Xiaowen Wang, Orly Vardeny, Brian Claggett, Muthiah Vaduganathan, Sheila M. Hegde, Hicham Skali, Maria A. Pabon, Alberto Foà, Safia Chatur, Annamaria Kosztin, Eileen O'Meara, Jean Rouleau, Margaret Redfield, Carolyn S.P. Lam, Michael Zile, Milton Packer, Amil M. Shah, Maja Cikes, Mauro Gori, Bela Merkely, Marc A. Pfeffer, John J.V. McMurray, Scott D. Solomon
Aims
To evaluate clinical outcomes, echocardiographic features, and the efficacy and safety of sacubitril/valsartan compared to valsartan across age groups in the PARAGON-HF trial.
Methods and results
A total of 4796 participants ≥50 years of age with chronic heart failure (HF) and left ventricular ejection fraction (LVEF) ≥45% were divided into three age groups: <65 years (n = 825), 65–74 years (n = 1772), and ≥75 years (n = 2199). Echocardiograms of 1097 patients were analysed in a standardized fashion at a core imaging laboratory. The primary composite outcome was total HF hospitalizations and cardiovascular (CV) death. Older patients were more likely to experience primary composite outcomes (compared to patients <65 years, adjusted rate ratio [aRR] for ≥75 years: 1.39, 95% confidence interval [CI] 1.21–1.61), total HF hospitalization (aRR 1.27, 95% CI 1.09–1.49), and CV death (adjusted hazard ratio [aHR] 2.04, 95% CI 1.44–2.87). Age did not modify the effect of sacubitril/valsartan compared to valsartan on primary composite endpoint (pinteraction = 0.79) in the overall population or in those with LVEF ≤57%. Older adults randomized to sacubitril/valsartan were more likely to develop hypotension compared to those receiving valsartan (pinteraction = 0.026). Older patients had smaller left ventricular chamber sizes, higher LVEF, and were more likely to have abnormal measures of diastolic function.
Conclusion
Older patients with HF with preserved ejection fraction had higher event rates than younger patients, more adverse events overall, and more hypotension when treated with sacubitril/valsartan; however, the treatment benefits of sacubitril/valsartan were retained in older patients.
{"title":"Effect of sacubitril/valsartan in heart failure with preserved ejection fraction across the age spectrum in PARAGON-HF","authors":"Xiaowen Wang, Orly Vardeny, Brian Claggett, Muthiah Vaduganathan, Sheila M. Hegde, Hicham Skali, Maria A. Pabon, Alberto Foà, Safia Chatur, Annamaria Kosztin, Eileen O'Meara, Jean Rouleau, Margaret Redfield, Carolyn S.P. Lam, Michael Zile, Milton Packer, Amil M. Shah, Maja Cikes, Mauro Gori, Bela Merkely, Marc A. Pfeffer, John J.V. McMurray, Scott D. Solomon","doi":"10.1002/ejhf.3535","DOIUrl":"10.1002/ejhf.3535","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Aims</h3>\u0000 \u0000 <p>To evaluate clinical outcomes, echocardiographic features, and the efficacy and safety of sacubitril/valsartan compared to valsartan across age groups in the PARAGON-HF trial.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods and results</h3>\u0000 \u0000 <p>A total of 4796 participants ≥50 years of age with chronic heart failure (HF) and left ventricular ejection fraction (LVEF) ≥45% were divided into three age groups: <65 years (<i>n</i> = 825), 65–74 years (<i>n</i> = 1772), and ≥75 years (<i>n</i> = 2199). Echocardiograms of 1097 patients were analysed in a standardized fashion at a core imaging laboratory. The primary composite outcome was total HF hospitalizations and cardiovascular (CV) death. Older patients were more likely to experience primary composite outcomes (compared to patients <65 years, adjusted rate ratio [aRR] for ≥75 years: 1.39, 95% confidence interval [CI] 1.21–1.61), total HF hospitalization (aRR 1.27, 95% CI 1.09–1.49), and CV death (adjusted hazard ratio [aHR] 2.04, 95% CI 1.44–2.87). Age did not modify the effect of sacubitril/valsartan compared to valsartan on primary composite endpoint (<i>p</i><sub>interaction</sub> = 0.79) in the overall population or in those with LVEF ≤57%. Older adults randomized to sacubitril/valsartan were more likely to develop hypotension compared to those receiving valsartan (<i>p</i><sub>interaction</sub> = 0.026). Older patients had smaller left ventricular chamber sizes, higher LVEF, and were more likely to have abnormal measures of diastolic function.