Ignace L.J. De Lathauwer, Wessel W. Nieuwenhuys, Frederique Hafkamp, Marta Regis, Rutger W.M. Brouwers, Mathias Funk, Hareld M.C. Kemps
Methods of non-invasive remote patient monitoring (RPM) for heart failure (HF) remain diverse. Understanding factors that influence the effectiveness of RPM on HF-related and all-cause hospitalizations, mortality, and emergency department visits is crucial for developing successful RPM interventions. This meta-analysis aims to synthesize and compare existing literature on RPM components that impact HF-related and all-cause hospitalizations, mortality and emergency department visits in HF patients.
{"title":"Remote patient monitoring in heart failure: A comprehensive meta-analysis of effective programme components for hospitalization and mortality reduction","authors":"Ignace L.J. De Lathauwer, Wessel W. Nieuwenhuys, Frederique Hafkamp, Marta Regis, Rutger W.M. Brouwers, Mathias Funk, Hareld M.C. Kemps","doi":"10.1002/ejhf.3568","DOIUrl":"https://doi.org/10.1002/ejhf.3568","url":null,"abstract":"Methods of non-invasive remote patient monitoring (RPM) for heart failure (HF) remain diverse. Understanding factors that influence the effectiveness of RPM on HF-related and all-cause hospitalizations, mortality, and emergency department visits is crucial for developing successful RPM interventions. This meta-analysis aims to synthesize and compare existing literature on RPM components that impact HF-related and all-cause hospitalizations, mortality and emergency department visits in HF patients.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"62 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991457","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":"The expanding role of heart failure nurses: A call for harmonized standards across Europe","authors":"Stefan Störk, Gabriele Hartner, Claire Lawson","doi":"10.1002/ejhf.3572","DOIUrl":"https://doi.org/10.1002/ejhf.3572","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"107 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991461","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}
Hailun Qin, Bart J. van Essen, Jozine M. ter Maaten, Adriaan A. Voors
Regular heavy alcohol consumption may lead to the development of alcohol-related cardiomyopathy and symptomatic heart failure (HF) later in life. However, the dose–response relationship between alcohol consumption and risk for incident HF, and whether these associations vary by sex and type of alcoholic beverage remains unclear.
{"title":"Alcohol consumption and incident heart failure in men and women","authors":"Hailun Qin, Bart J. van Essen, Jozine M. ter Maaten, Adriaan A. Voors","doi":"10.1002/ejhf.3587","DOIUrl":"https://doi.org/10.1002/ejhf.3587","url":null,"abstract":"Regular heavy alcohol consumption may lead to the development of alcohol-related cardiomyopathy and symptomatic heart failure (HF) later in life. However, the dose–response relationship between alcohol consumption and risk for incident HF, and whether these associations vary by sex and type of alcoholic beverage remains unclear.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"15 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142991458","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}
Victor Galusko, Florian A. Wenzl, Christophe Vandenbriele, Vasileios Panoulas, Thomas F. Lüscher, Diana A. Gorog
Cardiogenic shock (CS) carries a 30–50% in-hospital mortality rate, with little improvement in outcomes in the last decade. Challenges in improving outcomes are closely linked to the frequent late presentation or diagnosis of CS where the ‘point of no return’ has often passed, leading to haemodynamic dysregulation, progressive myocardial depression, hypotension, and a downward spiral of hypoperfusion, organ dysfunction and decreasing myocardial function, driven by inflammation and metabolic derangements. Novel therapeutic interventions may have varying efficacy depending on the type and stage of shock in which they are applied. Biomarkers that aid prediction and early detection of CS, provide early signs of organ dysfunction and define prognosis could help optimize management. Temporal change in such biomarkers, particularly in response to pharmacological interventions and/or mechanical circulatory support, can guide management and predict outcome. Several novel biomarkers enhance the prediction of mortality in CS, compared to conventional parameters such as lactate, with some, such as adrenomedullin and circulating dipeptidyl peptidase 3, also able to predict the development of CS. Some biomarkers reflect systemic inflammation (e.g. interleukin-6, angiopoietin 2, fibroblast growth factor 23 and suppressor of tumorigenicity 2) and are not specific to CS, yet inform on the activation of important pathways involved in the downward shock spiral. Other biomarkers signal end-organ hypoperfusion and could guide targeted interventions, while some may serve as novel therapeutic targets. We critically review current and novel biomarkers that guide prediction, detection, and prognostication in CS. Future use of biomarkers may help improve management in these high-risk patients.
