John W Ostrominski,Brian L Claggett,Akshay S Desai,Pardeep S Jhund,Carolyn S P Lam,Michele Senni,Sanjiv J Shah,Adriaan A Voors,Faiez Zannad,Bertram Pitt,Katja Rohwedder,Meike Brinker,Patrick Schloemer,John J V McMurray,Scott D Solomon,Muthiah Vaduganathan
AIMSThe estimated glucose disposal rate (eGDR) is a simple, non-invasive measure of insulin resistance. In this exploratory analysis of FINEARTS-HF, we evaluated whether lower eGDR, reflecting greater insulin resistance, is associated with adverse outcomes in heart failure (HF).METHODS AND RESULTSThe eGDR was calculated at baseline using waist circumference, glycated haemoglobin, and hypertension status. Clinical outcomes and treatment effects of finerenone according to baseline eGDR (
目的：估计葡萄糖处置率（eGDR）是一种简单、无创的胰岛素抵抗测量方法。在FINEARTS-HF的探索性分析中，我们评估了较低的eGDR（反映更大的胰岛素抵抗）是否与心力衰竭（HF）的不良结局相关。方法和结果eGDR在基线时使用腰围、糖化血红蛋白和高血压状态计算。根据基线eGDR（<中位数或≥中位数）评价芬尼酮的临床结局和治疗效果。在5851名（98%）具有可计算的eGDR（中位数[四分位数间距]5.1 [3.9-6.3]mg/kg/min）的参与者中，较低的eGDR与较高的蛋白尿和较差的基线hf相关健康状况相关。与eGDR≥5.1 mg/kg/min的受试者相比，eGDR <5.1 mg/kg/min的受试者心血管死亡和总心衰事件发生率高63%（校正率比[aRR] 1.63； 95%可信区间[CI] 1.41-1.87; p < 0.001）。在糖尿病患者（aRR 1.72; 95% CI 1.40-2.12）和非糖尿病患者（aRR 1.34; 95% CI 1.07-1.68； p相互作用= 0.06）中也观察到类似的结果。较低的基线eGDR还与较高的血管事件、肾脏结局、新发糖尿病和全因死亡发生率相关。芬尼酮对心血管死亡和总心衰事件（p相互作用= 0.64）以及新发糖尿病（p相互作用= 0.36）的治疗益处与基线eGDR类别无关。基线eGDR分类没有改变芬烯酮的安全性。结论：eGDR是一种有效的胰岛素抵抗指标，与心衰患者（包括非糖尿病患者）的心血管、肾脏和代谢结局广泛相关。芬尼酮降低了心血管结局和新发糖尿病的风险，与基线胰岛素抵抗无关。临床试验注册：clinicaltrials .gov NCT04435626。
{"title":"Finerenone according to insulin resistance in heart failure: Insights from the FINEARTS-HF trial.","authors":"John W Ostrominski,Brian L Claggett,Akshay S Desai,Pardeep S Jhund,Carolyn S P Lam,Michele Senni,Sanjiv J Shah,Adriaan A Voors,Faiez Zannad,Bertram Pitt,Katja Rohwedder,Meike Brinker,Patrick Schloemer,John J V McMurray,Scott D Solomon,Muthiah Vaduganathan","doi":"10.1002/ejhf.70034","DOIUrl":"https://doi.org/10.1002/ejhf.70034","url":null,"abstract":"AIMSThe estimated glucose disposal rate (eGDR) is a simple, non-invasive measure of insulin resistance. In this exploratory analysis of FINEARTS-HF, we evaluated whether lower eGDR, reflecting greater insulin resistance, is associated with adverse outcomes in heart failure (HF).METHODS AND RESULTSThe eGDR was calculated at baseline using waist circumference, glycated haemoglobin, and hypertension status. Clinical outcomes and treatment effects of finerenone according to baseline eGDR (<median or ≥median) were evaluated. Among 5851 (98%) participants with a calculable eGDR (median [interquartile range] 5.1 [3.9-6.3] mg/kg/min), lower eGDR was associated with greater albuminuria and worse HF-related health status at baseline. Compared with participants with eGDR ≥5.1 mg/kg/min, those with eGDR <5.1 mg/kg/min experienced a 63% higher rate of cardiovascular death and total HF events (adjusted rate ratio [aRR] 1.63; 95% confidence interval [CI] 1.41-1.87; p < 0.001). Similar findings were observed in participants with diabetes (aRR 1.72; 95% CI 1.40-2.12) and without diabetes (aRR 1.34; 95% CI 1.07-1.68; pinteraction = 0.06). Lower baseline eGDR was additionally associated with a higher rate of vascular events, kidney outcomes, new-onset diabetes, and all-cause death. Treatment benefits of finerenone on cardiovascular death and total HF events (pinteraction = 0.64) and new-onset diabetes (pinteraction = 0.36) appeared consistent irrespective of baseline eGDR category. Baseline eGDR category did not modify the safety profile of finerenone.CONCLUSIONSThe eGDR, a validated measure of insulin resistance, was associated with a wide range of cardiovascular, kidney, and metabolic outcomes in patients with HF, including among those without diabetes. Finerenone reduced risk of cardiovascular outcomes and new-onset diabetes, irrespective of baseline insulin resistance.CLINICAL TRIAL REGISTRATIONClinicalTrials.gov NCT04435626.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"103 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maja Ivanovski, Miha Mrak, Anja Zupan Mežnar, Matevž Jan, Catalin Pestrea, Sandro Brusich, Peter Bogyi, Sebastiaan Dhont, Zrinka Jurišić, Vassil Traykov, Borka Pezo Nikolić, Wilfried Mullens, David Žižek