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Older patients with HF with preserved ejection fraction had higher event rates than younger patients, more adverse events overall, and more hypotension when treated with sacubitril/valsartan; however, the treatment benefits of sacubitril/valsartan were retained in older patients.</p>\u0000 </section>\u0000 </div>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 1","pages":"96-106"},"PeriodicalIF":16.9,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825152","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}
Darryl P. Leong, Philip G. Joseph, Hisham Dokainish, Stefan Störk, John V.V. McMurray, Lisa M. Mielniczuk, Sanjib Kumar Sharma, Andrés Orlandini, Kamilu M. Karaye, Antoni Bayes-Genis, Tara McCready, Alex Grinvalds, Kumar Balasubramanian, Kelley R. Branch, Kristian Kragholm, Salim Yusuf
The aim of this study was to describe the prognostic importance of left ventricular ejection fraction (LVEF) versus right ventricular (RV) dilatation and dysfunction in patients with heart failure (HF) from countries of different income levels.
{"title":"The risk of death according to left ventricular ejection fraction and right ventricular dilatation in 17 321 adults with heart failure from 40 high-, middle- and low-income countries – A Global Congestive Heart Failure (G-CHF) study","authors":"Darryl P. Leong, Philip G. Joseph, Hisham Dokainish, Stefan Störk, John V.V. McMurray, Lisa M. Mielniczuk, Sanjib Kumar Sharma, Andrés Orlandini, Kamilu M. Karaye, Antoni Bayes-Genis, Tara McCready, Alex Grinvalds, Kumar Balasubramanian, Kelley R. Branch, Kristian Kragholm, Salim Yusuf","doi":"10.1002/ejhf.3550","DOIUrl":"https://doi.org/10.1002/ejhf.3550","url":null,"abstract":"The aim of this study was to describe the prognostic importance of left ventricular ejection fraction (LVEF) versus right ventricular (RV) dilatation and dysfunction in patients with heart failure (HF) from countries of different income levels.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"51 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825132","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}
Riccardo M. Inciardi, Mauro Riccardi, Gianluigi Savarese, Marco Metra, Muthiah Vaduganathan, Scott D. Solomon
Heart failure with preserved ejection fraction (HFpEF) accounts for half of the hospitalization for heart failure (HF) worldwide, and the prevalence is expected to increase along with population aging and increasing burden of cardio-kidney-metabolic disorders.1 Treatment options for chronic HFpEF have expanded in recent years.2 Sodium–glucose cotransporter 2 inhibitors (SGLT2i) are now guideline-recommended as a first-line treatment in patients with mildly reduced and preserved ejection fraction. In a meta-analysis of the EMPEROR-Preserved and DELIVER trials, SGLT2i reduced cardiovascular (CV) death or first hospitalization for HF by 20% with consistent reductions in both components (12% risk reduction in CV death and 26% risk reduction in first hospitalization for HF), among HF patients with left ventricular ejection fraction (LVEF) >40%.3 In the PARAGON-HF trial, treatment with sacubitril/valsartan led to a marginal reduction of total hospitalizations for HF and CV death compared to valsartan in patients with HF and LVEF ≥45%, with a more pronounced benefit observed in those with an LVEF below normal.4 Based on the results of this trial, sacubitril/valsartan received indications for use in patients with HF with mildly reduced ejection fraction (HFmrEF) and selected patients with HFpEF with an LVEF below normal in the United States. Lastly, in the FINEARTS-HF trial, the non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone showed a 16% relative risk reduction of worsening HF events and death from CV causes compared to placebo among patients with HF and LVEF ≥40%.5
These advances in HFpEF pharmacotherapy, along with the substantial residual risk of this population, highlight the need for an accelerated optimization of foundational medical therapy.
