Michael Böhm,Javed Butler,Amr Abdin,Gerasimos Filippatos,João Pedro Ferreira,Stuart J Pocock,Martina Brueckmann,Anne Pernille Ofstad,Elke Schueler,Christoph Wanner,Faiez Zannad,Stefan D Anker,Milton Packer,
AIMSEmpagliflozin reduces cardiovascular death (CVD) or hospitalization for heart failure (HHF), slows estimated glomerular filtration rate (eGFR) decline and improves quality of life (QoL) in heart failure with reduced ejection fraction (HFrEF). Whether the effect of empagliflozin is consistent according to atrial fibrillation (AF) status is worth exploring.METHODS AND RESULTSThe impact of AF versus sinus rhythm (SR) on outcomes as well as on eGFR decline and QoL were studied post-hoc in EMPEROR-Reduced. Of patients with available rhythm analyses and after exclusion of patients with missing or paced rhythms, 2785 were included (AF, n = 928, SR, n = 1857). Differences were not significant for the primary endpoint (p = 0.66), first (p = 0.19) and recurrent HHF (p = 0.45). On placebo, alcohol consumption (interaction p = 0.32), body mass index (interaction p = 0.93), diabetes (interaction p = 0.52), hypertension (interaction p = 0.24) were not different between AF and SR. Low ejection fraction and high Kidney Disease: Improving Global Outcomes (KDIGO) class had higher event rates but without interaction between SR and AF, respectively. After a median follow-up of 20 months, empagliflozin reduced CVD or HHF compared to placebo in AF and SR (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.63-1.08; and HR 0.69, 95% CI 0.56-0.84; interaction p = 0.29). The same applied to time to first HHF (interaction p = 0.20), while there was a borderline but insignificant interaction for first and recurrent HHF (p = 0.10). The effect on annual eGFR decline and QoL scores was not different. Incident AF was numerically lower but formally not significantly different (HR 0.66, 95% CI 0.40-1.09, p = 0.11, empagliflozin vs. placebo).CONCLUSIONSIn HFrEF, AF did not significantly modify outcomes after adjustment and did not associate with eGFR slopes. Empagliflozin reduced outcomes, eGFR decline and improved QoL regardless of AF or SR and probably reduced incident AF.
AIMSEmpagliflozin降低心血管死亡（CVD）或心力衰竭住院（HHF），减缓估计肾小球滤过率（eGFR）下降，改善心力衰竭伴射血分数（HFrEF）降低的生活质量（QoL）。依帕列净对房颤（AF）的影响是否一致值得探讨。方法和结果研究了AF与窦性心律（SR）对结果、eGFR下降和生活质量的影响。在可获得心律分析的患者中，在排除了节律缺失或有节奏的患者后，纳入了2785例患者（AF, n = 928， SR, n = 1857）。主要终点（p = 0.66）、首次终点（p = 0.19）和复发性HHF （p = 0.45）的差异无统计学意义。在安慰剂组，房颤和房颤之间的酒精摄入（相互作用p = 0.32）、体重指数（相互作用p = 0.93）、糖尿病（相互作用p = 0.52）、高血压（相互作用p = 0.24）没有差异。低射血分数和高肾病：改善整体结局（KDIGO）类别的事件发生率更高，但SR和房颤之间分别没有相互作用。中位随访20个月后，与安慰剂相比，恩格列净在房颤和SR中降低了CVD或HHF（风险比[HR] 0.82, 95%可信区间[CI] 0.63-1.08；风险比[HR] 0.69, 95% CI 0.56-0.84；相互作用p = 0.29）。同样适用于首次HHF的时间（相互作用p = 0.20），而首次和复发HHF存在临界但不显著的相互作用（p = 0.10）。对eGFR年下降和生活质量评分的影响无显著差异。发生率较低，但形式上没有显著差异（HR 0.66, 95% CI 0.40-1.09, p = 0.11，恩格列净vs安慰剂）。结论：在HFrEF中，AF没有显著改变调整后的结果，也与eGFR斜率无关。恩帕列净降低了结果，eGFR下降，改善了生活质量，无论AF或SR，并可能减少了AF的发生。
{"title":"Heart failure outcomes and empagliflozin effects in patients with heart failure and reduced ejection fraction in sinus rhythm or atrial fibrillation: Data from EMPEROR-Reduced.","authors":"Michael Böhm,Javed Butler,Amr Abdin,Gerasimos Filippatos,João Pedro Ferreira,Stuart J Pocock,Martina Brueckmann,Anne Pernille Ofstad,Elke Schueler,Christoph Wanner,Faiez Zannad,Stefan D Anker,Milton Packer, ","doi":"10.1002/ejhf.70021","DOIUrl":"https://doi.org/10.1002/ejhf.70021","url":null,"abstract":"AIMSEmpagliflozin reduces cardiovascular death (CVD) or hospitalization for heart failure (HHF), slows estimated glomerular filtration rate (eGFR) decline and improves