Aims
There is a lack of data from randomized clinical trials comparing treatment outcomes between conduction system pacing (CSP) modalities and biventricular pacing (BVP) in symptomatic patients with refractory atrial fibrillation (AF) scheduled for atrioventricular node ablation (AVNA). The CONDUCT-AF investigates whether CSP is non-inferior to BVP in improving left ventricular ejection fraction (LVEF) and clinical outcomes in heart failure (HF) patients with symptomatic AF undergoing AVNA.
Methods
This study is an investigator-initiated, prospective, randomized, multicentre clinical trial conducted across 10 European centres, enrolling 82 patients with symptomatic AF, HF with reduced LVEF, and narrow QRS. Participants will be randomized 1:1 to CSP or BVP with subsequent AVNA and followed for at least 24 months. The primary endpoint is the change in LVEF after 6 months. Secondary endpoints will include time to the first occurrence of worsening HF or cardiovascular death and its individual components, total number of HF hospitalizations, change in quality of life, N-terminal pro-B-type natriuretic peptide, 6-min walk test distance, and safety outcomes.
Conclusions
The CONDUCT-AF trial will provide critical insights into the optimal pacing modality for patients with HF and refractory AF undergoing AVNA. Recruitment is expected to conclude in 2025, with the first study results anticipated in 2026.
{"title":"The CONDUCT-AF trial: Rationale and design of a prospective, randomized, multicentre study comparing conduction system and biventricular pacing in patients undergoing atrioventricular node ablation for heart failure with atrial fibrillation","authors":"Maja Ivanovski, Miha Mrak, Anja Zupan Mežnar, Matevž Jan, Catalin Pestrea, Sandro Brusich, Peter Bogyi, Sebastiaan Dhont, Zrinka Jurišić, Vassil Traykov, Borka Pezo Nikolić, Wilfried Mullens, David Žižek","doi":"10.1002/ejhf.70013","DOIUrl":"10.1002/ejhf.70013","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>There is a lack of data from randomized clinical trials comparing treatment outcomes between conduction system pacing (CSP) modalities and biventricular pacing (BVP) in symptomatic patients with refractory atrial fibrillation (AF) scheduled for atrioventricular node ablation (AVNA). The CONDUCT-AF investigates whether CSP is non-inferior to BVP in improving left ventricular ejection fraction (LVEF) and clinical outcomes in heart failure (HF) patients with symptomatic AF undergoing AVNA.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This study is an investigator-initiated, prospective, randomized, multicentre clinical trial conducted across 10 European centres, enrolling 82 patients with symptomatic AF, HF with reduced LVEF, and narrow QRS. Participants will be randomized 1:1 to CSP or BVP with subsequent AVNA and followed for at least 24 months. The primary endpoint is the change in LVEF after 6 months. Secondary endpoints will include time to the first occurrence of worsening HF or cardiovascular death and its individual components, total number of HF hospitalizations, change in quality of life, N-terminal pro-B-type natriuretic peptide, 6-min walk test distance, and safety outcomes.