The rising prevalence worldwide, the burden on the healthcare system and costs related to hospitalization represent critical challenges in the management of HFpEF. Novel therapeutic options advocate a transformative change in the care of chronic HFpEF patients encompassing recognition of multiple treatments, along with the management of comorbidities according to specific HFpEF phenotype. An upfront combination of foundational therapies, potentially enhancing tolerance and persistence of each other, should represent the bedrock of HFpEF treatment by targeting multiple pathophysiological drivers. A simultaneous or rapid sequence initiation of SGLTi and the non-steroidal MRA finerenone may be considered along with tailored therapies including incretin-based therapies and ARNI (Figure 1), based on clinical phenotype and settings, to optimally improve health status and clinical outcomes of patients with HFpEF.
{"title":"Tailoring medical therapy for heart failure with preserved ejection fraction","authors":"Riccardo M. Inciardi, Mauro Riccardi, Gianluigi Savarese, Marco Metra, Muthiah Vaduganathan, Scott D. Solomon","doi":"10.1002/ejhf.3558","DOIUrl":"10.1002/ejhf.3558","url":null,"abstract":"<p>Heart failure with preserved ejection fraction (HFpEF) accounts for half of the hospitalization for heart failure (HF) worldwide, and the prevalence is expected to increase along with population aging and increasing burden of cardio-kidney-metabolic disorders.<span><sup>1</sup></span> Treatment options for chronic HFpEF have expanded in recent years.<span><sup>2</sup></span> Sodium–glucose cotransporter 2 inhibitors (SGLT2i) are now guideline-recommended as a first-line treatment in patients with mildly reduced and preserved ejection fraction. In a meta-analysis of the EMPEROR-Preserved and DELIVER trials, SGLT2i reduced cardiovascular (CV) death or first hospitalization for HF by 20% with consistent reductions in both components (12% risk reduction in CV death and 26% risk reduction in first hospitalization for HF), among HF patients with left ventricular ejection fraction (LVEF) >40%.<span><sup>3</sup></span> In the PARAGON-HF trial, treatment with sacubitril/valsartan led to a marginal reduction of total hospitalizations for HF and CV death compared to valsartan in patients with HF and LVEF ≥45%, with a more pronounced benefit observed in those with an LVEF below normal.<span><sup>4</sup></span> Based on the results of this trial, sacubitril/valsartan received indications for use in patients with HF with mildly reduced ejection fraction (HFmrEF) and selected patients with HFpEF with an LVEF below normal in the United States. Lastly, in the FINEARTS-HF trial, the non-steroidal mineralocorticoid receptor antagonist (MRA) finerenone showed a 16% relative risk reduction of worsening HF events and death from CV causes compared to placebo among patients with HF and LVEF ≥40%.<span><sup>5</sup></span></p><p>These advances in HFpEF pharmacotherapy, along with the substantial residual risk of this population, highlight the need for an accelerated optimization of foundational medical therapy.</p><p>The rising prevalence worldwide, the burden on the healthcare system and costs related to hospitalization represent critical challenges in the management of HFpEF. Novel therapeutic options advocate a transformative change in the care of chronic HFpEF patients encompassing recognition of multiple treatments, along with the management of comorbidities according to specific HFpEF phenotype. An upfront combination of foundational therapies, potentially enhancing tolerance and persistence of each other, should represent the bedrock of HFpEF treatment by targeting multiple pathophysiological drivers. A simultaneous or rapid sequence initiation of SGLTi and the non-steroidal MRA finerenone may be considered along with tailored therapies including incretin-based therapies and ARNI (<i>Figure</i> 1), based on clinical phenotype and settings, to optimally improve health status and clinical outcomes of patients with HFpEF.</p>","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 2","pages":"190-193"},"PeriodicalIF":16.9,"publicationDate":"2024-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/ejhf.3558","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142825135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Adriaan A. Voors, Marco Metra, Douwe Postmus, Barry H. Greenberg, Gadi Cotter, Beth A. Davison, Iris E. Beldhuis, G. Michael Felker, Gerasimos Filippatos, Peter S. Pang, Piotr Ponikowski, Claudio Gimpelewicz, John R. Teerlink
Serelaxin is recombinant human relaxin-2, a hormone responsible for haemodynamic adaptations and organ protection in pregnancy. In the RELAX-AHF trial, serelaxin demonstrated reductions in cardiac, renal and hepatic damage. In RELAX-AHF-2, organ damage-related biomarkers were assessed in a biomarker substudy.
