European Journal of Heart Failure最新文献

In this column, we want to provide clinicians and researchers with short and concise summaries of recently published studies in the European Journal of Heart Failure that we think may be of particular relevance to heart failure (HF) specialists (Figure 1). Key topics of this issue include characteristics and outcomes of patients with HF and history of malignancy, echocardiographic phenotyping of cardiac wasting in advanced cancer patients, the effect of sacubitril/valsartan for primary prevention of cancer therapy-related cardiac dysfunction (CTRCD) in early breast cancer and the associations between centre volume and cardiogenic shock (CS) outcomes in Germany.

Aims: To compare the effect of digoxin versus beta-blockers on left ventricular function, in patients with permanent atrial fibrillation (AF) and symptoms of heart failure within the RATE-AF randomized trial.

Methods and results: Blinded echocardiograms were performed at baseline and 12-month follow-up using a pre-defined imaging protocol and the index-beat approach. The change in systolic and diastolic function was assessed, stratified by left ventricular ejection fraction (LVEF). Overall, 145 patients completed follow-up, with median age 75 years (interquartile range 69-82) and 44% women. In 119 patients with baseline LVEF ≥50%, a significantly greater improvement in systolic function was noted in patients randomized to low-dose digoxin versus beta-blockers: adjusted mean difference for LVEF 2.3% (95% confidence interval [CI] 0.3-4.2; p = 0.021), s' 1.1 cm/s (95% CI 1.0-1.2; p = 0.001) and stroke volume 6.5 ml (95% CI 0.4-12.6; p = 0.037), with no difference in global longitudinal strain (p = 0.11) or any diastolic parameters. There were no significant differences between groups for patients with LVEF 40-49% and <40%. Digoxin reduced N-terminal pro-B-type natriuretic peptide compared to beta-blockers (geometric mean difference 0.77; 95% CI 0.64-0.92; p = 0.004), improved New York Heart Association functional class (odds ratio [OR] 11.3, 95% CI 4.3-29.8; p < 0.001) and modified European Heart Rhythm Association arrhythmia symptom class (OR 4.91, 95% CI 2.36-10.23; p < 0.001), with substantially less adverse events (incident rate ratio 0.21, 95% CI 0.13-0.31; p < 0.001). There were no interactions between treatment effects and baseline LVEF for these outcomes (interaction p = 0.62, 0.49, 0.07 and 0.13, respectively).

Conclusions: Low-dose digoxin in patients with symptoms of heart failure, preserved LVEF and permanent AF leads to a significantly greater improvement in systolic function compared to treatment with beta-blockers.

Aims: Age-associated clonal haematopoiesis of indeterminate potential (CHIP) has been linked to increased incidence and worse prognosis of chronic heart failure (CHF). CHIP arises from somatic mutations in haematopoietic stem and progenitor cells. Mosaic loss of Y chromosome (LOY), the most common somatic mutation in male blood cells, increases with age, drives clonal expansion of myeloid cells, and has been experimentally associated with cardiac fibrosis and heart failure in mice. However, its prognostic value and interplay with CHIP in CHF patients remain unclear.

Methods and results: We analysed 781 male CHF patients across the full spectrum of left ventricular ejection fraction to assess the prevalence and prognostic relevance of LOY and the two most common CHIP-driver mutations, DNMT3A and TET2. Both LOY and CHIP mutations increased with age and co-occurred in 27.1% of men >70 years. LOY independently predicted all-cause mortality in patients with heart failure with reduced ejection fraction (HFrEF). The co-occurrence of LOY and DNMT3A/TET2 mutations further increased mortality among CHIP carriers. This detrimental prognostic effect of LOY was confirmed in a validation cohort of HFrEF patients. Single-cell RNA sequencing of peripheral blood mononuclear cells from HFrEF patients with ischaemic heart failure revealed elevated pro-fibrotic signalling in LOY monocytes, characterized by increased inflammatory and remodelling markers (S100A8, TLR2, CLEC4D) and decreased expression of transforming growth factor-β inhibitors (SMAD7, TGIF2). In patients with both LOY and DNMT3A mutations, monocytes showed enhanced pro-inflammatory gene expression, including alarmins (S100A8, HMGB2) and interferon-related genes (IFNGR1, TRIM56, CD84).

