Pau Codina, Matthew M.Y. Lee, Daniela Tomasoni, Alberto Aimo
{"title":"What's new in heart failure? October 2025","authors":"Pau Codina, Matthew M.Y. Lee, Daniela Tomasoni, Alberto Aimo","doi":"10.1002/ejhf.70064","DOIUrl":"https://doi.org/10.1002/ejhf.70064","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 10","pages":"1803-1806"},"PeriodicalIF":10.8,"publicationDate":"2025-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145399066","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}
Awais Sheikh,Zi Michael Miao,Brian Claggett,Pablo Garcia-Pavia,Francesco Cappelli,Emre Aldinc,Julian Gillmore,Scott D Solomon,Marianna Fontana
AIMSTransthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive condition primarily affecting older adults, who are at increased risk of morbidity and mortality. In HELIOS-B, vutrisiran reduced all-cause mortality and recurrent cardiovascular events versus placebo in patients with ATTR-CM. This prespecified analysis evaluated efficacy and safety outcomes by age category (<75, 75 to <80, and ≥80 years) and across age as a continuous measure.METHODS AND RESULTSHELIOS-B randomized patients with ATTR-CM in a 1:1 ratio to vutrisiran 25 mg or placebo every 12 weeks for up to 36 months. Eligible patients were aged 18-85 years. We assessed the primary composite of all-cause mortality and recurrent cardiovascular events, changes in 6-min walk test (6MWT) and Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS), and safety outcomes across age groups. Among 654 patients (aged 45-85 years; mean 75.3 ± 6.7), 257 (39.3%) were <75, 201 (30.7%) 75 to <80, and 196 (30.0%) ≥80 years. Vutrisiran reduced the risk of the primary composite outcome in all age categories (pinteraction = 0.56) and across the age spectrum as a continuous function (pinteraction = 0.50). Consistent benefits were seen for individual outcome components, with no significant interaction between treatment and age. Functional capacity and quality of life were preserved across age groups (pinteraction = 0.35 and = 1.00 for KCCQ-OSS and 6MWT, respectively). Safety was comparable across groups, with no increase in adverse events in older patients.CONCLUSIONSVutrisiran reduced all-cause mortality and cardiovascular events and maintained function and quality of life in patients with ATTR-CM across the age spectrum, including those ≥80 years.
{"title":"Efficacy and safety of vutrisiran in transthyretin amyloid cardiomyopathy across the age spectrum: The HELIOS-B trial.","authors":"Awais Sheikh,Zi Michael Miao,Brian Claggett,Pablo Garcia-Pavia,Francesco Cappelli,Emre Aldinc,Julian Gillmore,Scott D Solomon,Marianna Fontana","doi":"10.1002/ejhf.70084","DOIUrl":"https://doi.org/10.1002/ejhf.70084","url":null,"abstract":"AIMSTransthyretin amyloid cardiomyopathy (ATTR-CM) is a progressive condition primarily affecting older adults, who are at increased risk of morbidity and mortality. In HELIOS-B, vutrisiran reduced all-cause mortality and recurrent cardiovascular events versus placebo in patients with ATTR-CM. This prespecified analysis evaluated efficacy and safety outcomes by age category (<75, 75 to <80, and ≥80 years) and across age as a continuous measure.METHODS AND RESULTSHELIOS-B randomized patients with ATTR-CM in a 1:1 ratio to vutrisiran 25 mg or placebo every 12 weeks for up to 36 months. Eligible patients were aged 18-85 years. We assessed the primary composite of all-cause mortality and recurrent cardiovascular events, changes in 6-min walk test (6MWT) and Kansas City Cardiomyopathy Questionnaire overall summary score (KCCQ-OSS), and safety outcomes across age groups. Among 654 patients (aged 45-85 years; mean 75.3 ± 6.7), 257 (39.3%) were <75, 201 (30.7%) 75 to <80, and 196 (30.0%) ≥80 years. Vutrisiran reduced the risk of the primary composite outcome in all age categories (pinteraction = 0.56) and across the age spectrum as a continuous function (pinteraction = 0.50). Consistent benefits were seen for individual outcome components, with no significant interaction between treatment and age. Functional capacity and quality of life were preserved across age groups (pinteraction = 0.35 and = 1.00 for KCCQ-OSS and 6MWT, respectively). Safety was comparable across groups, with no increase in adverse events in older patients.CONCLUSIONSVutrisiran reduced all-cause mortality and cardiovascular events and maintained function and quality of life in patients with ATTR-CM across the age spectrum, including those ≥80 years.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"72 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145381147","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}