{"title":"End-organ protective effect of serelaxin in patients hospitalized for heart failure: Results of the biomarker substudy of Relaxin in Acute Heart Failure-2 (RELAX-AHF-2)","authors":"Adriaan A. Voors, Marco Metra, Douwe Postmus, Barry H. Greenberg, Gadi Cotter, Beth A. Davison, Iris E. Beldhuis, G. Michael Felker, Gerasimos Filippatos, Peter S. Pang, Piotr Ponikowski, Claudio Gimpelewicz, John R. Teerlink","doi":"10.1002/ejhf.3551","DOIUrl":"https://doi.org/10.1002/ejhf.3551","url":null,"abstract":"Serelaxin is recombinant human relaxin-2, a hormone responsible for haemodynamic adaptations and organ protection in pregnancy. In the RELAX-AHF trial, serelaxin demonstrated reductions in cardiac, renal and hepatic damage. In RELAX-AHF-2, organ damage-related biomarkers were assessed in a biomarker substudy.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"7 20 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142810070","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}
Enzo Lüsebrink, Hugo Lanz, Antonia Kellnar, Nicole Karam, Samir Kapadia, Raj Makkar, William T. Abraham, Azeem Latib, Martin Leon, Anna Sannino, Mony Shuvy, Mayra Guerrero, Neil Fam, Javed Butler, Marianna Adamo, Volker Rudolph, Gilbert H.L. Tang, Thomas J. Stocker, Karl-Philipp Rommel, Philipp Lurz, Holger Thiele, Steffen Massberg, Fabien Praz, Bernard Prendergast, Jörg Hausleiter
Worldwide, valvular heart disease (VHD) is a common cause of hospitalization for acute heart failure. In acute heart failure caused by VHD, symptoms result from rapid haemodynamic changes and subsequent decline in cardiac function, and if left untreated, leads to acute decompensation and cardiogenic shock. Current evidence remains scarce and recommendations regarding the management of acute heart failure caused by VHD are lacking in most recent international guidelines. Herein, we review the management of acute heart failure caused by VHD with a focus on transcatheter therapies and describe currently available evidence based on a systematic literature search on the following valve pathologies: (i) aortic stenosis, (ii) aortic regurgitation, (iii) mitral regurgitation, and (iv) mitral stenosis. Articles reporting outcomes following urgent or emergent valve intervention in the setting of cardiogenic shock or acute heart failure were considered. After screening a total of 2234 articles, 76 published between 1994 and 2023 were included in subsequent analysis. Based on available evidence, proposed treatment algorithms to guide optimal management of acute heart failure caused by VHD were created. As the number of patients presenting with acute heart failure caused by VHD continues to rise and outcomes following transcatheter valve interventions continue to improve, it is inevitable that minimally invasive options will play an increasingly important role in the acute setting, especially given these patients are at an increased operative risk. This review aims to present an organized approach to the complex management and interventional treatment of patients with acute heart failure caused by VHD.