{"title":"Current and novel biomarkers in cardiogenic shock","authors":"Victor Galusko, Florian A. Wenzl, Christophe Vandenbriele, Vasileios Panoulas, Thomas F. Lüscher, Diana A. Gorog","doi":"10.1002/ejhf.3531","DOIUrl":"https://doi.org/10.1002/ejhf.3531","url":null,"abstract":"Cardiogenic shock (CS) carries a 30–50% in-hospital mortality rate, with little improvement in outcomes in the last decade. Challenges in improving outcomes are closely linked to the frequent late presentation or diagnosis of CS where the ‘point of no return’ has often passed, leading to haemodynamic dysregulation, progressive myocardial depression, hypotension, and a downward spiral of hypoperfusion, organ dysfunction and decreasing myocardial function, driven by inflammation and metabolic derangements. Novel therapeutic interventions may have varying efficacy depending on the type and stage of shock in which they are applied. Biomarkers that aid prediction and early detection of CS, provide early signs of organ dysfunction and define prognosis could help optimize management. Temporal change in such biomarkers, particularly in response to pharmacological interventions and/or mechanical circulatory support, can guide management and predict outcome. Several novel biomarkers enhance the prediction of mortality in CS, compared to conventional parameters such as lactate, with some, such as adrenomedullin and circulating dipeptidyl peptidase 3, also able to predict the development of CS. Some biomarkers reflect systemic inflammation (e.g. interleukin-6, angiopoietin 2, fibroblast growth factor 23 and suppressor of tumorigenicity 2) and are not specific to CS, yet inform on the activation of important pathways involved in the downward shock spiral. Other biomarkers signal end-organ hypoperfusion and could guide targeted interventions, while some may serve as novel therapeutic targets. We critically review current and novel biomarkers that guide prediction, detection, and prognostication in CS. Future use of biomarkers may help improve management in these high-risk patients.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"6 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987894","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}
Robert J. Mentz, Stefan D. Anker, Bertram Pitt, Peter Rossing, Luis M. Ruilope, Martin Gebel, Peter Kolkhof, Robert Lawatscheck, Katja Rohwedder, George L. Bakris
This post hoc analysis aimed to assess the efficacy and safety of the non-steroidal mineralocorticoid receptor antagonist finerenone by baseline diuretic use in FIDELITY, a pre-specified pooled analysis of the phase III trials FIDELIO-DKD and FIGARO-DKD.
{"title":"Efficacy and safety of finerenone in patients with chronic kidney disease and type 2 diabetes by diuretic use: A FIDELITY analysis","authors":"Robert J. Mentz, Stefan D. Anker, Bertram Pitt, Peter Rossing, Luis M. Ruilope, Martin Gebel, Peter Kolkhof, Robert Lawatscheck, Katja Rohwedder, George L. Bakris","doi":"10.1002/ejhf.3569","DOIUrl":"https://doi.org/10.1002/ejhf.3569","url":null,"abstract":"This post hoc analysis aimed to assess the efficacy and safety of the non-steroidal mineralocorticoid receptor antagonist finerenone by baseline diuretic use in FIDELITY, a pre-specified pooled analysis of the phase III trials FIDELIO-DKD and FIGARO-DKD.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"54 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987792","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}
Renato A. Hortegal, C. Charles Jain, Yogesh N.V. Reddy, Barry A. Borlaug, Alexander C. Egbe, William R. Miranda
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{"title":"Single-leg supine cycling: An alternative for patients requiring exercise catheterization and femoral access","authors":"Renato A. Hortegal, C. Charles Jain, Yogesh N.V. Reddy, Barry A. Borlaug, Alexander C. Egbe, William R. Miranda","doi":"10.1002/ejhf.3571","DOIUrl":"https://doi.org/10.1002/ejhf.3571","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"30 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987936","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, Letizia Fausta Bertoldi, Stefan Blankenberg, Jeroen Dauw, Dennis Eckner, Ingo Eitel, Tobias Graf, Patrick Horn, Joanna Jozwiak-Nozdrzykowska, Paulus Kirchhof, Stefan Kluge, Jannis Krais, Dirk von Lewinski, Axel Linke, Peter Luedike, Enzo Lüsebrink, Peter Nordbeck, Federico Pappalardo, Matthias Pauschinger, Alastair Proudfoot, Tienush Rassaf, Hermann Reichenspurner, Can Martin Sag, Clemens Scherer, P. Christian Schulze, Robert H.G. Schwinger, Carsten Skurk, Marek Sramko, Guido Tavazzi, Holger Thiele, Nuccia Morici, Ephraim B. Winzer, Dirk Westermann, Benedikt Schrage, Norman Mangner
This study aimed to investigate incidence and predictors of weaning failure and in-hospital death after successful weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock (CS).
