Journal: J Card Fail

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<div><h4>Right ventricular free wall strain and effect of defibrillator implantation in patients with non-ischemic systolic heart failure.</h4><i>Elming MB, Jensen DH, Winsløw UC, Risum N, ... Køber L, Thune JJ</i><br /><b>Aims</b><br />Patients with non-ischemic systolic heart failure have an increased risk of malignant ventricular arrhythmias and sudden cardiovascular death. Since the risk is less pronounced than for patients with ischemic cause of heart failure more discriminating tools are needed to identify patients most likely to benefit from implantable cardioverter-defibrillator (ICD) implantation. Right ventricular (RV) dysfunction is associated with a worse prognosis, but whether RV free wall strain (RV-FWS) measured with echocardiography can identify the patients most likely to benefit from ICD implantation is not known.<br /><b>Methods</b><br />In this extended follow-up analysis of the Danish Study to Assess the Efficacy of ICDs in Patients with Non-ischemic Systolic Heart Failure on Mortality (DANISH) trial, RV-FWS was measured with echocardiography in 445 patients prior to randomization. RV dysfunction was defined as RV-FWS > -20%. The primary endpoint was all-cause mortality.<br /><b>Results</b><br />Median RV-FWS was -18% (quartiles: -23% to -14%), and RV dysfunction was measured in 255 (57%) patients. During a median follow-up of 5.7 years, 170 (38%) patients died. There was a statistically significant interaction between RV dysfunction and the effect of ICD implantation (p=0.003), also after adjusting for known cardiovascular risk factors (p=0.01). ICD implantation significantly reduced all-cause mortality in patients with RV dysfunction, HR 0.54 (95% CI 0.36-0.80), p = 0.002, but not in patients with normal RV function, HR 1.34 (95% CI 0.84-2.12), p = 0.22.<br /><b>Conclusions</b><br />In patients with non-ischemic systolic heart failure, RV dysfunction on echocardiography was associated with greater effect of ICD implantation and could be used to select patients with benefit from ICD treatment.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 25 Jan 2023; epub ahead of print</small></div>
Elming MB, Jensen DH, Winsløw UC, Risum N, ... Køber L, Thune JJ
J Card Fail: 25 Jan 2023; epub ahead of print | PMID: 36708755
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<div><h4>Effect of flu vaccination on severity and outcome of heart failure decompensations.</h4><i>Miró Ò, Ivars N, Lopez-Ayala P, Gil V, ... Llorens P, (on behalf of the ICA-SEMES groupb)</i><br /><b>Objective</b><br />To investigate the relationship of seasonal flu vaccination with severity of decompensations and long-term outcomes of patients with heart failure (HF).<br /><b>Methods</b><br />We analyzed 6,147 consecutively enrolled decompensated HF patients who presented to 33 Spanish emergency departments (EDs) during January and February, 2018 and 2019, grouped according to seasonal flu vaccination status. Severity of HF decompensation was assessed with the MEESSI scale, need of hospitalization, and in-hospital all-cause mortality. Long-term outcomes analyzed were 90-day post-discharge adverse events and 90-day all-cause death. Associations between vaccination, HF decompensation severity, and long-term outcomes were explored by unadjusted and adjusted logistic and Cox regressions using 14 covariables that could act as potential confounders.<br /><b>Results</b><br />Overall median (IQR) age was 84 (IQR=77-89) years, 56% were women. Vaccinated patients (n=1,139, 19%) were older, with more comorbidities, and with worse baseline status assessed by NYHA class and Barthel index, than unvaccinated patients (n=5,008, 81%). Infection triggering decompensation was more frequent in vaccinated patients (50% versus 41%, p<0.001). In vaccinated and unvaccinated patients, high or very-high risk decompensation was seen in 21.9% and 21.1%, hospitalization occurred in 72.5% and 73.7%, in-hospital mortality was 7.4% and 7.0%, 90-day post-discharge adverse events were 57.4% and 53.2%, and 90-day mortality was 15.8% and 16.6%, respectively, with no significant differences between cohorts. After adjusting, vaccinated decompensated HF patients had a decreased odds for hospitalization (OR=0.823, 95%CI=0.709-0.955).<br /><b>Conclusion</b><br />In HF patients, seasonal flu vaccination is associated with less severe decompensations.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 24 Jan 2023; epub ahead of print</small></div>
Miró Ò, Ivars N, Lopez-Ayala P, Gil V, ... Llorens P, (on behalf of the ICA-SEMES groupb)
J Card Fail: 24 Jan 2023; epub ahead of print | PMID: 36706976