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>The CONDUCT-AF trial will provide critical insights into the optimal pacing modality for patients with HF and refractory AF undergoing AVNA. Recruitment is expected to conclude in 2025, with the first study results anticipated in 2026.</p>\u0000 </section>\u0000 </div>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 10","pages":"1927-1934"},"PeriodicalIF":10.8,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.70013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008793","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Reply to the letter regarding the article 'Oral ferric maltol improves iron deficiency anaemia in patients with chronic heart failure'.","authors":"Tibor Kempf,Jan Fuge,Johann Bauersachs","doi":"10.1002/ejhf.70029","DOIUrl":"https://doi.org/10.1002/ejhf.70029","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"15 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter regarding the article 'Association between antecedent myocardial infarction and heart failure with preserved versus reduced ejection fraction'.","authors":"Hui-Chin Chang,Shuo-Yan Gau","doi":"10.1002/ejhf.70045","DOIUrl":"https://doi.org/10.1002/ejhf.70045","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"57 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Luis Eduardo Echeverria,Edimar Bocchi,Caroline Demacq,Pedro Gabriel Melo de Barros E Silva,Lu-May Chiang,Sarfaraz Sayyed,Lucas Petri Damiani,Lilian Mazza Barbosa,Remo Holanda de Mendonça Furtado,Carlos A Morillo,Ruben Kevorkian,Felix Ramires,Maria Cecilia Bahit,Adolfo Chavez-Mendoza,José Antonio Magaña-Serrano,Justo Carbajales,Wilson Oliveira Junior,Israel Molina,Arguinaldo F Freitas Junior,Maria da Consolaçao Moreira,Adegil Henrique Silva,Telemaco Silva Junior,Wladimir Saporito,José Francisco Kerr Saraiva,Claudio Gimpelewicz,John J V McMurray,Renato Delascio Lopes,
AIMSThe PARACHUTE-HF trial (NCT04023227) is evaluating the effect of sacubitril/valsartan compared with enalapril on a hierarchical composite of cardiovascular events (cardiovascular death, first heart failure hospitalization), and change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in participants with heart failure and reduced ejection fraction (HFrEF) caused by chronic Chagas cardiomyopathy (CCC). We describe the baseline characteristics of participants in PARACHUTE-HF compared with prior HFrEF trials.METHODS AND RESULTSPARACHUTE-HF, a multicentre, active-controlled, open-label trial, enrolled 922 participants with confirmed CCC, New York Heart Association (NYHA) functional class II-IV, and left ventricular ejection fraction (LVEF) ≤40%. Participants were randomized 1:1 to sacubitril/valsartan (97/103 mg bid) or enalapril (10 mg bid). Enrolled participants (mean age: 64.2 years, 42.0% women) had a baseline LVEF of 29.8% (NYHA class II: 61.7%; NHYA class III/IV: 38.2%). History included hypertension (40.5%), atrial fibrillation/flutter (32.5%), ventricular arrhythmia (24.7%) and stroke (12.5%). The majority of patients had cardiac conduction abnormalities and 46.0% had conventional pacemaker, cardiac resynchronization therapy or implantable cardioverter-defibrillator. Mean systolic blood pressure was 118 mmHg, and median NT-proBNP level was 1730 pg/ml.CONCLUSIONSBaseline characteristics of this study highlight the unique clinical profile of patients with CCC-related HFrEF, including the high proportion of women affected, lower rates of comorbidities (hypertension/diabetes) and higher prevalence of stroke and pacemaker implantation when compared with other non-CCC-related HFrEF studies. These findings reinforce the need for dedicated heart failure treatments in this neglected subpopulation, particularly in Latin America where Chagas disease remains a significant public health issue.