{"title":"Incidence and predictors of weaning failure from veno-arterial extracorporeal membrane oxygenation therapy in patients with cardiogenic shock","authors":"Angela Dettling, Caroline Kellner, Jonas Sundermeyer, Benedikt N. Beer, Lisa Besch, Letizia Fausta Bertoldi, Stefan Blankenberg, Jeroen Dauw, Dennis Eckner, Ingo Eitel, Tobias Graf, Patrick Horn, Joanna Jozwiak-Nozdrzykowska, Paulus Kirchhof, Stefan Kluge, Jannis Krais, Dirk von Lewinski, Axel Linke, Peter Luedike, Enzo Lüsebrink, Peter Nordbeck, Federico Pappalardo, Matthias Pauschinger, Alastair Proudfoot, Tienush Rassaf, Hermann Reichenspurner, Can Martin Sag, Clemens Scherer, P. Christian Schulze, Robert H.G. Schwinger, Carsten Skurk, Marek Sramko, Guido Tavazzi, Holger Thiele, Nuccia Morici, Ephraim B. Winzer, Dirk Westermann, Benedikt Schrage, Norman Mangner","doi":"10.1002/ejhf.3583","DOIUrl":"https://doi.org/10.1002/ejhf.3583","url":null,"abstract":"This study aimed to investigate incidence and predictors of weaning failure and in-hospital death after successful weaning from veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock (CS).","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"15 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142987935","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}
Rosaria Benedetti, Ugo Chianese, Chiara Papulino, Lucia Scisciola, Mirko Cortese, Pietro Formisano, Nunzio Del Gaudio, Serena Cabaro, Vittoria D'Esposito, Ada Pesapane, Mariarosaria Conte, Giuseppe Signoriello, Michelangela Barbieri, Lucia Altucci, Giuseppe Paolisso
AimsHyperglycaemic conditions increase cardiac stress, a common phenomenon associated with inflammation, aging, and metabolic imbalance. Sodium–glucose cotransporter 2 inhibitors, a class of anti‐diabetic drugs, showed to improve cardiovascular functions although their mechanism of action has not yet been fully established. This study investigated the effects of empagliflozin on cardiomyocytes following high glucose exposure, specifically focusing on inflammatory and metabolic responses.Methods and resultsA three‐part strategy was formulated: (i) a meta‐analysis of selected randomized clinical trials was carried out to assess the anti‐inflammatory effects of empagliflozin in diabetic patients; (ii) the impact of empagliflozin on human cardiomyocyte AC16 cells exposed to normal (5 mM) and high (33 mM) glucose concentrations for 2 and 7 days was explored by evaluating gene expression and protein levels of pivotal markers associated with cardiac inflammation, stress, endoplasmic reticulum damage, and calcium modulation; (iii) in silico data from bioinformatic analyses were exploited to construct an interaction map delineating the potential mechanism of action of empagliflozin on cardiac tissue. Empagliflozin reversed high‐glucose mediated alterations at the transcriptional level, decreasing inflammatory, metabolic, and aging signatures. Specifically, in vitro experiments on human cardiomyocytes, meta‐analyses of clinical data on inflammatory biomarkers from diabetic peripheral blood samples, and sequencing of pathological human heart tissues, all support that empagliflozin exerts anti‐inflammatory effects both systemically and directly in cardiac tissue, on cardiomyocytes.ConclusionOur study provides insights based on robust mechanistic data for optimizing heart failure management and highlights the intricate interplay between diabetes, inflammation, aging, and cardiovascular health.
