European Journal of Heart Failure最新文献

Aims: Heart failure (HF) is a leading cause of cardiovascular mortality worldwide. However, comprehensive and updated assessments of HF-attributable mortality trends across Europe are limited. The aim of this study was to evaluate HF-attributed mortality trends in Europe between 2012 and 2021, examining variations by age, sex, and European region.

Methods and results: We extracted HF-attributed mortality data from the World Health Organization (WHO) mortality dataset for 2012-2021. Age-adjusted mortality rates (AAMRs) were analysed using joinpoint regression modelling, expressed as average annual percent change (AAPC) with 95% confidence intervals (CIs). A parallelism test compared trend differences across groups. To explore contributors to HF-attributable mortality, we analysed the mean alcohol consumption and the age-adjusted prevalence and trends of smoking habit, arterial hypertension (HTN), obesity and type 2 diabetes mellitus (DM) using the WHO non-communicable diseases dataset (2012-2021). From 2012 to 2021, 4 872 634 individuals (2 084 521 men and 2 788 113 women) died due to HF, equating to 11 522 deaths per 100 000 population. Overall, the AAMR increased (AAPC: +0.4% [95% CI 0.3-0.5], p < 0.001), with a significantly greater increase in men compared to women (p for parallelism = 0.02). HF-attributable mortality trend had a higher increase among patients aged less than 70 years compared to those aged 70 years or older (p for parallelism = 0.001). Regionally, AAMRs increased in Western (AAPC: +1.2% [95% CI 1.0-1.4], p < 0.001), Eastern (AAPC: +0.9% [95% CI 0.7-1.0], p < 0.001) and Northern Europe (AAPC: +0.5 [95% CI 0.3-0.6], p < 0.001) while plateaued in Southern Europe (AAPC: +3.2% [95% CI -3.2 to 10.1], p = 0.28). A similar increase was observed in the trend for AAMR in HF-attributable mortality among subjects died due to HF with reduced or preserved ejection fraction (p for parallelism = 0.18). During the same period, the age-adjusted prevalence of overweight, obesity and DM rose, while HTN, smoking habit and alcohol consumption decreased.

Conclusions: Heart failure-attributed mortality in Europe increased between 2012 and 2021. Substantial disparities persist across European regions and countries.

Aims: Lung ultrasound (LUS) is a widely used technique to assess de-aeration in critically ill patients with respiratory failure. There is paucity of data on LUS in cardiogenic shock (CS). We sought to evaluate the epidemiology of lung congestion and its relation with outcome.

Methods and results: The Altshock-2 registry is a multicentre, prospective, observational registry including all-comer CS patients. The LUS protocol included the examination of four zones using dichotomous assessment of lung congestion severity: ≤50% or >50%. LUS was performed at admission and at 24 h. Univariate and multivariate logistic regression analyses were performed. Overall, 185 patients (mean age 64.2 ± 13.5 years; 25.9% female) had a LUS at admission. A total of 128 patients (69.2%) had ≥50% of the investigated lung field with B-lines. At univariate Cox regression analysis, B-lines ≥50% at 24 h were significantly associated with increased 30-day mortality (hazard ratio [HR] 4.705; 95% confidence interval [CI] 2.329-9.508) and the reduction of B-lines during 24 h was associated with lower 30-day mortality (HR 0.739; 95% CI 0.571-0.956; p = 0.021). Results were confirmed at multivariate analysis after adjustment for significant covariates: B-lines ≥50% at 24 h (HR 2.23; 95% CI 1.042-8.654; p = 0.041) and the reduction in B-lines from baseline to 24 h (HR 0.815; 95% CI 0.415-1.132; p = 0.039). The sensitivity analysis, excluding patients with cardiac arrest, led to significantly increased accuracy in outcome prediction.

Conclusion: Assessment and monitoring of lung congestion with LUS over the first 24 h in patients with CS allow to further stratify clinical outcomes with higher accuracy when added to SCAI classification, especially when excluding patients with cardiac arrest at CS presentation.

Aims: Long-standing severe mitral regurgitation (MR) leads to left atrial (LA) enlargement, elevated pulmonary artery pressures, and ultimately right heart failure. While mitral valve transcatheter edge-to-edge repair (M-TEER) alleviates left-sided volume overload, its impact on right ventricular (RV) recovery is unclear. This study aims to use both conventional echocardiography and artificial intelligence to assess the recovery of RV function in patients undergoing M-TEER for severe MR.