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<div><h4>Electrocardiogram Detection of Pulmonary Hypertension Using Deep Learning.</h4><i>Aras MA, Abreau S, Mills H, Radhakrishnan L, ... Olgin JE, Tison GH</i><br /><b>Background</b><br />Pulmonary hypertension (PH) is life-threatening, and often diagnosed late in its course. We aimed to evaluate if a deep learning approach using electrocardiogram (ECG) data alone can detect PH and clinically important subtypes.<br /><b>Research question</b><br />Does an automated deep learning approach to ECG interpretation detect PH and its clinically important subtypes.<br /><b>Study design and methods</b><br />Adults with right heart catheterization (RHC) or an echocardiogram within 90 days of an ECG at the University of California, San Francisco (2012-2019) were retrospectively identified as PH or non-PH. A deep convolutional neural network was trained on patients\' 12-lead ECG voltage data. Patients were divided into training, development, and test sets in a ratio of 7:1:2.<br /><b>Results</b><br />Overall, 5016 PH and 19,454 non-PH patients were used in the study. Mean (SD) age at time of ECG was 62.29 (17.58) years and 49.88% were female. Mean interval between ECG and RHC or echocardiogram was 3.66 and 2.23 days for PH and non-PH patients, respectively. In the test dataset, the model achieved an area under the receiver operating characteristic curve (AUC), sensitivity, and specificity, respectively of 0.89, 0.79, and 0.84 to detect PH; 0.91, 0.83, and 0.84 to detect pre-capillary PH; 0.88, 0.81, and 0.81 to detect PAH, and 0.80, 0.73, and 0.76 to detect Group 3 PH. We additionally applied the trained model on ECGs from participants in the test dataset that were obtained from up to 2 years before diagnosis of PH: AUC was ≥0.79.<br /><b>Interpretation</b><br />A deep learning ECG algorithm can detect PH and PH subtypes around the time of diagnosis and can detect PH using ECGs that were done up to 2 years before RHC/echocardiogram diagnosis. This approach has the potential to reduce diagnostic delay in PH.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 24 Jan 2023; epub ahead of print</small></div>
Aras MA, Abreau S, Mills H, Radhakrishnan L, ... Olgin JE, Tison GH
J Card Fail: 24 Jan 2023; epub ahead of print | PMID: 36706977
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<div><h4>Prognostic value of the severity of clinical congestion in patients hospitalized for decompensated heart failure: Findings from the Japanese KCHF registry.</h4><i>Aida K, Nagao K, Kato T, Yaku H, ... Ozasa N, Kimura T</i><br /><b>Background</b><br />Congestion is a leading cause of hospitalization and a major therapeutic target in patients with heart failure (HF). Clinical practice in Japan is characterized by a long hospital stay, which facilitates more extensive decongestion during hospitalization. We herein examined the time course and prognostic impact of clinical congestion in a large contemporary Japanese cohort of HF.<br /><b>Methods</b><br />Peripheral edema, jugular venous pressure, and orthopnea were graded on a standardized 4-point scale (0 to 3) in 3787 hospitalized patients in a Japanese cohort of HF. Composite congestion scores (CCS) on admission and at discharge were calculated by summing individual scores. The primary outcome was a composite of all-cause death or HF hospitalization.<br /><b>Results</b><br />Median admission CCS was 4 (interquartile range: 3-6). Overall, 255 patients died during the median hospitalization length of 16 days, while 1395 died or were hospitalized for HF during a median post-discharge follow-up of 396 days. The cumulative 1-year incidence of the primary outcome increased at higher tertiles of congestion on admission (32.5, 39.3, and 41.0% in the mild [CCS ≤3], moderate [CCS=4 or 5], and severe [CCS ≥6] congestion groups, respectively, Log-rank P<0.001). The adjusted hazard ratios [HR] (95% confidence interval) of moderate and severe congestion relative to mild congestion were 1.205 (1.065-1.365, P=0.003) and 1.247 (1.103-1.410, P <0.001), respectively. Among 3445 patients discharged alive, 85% had CCS of 0 (complete decongestion) and 15% had CCS ≥1 (residual congestion) at discharge. While residual congestion predicted a risk of post-discharge death or HF hospitalization (adjusted HR: 1.314 [1.145-1.509], P <0.001), admission CCS correlated with the risk of post-discharge death or HF hospitalization, even in the complete decongestion group. No correlation was observed for post-discharge death or HF hospitalization between residual congestion at discharge and admission CCS (P for the interaction=0.316).<br /><b>Conclusion</b><br />In total, 85% of patients were discharged with complete decongestion in Japanese clinical practice. Clinical congestion, on admission and at discharge, was of prognostic value. The severity of congestion on admission was predictive of adverse outcomes, even in the absence of residual congestion.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 20 Jan 2023; epub ahead of print</small></div>