quality of life (QoL) in heart failure with reduced ejection fraction (HFrEF). Whether the effect of empagliflozin is consistent according to atrial fibrillation (AF) status is worth exploring.METHODS AND RESULTSThe impact of AF versus sinus rhythm (SR) on outcomes as well as on eGFR decline and QoL were studied post-hoc in EMPEROR-Reduced. Of patients with available rhythm analyses and after exclusion of patients with missing or paced rhythms, 2785 were included (AF, n = 928, SR, n = 1857). Differences were not significant for the primary endpoint (p = 0.66), first (p = 0.19) and recurrent HHF (p = 0.45). On placebo, alcohol consumption (interaction p = 0.32), body mass index (interaction p = 0.93), diabetes (interaction p = 0.52), hypertension (interaction p = 0.24) were not different between AF and SR. Low ejection fraction and high Kidney Disease: Improving Global Outcomes (KDIGO) class had higher event rates but without interaction between SR and AF, respectively. After a median follow-up of 20 months, empagliflozin reduced CVD or HHF compared to placebo in AF and SR (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.63-1.08; and HR 0.69, 95% CI 0.56-0.84; interaction p = 0.29). The same applied to time to first HHF (interaction p = 0.20), while there was a borderline but insignificant interaction for first and recurrent HHF (p = 0.10). The effect on annual eGFR decline and QoL scores was not different. Incident AF was numerically lower but formally not significantly different (HR 0.66, 95% CI 0.40-1.09, p = 0.11, empagliflozin vs. placebo).CONCLUSIONSIn HFrEF, AF did not significantly modify outcomes after adjustment and did not associate with eGFR slopes. Empagliflozin reduced outcomes, eGFR decline and improved QoL regardless of AF or SR and probably reduced incident AF.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"17 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145068356","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}
Marianna Adamo,Matteo Pagnesi,Ovidiu Chioncel,Antoni Bayes-Genis,Magdy Abdelhamid,Elena-Laura Antohi,Chiara Bucciarelli-Ducci,Alaide Chieffo,Bernard Cosyns,Martine Gilard,Julia Grapsa,Arántxa González,Finn Gustafsson,Bernard Iung,Michael Joner,Nicole Karam,Lars H Lund,Francesco Maisano,Brenda Moura,Fabien Praz,Tanja K Rudolph,Anna Sannino,Gianluigi Savarese,Carlo Gabriele Tocchetti,Vanessa P M Van Empel,Maurizio Volterrani,Stephan Windecker,Piotr Ponikowski,Giuseppe M C Rosano,Emanuele Barbato,Marco Metra
Aortic stenosis (AS) is common and can cause heart failure (HF) or contribute to the progression of pre-existing HF. The management of patients with concomitant AS and HF poses specific clinical challenges. Optimization of guideline-directed medical therapy for HF may be difficult in patients with AS, especially in case of reduced left ventricular ejection fraction. Transcatheter or surgical aortic valve replacement (AVR) is the evidence-based treatment of choice for patients with severe AS and HF. However, advanced cardiac damage, concomitant conditions that can cause HF in addition to AS, as well as some procedure-related factors, may contribute to persistence or worsening of HF after AVR. A multidisciplinary management involving an HF specialist is crucial in this setting and should include a dedicated pre-procedural HF and AS assessment, as well as a careful post-procedural follow-up, including monitoring of HF status. The aim of this clinical consensus statement is to summarize current knowledge on AS and HF, with a focus on pre-procedural and post-procedural management of patients with HF undergoing AVR.
