were reported for both acute renal failure and advanced chronic kidney disease (≥ stage 3) as total incidence and time to diagnosis. Cox proportional hazard regression model was used to estimate the association between time to event and outcomes.</div></div><div><h3>Results</h3><div>A total of 184,508 patients were included; 11,611 (6.3%) with documented substance use. Prior to matching, patients with substance use were younger, more often male, and with fewer comorbidities. In the matched cohort, patients with substance use were more likely to develop acute renal failure (71.7% vs 64.8%, p<0.0001) and advanced chronic renal disease (64.2% vs 61.4%, p<0.0001).</div></div><div><h3>Conclusions</h3><div>In patients with HF, substance use was independently associated with a higher likelihood of developing acute and chronic kidney disease.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Pages 193-194"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950371","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}
Pub Date : 2026-01-01DOI: 10.1016/j.cardfail.2025.11.008
Azadeh Farid , Blen Daniel , Maegan Cole , David Rawitscher , Carissa Cole , Gregory Milligan , Akash Rusia , Haider Nazeer , Robert Lee Smith , Nitin Kabra , Aasim Afzal
Introduction
Mavacamten is the first cardiac myosin inhibitor that was approved for the treatment of hypertrophic obstructive cardiomyopathy (HOCM). Mevacamten has revolutionized the treatment of HOCM and has shown sustained increase in quality-of-life metrics such as KCCQ, NYHA classification, increase in max VO2 and improvement in LVOT gradients. Although well tolerated, a small subset of patients can have side effects or intolerance leading to cessation of treatment. Patient occasionally also consider alternate strategy to avoid being on the medication long term. We herein report 3 cases of successful treatment of HOCM with mevacamten that subsequently underwent septal myectomy. We highlight the protocol utilized to transition the treatment approach given the paucity of data in literature.
Methods
All patient charts at HOCM clinic at Heart Recovery Center were retrospectively reviewed and data was analyzed. 3 patients were identified who underwent surgical myectomy after being on mevacamten for at least 3 months and were included in this study.
Results
3 patients were identified that underwent septal myectomy after being on mevacamten for over 6 months. All patients were instructed to stop mevacamten for 6 weeks prior to myectomy based on the metabolic profile of the drug. Patient age ranged from 43 to 70 years of age and included 2 females and one male. All 3 patients had mevacamten stopped due to side effects including chest pain, dizziness and headaches. Pre mevacamten LVOT gradients ranged from 33 to 83 mmHg and essentially normalized post mevacamten. Due to side effects patients did not see a significant KCCQ improvement on mevacamten. All 3 patients underwent successful robotic surgical myectomy with improvement in KCCQ and symptom burden at 3-month mark in 2 of 3 patients. No adverse effects were noted from the surgery or pretreatment with mevacamten with stopping the drug for 6 weeks.
Conclusion
Patient on mevacamten can undergo successful surgical myectomy after stopping the drug for a period of 6 weeks without adverse effects. Further larger studies are needed to adjudicate the transition protocol.