{"title":"Unlocking the power of empagliflozin: Rescuing inflammation in hyperglycaemia‐ exposed human cardiomyocytes through comprehensive multi‐level analysis","authors":"Rosaria Benedetti, Ugo Chianese, Chiara Papulino, Lucia Scisciola, Mirko Cortese, Pietro Formisano, Nunzio Del Gaudio, Serena Cabaro, Vittoria D'Esposito, Ada Pesapane, Mariarosaria Conte, Giuseppe Signoriello, Michelangela Barbieri, Lucia Altucci, Giuseppe Paolisso","doi":"10.1002/ejhf.3566","DOIUrl":"https://doi.org/10.1002/ejhf.3566","url":null,"abstract":"AimsHyperglycaemic conditions increase cardiac stress, a common phenomenon associated with inflammation, aging, and metabolic imbalance. Sodium–glucose cotransporter 2 inhibitors, a class of anti‐diabetic drugs, showed to improve cardiovascular functions although their mechanism of action has not yet been fully established. This study investigated the effects of empagliflozin on cardiomyocytes following high glucose exposure, specifically focusing on inflammatory and metabolic responses.Methods and resultsA three‐part strategy was formulated: (i) a meta‐analysis of selected randomized clinical trials was carried out to assess the anti‐inflammatory effects of empagliflozin in diabetic patients; (ii) the impact of empagliflozin on human cardiomyocyte AC16 cells exposed to normal (5 mM) and high (33 mM) glucose concentrations for 2 and 7 days was explored by evaluating gene expression and protein levels of pivotal markers associated with cardiac inflammation, stress, endoplasmic reticulum damage, and calcium modulation; (iii) <jats:italic>in silico</jats:italic> data from bioinformatic analyses were exploited to construct an interaction map delineating the potential mechanism of action of empagliflozin on cardiac tissue. Empagliflozin reversed high‐glucose mediated alterations at the transcriptional level, decreasing inflammatory, metabolic, and aging signatures. Specifically, <jats:italic>in vitro</jats:italic> experiments on human cardiomyocytes, meta‐analyses of clinical data on inflammatory biomarkers from diabetic peripheral blood samples, and sequencing of pathological human heart tissues, all support that empagliflozin exerts anti‐inflammatory effects both systemically and directly in cardiac tissue, on cardiomyocytes.ConclusionOur study provides insights based on robust mechanistic data for optimizing heart failure management and highlights the intricate interplay between diabetes, inflammation, aging, and cardiovascular health.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"26 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981344","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}
Dan Haberman, Rodrigo Estévez‐Loureiro, Andrew Czarnecki, Francesco Melillo, Marianna Adamo, Pedro Villablanca, Doron Sudarsky, Fabien Praz, Leor Perl, Xavier Freixa, Andrea Scotti, Paul Fefer, Konstantinos Spargias, Neil Fam, Lisa Manevich, Giulia Masiero, Luis Nombela‐Franco, Isaac Pascual, Gabriele Crimi, Vlasis Ninios, Ronen Beeri, Tomas Benito‐Gonzalez, Dabit Arzamendi, Estefanıa Fernández‐Peregrina, Francesco Giannini, Antonio Mangieri, Lion Poles, Jacob George, Julio Cesar Echarte Morales, Berenice Caneiro‐Queija, Paolo Denti, Davide Schiavi, Azeem Latib, Michael Chrissoheris, Haim Danenberg, Giuseppe Tarantini, Danny Dvir, Francesco Maisano, Maurizio Taramasso, Mony Shuvy