{"title":"Management of aortic stenosis and chronic heart failure: A clinical consensus statement of the Heart Failure Association (HFA) and the European Association of Percutaneous Cardiovascular Interventions (EAPCI) of the ESC.","authors":"Marianna Adamo,Matteo Pagnesi,Ovidiu Chioncel,Antoni Bayes-Genis,Magdy Abdelhamid,Elena-Laura Antohi,Chiara Bucciarelli-Ducci,Alaide Chieffo,Bernard Cosyns,Martine Gilard,Julia Grapsa,Arántxa González,Finn Gustafsson,Bernard Iung,Michael Joner,Nicole Karam,Lars H Lund,Francesco Maisano,Brenda Moura,Fabien Praz,Tanja K Rudolph,Anna Sannino,Gianluigi Savarese,Carlo Gabriele Tocchetti,Vanessa P M Van Empel,Maurizio Volterrani,Stephan Windecker,Piotr Ponikowski,Giuseppe M C Rosano,Emanuele Barbato,Marco Metra","doi":"10.1002/ejhf.70023","DOIUrl":"https://doi.org/10.1002/ejhf.70023","url":null,"abstract":"Aortic stenosis (AS) is common and can cause heart failure (HF) or contribute to the progression of pre-existing HF. The management of patients with concomitant AS and HF poses specific clinical challenges. Optimization of guideline-directed medical therapy for HF may be difficult in patients with AS, especially in case of reduced left ventricular ejection fraction. Transcatheter or surgical aortic valve replacement (AVR) is the evidence-based treatment of choice for patients with severe AS and HF. However, advanced cardiac damage, concomitant conditions that can cause HF in addition to AS, as well as some procedure-related factors, may contribute to persistence or worsening of HF after AVR. A multidisciplinary management involving an HF specialist is crucial in this setting and should include a dedicated pre-procedural HF and AS assessment, as well as a careful post-procedural follow-up, including monitoring of HF status. The aim of this clinical consensus statement is to summarize current knowledge on AS and HF, with a focus on pre-procedural and post-procedural management of patients with HF undergoing AVR.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"30 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145059039","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}
Sophie L V M Stroeks,Ping Wang,Marco Merlo,Steven Muller,Alessia Paldino,Nerea Mora-Ayestaran,Max Jason,Matteo Dal Ferro,Carola Pio Loca,Fernando Dominguez,Esther Gonzalez-Lopez,Arthur van den Wijngaard,Max F G H M Venner,Maurits Sikking,Michiel Minten,Bastien Nihant,Nina Beelen,Sharon Graw,Kristen Medo,Bart de Koning,Matthew Taylor,J Peter van Tintelen,Luisa Mestroni,Gianfranco Sinagra,Anneline S J M Te Riele,Pablo Garcia-Pavia,Stephane Heymans,Job A J Verdonschot
AIMSDilated cardiomyopathy (DCM) has a monogenic aetiology in up to 40% of patients. Understanding the spectrum of genotype-phenotype associations in DCM is crucial for risk stratification and personalized treatment. We aimed to (i) characterize genotype-specific features, (ii) evaluate whether phenotype-based clustering reflects underlying genotype, and (iii) compare the prognostic value of genotype- versus phenotype-based approaches.METHODS AND RESULTSA multicentre cohort of 534 DCM patients with a (likely) pathogenic variant were grouped by genotype (genotype-first approach) and clustered by clinical phenotype (phenotype-first approach). We compared clinical characteristics, identified genotype-phenotype associations, and evaluated outcomes, including all-cause mortality, heart failure hospitalization, heart transplantation, and malignant ventricular arrhythmias. Using the genotype-first approach, significant genotype-phenotype associations were found for 10 genes. FLNC, LMNA, DSP, and PLN variants were linked to arrhythmias. BAG3, TNNT2, DMD, and TTN were associated with increased cardiac volumes and decreased left ventricular ejection fraction (LVEF). Clustering identified four phenotypic clusters: (1) young, moderately reduced LVEF; (2) arrhythmias, moderate reduced LVEF; (3) low LVEF; (4) arrhythmias, low LVEF. There were no clear correlations between phenotypic clusters and genotype. The genotype-first approach showed that LMNA, FLNC, and BAG3 variants had the highest risk for heart failure and arrhythmogenic adverse outcomes. The phenotype-first approach indicated that clusters 3 and 4 were associated with the worst prognosis. Overall, genotype was the strongest predictor of outcome.CONCLUSIONSPatients with a genetic form of DCM exhibit clinical and genetic heterogeneity. Genotype-based risk stratification is more accurate compared to a phenotype-first approach, highlighting the importance of broad genetic screening among patients with DCM. Additionally, gene-specific risk prediction should become more prominent in current guidelines on management of genetic DCM patients.