{"title":"Management of acute decompensated valvular heart disease","authors":"Enzo Lüsebrink, Hugo Lanz, Antonia Kellnar, Nicole Karam, Samir Kapadia, Raj Makkar, William T. Abraham, Azeem Latib, Martin Leon, Anna Sannino, Mony Shuvy, Mayra Guerrero, Neil Fam, Javed Butler, Marianna Adamo, Volker Rudolph, Gilbert H.L. Tang, Thomas J. Stocker, Karl-Philipp Rommel, Philipp Lurz, Holger Thiele, Steffen Massberg, Fabien Praz, Bernard Prendergast, Jörg Hausleiter","doi":"10.1002/ejhf.3549","DOIUrl":"https://doi.org/10.1002/ejhf.3549","url":null,"abstract":"Worldwide, valvular heart disease (VHD) is a common cause of hospitalization for acute heart failure. In acute heart failure caused by VHD, symptoms result from rapid haemodynamic changes and subsequent decline in cardiac function, and if left untreated, leads to acute decompensation and cardiogenic shock. Current evidence remains scarce and recommendations regarding the management of acute heart failure caused by VHD are lacking in most recent international guidelines. Herein, we review the management of acute heart failure caused by VHD with a focus on transcatheter therapies and describe currently available evidence based on a systematic literature search on the following valve pathologies: (i) aortic stenosis, (ii) aortic regurgitation, (iii) mitral regurgitation, and (iv) mitral stenosis. Articles reporting outcomes following urgent or emergent valve intervention in the setting of cardiogenic shock or acute heart failure were considered. After screening a total of 2234 articles, 76 published between 1994 and 2023 were included in subsequent analysis. Based on available evidence, proposed treatment algorithms to guide optimal management of acute heart failure caused by VHD were created. As the number of patients presenting with acute heart failure caused by VHD continues to rise and outcomes following transcatheter valve interventions continue to improve, it is inevitable that minimally invasive options will play an increasingly important role in the acute setting, especially given these patients are at an increased operative risk. This review aims to present an organized approach to the complex management and interventional treatment of patients with acute heart failure caused by VHD.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"1 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142810072","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":"Tailored therapies for patients affected by systemic sclerosis with primary heart involvement: The role of rituximab","authors":"Daniela Tomasoni, Enrico Ammirati, Marco Metra","doi":"10.1002/ejhf.3543","DOIUrl":"https://doi.org/10.1002/ejhf.3543","url":null,"abstract":"Click on the article title to read more.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"21 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142804779","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}
Luca Monzo, Emmanuel Bresso, Kenneth Dickstein, Bertram Pitt, John G.F. Cleland, Stefan D. Anker, Carolyn S.P. Lam, Mandeep R. Mehra, Dirk J. van Veldhuisen, Barry Greenberg, Faiez Zannad, Nicolas Girerd
Patients experiencing ischaemic heart failure with reduced ejection fraction (HFrEF) represent a diverse group. We hypothesize that machine learning clustering can help separate distinctive patient phenotypes, paving the way for personalized management.
{"title":"Machine learning approach to identify phenotypes in patients with ischaemic heart failure with reduced ejection fraction","authors":"Luca Monzo, Emmanuel Bresso, Kenneth Dickstein, Bertram Pitt, John G.F. Cleland, Stefan D. Anker, Carolyn S.P. Lam, Mandeep R. Mehra, Dirk J. van Veldhuisen, Barry Greenberg, Faiez Zannad, Nicolas Girerd","doi":"10.1002/ejhf.3547","DOIUrl":"https://doi.org/10.1002/ejhf.3547","url":null,"abstract":"Patients experiencing ischaemic heart failure with reduced ejection fraction (HFrEF) represent a diverse group. We hypothesize that machine learning clustering can help separate distinctive patient phenotypes, paving the way for personalized management.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"19 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142797758","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}
Guoli Sun, Emil L. Fosbøl, Mikkel Faurschou, Morten Schou, Christian Torp-Pedersen, Lars Køber, Jawad H. Butt
Although certain autoimmune diseases (AIDs) have been associated with an increased rate of heart failure (HF), data on the long-term rate of HF across the spectrum of AIDs are lacking. We investigated the long-term rate of HF in individuals with a history of 28 different AIDs.