{"title":"Sacubitril/valsartan versus enalapril in chronic Chagas cardiomyopathy with heart failure: Baseline characteristics of the PARACHUTE-HF trial.","authors":"Luis Eduardo Echeverria,Edimar Bocchi,Caroline Demacq,Pedro Gabriel Melo de Barros E Silva,Lu-May Chiang,Sarfaraz Sayyed,Lucas Petri Damiani,Lilian Mazza Barbosa,Remo Holanda de Mendonça Furtado,Carlos A Morillo,Ruben Kevorkian,Felix Ramires,Maria Cecilia Bahit,Adolfo Chavez-Mendoza,José Antonio Magaña-Serrano,Justo Carbajales,Wilson Oliveira Junior,Israel Molina,Arguinaldo F Freitas Junior,Maria da Consolaçao Moreira,Adegil Henrique Silva,Telemaco Silva Junior,Wladimir Saporito,José Francisco Kerr Saraiva,Claudio Gimpelewicz,John J V McMurray,Renato Delascio Lopes, ","doi":"10.1002/ejhf.70026","DOIUrl":"https://doi.org/10.1002/ejhf.70026","url":null,"abstract":"AIMSThe PARACHUTE-HF trial (NCT04023227) is evaluating the effect of sacubitril/valsartan compared with enalapril on a hierarchical composite of cardiovascular events (cardiovascular death, first heart failure hospitalization), and change in N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels in participants with heart failure and reduced ejection fraction (HFrEF) caused by chronic Chagas cardiomyopathy (CCC). We describe the baseline characteristics of participants in PARACHUTE-HF compared with prior HFrEF trials.METHODS AND RESULTSPARACHUTE-HF, a multicentre, active-controlled, open-label trial, enrolled 922 participants with confirmed CCC, New York Heart Association (NYHA) functional class II-IV, and left ventricular ejection fraction (LVEF) ≤40%. Participants were randomized 1:1 to sacubitril/valsartan (97/103 mg bid) or enalapril (10 mg bid). Enrolled participants (mean age: 64.2 years, 42.0% women) had a baseline LVEF of 29.8% (NYHA class II: 61.7%; NHYA class III/IV: 38.2%). History included hypertension (40.5%), atrial fibrillation/flutter (32.5%), ventricular arrhythmia (24.7%) and stroke (12.5%). The majority of patients had cardiac conduction abnormalities and 46.0% had conventional pacemaker, cardiac resynchronization therapy or implantable cardioverter-defibrillator. Mean systolic blood pressure was 118 mmHg, and median NT-proBNP level was 1730 pg/ml.CONCLUSIONSBaseline characteristics of this study highlight the unique clinical profile of patients with CCC-related HFrEF, including the high proportion of women affected, lower rates of comorbidities (hypertension/diabetes) and higher prevalence of stroke and pacemaker implantation when compared with other non-CCC-related HFrEF studies. These findings reinforce the need for dedicated heart failure treatments in this neglected subpopulation, particularly in Latin America where Chagas disease remains a significant public health issue.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"30 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter regarding the article 'Oral ferric maltol improves iron deficiency anaemia in patients with chronic heart failure'.","authors":"Peng Sun","doi":"10.1002/ejhf.70024","DOIUrl":"https://doi.org/10.1002/ejhf.70024","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"24 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008782","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Letter regarding the article 'Effects of geranylgeranylacetone on diastolic and microvascular function in patients with heart failure with a preserved ejection fraction: A phase 2, randomized, placebo-controlled, crossover trial'.","authors":"Zongyu Yang,Liqiu Kou,Songjie Liao","doi":"10.1002/ejhf.70039","DOIUrl":"https://doi.org/10.1002/ejhf.70039","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"28 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008700","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Anne Marie Reimer Jensen, James C. Ross, Victoria Arthur, Michael E. Hall, Kunihiro Matsushita, Brandon Lennep, Pamela L. Lutsey, Tor Biering‐Sørensen, Amil M. Shah