{"title":"Impact of genotype-phenotype associations on prognosis in dilated cardiomyopathy.","authors":"Sophie L V M Stroeks,Ping Wang,Marco Merlo,Steven Muller,Alessia Paldino,Nerea Mora-Ayestaran,Max Jason,Matteo Dal Ferro,Carola Pio Loca,Fernando Dominguez,Esther Gonzalez-Lopez,Arthur van den Wijngaard,Max F G H M Venner,Maurits Sikking,Michiel Minten,Bastien Nihant,Nina Beelen,Sharon Graw,Kristen Medo,Bart de Koning,Matthew Taylor,J Peter van Tintelen,Luisa Mestroni,Gianfranco Sinagra,Anneline S J M Te Riele,Pablo Garcia-Pavia,Stephane Heymans,Job A J Verdonschot","doi":"10.1002/ejhf.70040","DOIUrl":"https://doi.org/10.1002/ejhf.70040","url":null,"abstract":"AIMSDilated cardiomyopathy (DCM) has a monogenic aetiology in up to 40% of patients. Understanding the spectrum of genotype-phenotype associations in DCM is crucial for risk stratification and personalized treatment. We aimed to (i) characterize genotype-specific features, (ii) evaluate whether phenotype-based clustering reflects underlying genotype, and (iii) compare the prognostic value of genotype- versus phenotype-based approaches.METHODS AND RESULTSA multicentre cohort of 534 DCM patients with a (likely) pathogenic variant were grouped by genotype (genotype-first approach) and clustered by clinical phenotype (phenotype-first approach). We compared clinical characteristics, identified genotype-phenotype associations, and evaluated outcomes, including all-cause mortality, heart failure hospitalization, heart transplantation, and malignant ventricular arrhythmias. Using the genotype-first approach, significant genotype-phenotype associations were found for 10 genes. FLNC, LMNA, DSP, and PLN variants were linked to arrhythmias. BAG3, TNNT2, DMD, and TTN were associated with increased cardiac volumes and decreased left ventricular ejection fraction (LVEF). Clustering identified four phenotypic clusters: (1) young, moderately reduced LVEF; (2) arrhythmias, moderate reduced LVEF; (3) low LVEF; (4) arrhythmias, low LVEF. There were no clear correlations between phenotypic clusters and genotype. The genotype-first approach showed that LMNA, FLNC, and BAG3 variants had the highest risk for heart failure and arrhythmogenic adverse outcomes. The phenotype-first approach indicated that clusters 3 and 4 were associated with the worst prognosis. Overall, genotype was the strongest predictor of outcome.CONCLUSIONSPatients with a genetic form of DCM exhibit clinical and genetic heterogeneity. Genotype-based risk stratification is more accurate compared to a phenotype-first approach, highlighting the importance of broad genetic screening among patients with DCM. Additionally, gene-specific risk prediction should become more prominent in current guidelines on management of genetic DCM patients.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"69 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043639","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}
Kalliopi Keramida,Teresa Lopez-Fernandez,Markus S Anker,Mark C Petrie,Pietro Ameri,Lisa J Anderson,Jutta Bergler-Klein,Anita Deswal,Dimitrios Farmakis,Borja Ibañez,Carolyn S P Lam,Ninian N Lang,Alexander R Lyon,Mariana Mirabel,Brenda Moura,Walter J Paulus,Amina Rakisheva,Gianluigi Savarese,Michele Senni,Carlo Gabriele Tocchetti,Marco Metra,Gerasimos Filippatos
Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized in cancer patients and survivors, yet it remains underdiagnosed and its epidemiology largely unknown. This statement underscores the imperative need to include HFpEF in the cardiotoxicities identified during or after anticancer treatments. It also highlights the prognostic value of pre-existing HFpEF for periprocedural and cardiotoxicity risk and it discusses the challenges in the diagnosis and treatment of HFpEF in cancer patients. It also explores the aetiologic role of anticancer therapies (chemotherapy, targeted and hormonal therapies and radiotherapy) in the pathogenesis of HFpEF. Special emphasis is given on the importance of considering HFpEF from cancer diagnosis throughout treatment and survivorship and provides useful insights for cardiologists and oncologists in the monitoring and management of these patients. Finally, it highlights the key gaps in current knowledge that require further investigation through well-designed research trials to enhance our understanding and improve clinical outcomes.