{"title":"Long-term rate of heart failure in patients with autoimmune disease: A nationwide cohort study","authors":"Guoli Sun, Emil L. Fosbøl, Mikkel Faurschou, Morten Schou, Christian Torp-Pedersen, Lars Køber, Jawad H. Butt","doi":"10.1002/ejhf.3541","DOIUrl":"https://doi.org/10.1002/ejhf.3541","url":null,"abstract":"Although certain autoimmune diseases (AIDs) have been associated with an increased rate of heart failure (HF), data on the long-term rate of HF across the spectrum of AIDs are lacking. We investigated the long-term rate of HF in individuals with a history of 28 different AIDs.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"38 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142797759","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}
Henriikka Mälkönen, Jukka Lehtonen, Pauli Pöyhönen, Valtteri Uusitalo, Mikko I. Mäyränpää, Markku Kupari
AimsWe set out to assess the utility of endomyocardial biopsy (EMB) in cardiac sarcoidosis (CS). Historically, EMB sensitivity in CS is only ≤25%, but comprehensive analyses of its current diagnostic performance are not available.Methods and resultsThe data of 260 consecutive patients with CS (mean age 49 years, 60% female) meeting the Heart Rhythm Society diagnostic criteria were analysed retrospectively. Overall, 216 patients (83%) had undergone EMB, 47 with repeat procedures. EMB overall sensitivity was 38%, rising to 49% after repeat biopsies. On logistic regression analysis, positive EMB was predicted independently by presentation with ventricular tachyarrhythmia with an odds ratio (OR) of 3.8 (95% confidence interval [CI] 1.2–12.0, p = 0.021), left ventricular ejection fraction ≤45% (OR 3.7, 95% CI 1.5–9.1, p = 0.004), elevation of cardiac troponins (OR 2.7, 95% CI 1.1–6.4, p = 0.024), and presence of late gadolinium enhancement in left ventricular mid‐apical septal segments on magnetic resonance imaging (OR 4.1, 95% CI 1.2–13.8, p = 0.024). EMB sensitivity, counting in repeats, was 16% in patients (n = 37) without any independent predictor versus 38%, 60%, 79%, and 88% in those with 1 (n = 76), 2 (n = 62), 3 (n = 33), and 4/4 (n = 8) predictors, respectively. The rate of serious complications was 0.7% without mortality or permanent harm. Positive EMB was not an independent predictor of prognosis.ConclusionThe sensitivity of EMB in CS depends on the extent, activity, and location of myocardial involvement, being the higher the more severe CS is. Its use should rely on weighing the pre‐test likelihood and individual value of positive biopsy against the procedural risks.
目的：我们开始评估心肌内膜活检（EMB）在心脏结节病（CS）中的应用。从历史上看，EMB在CS中的敏感性仅≤25%，但目前还没有对其诊断性能的全面分析。方法与结果对符合心律学会诊断标准的连续260例CS患者（平均年龄49岁，60%为女性）的资料进行回顾性分析。总的来说，216名患者（83%）接受了EMB， 47名患者接受了重复手术。EMB的总体敏感性为38%，在重复活检后上升至49%。在logistic回归分析中，EMB阳性的独立预测是：表现为室性心动过速，比值比（OR）为3.8(95%可信区间[CI] 1.2-12.0, p = 0.021)，左心室射血分数≤45% (OR 3.7, 95% CI 1.5-9.1, p = 0.004)，心肌肌钙蛋白升高（OR 2.7, 95% CI 1.1-6.4, p = 0.024），磁共振成像显示左心室中尖间隔段晚期钆增强（OR 4.1, 95% CI 1.2-13.8, p = 0.024）。P = 0.024)。以重复数计算，无独立预测因子的患者（n = 37）的EMB敏感性为16%，而有1 （n = 76）、2 （n = 62）、3 （n = 33）和4/4 （n = 8）预测因子的患者的EMB敏感性分别为38%、60%、79%和88%。严重并发症发生率为0.7%，无死亡或永久性伤害。EMB阳性不是预后的独立预测因子。结论EMB对CS的敏感性与心肌受累程度、活动程度和部位有关，CS越严重，EMB的敏感性越高。它的使用应该依赖于权衡测试前的可能性和阳性活检的个体价值与程序风险。
{"title":"Endomyocardial biopsy in the diagnosis of cardiac sarcoidosis","authors":"Henriikka Mälkönen, Jukka Lehtonen, Pauli Pöyhönen, Valtteri Uusitalo, Mikko I. Mäyränpää, Markku Kupari","doi":"10.1002/ejhf.3545","DOIUrl":"https://doi.org/10.1002/ejhf.3545","url":null,"abstract":"AimsWe set out to assess the utility of endomyocardial biopsy (EMB) in cardiac sarcoidosis (CS). Historically, EMB sensitivity in CS is only ≤25%, but comprehensive analyses of its current diagnostic performance are not available.Methods and resultsThe data of 260 consecutive patients with <jats:styled-content style=\"fixed-case\">CS</jats:styled-content> (mean age 49 years, 60% female) meeting the Heart Rhythm Society diagnostic criteria were analysed retrospectively. Overall, 216 patients (83%) had undergone <jats:styled-content style=\"fixed-case\">EMB</jats:styled-content>, 47 with repeat procedures. <jats:styled-content