Aida K, Nagao K, Kato T, Yaku H, ... Ozasa N, Kimura T
J Card Fail: 20 Jan 2023; epub ahead of print | PMID: 36690136
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<div><h4>Multiple Prior Live Births are Associated with Cardiac Remodeling and Heart Failure Risk in Women.</h4><i>Sarma AA, Paniagua SM, Lau ES, Wang D, ... Shah SJ, Ho JE</i><br /><b>Introduction</b><br />Greater parity has been associated with cardiovascular disease risk, though effects on cardiac remodeling and heart failure risk remain unclear.<br /><b>Methods</b><br />We examined the association of number of live births and echocardiographic measures of cardiac structure and function in participants of the Framingham Heart Study (FHS) using multivariable linear regression. We next examined the association of parity with incident heart failure with preserved (HFpEF) or reduced (HFrEF) ejection fraction using a Fine-Gray subdistribution hazards model in a pooled analysis of n=12,635 participants of FHS, the Cardiovascular Health Study, the Multi-Ethnic Study of Atherosclerosis, and Prevention of Renal and Vascular Endstage Disease. Secondary analyses included major CVD, MI, and stroke.<br /><b>Results</b><br />Among n=3931 FHS participants (mean age 48 ± 13 years), higher number of live births was associated with worse LV fractional shortening (multivariable β -1.11 (0.31), p= 0.0005 in ≥ 5 live births vs nulliparous women) and worse cardiac mechanics including global circumferential strain and longitudinal and radial dyssynchrony (p< 0.01 for all comparing ≥ 5 live births vs nulliparity). When examining HF subtypes, women with ≥5 live births were at higher risk of developing future HFrEF compared with nulliparous women (HR 1.93, 95% CI 1.19-3.12, p=0.008); by contrast, a lower risk of HFpEF was observed (HR 0.58, 95% CI 0.37-0.91, p=0.02).<br /><b>Conclusions</b><br />Greater number of live births are associated with worse cardiac structure and function. While there was no association with overall HF, a higher number of live births was associated with greater risk for incident HFrEF.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 10 Jan 2023; epub ahead of print</small></div>
Sarma AA, Paniagua SM, Lau ES, Wang D, ... Shah SJ, Ho JE
J Card Fail: 10 Jan 2023; epub ahead of print | PMID: 36638956
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<div><h4>Blood coagulation disorders in heart failure: from basic science to clinical perspectives.</h4><i>Siniarski A, Gąsecka A, Borovac J, Papakonstantinou PE, ... Guerreiro RA, Parker WAE</i><br /><AbstractText>Heart failure (HF) is a clinical syndrome divided into three subtypes, based on the left ventricular ejection fraction. Every subtype has specific clinical characteristics and concomitant diseases, substantially increasing risk of thromboembolic complications such as stroke, peripheral embolism and pulmonary embolism. Despite the annual prevalence of 1% and devastating clinical consequences, thromboembolic complications are not typically recognised as the leading problem in HF patients, representing an underappreciated clinical challenge. Although the currently available data do not support routine anticoagulation in patients with HF and sinus rhythm, initial reports suggest that such strategy might be beneficial in a subset of patients at especially high thromboembolic risk. Considering the existing evidence gap, we aimed to review the currently available data regarding coagulation disorders in acute and chronic HF based on the insight from preclinical and clinical studies, summarize the evidence regarding anticoagulation in HF in special case scenarios and outline future research directions to establish the optimal patient-tailored strategies for antiplatelet and anticoagulant therapy in HF. In summary, we highlight the top 10 pearls in the management of patients with HF and no other specific indications for oral anticoagulation therapy. Further studies are urgently needed to shed light on the pathophysiological role of platelet activation in HF and to evaluate whether antiplatelet or antithrombotic therapy could be beneficial in HF patients.</AbstractText><br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 09 Jan 2023; epub ahead of print</small></div>
Siniarski A, Gąsecka A, Borovac J, Papakonstantinou PE, ... Guerreiro RA, Parker WAE
J Card Fail: 09 Jan 2023; epub ahead of print | PMID: 36632933