{"title":"Heart failure with preserved ejection fraction in cancer patients and survivors. A scientific statement of the Heart Failure Association of the ESC and the ESC Council of Cardio-Oncology.","authors":"Kalliopi Keramida,Teresa Lopez-Fernandez,Markus S Anker,Mark C Petrie,Pietro Ameri,Lisa J Anderson,Jutta Bergler-Klein,Anita Deswal,Dimitrios Farmakis,Borja Ibañez,Carolyn S P Lam,Ninian N Lang,Alexander R Lyon,Mariana Mirabel,Brenda Moura,Walter J Paulus,Amina Rakisheva,Gianluigi Savarese,Michele Senni,Carlo Gabriele Tocchetti,Marco Metra,Gerasimos Filippatos","doi":"10.1002/ejhf.70005","DOIUrl":"https://doi.org/10.1002/ejhf.70005","url":null,"abstract":"Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized in cancer patients and survivors, yet it remains underdiagnosed and its epidemiology largely unknown. This statement underscores the imperative need to include HFpEF in the cardiotoxicities identified during or after anticancer treatments. It also highlights the prognostic value of pre-existing HFpEF for periprocedural and cardiotoxicity risk and it discusses the challenges in the diagnosis and treatment of HFpEF in cancer patients. It also explores the aetiologic role of anticancer therapies (chemotherapy, targeted and hormonal therapies and radiotherapy) in the pathogenesis of HFpEF. Special emphasis is given on the importance of considering HFpEF from cancer diagnosis throughout treatment and survivorship and provides useful insights for cardiologists and oncologists in the monitoring and management of these patients. Finally, it highlights the key gaps in current knowledge that require further investigation through well-designed research trials to enhance our understanding and improve clinical outcomes.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"36 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145043634","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}
Benedikt N Beer,Lina Benson,Christian Basile,Benedikt Schrage,Peter Moritz Becher,Stefan Blankenberg,Paulus Kirchhof,Barna Szabó-Söderberg,Marco Metra,Anne Lindberg,Egidio Imbalzano,Giuseppe M C Rosano,Patric Karlström,Peter G M Mol,Raffaele Scorza,Lars H Lund,Felix Lindberg,Gianluigi Savarese
AIMSPatients with heart failure (HF) with reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD) are poorly represented in HFrEF trials testing beta-blockers. We assessed cardiovascular effectiveness and respiratory safety of beta-blockers in these patients.METHODS AND RESULTSPatients with HFrEF and COPD in the Swedish HF Registry (2006-2023) were included. Overlap-weighted models were used to assess associations between beta-blocker use and 5-year risk of outcomes, with cardiovascular death/total hospitalizations for HF (HHF) representing the primary cardiovascular effectiveness outcome, and total severe COPD exacerbations being the primary respiratory safety outcome. Of 5084 patients with HFrEF and COPD, median age was 75 years (interquartile range [IQR] 69-81), 68.3% were male, 36.9% were in GOLD group E, 91.5% used beta-blockers. Over a median follow-up of 2.5 years (IQR 1.0-4.8), beta-blocker users had lower crude risk of cardiovascular death/total HHF (rate ratio [RR] 0.66, 95% confidence interval [CI] 0.56-0.78) and total severe COPD exacerbations (RR 0.75, 95% CI 0.60-0.93). After overlap weighting, beta-blocker use was independently associated with lower risk of cardiovascular death/total HHF (RR 0.74, 95% CI 0.58-0.96) but not total severe COPD exacerbations (RR 0.99, 95% CI 0.73-1.35). These associations were consistent across subgroups (including GOLD groups), except for the greater magnitude of the association with lower risk of cardiovascular death/total HHF in patients with left ventricular ejection fraction <30% (p for interaction = 0.004). Falsification analyses suggested no influence from residual confounding.CONCLUSIONSIn patients with HFrEF and COPD, beta-blocker use was associated with lower risk of cardiovascular death/total HHF, without evidence of safety concerns for COPD exacerbations.
患有心力衰竭（HF）并射血分数降低（HFrEF）和慢性阻塞性肺疾病（COPD）的患者在HFrEF试验中测试β受体阻滞剂的比例较低。我们评估了-受体阻滞剂在这些患者中的心血管有效性和呼吸安全性。方法和结果纳入瑞典HF登记处（2006-2023）的HFrEF和COPD患者。重叠加权模型用于评估β受体阻滞剂使用与5年预后风险之间的关系，心血管死亡/ HF （HHF）住院总次数代表主要心血管有效性结局，而慢性阻塞性肺病严重加重总次数是主要呼吸安全性结局。5084例HFrEF合并COPD患者中位年龄为75岁（四分位数范围[IQR] 69-81）， 68.3%为男性，36.9%为GOLD E组，91.5%使用β受体阻滞剂。在中位随访2.5年（IQR 1.0-4.8）中，β受体阻滞剂使用者心血管死亡/总HHF的粗风险（比率比[RR] 0.66, 95%可信区间[CI] 0.56-0.78）和总严重COPD加重（RR 0.75, 95% CI 0.60-0.93）较低。重叠加权后，β受体阻滞剂的使用与心血管死亡/总HHF风险降低独立相关（RR 0.74, 95% CI 0.58-0.96），但与总COPD严重加重风险无关（RR 0.99, 95% CI 0.73-1.35）。除了左心室射血分数<30%的患者心血管死亡/总HHF风险较低（相互作用p = 0.004）外，这些关联在各亚组（包括GOLD组）中是一致的。证伪分析表明，残余混杂没有影响。结论：在HFrEF和COPD患者中，β受体阻滞剂的使用与心血管死亡/总HHF风险降低相关，没有证据表明对COPD加重有安全性担忧。
