Netherlands Heart Journal最新文献

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.

Introduction: Current expert consensus recommends remote monitoring (RM) for cardiac implantable electronic devices (CIEDs). As this recommendation is primarily based on studies involving implantable cardioverter defibrillators (ICDs), the HERO (HEart Rhythm management Optimisation of pacemaker recipients using remote monitoring) study aimed to reinforce this recommendation for pacemaker recipients.

Methods: The exploratory, retrospective, single-centre HERO study included 203 patients with an increased stroke risk (CHA₂DS₂-VASc score ≥ 2) but without a history of atrial fibrillation or flutter, who received a pacemaker between January 2016 and April 2018. Occurrence and detection time of atrial and ventricular arrhythmias were analysed in patients with RM (RM+; n = 60) and those without RM (RM-; n = 143), together with CIED adverse events, cardiology visits and anticoagulation adjustments.

Results: The median age of the patients was 80 (73-85) years, with 55.2% being men. During a median follow-up of 5.0 years, 53.7% were diagnosed with at least one arrhythmic event (RM+ 60.0% vs RM- 51.0%, p = 0.28). The median time from pacemaker implantation to detection of first arrhythmic event was 2.5 (0.5-8.2) years in the RM+ group versus 2.8 (1.2-8.0) years in the RM- group (hazard ratio 0.89; 95% confidence interval 0.59-1.35; p = 0.58). There were no differences in the number of adverse events or anticoagulation adjustments during follow-up. More CIED telephone consultations were conducted in the RM+ group.

Conclusion: A substantial proportion of pacemaker patients experienced one or more arrhythmic events during follow-up. The HERO study did not demonstrate a difference in time to detection of the first event when using remote monitoring.

Introduction: Patients with non-ischaemic cardiomyopathy (NICMP) have a class IIa primary prevention indication for an implantable cardioverter-defibrillator (ICD). Recent studies have shown that the evidence for a survival benefit following ICD implantation in this patient group is not particularly robust. In 2023, the Dutch Society of Cardiology published an update of the ESC guideline to better select patients with NICMP for ICD implantation. The objective of this study was to analyse the impact of this guideline on the number of indications in a retrospective cohort of patients who had received an ICD and whether the patients without an indication were also without appropriate ICD therapy.

Methods: A single-centre, retrospective observational study was performed in 134 patients with NICMP who underwent ICD implantation for primary prevention between 2015 and 2020.

Results: After applying the new Dutch guideline, 74 out of 134 patients with NICMP without a high-risk phenotype (35 patients) had no ICD indication (group 2). The remaining 25 patients were considered to have an ICD indication (group 1). During a median follow-up of 66 months (interquartile range 52-81) the incidence of appropriate ICD therapy (antitachycardia pacing and shock) was comparable in both groups: 4 patients in group 1 (16%) and 9 in group 2 (12%), p = 0.623.

Conclusion: The new 2023 guideline for ICD implantation in NICMP patients does indeed rule out a significant group of patients from ICD implantation. Nevertheless, our data show that patients without an indication still had comparable rates of appropriate ICD therapy.