{"title":"Successful Transition From Mavacamten To Septal Myectomy In Patients With Hypertrophic Obstructive Cardiomyopathy Associated With Preserved Quality Of Life Metrics","authors":"Azadeh Farid , Blen Daniel , Maegan Cole , David Rawitscher , Carissa Cole , Gregory Milligan , Akash Rusia , Haider Nazeer , Robert Lee Smith , Nitin Kabra , Aasim Afzal","doi":"10.1016/j.cardfail.2025.11.008","DOIUrl":"10.1016/j.cardfail.2025.11.008","url":null,"abstract":"<div><h3>Introduction</h3><div>Mavacamten is the first cardiac myosin inhibitor that was approved for the treatment of hypertrophic obstructive cardiomyopathy (HOCM). Mevacamten has revolutionized the treatment of HOCM and has shown sustained increase in quality-of-life metrics such as KCCQ, NYHA classification, increase in max VO2 and improvement in LVOT gradients. Although well tolerated, a small subset of patients can have side effects or intolerance leading to cessation of treatment. Patient occasionally also consider alternate strategy to avoid being on the medication long term. We herein report 3 cases of successful treatment of HOCM with mevacamten that subsequently underwent septal myectomy. We highlight the protocol utilized to transition the treatment approach given the paucity of data in literature.</div></div><div><h3>Methods</h3><div>All patient charts at HOCM clinic at Heart Recovery Center were retrospectively reviewed and data was analyzed. 3 patients were identified who underwent surgical myectomy after being on mevacamten for at least 3 months and were included in this study.</div></div><div><h3>Results</h3><div>3 patients were identified that underwent septal myectomy after being on mevacamten for over 6 months. All patients were instructed to stop mevacamten for 6 weeks prior to myectomy based on the metabolic profile of the drug. Patient age ranged from 43 to 70 years of age and included 2 females and one male. All 3 patients had mevacamten stopped due to side effects including chest pain, dizziness and headaches. Pre mevacamten LVOT gradients ranged from 33 to 83 mmHg and essentially normalized post mevacamten. Due to side effects patients did not see a significant KCCQ improvement on mevacamten. All 3 patients underwent successful robotic surgical myectomy with improvement in KCCQ and symptom burden at 3-month mark in 2 of 3 patients. No adverse effects were noted from the surgery or pretreatment with mevacamten with stopping the drug for 6 weeks.</div></div><div><h3>Conclusion</h3><div>Patient on mevacamten can undergo successful surgical myectomy after stopping the drug for a period of 6 weeks without adverse effects. Further larger studies are needed to adjudicate the transition protocol.</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":"145950114","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}
Pub Date : 2026-01-01DOI: 10.1016/j.cardfail.2025.11.017
Karldon I. Nwaezeapu , Godbless Ajenaghughrure , Emmanuel Daniel , Toyin Falade , Abdul-Rahaman Ottun , Chukwuemeka Aghasili , Mohammed El Nayir
Background
Inflammation plays a pivotal role in cardiovascular pathophysiology, yet the clinical significance of C-reactive protein (CRP) in left ventricular assist device (LVAD) recipients remains poorly characterized. We sought to evaluate whether baseline CRP levels could predict major cardiovascular and non-cardiovascular outcomes in this high-risk population.
Methods
We conducted a retrospective analysis using the multi-center TriNetX Research network, identifying adult patients who underwent LVAD implantation between 2015-2023. Patients were categorized by pre-implantation CRP levels: low-inflammatory state (0-3 mg/L) versus elevated-inflammatory state (≥4 mg/L). Following rigorous propensity score matching (n=551 pairs) accounting for 25 cardiovascular and metabolic comorbidities, we compared outcomes over a 5-year surveillance period using multivariable analyses.
Results
Patients with low CRP levels experienced a substantial reduction in all-cause mortality compared to those with elevated CRP (28.4% vs 41.2%; OR 0.566 [95% CI 0.440-0.728]; p<0.001). This survival benefit was accompanied by significant reductions in acute pulmonary edema (5.7% vs 9.3%; OR 0.585 [0.356-0.962]; p=0.033). Notably, patients with lower inflammatory burden exhibited higher rates of pacemaker implantation (27.4% vs 18.8%; OR 1.631 [1.170-2.275]; p=0.004), suggesting potential differences in arrhythmia management approaches. Strong trends toward reduced acute kidney injury (30.5% vs 41.1%; OR 0.629 [0.386-1.025]; p=0.062) and infectious pulmonary complications (17.6% vs 23.1%; OR 0.710 [0.496-1.017]; p=0.061) were observed in the low-CRP cohort. Traditional cardiac arrhythmic endpoints showed consistent but non-significant reductions across all categories.