Lara E E C Zonneveld,Iris E Beldhuis,Hailun Qin,Dirk J van Veldhuisen,Jenifer E Coster,Wybe Nieuwland,Jan A Krikken,Peter van der Meer,Adriaan A Voors,Kevin Damman,Jozine M Ter Maaten
AIMSDiuretic resistance is frequently observed in patients with acute decompensated heart failure (ADHF), specifically in those with chronic use of loop diuretics (LD). Natriuresis-guided therapy may be useful to overcome this, however it is unknown whether its effect is impacted by chronic LD use. The aim of this study was to evaluate the effect of outpatient LD use on natriuresis and clinical outcomes, and to determine whether natriuresis-guided therapy modifies these effects in patients hospitalized for ADHF.METHODS AND RESULTSIn this prespecified sub-analysis of the PUSH-AHF trial, the association between outpatient LD use, predefined primary, secondary and safety outcomes as established in the PUSH-AHF protocol, and the effect of natriuresis-guided therapy as compared with standard of care was evaluated. Patients in both arms received the first in-hospital LD dose based on renal function and outpatient LD dose. Out of 310 randomized patients, 133 (43%) had no prior LD use, 65 (21%) used 0-1 mg bumetanide and 112 (36%) used >1 mg bumetanide (or equivalent). Patients with higher outpatient LD doses had a longer history of heart failure and worse renal function (p for trend <0.001). Higher outpatient LD doses were associated with lower 24-h natriuresis (340 ± 194 mmol vs. 420 ± 200 mmol in diuretic-naïve patients, p for trend = 0.002). Natriuresis-guided therapy significantly increased 24-h natriuresis regardless of outpatient LD use (p for interaction = 0.420). No interaction between outpatient LD use, natriuresis-guided therapy and the effect on the combined endpoint of heart failure rehospitalization or all-cause mortality at 180 days was observed (p for interaction = 0.881).CONCLUSIONSOutpatient LD use results in reduced natriuresis. However, the beneficial effects of natriuresis-guided diuretic therapy on 24-h natriuresis were consistent, regardless of previous LD use.
{"title":"Outpatient loop diuretic use and the effect of natriuresis-guided diuretic therapy: A prespecified sub-analysis of the PUSH-AHF study.","authors":"Lara E E C Zonneveld,Iris E Beldhuis,Hailun Qin,Dirk J van Veldhuisen,Jenifer E Coster,Wybe Nieuwland,Jan A Krikken,Peter van der Meer,Adriaan A Voors,Kevin Damman,Jozine M Ter Maaten","doi":"10.1002/ejhf.70080","DOIUrl":"https://doi.org/10.1002/ejhf.70080","url":null,"abstract":"AIMSDiuretic resistance is frequently observed in patients with acute decompensated heart failure (ADHF), specifically in those with chronic use of loop diuretics (LD). Natriuresis-guided therapy may be useful to overcome this, however it is unknown whether its effect is impacted by chronic LD use. The aim of this study was to evaluate the effect of outpatient LD use on natriuresis and clinical outcomes, and to determine whether natriuresis-guided therapy modifies these effects in patients hospitalized for ADHF.METHODS AND RESULTSIn this prespecified sub-analysis of the PUSH-AHF trial, the association between outpatient LD use, predefined primary, secondary and safety outcomes as established in the PUSH-AHF protocol, and the effect of natriuresis-guided therapy as compared with standard of care was evaluated. Patients in both arms received the first in-hospital LD dose based on renal function and outpatient LD dose. Out of 310 randomized patients, 133 (43%) had no prior LD use, 65 (21%) used 0-1 mg bumetanide and 112 (36%) used >1 mg bumetanide (or equivalent). Patients with higher outpatient LD doses had a longer history of heart failure and worse renal function (p for trend <0.001). Higher outpatient LD doses were associated with lower 24-h natriuresis (340 ± 194 mmol vs. 420 ± 200 mmol in diuretic-naïve patients, p for trend = 0.002). Natriuresis-guided therapy significantly increased 24-h natriuresis regardless of outpatient LD use (p for interaction = 0.420). No interaction between outpatient LD use, natriuresis-guided therapy and the effect on the combined endpoint of heart failure rehospitalization or all-cause mortality at 180 days was observed (p for interaction = 0.881).CONCLUSIONSOutpatient LD use results in reduced natriuresis. However, the beneficial effects of natriuresis-guided diuretic therapy on 24-h natriuresis were consistent, regardless of previous LD use.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"111 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145381109","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}
Jaime Mazón-Ruiz,Eduardo Josué Banegas-Deras,Jose María Fernández-Rodríguez,Mar Domingo,Rafael de la Espriella,Pau Llàcer,Marta Cobo-Marcos,Joan Carles Trullàs,Jan Biegus,Antoni Bayés-Genís,Julio Nuñez,Gregorio Romero-González
Chloride, together with sodium, is one of the major extracellular ions and plays a critical yet often overlooked role in the pathophysiology of heart failure (HF). Beyond its passive role in maintaining electroneutrality and osmotic balance, chloride actively contributes to renal tubular transport via Na+-Cl- cotransporter (NCC) and Na+-K+-2Cl- cotransporter (NKCC), regulates acid-base homeostasis through bicarbonate exchange, and modulates neurohormonal activity by influencing renin release at the macula densa. In HF, hypochloraemia (whether dilutional or due to true ionic depletion) activates maladaptive mechanisms including enhanced sodium reabsorption, metabolic alkalosis, and sustained activation of the renin-angiotensin-aldosterone system. These alterations collectively exacerbate fluid retention, promote diuretic resistance, and worsen congestion. Emerging evidence suggests that low serum chloride levels are independently associated with higher mortality, reduced natriuretic response, and poorer decongestion outcomes. This review synthesizes the pathophysiological and clinical significance of chloride in HF and examines emerging therapeutic strategies aimed at restoring chloride homeostasis and improving diuretic response. These include sodium-free chloride formulations, chloride-sparing diuretics, and hypertonic saline solutions, with trials such as SMAC-HF and SALT-HF suggesting clinical benefit, particularly in hypochloraemic patients. Novel technologies, such as automated chloride-balanced diuresis systems, represent a promising tool for individualized fluid management. Recognizing hypochloraemia as a modifiable therapeutic target (rather than a bystander) may lead to a paradigm shift in the approach to congestion and volume overload in HF. A chloride-guided strategy offers the potential for more effective and personalized decongestive therapy.
氯离子和钠离子是主要的细胞外离子之一，在心力衰竭（HF）的病理生理中起着至关重要的作用，但往往被忽视。除了维持电中性和渗透平衡的被动作用外，氯离子还通过Na+- cl -共转运体（NCC）和Na+- k +- 2cl -共转运体（NKCC）积极参与肾小管运输，通过碳酸氢盐交换调节酸碱稳态，并通过影响肾素在黄斑致密处的释放来调节神经激素活性。在HF中，低氯血症（无论是稀释型还是真正的离子耗尽）激活了不适应机制，包括钠重吸收增强、代谢性碱中毒和肾素-血管紧张素-醛固酮系统的持续激活。这些改变共同加剧液体潴留，促进利尿剂抵抗，加重充血。新出现的证据表明，低血清氯化物水平与较高的死亡率、降低的利钠反应和较差的去充血结果独立相关。本文综述了HF中氯化物的病理生理和临床意义，并探讨了旨在恢复氯化物稳态和改善利尿反应的新兴治疗策略。这些包括无钠氯化物制剂、保留氯化物的利尿剂和高渗盐水溶液，SMAC-HF和SALT-HF等试验表明临床益处，特别是在低氯血症患者中。新技术，如自动化氯化物平衡利尿系统，代表了个性化流体管理的一个有前途的工具。认识到低氯血症是一个可改变的治疗靶点（而不是一个旁观者）可能会导致心力衰竭患者充血和容量过载方法的范式转变。氯化物引导策略提供了更有效和个性化的减充血性治疗的潜力。