Methods and results: The change in RV function from baseline to 3-month follow-up was analysed in a dual-centre registry of patients undergoing M-TEER for severe MR. RV function was conventionally assessed by measuring the tricuspid annular plane systolic excursion (TAPSE). Additionally, RV function was evaluated using a deep learning model that predicts RV ejection fraction (RVEF) based on two-dimensional apical four-chamber view echocardiographic videos. Among the 851 patients who underwent M-TEER, the 1-year survival rate was 86.8%. M-TEER resulted in a significant reduction in both LA volume and estimated systolic pulmonary artery pressure (sPAP) levels (median LA volume: from 123 ml [interquartile range, IQR 92-169 ml] to 104 ml [IQR 78-142 ml], p < 0.001; median sPAP: from 46 mmHg [IQR 35-58 mmHg] to 41 mmHg [IQR 32-54 mmHg], p = 0.036). In contrast, TAPSE remained unchanged (median: from 17 mm [IQR 14-21 mm] to 18 mm [IQR 15-21 mm], p = 0.603). The deep learning model confirmed this finding, showing no significant change in predicted RVEF after M-TEER (median: from 43.1% [IQR 39.1-47.4%] to 43.2% [IQR 39.2-47.2%], p = 0.475).

Conclusions: While M-TEER improves left-sided haemodynamics, it does not lead to significant RV function recovery, as confirmed by both conventional echocardiography and artificial intelligence. This finding underscores the importance of treating patients before irreversible right heart damage occurs.

Aims: We questioned the long-standing paradigm that sodium/chloride restriction is essential for effective decongestion in acute heart failure (AHF). This study compared the decongestive effects of two isotonic infusion strategies: 5% glucose (for intravascular volume repletion only) versus 0.9% NaCl (providing additional sodium/chloride supplementation), both added to protocolized diuretic therapy.

Methods and results: This single-centre, prospective, randomized, single-blind study included patients with fluid overload who were randomized 1:1 to continuous infusions (83.3 ml/h) of either 0.9% NaCl or 5% glucose for 48 h. Co-primary endpoints included 24- and 48-h urine output, natriuresis within 48 h, and total furosemide dose up to 48 h. The NaCl group (n = 25) significantly outperformed glucose group (n = 25) in all co-primary endpoints: the median urine output was higher in the NaCl group versus glucose group at 24 and 48 h (cumulative during 48 h: 9500 vs. 7395 ml, p = 0.001), the NaCl group had higher natriuresis during 48 h of decongestion (p < 0.05), which was achieved with lower cumulative doses of furosemide (220 vs. 280 mg, p = 0.02). The fractional excretion of lithium was higher in the NaCl versus glucose group (19.0 ± 8.9% vs. 14.7 ± 9.6%, p = 0.030), indicating inhibited proximal tubular sodium reabsorption. There was no difference in absolute distal reabsorption, but relative distal sodium reabsorption in the NaCl group was lower (86.9 ± 12.3% vs. 91.5 ± 9.3%, p < 0.001).

Conclusions: The infusion of NaCl compared to glucose added to diuretic therapy led to significantly higher diuresis, natriuresis, and lower loop diuretic use, driven by lower sodium avidity and inhibition of proximal tubular sodium reabsorption.

Clinical trial registration: ClinicalTrials.gov NCT05962255.

Aims: This analysis aims to investigate the relationship between changes in cardiac structure and function and changes in health-related quality of life in patients with heart failure with reduced ejection fraction (HFrEF).

Methods and results: The association between echocardiographic measures and Kansas City Cardiomyopathy Questionnaire (KCCQ)-12 scores was examined in HFrEF patients of the EVALUATE-HF trial who were randomized to sacubitril-valsartan or enalapril for 12 weeks followed by 12 weeks of open-label sacubitril-valsartan for both groups. We used linear regression models adjusted for age, sex, treatment assignment at randomization, baseline KCCQ-12 score, baseline echo measurements, and other clinical variables. Among 406 patients (median age 67 years; 25% women), the KCCQ-12 overall summary score (KCCQ-12-OSS) improved by +9 points (95% confidence interval +7 to +11 points) over 24 weeks. Increases in mitral e' velocities correlated with KCCQ-12-OSS improvement (+2.5 and +2.3 points per standard deviation [SD] increase in septal and lateral e' velocities, respectively, p < 0.05 for each). Decreases in septal E/e' ratio and left atrial volume index (LAVi) also correlated with KCCQ-12-OSS improvement (+3.2 and +2.0 points per SD decrease in septal E/e' ratio and LAVi, respectively, p < 0.05 for each). Changes in left ventricular size, ejection fraction, longitudinal strain, and right ventricular function were not associated with changes in KCCQ-12-OSS. Similar associations were observed for other KCCQ-12 domains.