Conclusions
Our findings establish CRP as a robust prognostic indicator in LVAD management, with lower inflammatory status conferring significant protection against mortality and end-organ dysfunction. The inverse relationship between CRP and pacemaker utilization presents an intriguing clinical paradox warranting mechanistic investigation. These data support the routine assessment of inflammatory status in LVAD candidates and suggest that targeted anti-inflammatory interventions may represent a promising therapeutic avenue to improve outcomes in advanced heart failure patients requiring mechanical circulatory support.
背景：炎症在心血管病理生理中起着关键作用，然而c反应蛋白（CRP）在左心室辅助装置（LVAD）受者中的临床意义仍然知之甚少。我们试图评估基线CRP水平是否可以预测高危人群的主要心血管和非心血管结局。方法采用多中心TriNetX研究网络进行回顾性分析，确定2015-2023年间接受LVAD植入的成年患者。根据植入前CRP水平对患者进行分类：低炎症状态（0- 3mg /L）和高炎症状态（≥4mg /L）。根据严格的倾向评分匹配（n=551对），考虑到25种心血管和代谢合并症，我们使用多变量分析比较了5年监测期间的结果。结果与CRP水平升高的患者相比，低CRP水平患者的全因死亡率显著降低（28.4% vs 41.2%; OR 0.566 [95% CI 0.44 -0.728]; p<0.001）。这种生存获益伴随着急性肺水肿的显著减少（5.7% vs 9.3%; OR 0.585 [0.356-0.962]; p=0.033）。值得注意的是，炎症负担较轻的患者起搏器植入率较高（27.4% vs 18.8%； OR为1.631 [1.170-2.275];p=0.004），提示心律失常治疗方法存在潜在差异。在低crp组中，急性肾损伤（30.5% vs 41.1%; OR 0.629 [0.386-1.025]; p=0.062）和感染性肺部并发症（17.6% vs 23.1%; OR 0.710 [0.496-1.017]; p=0.061）的发生率明显降低。传统的心律失常终点在所有类别中均显示出一致但不显著的降低。结论：研究结果表明，CRP是LVAD治疗的一个强有力的预后指标，较低的炎症状态赋予了对死亡率和终末器官功能障碍的显著保护。CRP与起搏器使用之间的负相关关系呈现出一个有趣的临床悖论，值得进行机制研究。这些数据支持对LVAD候选者炎症状态的常规评估，并表明靶向抗炎干预可能是改善需要机械循环支持的晚期心力衰竭患者预后的有希望的治疗途径。
{"title":"Inflammatory Burden Predicts Adverse Outcomes In Lvad Recipients: C-reactive Protein As A Prognostic Marker In Advanced Heart Failure Management","authors":"Karldon I. Nwaezeapu , Godbless Ajenaghughrure , Emmanuel Daniel , Toyin Falade , Abdul-Rahaman Ottun , Chukwuemeka Aghasili , Mohammed El Nayir","doi":"10.1016/j.cardfail.2025.11.017","DOIUrl":"10.1016/j.cardfail.2025.11.017","url":null,"abstract":"<div><h3>Background</h3><div>Inflammation plays a pivotal role in cardiovascular pathophysiology, yet the clinical significance of C-reactive protein (CRP) in left ventricular assist device (LVAD) recipients remains poorly characterized. We sought to evaluate whether baseline CRP levels could predict major cardiovascular and non-cardiovascular outcomes in this high-risk population.</div></div><div><h3>Methods</h3><div>We conducted a retrospective analysis using the multi-center TriNetX Research network, identifying adult patients who underwent LVAD implantation between 2015-2023. Patients were categorized by pre-implantation CRP levels: low-inflammatory state (0-3 mg/L) versus elevated-inflammatory state (≥4 mg/L). Following rigorous propensity score matching (n=551 pairs) accounting for 25 cardiovascular and metabolic comorbidities, we compared outcomes over a 5-year surveillance period using multivariable analyses.</div></div><div><h3>Results</h3><div>Patients with low CRP levels experienced a substantial reduction in all-cause mortality compared to those with elevated CRP (28.4% vs 41.2%; OR 0.566 [95% CI 0.440-0.728]; p<0.001). This survival benefit was accompanied by significant reductions in acute pulmonary edema (5.7% vs 9.3%; OR 0.585 [0.356-0.962]; p=0.033). Notably, patients with lower inflammatory burden exhibited higher rates of pacemaker implantation (27.4% vs 18.8%; OR 1.631 [1.170-2.275]; p=0.004), suggesting potential differences in arrhythmia management approaches. Strong trends toward reduced acute kidney injury (30.5% vs 41.1%; OR 0.629 [0.386-1.025]; p=0.062) and infectious pulmonary complications (17.6% vs 23.1%; OR 0.710 [0.496-1.017]; p=0.061) were observed in the low-CRP cohort. Traditional cardiac arrhythmic endpoints showed consistent but non-significant reductions across all categories.