{"title":"The chloride paradigm shift in heart failure: From neglected ion to keystone of precision diuretic therapy.","authors":"Jaime Mazón-Ruiz,Eduardo Josué Banegas-Deras,Jose María Fernández-Rodríguez,Mar Domingo,Rafael de la Espriella,Pau Llàcer,Marta Cobo-Marcos,Joan Carles Trullàs,Jan Biegus,Antoni Bayés-Genís,Julio Nuñez,Gregorio Romero-González","doi":"10.1002/ejhf.70081","DOIUrl":"https://doi.org/10.1002/ejhf.70081","url":null,"abstract":"Chloride, together with sodium, is one of the major extracellular ions and plays a critical yet often overlooked role in the pathophysiology of heart failure (HF). Beyond its passive role in maintaining electroneutrality and osmotic balance, chloride actively contributes to renal tubular transport via Na+-Cl- cotransporter (NCC) and Na+-K+-2Cl- cotransporter (NKCC), regulates acid-base homeostasis through bicarbonate exchange, and modulates neurohormonal activity by influencing renin release at the macula densa. In HF, hypochloraemia (whether dilutional or due to true ionic depletion) activates maladaptive mechanisms including enhanced sodium reabsorption, metabolic alkalosis, and sustained activation of the renin-angiotensin-aldosterone system. These alterations collectively exacerbate fluid retention, promote diuretic resistance, and worsen congestion. Emerging evidence suggests that low serum chloride levels are independently associated with higher mortality, reduced natriuretic response, and poorer decongestion outcomes. This review synthesizes the pathophysiological and clinical significance of chloride in HF and examines emerging therapeutic strategies aimed at restoring chloride homeostasis and improving diuretic response. These include sodium-free chloride formulations, chloride-sparing diuretics, and hypertonic saline solutions, with trials such as SMAC-HF and SALT-HF suggesting clinical benefit, particularly in hypochloraemic patients. Novel technologies, such as automated chloride-balanced diuresis systems, represent a promising tool for individualized fluid management. Recognizing hypochloraemia as a modifiable therapeutic target (rather than a bystander) may lead to a paradigm shift in the approach to congestion and volume overload in HF. A chloride-guided strategy offers the potential for more effective and personalized decongestive therapy.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"166 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-10-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145381111","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}
Heart failure (HF) is characterized by increasing prevalence, high morbidity and mortality, poor quality of life, and substantial healthcare costs. Despite advancements in pharmacologic and device-based therapies, translating evidence from randomized controlled trials into clinical practice remains suboptimal. The Global Registries and Surveys Programme-Heart Failure (GRASP-HF) is a pan-European, snapshot, observational study, aiming at assessing the real-world implementation of evidence-based HF management. GRASP-HF captures both acute and chronic HF presentations to assess the adherence to the 2021 and 2023 European Society of Cardiology (ESC) HF Guidelines. It also serves as a platform for the accreditation of HF centres for the Improving Care through Accreditation and Recognition in Heart Failure (ICARe-HF) programme. This manuscript outlines the rationale, methodology, and design of GRASP-HF. Unlike previous registries, GRASP-HF ensures that all patients are consecutively enrolled over a pre-defined 2-month period, minimizing selection bias. GRASP-HF offers a real-time perspective on diagnostic strategies, use of guideline-recommended medical therapy and implementation of quality-of-care indicators. In addition, GRASP-HF addresses less explored domains by other registries, such as frailty, rare aetiologies (e.g. amyloidosis, genetic cardiomyopathies, Takotsubo syndrome), as well as non-fatal events during hospitalization and follow-up. GRASP-HF is also designed to inform ESC educational strategies and to benchmark progresses in HF care across European and non-European centres. In conjunction with ICARe-HF, annual repetition of GRASP-HF aims to facilitate continuous feedback between evidence, practice, and quality improvement. GRASP-HF will assist National Cardiac Societies in shaping national and institutional policies and will contribute with data-driven insights to future guideline development.
