Netherlands Heart Journal最新文献

Introduction: In severe cardiogenic shock the use of temporary mechanical circulatory support has increased during the past decade, with the Impella CP emerging as an alternative to the intra-aortic balloon pump. This study aims to assess the clinical outcomes associated with Impella CP-only support in patients with cardiogenic shock within two tertiary institutions specialised in durable mechanical support in the Netherlands.

Methods: All patients receiving Impella CP implantation for cardiogenic shock in the UMC Utrecht and UMC Groningen were studied between December 2020 and August 2023. Exclusion criteria included the use of additional mechanical support. The primary outcome evaluated was 30-day mortality. Secondary outcomes included LVAD implantations, cardiac recovery, and safety outcomes. Patients were categorised as Impella-optimal (Impella support expected to be sufficient) or Impella-limited (Impella support not sufficient but no further escalation because of comorbidities).

Results: The cohort consisted of 28 patients. The mean age was 60 years, and 71% were males. In the Impella-limited group, mortality was 100%, and LVAD implantation was performed in just 10%, while in the Impella-optimal group, mortality was 17% and LVAD implantation was performed in 50%. Complications were primarily related to bleeding (7%) and vascular events (11%).

Conclusions: This study suggests that Impella CP support in cardiogenic shock can be safe and feasible, serving as a bridge-to-recovery or a bridge-to-decision for LVAD implantation candidacy. However, Impella CP in the Impella-limited group is not useful. This underscores the importance of precise patient selection in cardiogenic shock therapy escalation.

Background: Persistent congestion in heart failure (HF) carries a dismal prognosis. Bioimpedance analysis (BIA) non-invasively identifies extracellular water (ECW) redistribution associated with acute HF. However, its role in detecting subclinical congestion in HF outpatients still needs to be explored.

Methods: Eighty-three adult outpatients with HFrEF were recruited for a single-center prospective study. Segmental multi-frequency BIA was used to assess body composition and the extracellular-to-total body water ratio (ECW/TBW), a marker of fluid redistribution. Subclinical congestion was defined as ECW/TBW_z‑score > 2 without clinical signs of congestion. The primary outcome was a composite of all-cause death and worsening HF (WHF) events.

Results: In this cohort, 57% of patients had subclinical congestion. Higher congestion grades were associated with age, female sex, and comorbidities. ECW/TBW_z‑score correlated linearly with NT-proBNP levels and low muscular indexes were associated with congestion severity. During a median follow-up of 10 months, 27% of patients experienced the primary outcome, mostly WHF events. Both subclinical and clinical congestion were independently associated with an increased risk of the primary outcome, with hazard ratios (HR) of 9.4 (1.04-85.1; p = 0.046) and 17 (1.11-261; p = 0.042), respectively. NT-proBNP and ECW/TBW_z‑score showed similar power in predicting the outcome.

Conclusions: BIA detects subclinical congestion-a condition highly prevalent in outpatients with HFrEF. An increased ECW/TBW ratio correlates with established markers of congestion and is associated with adverse events in this population. These findings support the integration of BIA into routine HF care; however, further studies are needed to establish the clinical benefits of BIA-guided management and its impact on patient outcomes.

Introduction: Heart failure with preserved ejection fraction (HFpEF) represents a heterogeneous syndrome characterised by various underlying aetiologies, such as transthyretin amyloid cardiomyopathy (ATTR-CM). The aim of this study was to determine the true prevalence of ATTR-CM in a Dutch all-comers cohort of HFpEF patients.

Methods: From 2018 to 2023, all patients diagnosed with HFpEF underwent prospective screening for ATTR-CM. Diagnosis of ATTR-CM was made in accordance with guideline recommendations.

Results: Of the 202 HFpEF patients included (mean ± standard deviation age: 76 ± 7 years; 64% female), 9 (5%) showed cardiac uptake on scintigraphy, of whom 6 (3%) were subsequently diagnosed with wild-type ATTR-CM. Left ventricular wall thickness (LVWT) was significantly higher in ATTR-CM patients than non-amyloid HFpEF patients (median interventricular septum diameter: 15 mm; interquartile range (IQR): 11-17 vs 10 mm; IQR: 9-11; p < 0.001). Interestingly, 2 ATTR-CM patients (33%) did not have increased LVWT at the time of diagnosis. These 2 patients were in a less advanced prognostic stage.

Conclusion: This study revealed a low prevalence of ATTR-CM (3%) in an unselected HFpEF cohort. We identified ATTR-CM patients without increased LVWT (33%), who presented at an earlier disease stage. Hence, relying exclusively on LVWT for the diagnosis of ATTR-CM may result in delayed and/or missed diagnoses.

The PLN Foundation, established in 2012, supports about 1700 individuals with a phospholamban (PLN) gene mutation causing severe cardiomyopathy. It aims to cure this rare disease by collaborating with universities, research institutions, and biotechnology companies. However, the foundation often faces challenges in being recognised as an equal research partner, with legal departments and technology transfer offices (TTOs) prioritising institutional interests over the public good, leading to delays and inefficiencies. The scientific culture's 'publish or perish' mentality, patent ownership issues, and bureaucratic ethics review processes further complicate progress. To overcome these barriers, the foundation advocates IP co-ownership, patient leadership, streamlined agreements, provisional ethical approvals, improved research logistics, revised evaluation metrics for scientists, and a shift in TTO strategies towards co-creation. These measures aim to enhance collaboration, accelerate therapeutic development, and ensure the accessibility and affordability of new treatments for rare diseases.