</div></div><div><h3>Conclusions</h3><div>Our findings establish CRP as a robust prognostic indicator in LVAD management, with lower inflammatory status conferring significant protection against mortality and end-organ dysfunction. The inverse relationship between CRP and pacemaker utilization presents an intriguing clinical paradox warranting mechanistic investigation. These data support the routine assessment of inflammatory status in LVAD candidates and suggest that targeted anti-inflammatory interventions may represent a promising therapeutic avenue to improve outcomes in advanced heart failure patients requiring mechanical circulatory support.</div></div>","PeriodicalId":15204,"journal":{"name":"Journal of Cardiac Failure","volume":"32 1","pages":"Page 176"},"PeriodicalIF":8.2,"publicationDate":"2026-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145950166","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}
Pub Date : 2026-01-01DOI: 10.1016/j.cardfail.2025.11.071
Suchita Pande, Gregory L. Martin, Robert M. Blanton
Introduction
Heart failure (HF) remains a major clinical challenge, with limited therapeutic strategies directly targeting cardiac myocyte dysfunction. Drugs which activate cGMP-dependent protein kinase 1(PKG1), such as sacubitril/valsartan, nitrates, and vericiguat, improve LV function and outcomes in HF but are limited by PKG1-induced vasodilation and hypotension. Mixed-lineage kinase 3 (MLK3) is a novel substrate of PKG1α which mediates PKG1 preservation of LV function in heart failure models, yet does not mediate the acute hypotensive effects of PKG1 activation. While MLK3 kinase activity enhances contractility, its therapeutic potential in HF remains unexplored. This study investigated whether AAV9-mediated MLK3 overexpression after transaortic constriction (TAC) restores LV function and opposes pathological LV remodeling in a preclinical heart failure model while bypassing PKG1α-induced hypotension.
Hypothesis
AAV9-mediated MLK3 overexpression in a pressure-overload HF model preserves LV systolic and diastolic function and opposes myocardial fibrosis.
Methods
Male 12-week-old mice underwent 26G TAC or sham surgery. Five days post-TAC, AAV9-MLK3 or AAV9-TdTomato (negative control) was delivered via retro-orbital injection under the cardiac myocyte-specific cTNT promoter. Cardiac function was evaluated 28 days later using echocardiography, invasive hemodynamics, and histological analysis.
Results
At day 5 post-TAC, compared with sham, mice subjected to TAC developed reduced LV ejection fraction, prior to AAV9 randomization. At 28 days post-AAV9, the AAV9-MLK3-treated TAC mice exhibited significantly improved LV ejection fraction and fractional shortening compared to TAC controls. MLK3 overexpression preserved LV systolic pressure and enhanced diastolic indices, including mitral E/A ratio, tau, and LV relaxation rate. No significant changes were observed between AAV9 groups in LV wall thickness, whole heart mass, or LV mass normalized to tibia length. Histological analysis revealed persistent fibrosis in both MLK3-treated and control TAC mice, indicating that MLK3 functional benefits occur independently of fibrosis modulation. MLK3 expression was increased approximately 3-fold in AAV9-MLK3 LV tissue compared with control AAV9.