Conclusions: Somatic mutations in blood cells-particularly LOY-are associated with increased mortality in male CHF patients, with LOY emerging as an independent prognostic marker.

Aims: The precise outcomes for patients with residual pulmonary hypertension (PH) following the optimized treatment of acute decompensated heart failure (ADHF) remain poorly understood. This study aimed to investigate the prognostic association of PH, categorized according to left ventricular ejection fraction (LVEF), in hospitalized ADHF patients.

Methods and results: The WET-HF registry is a multicentre, prospective cohort ADHF registry. Patients were classified into four groups according to tricuspid regurgitation velocity (TRV) and LVEF. PH was defined as peak TRV >2.8 m/s. The primary endpoint was a composite of all-cause mortality and heart failure (HF) rehospitalization at 2 years. In total, 1702 patients had nonPH-HF with LVEF <50% (n = 689 [40.5%]), PH-HF with LVEF <50% (n = 291 [17.1%]), nonPH-HF with LVEF ≥50% (n = 453 [26.6%]), and PH-HF with LVEF ≥50% (n = 269 [15.8%]). A significant difference in the composite endpoint was observed between patients with and without PH (42.3% vs. 30.4%, p < 0.001), with no significant interaction between PH and LVEF. Notably, in the nonPH-HF group, there were significant differences in clinical outcomes between patients with more than 30% B-type natriuretic peptide (BNP) improvement and those with less (composite endpoint 27.5% vs. 41.8%, p < 0.001; all-cause mortality 9.4% vs. 24.6%, p < 0.001; HF rehospitalization 20.2% vs. 32.8%, p = 0.001). However, no such difference was evident in the PH-HF group.

Conclusions: The prognostic importance of residual PH was comparable across both HF with reduced and preserved ejection fraction patients. While the prognostic significance of BNP improvement on clinical outcomes was attenuated in the presence of residual PH, utilizing residual PH for risk stratification effectively identified patients at increased risk of mortality and rehospitalization following ADHF, irrespective of their LVEF.

Aims: Right ventricular reverse remodelling (RVRR) is linked to improved survival in patients with severe tricuspid regurgitation (TR) and right-sided heart failure who underwent interventional treatment. However, the role of residual TR on RVRR remains unclear. In this analysis the impact of residual TR on RVRR after interventional TR treatment, which was validated by two independent cohorts at four sites using echocardiography or cardiac magnetic resonance (CMR) imaging, was investigated.

Methods and results: Overall, 253 patients who were treated for severe TR and right-sided heart failure using different treatment modalities (tricuspid transcatheter edge-to-edge repair [T-TEER], transcatheter tricuspid valve annuloplasty, orthotopic transcatheter TV replacement [TTVR], heterotopic TTVR) were included. Three-dimensional echocardiographic and CMR-based assessment of RVRR and clinical evaluation of decongestion or exercise capacity were performed at baseline and 30 days after the procedure. Mortality was analysed at 1 year after transcatheter tricuspid valve intervention (TTVI). In patients with residual TR ≤1+ pronounced reduction of right ventricular end-diastolic and end-systolic volumes was observed. In patients with residual TR ≥2+ the effect of RVRR gradually decreased with higher residual TR reinforcing the relevance of optimal procedural results for RVRR. These findings were validated in two independent cohorts. In contrast to RVRR, residual TR ≤1+ and 2+ were associated with similar 1-year survival. RVRR was only observed after T-TEER or orthotopic TTVR, but not after heterotopic TTVR as expected. However, all three treatment modalities were accompanied by significant decongestion and functional improvement at 30-day follow-up.

Conclusions: In patients with severe TR and right-sided heart failure undergoing TTVI, superior procedural results were associated with more pronounced RVRR.