AimsTo jointly model longitudinal measures of left ventricular ejection fraction (LVEF) and E/A ratio in late‐life, and to assess whether predicted trajectory membership is associated with heart failure risk.Methods and resultsUsing a Bayesian non‐parametric trajectory approach, trajectories were modelled among 747 Jackson Heart Study participants who underwent ≥2 echocardiograms in 2000–2004 (age 65 ± 5 years), 2011–2013 (75 ± 5), and 2018–2019 (81 ± 5). Using the resulting model, we predicted trajectory membership for 4419 distinct Atherosclerosis Risk in Communities (ARIC) study participants based on single time‐point measures of LVEF and E/A ratio (age 75 ± 5 years; ‘testing cohort’). Multivariable Cox models assessed the relationship between predicted trajectory and incident heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF). We evaluated associations of 4877 plasma proteins (SOMAscan) with predicted trajectory and performed Mendelian randomization to assess causal effects on LVEF and volume. Six trajectories were identified: pink (prevalence 50%) and light green (17%) – increasing LVEF, decreasing E/A ratio with age; red (22%) – no increase in LVEF; dark green (4%) – declining LVEF; orange (2%) – steeply declining LVEF, rising E/A ratio; and blue (4%) – rising E/A ratio despite increasing LVEF. In the testing cohort, red and dark green associated with HFrEF alone, blue with HFpEF alone, and orange with both compared to pink. Trajectory membership provided incremental value in predicting heart failure and HFpEF. Mendelian randomization identified potential causal effects of 13 trajectory‐associated proteins on LVEF and volume.ConclusionsBayesian non‐parametric modelling identifies cardiac function trajectories differentially associated with HFpEF and HFrEF and holds promise to improve risk prediction and enable therapeutic target discovery.
{"title":"Integrated trajectories of systolic and diastolic function differentially associate with risk for heart failure with preserved and reduced ejection fraction and proteomic profiles","authors":"Anne Marie Reimer Jensen, James C. Ross, Victoria Arthur, Michael E. Hall, Kunihiro Matsushita, Brandon Lennep, Pamela L. Lutsey, Tor Biering‐Sørensen, Amil M. Shah","doi":"10.1002/ejhf.70015","DOIUrl":"https://doi.org/10.1002/ejhf.70015","url":null,"abstract":"AimsTo jointly model longitudinal measures of left ventricular ejection fraction (LVEF) and E/A ratio in late‐life, and to assess whether predicted trajectory membership is associated with heart failure risk.Methods and resultsUsing a Bayesian non‐parametric trajectory approach, trajectories were modelled among 747 Jackson Heart Study participants who underwent ≥2 echocardiograms in 2000–2004 (age 65 ± 5 years), 2011–2013 (75 ± 5), and 2018–2019 (81 ± 5). Using the resulting model, we predicted trajectory membership for 4419 distinct Atherosclerosis Risk in Communities (ARIC) study participants based on single time‐point measures of LVEF and E/A ratio (age 75 ± 5 years; ‘testing cohort’). Multivariable Cox models assessed the relationship between predicted trajectory and incident heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF). We evaluated associations of 4877 plasma proteins (SOMAscan) with predicted trajectory and performed Mendelian randomization to assess causal effects on LVEF and volume. Six trajectories were identified: pink (prevalence 50%) and light green (17%) – increasing LVEF, decreasing E/A ratio with age; red (22%) – no increase in LVEF; dark green (4%) – declining LVEF; orange (2%) – steeply declining LVEF, rising E/A ratio; and blue (4%) – rising E/A ratio despite increasing LVEF. In the testing cohort, red and dark green associated with HFrEF alone, blue with HFpEF alone, and orange with both compared to pink. Trajectory membership provided incremental value in predicting heart failure and HFpEF. Mendelian randomization identified potential causal effects of 13 trajectory‐associated proteins on LVEF and volume.ConclusionsBayesian non‐parametric modelling identifies cardiac function trajectories differentially associated with HFpEF and HFrEF and holds promise to improve risk prediction and enable therapeutic target discovery.