{"title":"Global Registries and Surveys Programme-Heart Failure (GRASP-HF): Rationale, study design and research implications.","authors":"Ovidiu Chioncel,Gianluigi Savarese,Cecile Laroche,Offer Amir,Mariya Tokmakova,Antonio Cannata,Loi Do Doan,Tarek Abdelhameed Nagib Ahmed Kafafy,Jan Krejci,Brenda Moura,Lars Lund,Marianna Adamo,Wendy Guillouche,Maurizio Volterani,Bernard Iung,Marco Metra, ","doi":"10.1002/ejhf.70065","DOIUrl":"https://doi.org/10.1002/ejhf.70065","url":null,"abstract":"Heart failure (HF) is characterized by increasing prevalence, high morbidity and mortality, poor quality of life, and substantial healthcare costs. Despite advancements in pharmacologic and device-based therapies, translating evidence from randomized controlled trials into clinical practice remains suboptimal. The Global Registries and Surveys Programme-Heart Failure (GRASP-HF) is a pan-European, snapshot, observational study, aiming at assessing the real-world implementation of evidence-based HF management. GRASP-HF captures both acute and chronic HF presentations to assess the adherence to the 2021 and 2023 European Society of Cardiology (ESC) HF Guidelines. It also serves as a platform for the accreditation of HF centres for the Improving Care through Accreditation and Recognition in Heart Failure (ICARe-HF) programme. This manuscript outlines the rationale, methodology, and design of GRASP-HF. Unlike previous registries, GRASP-HF ensures that all patients are consecutively enrolled over a pre-defined 2-month period, minimizing selection bias. GRASP-HF offers a real-time perspective on diagnostic strategies, use of guideline-recommended medical therapy and implementation of quality-of-care indicators. In addition, GRASP-HF addresses less explored domains by other registries, such as frailty, rare aetiologies (e.g. amyloidosis, genetic cardiomyopathies, Takotsubo syndrome), as well as non-fatal events during hospitalization and follow-up. GRASP-HF is also designed to inform ESC educational strategies and to benchmark progresses in HF care across European and non-European centres. In conjunction with ICARe-HF, annual repetition of GRASP-HF aims to facilitate continuous feedback between evidence, practice, and quality improvement. GRASP-HF will assist National Cardiac Societies in shaping national and institutional policies and will contribute with data-driven insights to future guideline development.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"108 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145339419","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}
Mark Luedde,Stefan Agewall,Giuseppe Ambrosio,Antoni Bayes-Genis,Claudio Borghi,Elisabetta Cerbai,Gheorghe A Dan,Heinz Drexel,Péter Ferdinandy,Erik Lerkevang Grove,Juan Carlos Kaski,Roland Klingenberg,Joao Morais,William Parker,Mark C Petrie,Bianca Rocca,Anne Grete Semb,Michele Senni,Christian Sohns,Patrick Sulzgruber,Juan Tamargo,Marco Metra,Michael Böhm,Dobromir Dobrev,Samuel Sossalla
Heart failure (HF) and atrial fibrillation (AF) are major global health challenges with rising prevalence and significant morbidity, mortality, and healthcare burden. Despite advances in HF management, AF remains a critical comorbidity that worsens outcomes and requires ad hoc treatment strategies, increasing the risk of non-adherence and side effects. While rhythm control strategies in AF have gained attention for their prognostic benefits in HF, the pharmacological treatment of HF in patients with AF, including the benefit of rhythm versus rate control, remains underexplored. The relationship between HF and AF lacks sufficient evidence and targeted research to assess the optimal treatment strategies. This narrative review critically examines current HF pharmacotherapy in the context of AF, focusing on the four cornerstone treatments and modifiers of prognosis for HF with reduced ejection fraction: beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/sacubitril-valsartan, aldosterone antagonists, and sodium-glucose co-transporter 2 inhibitors. Although these therapies are well-established in HF patients, their efficacy in patients with concomitant AF requires further prospective investigation. The unique challenges posed by AF, including arrhythmia-induced remodelling and cardiomyopathy, necessitate a more individually tailored treatment. We also highlight critical knowledge gaps and the need for dedicated clinical trials specifically assessing HF therapies in AF subgroups, such as paroxysmal, long-standing persistent and permanent AF, and the benefit of heart rate and rhythm control strategies. The future of precision medicine in HF-AF management lies in bridging these evidence gaps through targeted research and interdisciplinary collaboration.