{"title":"Beta-blockers in patients with heart failure with reduced ejection fraction and concomitant chronic obstructive pulmonary disease: Cardiovascular and respiratory outcomes.","authors":"Benedikt N Beer,Lina Benson,Christian Basile,Benedikt Schrage,Peter Moritz Becher,Stefan Blankenberg,Paulus Kirchhof,Barna Szabó-Söderberg,Marco Metra,Anne Lindberg,Egidio Imbalzano,Giuseppe M C Rosano,Patric Karlström,Peter G M Mol,Raffaele Scorza,Lars H Lund,Felix Lindberg,Gianluigi Savarese","doi":"10.1002/ejhf.70046","DOIUrl":"https://doi.org/10.1002/ejhf.70046","url":null,"abstract":"AIMSPatients with heart failure (HF) with reduced ejection fraction (HFrEF) and chronic obstructive pulmonary disease (COPD) are poorly represented in HFrEF trials testing beta-blockers. We assessed cardiovascular effectiveness and respiratory safety of beta-blockers in these patients.METHODS AND RESULTSPatients with HFrEF and COPD in the Swedish HF Registry (2006-2023) were included. Overlap-weighted models were used to assess associations between beta-blocker use and 5-year risk of outcomes, with cardiovascular death/total hospitalizations for HF (HHF) representing the primary cardiovascular effectiveness outcome, and total severe COPD exacerbations being the primary respiratory safety outcome. Of 5084 patients with HFrEF and COPD, median age was 75 years (interquartile range [IQR] 69-81), 68.3% were male, 36.9% were in GOLD group E, 91.5% used beta-blockers. Over a median follow-up of 2.5 years (IQR 1.0-4.8), beta-blocker users had lower crude risk of cardiovascular death/total HHF (rate ratio [RR] 0.66, 95% confidence interval [CI] 0.56-0.78) and total severe COPD exacerbations (RR 0.75, 95% CI 0.60-0.93). After overlap weighting, beta-blocker use was independently associated with lower risk of cardiovascular death/total HHF (RR 0.74, 95% CI 0.58-0.96) but not total severe COPD exacerbations (RR 0.99, 95% CI 0.73-1.35). These associations were consistent across subgroups (including GOLD groups), except for the greater magnitude of the association with lower risk of cardiovascular death/total HHF in patients with left ventricular ejection fraction <30% (p for interaction = 0.004). Falsification analyses suggested no influence from residual confounding.CONCLUSIONSIn patients with HFrEF and COPD, beta-blocker use was associated with lower risk of cardiovascular death/total HHF, without evidence of safety concerns for COPD exacerbations.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145032000","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}
Parin Shah,Terak Bekfani,Pawel Rubis,Andrew L Clark,John G F Cleland
{"title":"Potential therapeutic effects of warming on patients with heart failure.","authors":"Parin Shah,Terak Bekfani,Pawel Rubis,Andrew L Clark,John G F Cleland","doi":"10.1002/ejhf.70011","DOIUrl":"https://doi.org/10.1002/ejhf.70011","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"56 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017859","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}
Joseph Campain,Denis J Wakeham,Katrin Dias,James P MacNamara,Mitchel Samels,Erin J Howden,Graeme Carrick-Ranson,Michinari Hieda,Benjamin D Levine,Satyam Sarma,Christopher M Hearon
AIMSObesity is commonly hypothesized to lead to the development of heart failure (HF) in part due to increases in blood volume (BV) and left ventricular (LV) remodelling. Whether adiposity and obesity severity are associated with BV expansion and subsequent LV remodelling in middle-aged individuals at increased risk (IR) prior to the onset of HF is unknown.METHODS AND RESULTSWe analysed data from 96 middle-aged (40-64 years) non-obese (25.8 [23.6-28.6] kg/m2) controls (CON) and 126 IR middle-aged adults (elevated cardiac biomarkers plus established risk factors). IR adults were stratified based upon body mass index class: (1) <30 kg/m2, IRNon-Obese (n = 28, 28.2 [24.6-29.9] kg/m2); (2) Class I >30-35 kg/m2, IRClass-I (n = 39, 33 [31.9-33.6] kg/m2); and, (3) Class II/III >35 kg/m2, IRClass-II/IIII (n = 59, 41.2 [37.1-43.8] kg/m2). BV (carbon monoxide rebreathing), body composition (hydrodensitometry or dual-energy X-ray absorptiometry), and LV structure and function (echocardiography) were assessed. Fat mass was independently associated with BV (β = 0.17, p < 0.001) which was independently associated with LV end-diastolic volume (LVEDV) index (β = 0.54, p < 0.001). BV was lower in CON (5046 ± 1123 ml) than all IR groups (IRNon-Obese: 5622 ± 1137; IRClass-I: 6033 ± 1237; IRClass-II/III: 6548 ± 1153 mL; all p < 0.05). IRClass-II/III had greater erythrocyte volume compared to CON (p < 0.005), even after normalization to fat-free mass (CON: 36.2 ± 4.6; IRClass-II/III: 39.9 ± 5.1 ml/kg fat-free mass; p < 0.001). Only IRClass-II/III had an enlarged LV end-diastolic volume when normalized to body surface area compared to both CON and IRNon-Obese (both, p < 0.05).CONCLUSIONSWhile lean mass is the primary determinant of BV, fat mass is independently associated with BV expansion and larger LVEDV. IR adults with class II/III obesity display distinct LV enlargement that is disproportionate to body size (i.e. LVEDV index) and may represent a physiologically distinct subgroup of obesity as opposed to a simple continuum of disease severity.
