European Journal of Heart Failure最新文献

Aims: Clonal haematopoiesis (CH) is recognized as a significant risk factor for various non-haematologic conditions, including cardiovascular diseases. However, recent studies examining its relationship with heart failure (HF) have reported conflicting findings. To address these inconsistencies, the present meta-analysis aimed to evaluate the association of CH with the incidence and clinical outcomes of HF.

Methods and results: MEDLINE, Cochrane Library and Scopus were searched until 12 December 2024. Triple-independent study selection, data extraction and quality assessment were performed. Evidence was pooled using three-level mixed-effects meta-analyses. Participants (n = 57 755) with CH had significantly greater risk of new-onset HF compared to the non-CH group (hazard ratio [HR] 1.23, 95% confidence interval [CI] 1.12-1.35, p < 0.0001; I² = 0%), irrespective of a prior history of coronary artery disease. CH was also correlated with a higher risk of the composite outcome of all-cause mortality and hospitalization for HF (HHF) compared to the non-CH group in patients with established HF (HR 1.84, 95% CI 1.25-2.70, p = 0.002; I² = 0%). Specifically, CH was associated with a 95% higher risk of all-cause mortality (HR 1.95, 95% CI 1.54-2.47, p < 0.0001; I² = 0%), with a 3% increase in risk for every 1% increase in variant allele fraction. Participants with concomitant HF and CH had a 56% higher risk of HHF compared to non-CH HF patients (HR 1.56, 95% CI 1.05-2.33, p = 0.029; I² = 19%).

Conclusion: Clonal haematopoiesis is associated with an increased risk of incident HF and worse prognosis in individuals affected by HF. These findings highlight the potential of CH to contribute to a deeper understanding of HF, improve risk stratification, and support more personalized approaches to its management.

Introduction

Exercise-based cardiac rehabilitation in individuals with heart failure with reduced ejection fraction (HFrEF) elicits clinically meaningful improvements in exercise capacity and quality of life while reducing hospital readmissions.¹ Training dose is an important determinant of the response to cardiac rehabilitation, where both the volume and intensity of exercise performed are critical to the magnitude of adaptation.² Achieving more work (intensity, or duration) within a given session likely leads to greater adaptive responses and may improve clinical outcomes following exercise-based rehabilitation.³ Ergogenic aids that facilitate an ability to perform more work during each rehabilitation session may therefore be of clinical importance. An acute bout of passive heating increases core, skin and tissue temperatures, augmenting blood flow and shear stress and subsequent oxygen delivery.⁴ Therefore, we aimed to assess whether acute lower-limb heating increases femoral artery blood flow and lower-limb tissue oxygenation, that translates to increased post-heating exercise performance in individuals with HFrEF.

Aims: Chronic kidney disease is a frequent comorbidity in heart failure (HF) patients, affecting prognosis and mortality. This study investigates the relationship between kidney function and adverse kidney events preceding death in HF patients.

Methods and results: We analysed registry data of HF patients who died between 2014 and 2021, with at least 1 year of HF diagnosis. Adverse kidney events, including acute kidney injury (AKI) and end-stage kidney disease (ESKD), were assessed. Patients were grouped by estimated glomerular filtration rate (eGFR) 1 year before death: eGFR ≥60, eGFR 30-59, and eGFR<30 ml/min/1.73 m². Among 36 435 HF patients who died, 37% had eGFR ≥60 ml/min/1.73 m², 46% had eGFR 30-59 ml/min/1.73 m², and 17% had eGFR <30 ml/min/1.73 m² 1 year before death. Median age was 81 years, and 61.2% were men. Adverse kidney events occurred in 13.1% of patients. AKI was inversely related to kidney function, affecting 6.5% (95% confidence interval 6.1-6.9) of those with eGFR ≥60 ml/min/1.73 m², 7.0% (6.6-7.4) with eGFR 30-59 ml/min/1.73 m², and 21.9% (20.9-22.9) with eGFR <30 ml/min/1.73 m². ESKD occurred in 0.7% (0.6-0.9), 2.6% (2.4-2.8), and 35.5% (34.3-36.7) of patients in the respective eGFR categories. In the last 3 months before death, kidney function notably declined, with increased chronic kidney replacement therapy. Factors associated with higher adverse kidney events included younger age, male sex, in-hospital death, and greater frailty.

Conclusions: In HF patients, AKI and ESKD are common in the last year of life, particularly in those with lower baseline eGFR, with kidney decline accelerating in the final months.