AimsTo evaluate the association between transcatheter edge‐to‐edge repair (TEER) and outcomes in patients with significant mitral regurgitation (MR) following acute myocardial infarction (MI), focusing on the aetiology of acute post‐MI MR in high‐risk surgical patients.Methods and resultsThe International Registry of MitraClip in Acute Mitral Regurgitation following Acute Myocardial Infarction (IREMMI) includes 187 patients with severe MR post‐MI managed with TEER. Of these, 176 were included in the analysis, 23 (13%) patients had acute papillary muscle rupture (PMR) and 153 (87%) acute secondary MR. The mean age was 70 ± 10 years and 41% were female. PMR patients had fewer cardiovascular risk factors: hypertension (52% vs. 73%, p = 0.04), diabetes (26% vs. 48%, p < 0.01) but a higher left ventricular ejection fraction (45± 15% vs.35± 10%, p < 0.01) compared secondary MR patients. PMR patients were more likely to present in cardiogenic shock (91% vs. 51%, p = 0.001), require mechanical circulatory support (74% vs. 34%, p = 0.01), and had a higher EuroSCORE II (23± 13% vs. 13± 11%, p = 0.011). The median time from MI to TEER was shorter in PMR (6 days) versus secondary MR (20 days) (p < 0.01). Procedural success was similar (87% vs. 92%, p = 0.49) with comparable MR grade reduction. However, PMR patients had significantly higher in‐hospital mortality rates (adjusted odds ratio [OR] 3.05, 95% confidence interval [CI] 1.15–8.12, p = 0.02), 30‐day mortality rates (unadjusted OR 3.99, 95% CI 1.42–11.26, p = 0.01) and a higher rate of conversion to surgical mitral valve replacement (22% vs. 3%, p < 0.01) (unadjusted OR 8.17, 95% CI 2.15–30.96, p < 0.001). Aetiology of MR, cardiogenic shock, and procedure timing significantly impacted in‐hospital mortality. After adjusting for EuroSCORE II and cardiogenic shock, MR aetiology remained the strongest predictor (adjusted OR 6.71; 95% CI 2.06–21.86, p < 0.01).ConclusionTranscatheter edge‐to‐edge repair may be considered a salvage or bridge procedure in decompensated post‐MI MR patients of both aetiologies; however, patients with PMR have a higher risk of mortality and conversion to surgery.
目的评估急性心肌梗死（MI）后明显二尖瓣反流（MR）患者的经导管边缘到边缘修复（TEER）与预后之间的关系，重点研究高危手术患者急性心肌梗死后MR的病因。方法和结果MitraClip在急性心肌梗死后急性二尖瓣反流（IREMMI）中的国际注册包括187例使用TEER治疗的严重MR - MI后患者。其中176例纳入分析，急性乳头肌破裂（PMR） 23例（13%），急性继发性mr 153例（87%），平均年龄70±10岁，女性占41%。PMR患者心血管危险因素较少：高血压（52% vs. 73%, p = 0.04），糖尿病(26% vs. 48%, p <；0.01)，但左室射血分数较高(45±15% vs.35±10%,p <；0.01)。PMR患者更容易出现心源性休克（91% vs. 51%, p = 0.001），需要机械循环支持（74% vs. 34%, p = 0.01），并且EuroSCORE II更高（23±13% vs. 13±11%,p = 0.011）。PMR从MI到TEER的中位时间（6天）短于继发MR（20天）(p <；0.01)。手术成功率相似（87% vs. 92%, p = 0.49）， MR等级降低相似。然而，PMR患者的住院死亡率（校正优势比[OR] 3.05, 95%可信区间[CI] 1.15-8.12, p = 0.02）、30天死亡率（未校正优势比[OR] 3.99, 95% CI 1.42-11.26, p = 0.01）和转行二尖瓣置换术的比率(22%对3%，p <；0.01)(未经调整OR 8.17, 95% CI 2.15-30.96, p <；0.001)。磁共振的病因、心源性休克和手术时机对住院死亡率有显著影响。在调整EuroSCORE II和心源性休克后，MR病因学仍然是最强的预测因子(调整OR为6.71；95% CI 2.06-21.86, p <；0.01)。结论：对于两种病因的失代偿性心肌梗死后MR患者，经导管边缘到边缘修复可被视为一种补救性或桥接性手术；然而，PMR患者有更高的死亡率和转行手术的风险。
{"title":"Transcatheter edge‐to‐edge repair in severe mitral regurgitation following acute myocardial infarction – aetiology‐based analysis","authors":"Dan Haberman, Rodrigo Estévez‐Loureiro, Andrew Czarnecki, Francesco Melillo, Marianna Adamo, Pedro Villablanca, Doron Sudarsky, Fabien Praz, Leor Perl, Xavier Freixa, Andrea Scotti, Paul Fefer, Konstantinos Spargias, Neil Fam, Lisa Manevich, Giulia Masiero, Luis Nombela‐Franco, Isaac Pascual, Gabriele Crimi, Vlasis Ninios, Ronen Beeri, Tomas Benito‐Gonzalez, Dabit Arzamendi, Estefanıa Fernández‐Peregrina, Francesco Giannini, Antonio Mangieri, Lion Poles, Jacob George, Julio