{"title":"Distinct blood volume and left ventricular adaptation to severe obesity in middle-aged adults at risk for heart failure.","authors":"Joseph Campain,Denis J Wakeham,Katrin Dias,James P MacNamara,Mitchel Samels,Erin J Howden,Graeme Carrick-Ranson,Michinari Hieda,Benjamin D Levine,Satyam Sarma,Christopher M Hearon","doi":"10.1002/ejhf.70037","DOIUrl":"https://doi.org/10.1002/ejhf.70037","url":null,"abstract":"AIMSObesity is commonly hypothesized to lead to the development of heart failure (HF) in part due to increases in blood volume (BV) and left ventricular (LV) remodelling. Whether adiposity and obesity severity are associated with BV expansion and subsequent LV remodelling in middle-aged individuals at increased risk (IR) prior to the onset of HF is unknown.METHODS AND RESULTSWe analysed data from 96 middle-aged (40-64 years) non-obese (25.8 [23.6-28.6] kg/m2) controls (CON) and 126 IR middle-aged adults (elevated cardiac biomarkers plus established risk factors). IR adults were stratified based upon body mass index class: (1) <30 kg/m2, IRNon-Obese (n = 28, 28.2 [24.6-29.9] kg/m2); (2) Class I >30-35 kg/m2, IRClass-I (n = 39, 33 [31.9-33.6] kg/m2); and, (3) Class II/III >35 kg/m2, IRClass-II/IIII (n = 59, 41.2 [37.1-43.8] kg/m2). BV (carbon monoxide rebreathing), body composition (hydrodensitometry or dual-energy X-ray absorptiometry), and LV structure and function (echocardiography) were assessed. Fat mass was independently associated with BV (β = 0.17, p < 0.001) which was independently associated with LV end-diastolic volume (LVEDV) index (β = 0.54, p < 0.001). BV was lower in CON (5046 ± 1123 ml) than all IR groups (IRNon-Obese: 5622 ± 1137; IRClass-I: 6033 ± 1237; IRClass-II/III: 6548 ± 1153 mL; all p < 0.05). IRClass-II/III had greater erythrocyte volume compared to CON (p < 0.005), even after normalization to fat-free mass (CON: 36.2 ± 4.6; IRClass-II/III: 39.9 ± 5.1 ml/kg fat-free mass; p < 0.001). Only IRClass-II/III had an enlarged LV end-diastolic volume when normalized to body surface area compared to both CON and IRNon-Obese (both, p < 0.05).CONCLUSIONSWhile lean mass is the primary determinant of BV, fat mass is independently associated with BV expansion and larger LVEDV. IR adults with class II/III obesity display distinct LV enlargement that is disproportionate to body size (i.e. LVEDV index) and may represent a physiologically distinct subgroup of obesity as opposed to a simple continuum of disease severity.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"13 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145017858","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}
Mohamad F Barakat,Nelson Amaral,Daniel Brayson,George Amin-Youssef,Huda Abu-Own,Salma Ayis,Francesco Papalia,Fadi Jouhra,Adam Nabeebaccus,Mark Monaghan,Gerry Carr-White,Alison Sleigh,Geoffrey Charles-Edwards,Ajay M Shah,Graham J Kemp,Andrew J Murray,Darlington O Okonko
AIMSSkeletal muscle energetic augmentation might be a mechanism via which intravenous iron improves symptoms in heart failure, but no direct measurement of intrinsic mitochondrial function has been performed to support this notion. This molecular substudy of the FERRIC-HF II trial tested the hypothesis that ferric derisomaltose (FDI) would improve electron transport chain activity, given its high dependence on iron-sulfur clusters which facilitate electron transfer during oxidative phosphorylation.METHODS AND RESULTSVastus lateralis skeletal muscle biopsies were taken before and 2 weeks after randomization. Mitochondrial complex I, II, and I&II respiration were quantified with respirometry of permeabilized fresh skeletal muscle biopsies. Net respiratory capacities, reflecting respiration that is truly available for adenosine triphosphate generation, were calculated by subtracting non-phosphorylating LEAK respiration. Complex I-V and myoglobin protein levels, and skeletal muscle fibre type composition were assayed. Patients randomised to FDI (n = 21) or placebo (n = 19) were similar (age 66 ± 13 years, 73% men, left ventricular ejection fraction 37 ± 8%, 48% New York Heart Association class III, 50% diabetic). After 2 weeks, total complex I-linked respiration (0.33 [interquartile range 0.24-0.37] vs. 0.19 [0.06-0.27] nmol/min/mg, p = 0.03) and net complex I-linked respiration (0.21 [0.16-0.24] vs. 0.11 [0.04-0.16] nmol/min/mg, p = 0.01) were higher in patients allocated to FDI. There was no intergroup difference in other respiratory states, in mitochondrial abundance as reflected by complex I-V protein levels, and in skeletal muscle myoglobin and oxidative fibre type content.CONCLUSIONSIron repletion induces an early, selective, and potentially direct enhancement of mitochondrial complex I-dependent respiration in the skeletal muscle of heart failure patients. This could be harnessed to optimize repletion protocols to maximize patient benefits.