style=\"fixed-case\">EMB</jats:styled-content> overall sensitivity was 38%, rising to 49% after repeat biopsies. On logistic regression analysis, positive <jats:styled-content style=\"fixed-case\">EMB</jats:styled-content> was predicted independently by presentation with ventricular tachyarrhythmia with an odds ratio (<jats:styled-content style=\"fixed-case\">OR</jats:styled-content>) of 3.8 (95% confidence interval [CI] 1.2–12.0, <jats:italic>p</jats:italic> = 0.021), left ventricular ejection fraction ≤45% (<jats:styled-content style=\"fixed-case\">OR</jats:styled-content> 3.7, 95% CI 1.5–9.1, <jats:italic>p</jats:italic> = 0.004), elevation of cardiac troponins (<jats:styled-content style=\"fixed-case\">OR</jats:styled-content> 2.7, 95% CI 1.1–6.4, <jats:italic>p</jats:italic> = 0.024), and presence of late gadolinium enhancement in left ventricular mid‐apical septal segments on magnetic resonance imaging (<jats:styled-content style=\"fixed-case\">OR</jats:styled-content> 4.1, 95% CI 1.2–13.8, <jats:italic>p</jats:italic> = 0.024). <jats:styled-content style=\"fixed-case\">EMB</jats:styled-content> sensitivity, counting in repeats, was 16% in patients (<jats:italic>n</jats:italic> = 37) without any independent predictor versus 38%, 60%, 79%, and 88% in those with 1 (<jats:italic>n</jats:italic> = 76), 2 (<jats:italic>n</jats:italic> = 62), 3 (<jats:italic>n</jats:italic> = 33), and 4/4 (<jats:italic>n</jats:italic> = 8) predictors, respectively. The rate of serious complications was 0.7% without mortality or permanent harm. Positive <jats:styled-content style=\"fixed-case\">EMB</jats:styled-content> was not an independent predictor of prognosis.ConclusionThe sensitivity of <jats:styled-content style=\"fixed-case\">EMB</jats:styled-content> in <jats:styled-content style=\"fixed-case\">CS</jats:styled-content> depends on the extent, activity, and location of myocardial involvement, being the higher the more severe <jats:styled-content style=\"fixed-case\">CS</jats:styled-content> is. Its use should rely on weighing the pre‐test likelihood and individual value of positive biopsy against the procedural risks.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"27 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782458","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}
Lawrence Zeldin, Joanna B.S. Eichler, Sergio L. Teruya, Ariel Y. Weinsaft, Alfonsina Mirabal, Margaret O. Cuomo, Kimberly Mateo, Stephen Helmke, Mathew S. Maurer
Transthyretin cardiomyopathy (ATTR-CM) is characterized by episodes of worsening heart failure (WHF) which can include heart failure (HF) hospitalizations or urgent unplanned visits for administration of intravenous diuretics. WHF characterized by outpatient intensification of oral loop diuretics is common yet its prognostic implications for ATTR-CM patients relative to other WHF events remains unclear. We assessed how WHF characterized by outpatient diuretic intensification (ODI) relates to mortality in this population.
{"title":"Outpatient worsening of heart failure and mortality in transthyretin amyloid cardiomyopathy","authors":"Lawrence Zeldin, Joanna B.S. Eichler, Sergio L. Teruya, Ariel Y. Weinsaft, Alfonsina Mirabal, Margaret O. Cuomo, Kimberly Mateo, Stephen Helmke, Mathew S. Maurer","doi":"10.1002/ejhf.3540","DOIUrl":"https://doi.org/10.1002/ejhf.3540","url":null,"abstract":"Transthyretin cardiomyopathy (ATTR-CM) is characterized by episodes of worsening heart failure (WHF) which can include heart failure (HF) hospitalizations or urgent unplanned visits for administration of intravenous diuretics. WHF characterized by outpatient intensification of oral loop diuretics is common yet its prognostic implications for ATTR-CM patients relative to other WHF events remains unclear. We assessed how WHF characterized by outpatient diuretic intensification (ODI) relates to mortality in this population.","PeriodicalId":164,"journal":{"name":"European Journal of Heart Failure","volume":"79 1","pages":""},"PeriodicalIF":18.2,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142782457","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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