Conclusions: In the EVALUATE-HF trial, increases in mitral e' velocities and decreases in septal E/e' ratio and LAVi were associated with improved KCCQ-12 scores over 24 weeks, after adjusting for treatment assignment. These findings suggest that reductions in left ventricular filling pressures and left atrial size are closely coupled with improved physical function and quality of life in HFrEF patients, which may provide insights into the early benefits of sacubitril-valsartan.

Clinical trial registration: ClinicalTrials.gov Identifier: NCT02874794.

Aims: To comprehensively assess the prognostic value of frailty at admission and trajectories of frailty during hospitalization in acute heart failure (AHF).

Methods and results: This retrospective, single-centre study (AHF-COR Registry) includes hospitalized AHF patients ≥65 years, admitted to a tertiary hospital in Vienna between 2012 and 2019. Frailty was assessed at admission and discharge by nursing staff, based on care needs in personal hygiene, nutrition, mobility, bowel and bladder control, categorizing patients into three groups: non-frailty, moderate frailty, and severe frailty. Our study encompassed 2619 patients admitted for AHF (mean age 81 ± 8 years), of whom 31% died within 1 year. A total of 46% of patients were not frail, 42% were moderately frail, and 12% were severely frail. Patients with frailty were more likely to be female and had a higher cardiovascular comorbidity burden. We identified moderate and severe frailty as independent prognostic markers of 1-year mortality (adjusted hazard ratio [HR] 1.89; 95% confidence interval [CI] 1.60-2.23; p < 0.001; adjusted HR 2.91; 2.36-3.59; p < 0.001). Similar results were found for 28-day and 5-year mortality risk. Improvement in frailty status during hospitalization resulted in a significantly lower risk of 1-year mortality (adjusted HR 0.65; 95% CI 0.49-0.88; p < 0.001), while worsening of frailty was associated with higher risk (adjusted HR 3.18; 95% CI 2.07-4.91; p < 0.001). Prescription of guideline-directed medical therapy in patients with heart failure with reduced ejection fraction decreased with increasing frailty but was consistently associated with a reduced risk of mortality, regardless of frailty status, as no significant interaction effect was observed (p_{frailty-interaction} = 0.592).

Conclusions: Frailty is an independent prognostic marker of increased mortality risk in patients with AHF. Improvement of frailty status during hospitalization reduces mortality risk while worsening of frailty increases mortality risk.

Aims: The impact of treatment for tricuspid regurgitation (TR) across different levels of left ventricular ejection fraction (LVEF) remains uncertain. This study aimed to compare the outcomes of surgical and transcatheter tricuspid valve interventions (TTVI) to conservative (medical) management across LVEF categories.

Methods and results: Patients with severe isolated TR from the TRIGISTRY, a multicentre international registry, were categorized based on LVEF (preserved ejection fraction [pEF]: ≥50%, mildly reduced ejection fraction [mrEF]: 41-49%, and reduced ejection fraction [rEF]: ≤40%). We assessed the impact of treatment modality and procedural success (mild-to-moderate or lower residual TR) on 2-year survival within each LVEF category. Among 2384 patients, 1383 had pEF, 400 had mrEF, and 601 had rEF. Compared to conservative management, surgery (p < 0.0005) and TTVI (p < 0.0001) were associated with a survival benefit in patients with pEF. No significant survival advantage was observed in patients with mrEF (p = 0.28 for both), nor in those with rEF (p = 0.76 and p = 0.22, respectively). Similar results were obtained when surgical and transcatheter interventions were grouped (p < 0.0001, p = 0.17 and p = 0.29 in patients with pEF, mrEF and rEF, respectively). Patients with residual TR after TTVI exhibited a trend toward worse survival compared to those managed conservatively across all LVEF categories (p = 0.47, p = 0.33 and p = 0.008 in pEF, mrEF and rEF, respectively).

Conclusions: Transcatheter tricuspid valve intervention, whether surgical or transcatheter-based, was associated with improved survival in patients with pEF but not in those with mrEF or rEF. Residual TR remained a significant prognostic factor across the entire LVEF spectrum. These findings highlight the need for careful patient selection when considering TTVI in individuals with rEF.