骨骼肌能量增强可能是静脉注射铁改善心力衰竭症状的一种机制，但没有对内在线粒体功能的直接测量来支持这一观点。ferric - hf II试验的分子亚研究验证了这样的假设：考虑到铁硫团簇在氧化磷酸化过程中促进电子转移的高度依赖，二异麦芽糖铁（FDI）会提高电子传递链的活性。方法与结果随机分组前和随机分组后2周分别行股外侧骨骼肌活检。线粒体复合体I、II和I&II呼吸用透性新鲜骨骼肌活检呼吸测定法定量。净呼吸能力，反映呼吸真正可用于三磷酸腺苷的产生，通过减去非磷酸化的LEAK呼吸来计算。测定复合体I-V和肌红蛋白水平，以及骨骼肌纤维类型组成。随机分配到FDI组（n = 21）或安慰剂组（n = 19）的患者相似（年龄66±13岁，73%为男性，左室射血分数37±8%，48%为纽约心脏协会III级，50%为糖尿病）。2周后，分配到FDI的患者的总复合i联呼吸（0.33[四分位数间距0.24-0.37]比0.19 [0.06-0.27]nmol/min/mg, p = 0.03）和净复合i联呼吸（0.21[0.16-0.24]比0.11 [0.04-0.16]nmol/min/mg, p = 0.01）更高。其他呼吸状态、复合体I-V蛋白水平反映的线粒体丰度、骨骼肌肌红蛋白和氧化纤维类型含量在组间无差异。结论：在心力衰竭患者的骨骼肌中，铁离子补充可诱导线粒体复合体i依赖性呼吸的早期、选择性和潜在的直接增强。这可以用来优化补充方案，以最大限度地提高患者的利益。
{"title":"Ferric derisomaltose augments intrinsic skeletal muscle electron transport chain activity in heart failure: A FERRIC-HF II molecular substudy.","authors":"Mohamad F Barakat,Nelson Amaral,Daniel Brayson,George Amin-Youssef,Huda Abu-Own,Salma Ayis,Francesco Papalia,Fadi Jouhra,Adam Nabeebaccus,Mark Monaghan,Gerry Carr-White,Alison Sleigh,Geoffrey Charles-Edwards,Ajay M Shah,Graham J Kemp,Andrew J Murray,Darlington O Okonko","doi":"10.1002/ejhf.70028","DOIUrl":"https://doi.org/10.1002/ejhf.70028","url":null,"abstract":"AIMSSkeletal muscle energetic augmentation might be a mechanism via which intravenous iron improves symptoms in heart failure, but no direct measurement of intrinsic mitochondrial function has been performed to support this notion. This molecular substudy of the FERRIC-HF II trial tested the hypothesis that ferric derisomaltose (FDI) would improve electron transport chain activity, given its high dependence on iron-sulfur clusters which facilitate electron transfer during oxidative phosphorylation.METHODS AND RESULTSVastus lateralis skeletal muscle biopsies were taken before and 2 weeks after randomization. Mitochondrial complex I, II, and I&II respiration were quantified with respirometry of permeabilized fresh skeletal muscle biopsies. Net respiratory capacities, reflecting respiration that is truly available for adenosine triphosphate generation, were calculated by subtracting non-phosphorylating LEAK respiration. Complex I-V and myoglobin protein levels, and skeletal muscle fibre type composition were assayed. Patients randomised to FDI (n = 21) or placebo (n = 19) were similar (age 66 ± 13 years, 73% men, left ventricular ejection fraction 37 ± 8%, 48% New York Heart Association class III, 50% diabetic). After 2 weeks, total complex I-linked respiration (0.33 [interquartile range 0.24-0.37] vs. 0.19 [0.06-0.27] nmol/min/mg, p = 0.03) and net complex I-linked respiration (0.21 [0.16-0.24] vs. 0.11 [0.04-0.16] nmol/min/mg, p = 0.01) were higher in patients allocated to FDI. There was no intergroup difference in other respiratory states, in mitochondrial abundance as reflected by complex I-V protein levels, and in skeletal muscle myoglobin and oxidative fibre type content.CONCLUSIONSIron repletion induces an early, selective, and potentially direct enhancement of mitochondrial complex I-dependent respiration in the skeletal muscle of heart failure patients. This could be harnessed to optimize repletion protocols to maximize patient benefits.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"26 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008690","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}
Mohammad A Almesned,Bart J van Essen,Adriaan A Voors,Erik Lipsic
{"title":"Reply to the letter regarding the article 'Association between antecedent myocardial infarction and heart failure with preserved versus reduced ejection fraction'.","authors":"Mohammad A Almesned,Bart J van Essen,Adriaan A Voors,Erik Lipsic","doi":"10.1002/ejhf.70044","DOIUrl":"https://doi.org/10.1002/ejhf.70044","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"16 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008694","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}
Soufiane Nassiri,Geert H D Voordes,M Louis Handoko,Adriaan A Voors
{"title":"Reply to the letter regarding the article 'Effects of geranylgeranylacetone on diastolic and microvascular function in patients with heart failure with a preserved ejection fraction: A phase 2, randomized, placebo-controlled, crossover trial'.","authors":"Soufiane Nassiri,Geert H D Voordes,M Louis Handoko,Adriaan A Voors","doi":"10.1002/ejhf.70038","DOIUrl":"https://doi.org/10.1002/ejhf.70038","url":null,"abstract":"","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"163 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2025-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145008697","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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