Conclusion
AAV9-mediated MLK3 overexpression significantly improves LV function in pressure-overloaded hearts but does not reduce fibrosis. This supports that MLK3 enhances cardiac performance through fibrosis-independent mechanisms, such as direct effects on cardiomyocyte contractility or intracellular signaling. While MLK3 activation presents a promising therapeutic avenue for HF, additional strategies may be needed to mitigate fibrosis-related disease progression.
{"title":"Targeted Mixed Lineage Kinase Overexpression Restores Cardiac Function Despite Persistent Fibrosis In Pressure-overloaded Hearts","authors":"Suchita Pande, Gregory L. Martin, Robert M. Blanton","doi":"10.1016/j.cardfail.2025.11.071","DOIUrl":"10.1016/j.cardfail.2025.11.071","url":null,"abstract":"<div><h3>Introduction</h3><div>Heart failure (HF) remains a major clinical challenge, with limited therapeutic strategies directly targeting cardiac myocyte dysfunction. Drugs which activate cGMP-dependent protein kinase 1(PKG1), such as sacubitril/valsartan, nitrates, and vericiguat, improve LV function and outcomes in HF but are limited by PKG1-induced vasodilation and hypotension. Mixed-lineage kinase 3 (MLK3) is a novel substrate of PKG1α which mediates PKG1 preservation of LV function in heart failure models, yet does not mediate the acute hypotensive effects of PKG1 activation. While MLK3 kinase activity enhances contractility, its therapeutic potential in HF remains unexplored. This study investigated whether AAV9-mediated MLK3 overexpression after transaortic constriction (TAC) restores LV function and opposes pathological LV remodeling in a preclinical heart failure model while bypassing PKG1α-induced hypotension.</div></div><div><h3>Hypothesis</h3><div>AAV9-mediated MLK3 overexpression in a pressure-overload HF model preserves LV systolic and diastolic function and opposes myocardial fibrosis.</div></div><div><h3>Methods</h3><div>Male 12-week-old mice underwent 26G TAC or sham surgery. Five days post-TAC, AAV9-MLK3 or AAV9-TdTomato (negative control) was delivered via retro-orbital injection under the cardiac myocyte-specific cTNT promoter. Cardiac function was evaluated 28 days later using echocardiography, invasive hemodynamics, and histological analysis.</div></div><div><h3>Results</h3><div>At day 5 post-TAC, compared with sham, mice subjected to TAC developed reduced LV ejection fraction, prior to AAV9 randomization. At 28 days post-AAV9, the AAV9-MLK3-treated TAC mice exhibited significantly improved LV ejection fraction and fractional shortening compared to TAC controls. MLK3 overexpression preserved LV systolic pressure and enhanced diastolic indices, including mitral E/A ratio, tau, and LV relaxation rate. No significant changes were observed between AAV9 groups in LV wall thickness, whole heart mass, or LV mass normalized to tibia length. Histological analysis revealed persistent fibrosis in both MLK3-treated and control TAC mice, indicating that MLK3 functional benefits occur independently of fibrosis modulation. MLK3 expression was increased approximately 3-fold in AAV9-MLK3 LV tissue compared with control AAV9.</div></div><div><h3>Conclusion</h3><div>AAV9-mediated MLK3 overexpression significantly improves LV function in pressure-overloaded hearts but does not reduce fibrosis. This supports that MLK3 enhances cardiac performance through fibrosis-independent mechanisms, such as direct effects on cardiomyocyte contractility or intracellular signaling. While MLK3 activation presents a promising therapeutic avenue for HF, additional strategies may be needed to mitigate fibrosis-related disease progression.</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":"145950337","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号