{"title":"European Journal of Heart Failure consensus statement. Heart failure pharmacotherapy for patients with heart failure with reduced ejection fraction and concomitant atrial fibrillation: Review of evidence and call to action.","authors":"Mark Luedde,Stefan Agewall,Giuseppe Ambrosio,Antoni Bayes-Genis,Claudio Borghi,Elisabetta Cerbai,Gheorghe A Dan,Heinz Drexel,Péter Ferdinandy,Erik Lerkevang Grove,Juan Carlos Kaski,Roland Klingenberg,Joao Morais,William Parker,Mark C Petrie,Bianca Rocca,Anne Grete Semb,Michele Senni,Christian Sohns,Patrick Sulzgruber,Juan Tamargo,Marco Metra,Michael Böhm,Dobromir Dobrev,Samuel Sossalla","doi":"10.1002/ejhf.70069","DOIUrl":"https://doi.org/10.1002/ejhf.70069","url":null,"abstract":"Heart failure (HF) and atrial fibrillation (AF) are major global health challenges with rising prevalence and significant morbidity, mortality, and healthcare burden. Despite advances in HF management, AF remains a critical comorbidity that worsens outcomes and requires ad hoc treatment strategies, increasing the risk of non-adherence and side effects. While rhythm control strategies in AF have gained attention for their prognostic benefits in HF, the pharmacological treatment of HF in patients with AF, including the benefit of rhythm versus rate control, remains underexplored. The relationship between HF and AF lacks sufficient evidence and targeted research to assess the optimal treatment strategies. This narrative review critically examines current HF pharmacotherapy in the context of AF, focusing on the four cornerstone treatments and modifiers of prognosis for HF with reduced ejection fraction: beta-blockers, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers/sacubitril-valsartan, aldosterone antagonists, and sodium-glucose co-transporter 2 inhibitors. Although these therapies are well-established in HF patients, their efficacy in patients with concomitant AF requires further prospective investigation. The unique challenges posed by AF, including arrhythmia-induced remodelling and cardiomyopathy, necessitate a more individually tailored treatment. We also highlight critical knowledge gaps and the need for dedicated clinical trials specifically assessing HF therapies in AF subgroups, such as paroxysmal, long-standing persistent and permanent AF, and the benefit of heart rate and rhythm control strategies. The future of precision medicine in HF-AF management lies in bridging these evidence gaps through targeted research and interdisciplinary collaboration.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"17 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145338758","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}
Sam Straw,Pieter Martens,Nathan Mewton,Klaus K Witte,Wilfried Mullens
{"title":"The problem with hospitalization endpoints in heart failure trials.","authors":"Sam Straw,Pieter Martens,Nathan Mewton,Klaus K Witte,Wilfried Mullens","doi":"10.1002/ejhf.70070","DOIUrl":"https://doi.org/10.1002/ejhf.70070","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"72 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331696","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}
AIMSLeft ventricular ejection fraction (LVEF) is a key measure of cardiac function. While prior studies showed a U-shaped relationship between LVEF and mortality, its association with worsening heart failure (HF) remains unclear. We aimed to evaluate the association between the full spectrum of LVEF and the risk of worsening HF.METHODS AND RESULTSWe analysed data from 93 694 consecutive participants (median age 62 years [interquartile range: 50-76 years], 51.4% men) undergoing echocardiography at a tertiary medical centre. LVEF, measured by biplane Simpson's method, was categorized into 5% intervals from <20% to ≥70%. The primary outcome was a composite of all-cause mortality or worsening HF, while the secondary outcomes included all-cause mortality, cardiovascular death, and worsening HF. The primary outcome occurred in 32 398 (34.6%) participants over a median follow-up of 8.3 years. A U-shaped relationship between LVEF and the primary outcome was observed, with a nadir at 60-70% and an increased risk when LVEF was ≥70% [adjusted hazard ratio (aHR) 1.12; 95% confidence interval (CI) 1.06-1.18]. Similar patterns were observed for the secondary outcomes. Participants with LVEF ≥70% also had a higher risk of worsening HF (aHR 1.13, 95% CI 1.03-1.23). This U-shaped association was consistent across subgroups stratified by age, sex, hypertension, and diabetes, and was observed for both incident and recurrent HF events.CONCLUSIONSLeft ventricular ejection fraction demonstrated a U-shaped association with worsening HF, with the lowest risk at 60-70%. Supranormal LVEF (≥70%) identified a high-risk phenotype, underscoring the need for tailored management strategies for this subgroup.