Cesar Echarte Morales, Berenice Caneiro‐Queija, Paolo Denti, Davide Schiavi, Azeem Latib, Michael Chrissoheris, Haim Danenberg, Giuseppe Tarantini, Danny Dvir, Francesco Maisano, Maurizio Taramasso, Mony Shuvy","doi":"10.1002/ejhf.3582","DOIUrl":"https://doi.org/10.1002/ejhf.3582","url":null,"abstract":"AimsTo evaluate the association between transcatheter edge‐to‐edge repair (TEER) and outcomes in patients with significant mitral regurgitation (MR) following acute myocardial infarction (MI), focusing on the aetiology of acute post‐MI MR in high‐risk surgical patients.Methods and resultsThe International Registry of MitraClip in Acute Mitral Regurgitation following Acute Myocardial Infarction (IREMMI) includes 187 patients with severe MR post‐MI managed with TEER. Of these, 176 were included in the analysis, 23 (13%) patients had acute papillary muscle rupture (PMR) and 153 (87%) acute secondary MR. The mean age was 70 ± 10 years and 41% were female. PMR patients had fewer cardiovascular risk factors: hypertension (52% vs. 73%, <jats:italic>p</jats:italic> = 0.04), diabetes (26% vs. 48%, <jats:italic>p</jats:italic> < 0.01) but a higher left ventricular ejection fraction (45± 15% vs.35± 10%, <jats:italic>p</jats:italic> < 0.01) compared secondary MR patients. PMR patients were more likely to present in cardiogenic shock (91% vs. 51%, <jats:italic>p</jats:italic> = 0.001), require mechanical circulatory support (74% vs. 34%, <jats:italic>p</jats:italic> = 0.01), and had a higher EuroSCORE II (23± 13% vs. 13± 11%, <jats:italic>p</jats:italic> = 0.011). The median time from MI to TEER was shorter in PMR (6 days) versus secondary MR (20 days) (<jats:italic>p</jats:italic> < 0.01). Procedural success was similar (87% vs. 92%, <jats:italic>p</jats:italic> = 0.49) with comparable MR grade reduction. However, PMR patients had significantly higher in‐hospital mortality rates (adjusted odds ratio [OR] 3.05, 95% confidence interval [CI] 1.15–8.12, <jats:italic>p</jats:italic> = 0.02), 30‐day mortality rates (unadjusted OR 3.99, 95% CI 1.42–11.26, <jats:italic>p</jats:italic> = 0.01) and a higher rate of conversion to surgical mitral valve replacement (22% vs. 3%, <jats:italic>p</jats:italic> < 0.01) (unadjusted OR 8.17, 95% CI 2.15–30.96, <jats:italic>p</jats:italic> < 0.001). Aetiology of MR, cardiogenic shock, and procedure timing significantly impacted in‐hospital mortality. After adjusting for EuroSCORE II and cardiogenic shock, MR aetiology remained the strongest predictor (adjusted OR 6.71; 95% CI 2.06–21.86, <jats:italic>p</jats:italic> < 0.01).ConclusionTranscatheter edge‐to‐edge repair may be considered a salvage or bridge procedure in decompensated post‐MI MR patients of both aetiologies; however, patients with PMR have a higher risk of mortality and conversion to surgery.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"51 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981343","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}
Carlos Diaz‐Arocutipa, Adrian V. Hernandez, Cesar Joel Benites‐Moya, Norma Nicole Gamarra‐Valverde, Rafael Yrivarren‐Cespedes, Javier Torres‐Valencia, Lourdes Vicent
