European Journal of Heart Failure最新文献

Aims: Ethnicity can influence patient outcomes and treatment efficacy, but knowledge is limited on how multimorbidity interacts with clinical events, for example when heart failure (HF) and atrial fibrillation (AF) combine.

Methods and results: 16 713 patients were included from 12 randomized placebo-controlled trials in HF (11 vs beta-blockers and 1 vs spironolactone), of which 13 568 patients (81.2%) were in sinus rhythm and 3145 (18.8%) had comorbid AF at baseline. Non-white ethnicity was recorded in 1899 (11%), with these patients being younger than those of white ethnicity (median age 58 vs 67 years), higher rates of diabetes and hypertension, and lower left-ventricular ejection fraction (median 25% vs 30%). During median follow-up of 1.4 years (interquartile range 0.8-2.3), the primary outcome of all-cause mortality occurred in 394 (21%) non-white patients and 2142 (15%) white patients, with confounder-adjusted hazard ratio (HR) 1.36, 95% CI 1.20-1.54; P < .001. The impact of ethnicity on death was greater in patients with coexisting HF and AF (non-white vs white HR 2.05; 95% CI 1.55-2.70; P < .001) than in those with HF in sinus rhythm (HR 1.24; 95% CI 1.08-1.41; P = .002). The interaction P-value was .003, and confirmed using propensity-score matching to account for baseline differences (P = .009). Similar disparities with ethnicity were seen for the secondary outcomes of cardiovascular and HF-related death, and cardiovascular and HF-related hospitalization.

Conclusion: Non-white patients with HF and reduced ejection fraction suffer from substantially higher rates of death than white patients, with comorbid atrial fibrillation leading to significant worsening of this ethnicity-related disparity.

Aims: Acoramidis is an oral transthyretin (TTR) stabilizer that achieves near-complete (≥90%) TTR stabilization. This post-hoc analysis evaluated response categories based on NT-proBNP concentration and 6-minute walk distance (6MWD) changes among participants with transthyretin amyloid cardiomyopathy (ATTR-CM) in the phase 3 ATTRibute-CM trial.

Methods and results: Clinically meaningful improvement (CMI) was defined as a decrease from baseline to Month 30 in NT-proBNP of >700 ng/L and >30%, and separately, a 6MWD increase of >35 m. Data from 611 participants were analysed (409: acoramidis; 202: placebo). Median baseline NT-proBNP and 6MWD values were 2273 ng/L and 365 m in the acoramidis group and 2274 ng/L and 352 m in the placebo group, respectively. A significantly higher proportion of participants in the acoramidis group reached CMI in NT-proBNP or 6MWD (22.7%) compared with the placebo group (8.9%; OR 3.0, 95% CI 1.8-5.1; p < 0.001).

Conclusion: Acoramidis led to CMI from baseline in NT-proBNP concentration or 6MWD in a considerable proportion of participants with ATTR-CM. These findings suggest that the treatment paradigm of ATTR-CM may evolve from slowing disease progression to achieving improvement.

Background and aims: We aimed to assess regression and development rates of ≥moderate secondary MR and TR in patients with HFrEF in association with contemporary GDMT.

Methods: Patients with <1 year diagnosis of HFrEF with mildly (40%≤EF<50%) or moderately (<40%) reduced EF enrolled in GDMT titration program 2019-2024 were identified. Rates of regression of ≥moderate MR/TR to ≤mild and rates of development of incident ≥moderate MR/TR were calculated.

Results: Among 844 patients (median age 64; 68% men; 26% mildly reduced EF; 24% NYHA class III/IV), 28% had ≥moderate MR and 14% had ≥moderate TR at baseline. Over median 7.1 months, 171 (75%) patients with ≥moderate MR experienced regression to no/mild MR. Similarly, 87 (75%) patients with ≥moderate TR had regression to no/mild TR over the same period. In contrast, over median 13 months, incident ≥moderate MR developed in 5% of patients with no/mild baseline MR and incident ≥moderate TR developed in 6% with no/mild baseline TR. Number of GDMT medications at follow-up was less in patients who did not have MR/TR regression (vs who did) and in patients who developed MR/TR (vs who did not). On subgroup analysis, patients with NYHA class I/II received similar number of GDMT and had similar rate of MR and TR regression and development vs patients with NYHA III/IV. However, patients with mildly reduced EF received less GDMT medications vs patients with moderately reduced EF and experienced less MR regression.

Conclusion: In patients with a recent diagnosis of HFrEF receiving contemporary GDMT, the majority of patients with ≥moderate secondary MR and TR achieved regression of MR/TR, and the minority of patients without significant baseline MR/TR developed ≥moderate regurgitation at follow-up.