目的：左室射血分数（LVEF）是衡量心功能的关键指标。虽然先前的研究显示LVEF与死亡率呈u型关系，但其与心力衰竭（HF）恶化的关系尚不清楚。我们的目的是评估全谱LVEF与心衰恶化风险之间的关系。方法和结果我们分析了93 694名在三级医疗中心接受超声心动图检查的连续参与者（中位年龄62岁[四分位数间距：50-76岁]，51.4%为男性）的数据。LVEF采用双翼辛普森法测量，从<20%到≥70%分为5个区间。主要结局是全因死亡率或心衰恶化的综合结果，而次要结局包括全因死亡率、心血管死亡和心衰恶化。主要结局发生在33298名（34.6%）参与者中位随访8.3年。LVEF与主要结局之间呈u型关系，最低为60-70%，当LVEF≥70%时风险增加[校正风险比（aHR） 1.12；95%置信区间（CI） 1.06-1.18]。在次要结果中也观察到类似的模式。LVEF≥70%的参与者HF恶化的风险也更高（aHR 1.13, 95% CI 1.03-1.23）。这种u型关联在按年龄、性别、高血压和糖尿病分层的亚组中是一致的，并且在心衰事件和复发性心衰事件中都被观察到。结论左室射血分数与心衰恶化呈u型关系，最低风险为60-70%。异常LVEF（≥70%）是一种高风险表型，强调需要针对该亚组制定量身定制的管理策略。
{"title":"A U-shaped relationship between left ventricular ejection fraction and risk of worsening heart failure.","authors":"Hao-Chih Chang,Wei-Ming Huang,Liang-Yin Lin,Ching-Wei Lee,Chih-Hsueh Tseng,Wen-Chung Yu,Hao-Min Cheng,Chern-En Chiang,Chen-Huan Chen,Shih-Hsien Sung","doi":"10.1002/ejhf.70061","DOIUrl":"https://doi.org/10.1002/ejhf.70061","url":null,"abstract":"AIMSLeft ventricular ejection fraction (LVEF) is a key measure of cardiac function. While prior studies showed a U-shaped relationship between LVEF and mortality, its association with worsening heart failure (HF) remains unclear. We aimed to evaluate the association between the full spectrum of LVEF and the risk of worsening HF.METHODS AND RESULTSWe analysed data from 93 694 consecutive participants (median age 62 years [interquartile range: 50-76 years], 51.4% men) undergoing echocardiography at a tertiary medical centre. LVEF, measured by biplane Simpson's method, was categorized into 5% intervals from <20% to ≥70%. The primary outcome was a composite of all-cause mortality or worsening HF, while the secondary outcomes included all-cause mortality, cardiovascular death, and worsening HF. The primary outcome occurred in 32 398 (34.6%) participants over a median follow-up of 8.3 years. A U-shaped relationship between LVEF and the primary outcome was observed, with a nadir at 60-70% and an increased risk when LVEF was ≥70% [adjusted hazard ratio (aHR) 1.12; 95% confidence interval (CI) 1.06-1.18]. Similar patterns were observed for the secondary outcomes. Participants with LVEF ≥70% also had a higher risk of worsening HF (aHR 1.13, 95% CI 1.03-1.23). This U-shaped association was consistent across subgroups stratified by age, sex, hypertension, and diabetes, and was observed for both incident and recurrent HF events.CONCLUSIONSLeft ventricular ejection fraction demonstrated a U-shaped association with worsening HF, with the lowest risk at 60-70%. Supranormal LVEF (≥70%) identified a high-risk phenotype, underscoring the need for tailored management strategies for this subgroup.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"41 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-10-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145331749","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}
Cristina Madaudo, Amitai Segev, Emanuele Bobbio, Chiara Baggio, Jonathan Schütze, Piero Gentile, Marta Sanguineti, Luca Monzo, Matteo Schettino, Emma Ferone, Ahmed Elsanhoury, Anan Younis, Matteo Palazzini, Adriana Ferroni, Valentina Giani, Matthew Sadler, Mohammad Albarjas, Leonardo Calò, Christian Lars Polte, Andrea Garascia, Stefano Figliozzi, Paul A. Scott, Ajay M. Shah, Alfredo Ruggero Galassi, Mauro Giacca, Gianfranco Sinagra, Entela Bollano, Theresa McDonagh, Carsten Tschöpe, Giuseppina Novo, Enrico Ammirati, Roy Beigel, Christoph Gräni, Marco Merlo, Pietro Ameri, Antonio Cannata, Daniel I. Bromage
Acute myocarditis (AM) is a heterogeneous clinical condition. Several classification models have been proposed to predict adverse clinical outcomes, but risk stratification remains challenging, particularly for patients presenting with preserved left ventricular ejection fraction (LVEF). Neutrophil-to-lymphocyte ratio (NLR) is a useful tool for risk stratification in patients with AM. This study aimed to compare the predictive accuracy of available risk stratification models, including NLR, for identifying patients with AM at increased risk of adverse events.