AimsDifferentiation between patients with Takotsubo syndrome and acute coronary syndrome (ACS) remains a challenge. We performed a systematic review to identify and evaluate diagnostic predictive models to distinguish both conditions.Methods and resultsWe performed an electronic search in PubMed, EMBASE, and Scopus until January 2024. Observational studies that developed and/or validated multivariable diagnostic models to differentiate Takotsubo syndrome from ACS were included. The risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). We conducted a narrative synthesis of the performance measures of the diagnostic models evaluated in each study. In addition, a random‐effects meta‐analysis of the c‐statistic with its 95% confidence interval (CI) of the InterTAK model was performed. Of 1015 articles, a total of 11 studies (n = 4552) were included. We identified eight new diagnostic models and eight were external validation of existing models. The most frequent model was InterTAK (n = 4). The reported c‐statistic ranged from 0.77 to 0.97 across all models. Calibration plots were reported only for two models. The summary c‐statistic was 0.89 (95% confidence interval 0.73–0.96) for the InterTAK model. The risk of bias was high for all models and the applicability was of low (50%) or unclear (50%) concern.ConclusionOur review identified multiple diagnostic models to diagnose Takotsubo syndrome. Although most models showed acceptable‐to‐good discriminative performance, calibration measures were almost unreported and the risk of bias was a concern in most studies.
{"title":"Diagnostic models to differentiate Takotsubo syndrome from acute coronary syndrome: A systematic review and meta‐analysis","authors":"Carlos Diaz‐Arocutipa, Adrian V. Hernandez, Cesar Joel Benites‐Moya, Norma Nicole Gamarra‐Valverde, Rafael Yrivarren‐Cespedes, Javier Torres‐Valencia, Lourdes Vicent","doi":"10.1002/ejhf.3584","DOIUrl":"https://doi.org/10.1002/ejhf.3584","url":null,"abstract":"AimsDifferentiation between patients with Takotsubo syndrome and acute coronary syndrome (ACS) remains a challenge. We performed a systematic review to identify and evaluate diagnostic predictive models to distinguish both conditions.Methods and resultsWe performed an electronic search in PubMed, EMBASE, and Scopus until January 2024. Observational studies that developed and/or validated multivariable diagnostic models to differentiate Takotsubo syndrome from ACS were included. The risk of bias was assessed using the Prediction model Risk Of Bias ASsessment Tool (PROBAST). We conducted a narrative synthesis of the performance measures of the diagnostic models evaluated in each study. In addition, a random‐effects meta‐analysis of the c‐statistic with its 95% confidence interval (CI) of the InterTAK model was performed. Of 1015 articles, a total of 11 studies (<jats:italic>n</jats:italic> = 4552) were included. We identified eight new diagnostic models and eight were external validation of existing models. The most frequent model was InterTAK (<jats:italic>n</jats:italic> = 4). The reported c‐statistic ranged from 0.77 to 0.97 across all models. Calibration plots were reported only for two models. The summary c‐statistic was 0.89 (95% confidence interval 0.73–0.96) for the InterTAK model. The risk of bias was high for all models and the applicability was of low (50%) or unclear (50%) concern.ConclusionOur review identified multiple diagnostic models to diagnose Takotsubo syndrome. Although most models showed acceptable‐to‐good discriminative performance, calibration measures were almost unreported and the risk of bias was a concern in most studies.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"77 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142981342","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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