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"66 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Alberto Aimo, Giuseppe Vergaro, Maria Concetta Pastore, Daniela Tomasoni, Vincenzo Castiglione, Riccardo Saro, Elisa Zaro, Antonio Maria Sammartino, Elisa Giacomin, Matteo Serenelli, Alberto Cipriani, Aldostefano Porcari, Andrea Di Lenarda, Marco Metra, Gianfranco Sinagra, Matteo Cameli, Marco Merlo, Michele Emdin
{"title":"High prevalence of wild‐type transthyretin cardiac amyloidosis in older adults with carpal tunnel syndrome, heart failure or increased left ventricular mass: The CAPTURE study","authors":"Alberto Aimo, Giuseppe Vergaro, Maria Concetta Pastore, Daniela Tomasoni, Vincenzo Castiglione, Riccardo Saro, Elisa Zaro, Antonio Maria Sammartino, Elisa Giacomin, Matteo Serenelli, Alberto Cipriani, Aldostefano Porcari, Andrea Di Lenarda, Marco Metra, Gianfranco Sinagra, Matteo Cameli, Marco Merlo, Michele Emdin","doi":"10.1002/ejhf.70030","DOIUrl":"https://doi.org/10.1002/ejhf.70030","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"38 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144928251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Angela Dettling, Caroline Kellner, Jonas Sundermeyer, Benedikt N. Beer, Lisa Besch, Marvin Kriz, Stefan Kluge, Paulus Kirchhof, Stefan Blankenberg, Benedikt Schrage
AimsMortality for cardiogenic shock (CS) remains high. To improve outcomes, centralization of treatment in specialized centres, especially those with expertise in mechanical circulatory support (MCS), has been recommended. High‐volume centres may be able to provide standardized, better care. We analysed associations between centre volume and outcomes in Germany, a large country with multiple types of CS centres.Methods and resultsBased on data from all CS patients treated in Germany from 2017–2021, the association between annual CS/MCS hospital volume and in‐hospital mortality was assessed using adjusted Cox‐regression, and spline plots were used to assess case thresholds. Overall, 220 223 CS patients underwent treatment at 1232 hospitals; 435/1232 (35%) of these performed MCS therapy, although only few hospitals (60/435, 14%) performed >25 MCS cases per year on average. Treatment at hospitals with a higher annual volume of CS and MCS cases was associated with a significantly lower mortality risk as compared to hospitals with a lower volume (upper third vs. lower two‐thirds; CS: hazard ratio [HR] 0.92, 95% confidence interval [CI] 0.91–0.94; p < 0.001; MCS: HR 0.80, 95% CI 0.76–0.84; p < 0.001). These associations were continuous without a detectable ceiling effect, with spline plots suggesting case thresholds of at least 90 CS cases/25 MCS cases per year.ConclusionsCare for patients with CS treated with and without MCS is associated with lower in‐hospital mortality in hospitals that manage high volumes of CS and MCS. This analysis indicates that centralization of CS care in specialized centres treating high volumes of patients with CS and MCS might improve outcomes.
目的心源性休克（CS）的死亡率仍然很高。为了改善结果，建议在专门的中心集中治疗，特别是那些具有机械循环支持（MCS）专业知识的中心。大容量中心可能能够提供标准化的、更好的护理。我们分析了德国中心数量与结果之间的关系，德国是一个拥有多种类型CS中心的大国。方法和结果基于2017-2021年在德国接受治疗的所有CS患者的数据，使用调整后的Cox回归评估年度CS/MCS医院容量与院内死亡率之间的关系，并使用样条图评估病例阈值。总体而言，220223名CS患者在1232家医院接受了治疗；其中435/1232（35%）进行了MCS治疗，尽管只有少数医院（60/435,14%）平均每年治疗25例MCS病例。与数量较少的医院相比，每年接收CS和MCS病例较多的医院的治疗与较低的死亡风险相关（三分之一以上vs三分之二以下；CS：风险比[HR] 0.92, 95%可信区间[CI] 0.91-0.94; p < 0.001; MCS: HR 0.80, 95% CI 0.76-0.84; p < 0.001）。这些关联是连续的，没有可检测到的天花板效应，样条图显示病例阈值至少为每年90例CS /25例MCS。结论：在大量使用CS和MCS的医院中，接受和不接受MCS治疗的CS患者的恐慌与较低的院内死亡率相关。这一分析表明，在专门的中心集中治疗大量的CS和MCS患者可能会改善结果。
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