{"title":"Neutrophil-to-lymphocyte ratio for risk stratification in acute myocarditis across the left ventricular ejection fraction spectrum","authors":"Cristina Madaudo, Amitai Segev, Emanuele Bobbio, Chiara Baggio, Jonathan Schütze, Piero Gentile, Marta Sanguineti, Luca Monzo, Matteo Schettino, Emma Ferone, Ahmed Elsanhoury, Anan Younis, Matteo Palazzini, Adriana Ferroni, Valentina Giani, Matthew Sadler, Mohammad Albarjas, Leonardo Calò, Christian Lars Polte, Andrea Garascia, Stefano Figliozzi, Paul A. Scott, Ajay M. Shah, Alfredo Ruggero Galassi, Mauro Giacca, Gianfranco Sinagra, Entela Bollano, Theresa McDonagh, Carsten Tschöpe, Giuseppina Novo, Enrico Ammirati, Roy Beigel, Christoph Gräni, Marco Merlo, Pietro Ameri, Antonio Cannata, Daniel I. Bromage","doi":"10.1002/ejhf.70072","DOIUrl":"https://doi.org/10.1002/ejhf.70072","url":null,"abstract":"Acute myocarditis (AM) is a heterogeneous clinical condition. Several classification models have been proposed to predict adverse clinical outcomes, but risk stratification remains challenging, particularly for patients presenting with preserved left ventricular ejection fraction (LVEF). Neutrophil-to-lymphocyte ratio (NLR) is a useful tool for risk stratification in patients with AM. This study aimed to compare the predictive accuracy of available risk stratification models, including NLR, for identifying patients with AM at increased risk of adverse events.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"20 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296169","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}
Lucia Venneri, Alberto Aimo, Aldostefano Porcari, Irem Sezer, Adam Ioannou, Awais Sheikh, Josephine Mansell, Yousuf Razvi, Surabhi Bhaskar Iyer, Ana Martinez-Naharro, Francesco Bandera, Sze Chi Lim, Matthew Frost, Justin Ezekowitz, Carolyn S.P. Lam, William Moody, Carol Whelan, Helen Lachmann, Ashutosh Wechelakar, Michele Emdin, Philip N. Hawkins, Scott David Solomon, Julian D. Gillmore, Marianna Fontana
In transthyretin amyloid cardiomyopathy (ATTR-CM), reduced stroke volume (SV) portends a poor prognosis. Artificial intelligence (AI) enables rapid, standardized assessment of left ventricular outflow tract velocity-time integral (LVOT-VTI), which is a reliable surrogate for SV. We investigated longitudinal changes in AI-derived LVOT-VTI as outcome predictors in ATTR-CM.
{"title":"Artificial intelligence-based echocardiographic assessment for monitoring disease progression in transthyretin cardiac amyloidosis","authors":"Lucia Venneri, Alberto Aimo, Aldostefano Porcari, Irem Sezer, Adam Ioannou, Awais Sheikh, Josephine Mansell, Yousuf Razvi, Surabhi Bhaskar Iyer, Ana Martinez-Naharro, Francesco Bandera, Sze Chi Lim, Matthew Frost, Justin Ezekowitz, Carolyn S.P. Lam, William Moody, Carol Whelan, Helen Lachmann, Ashutosh Wechelakar, Michele Emdin, Philip N. Hawkins, Scott David Solomon, Julian D. Gillmore, Marianna Fontana","doi":"10.1002/ejhf.70073","DOIUrl":"https://doi.org/10.1002/ejhf.70073","url":null,"abstract":"In transthyretin amyloid cardiomyopathy (ATTR-CM), reduced stroke volume (SV) portends a poor prognosis. Artificial intelligence (AI) enables rapid, standardized assessment of left ventricular outflow tract velocity-time integral (LVOT-VTI), which is a reliable surrogate for SV. We investigated longitudinal changes in AI-derived LVOT-VTI as outcome predictors in ATTR-CM.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"32 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145296167","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}
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