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<div><h4>Assessment of Biomarkers of Myocardial injury, Inflammation, and Renal Function in Heart Failure with Reduced Ejection Fraction: The VICTORIA Biomarker Substudy.</h4><i>deFilippi CR, Alemayehu WG, Voors AA, Kaye D, ... O\'Connor CM, VICTORIA Study Group</i><br /><b>Background</b><br />Circulating biomarkers may be useful in understanding prognosis and treatment efficacy in heart failure with reduced ejection fraction (HFrEF). In the VICTORIA trial, vericiguat, a soluble guanylate cyclase (sGC) stimulator, reduced the primary outcome of cardiovascular death or HF hospitalization in HFrEF. We evaluated biomarkers of cardiac injury, inflammation, and renal function for associations with outcomes and vericiguat treatment effect.<br /><b>Methods</b><br />High-sensitivity cardiac troponin T (hs-cTnT), growth differentiation factor-15 (GDF-15), interleukin-6 (IL-6), high-sensitivity C-reactive protein (hs-CRP), and cystatin C were measured at baseline and 16 weeks. Associations of biomarkers with the primary outcome and its components were estimated. Interaction with study treatment was tested. Changes in biomarkers over time were examined by study treatment.<br /><b>Results</b><br />One or more biomarkers were measured in 4652 (92%) of 5050 participants at baseline and 4063 (81%) at 16 weeks. After adjustment, higher values of hs-cTnT, GDF-15, and IL-6 were associated with the primary outcome, independent of NT-proBNP. Higher hs-cTnT values were associated with a hazard ratio per log standard deviation of 1.21 (95% confidence interval 1.14-1.27). A treatment interaction with vericiguat was evident with hs-cTnT and cardiovascular death (p=0.04), but not HF hospitalization (p=0.38). All biomarkers except cystatin C declined over 16 weeks and no relationship between treatment assignment and changes in biomarker levels was observed.<br /><b>Conclusions</b><br />hs-cTnT, GDF-15, and IL-6 levels were associated with risk of the primary outcome in VICTORIA. Uniquely, lower hs-cTnT was associated with a lower rate of cardiovascular death but not HF hospitalization after treatment with vericiguat.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 09 Jan 2023; epub ahead of print</small></div>
deFilippi CR, Alemayehu WG, Voors AA, Kaye D, ... O'Connor CM, VICTORIA Study Group
J Card Fail: 09 Jan 2023; epub ahead of print | PMID: 36634811
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<div><h4>Circulating Angiokines are Associated with Reverse Remodeling and Outcomes in Chronic Heart Failure.</h4><i>Harrington J, Nixon AB, Daubert MA, Yow E, ... Felker GM, Karra R</i><br /><b>Background</b><br />We sought to determine whether circulating modifiers of endothelial function are associated with cardiac structure and clinical outcomes in patients with HFrEF.<br /><b>Methods</b><br />We measured 25 proteins related to endothelial function in 99 patients from the GUIDE-IT study. Protein levels were evaluated for association with echocardiographic parameters and the incidence of all-cause death and hospitalization for heart failure (HHF).<br /><b>Results</b><br />Higher concentrations of ANGPT2, VEGFR1 and HGF were significantly associated with worse function and larger ventricular volumes. Over time, decreases in ANGPT2 and, to a lesser extent, VEGFR1 and HGF, were associated with improvements in cardiac size and function. Individuals with higher concentrations of ANGPT2, VEGFR1, or HGF concentrations had an increased risk for a composite of death and HHF in the following year (HR 2.76 (95% CI 1.73 to 4.40) per 2-fold change in ANGPT2; HR 1.76 (95% CI 1.11 to 2.79) for VEGFR1; and HR 4.04 (95% CI 2.19 to 7.44) for HGF).<br /><b>Conclusions</b><br />Proteins related to endothelial function associate with cardiac size, cardiac function, and clinical outcomes in patients with HFrEF. These results support the concept that endothelial function may be an important contributor to the progression and recovery from HFrEF.<br /><br />Copyright © 2023. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 08 Jan 2023; epub ahead of print</small></div>
Harrington J, Nixon AB, Daubert MA, Yow E, ... Felker GM, Karra R
J Card Fail: 08 Jan 2023; epub ahead of print | PMID: 36632934
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<div><h4>Practical Patient Care Considerations with Use of Vericiguat After Worsening Heart Failure Events.</h4><i>Rao VN, Diez J, Gustafsson F, Mentz RJ, ... Jankowska EA, Bauersachs J</i><br /><AbstractText>Vericiguat is a soluble guanylate cyclase stimulator approved by multiple global regulatory bodies and recommended in recently updated clinical practice guidelines to reduce morbidity and mortality in patients with worsening chronic heart failure (HF) with reduced ejection fraction (HFrEF). Despite the growing armament of evidence-based medical therapy for HFrEF that have demonstrated clinical outcome benefits, there is a need to address residual risk following worsening HF events. When considering therapies aimed to mitigate post-event cardiovascular risk, potential barriers preventing the prescription of vericiguat in eligible patients may include provider\'s lack of familiarity, clinical inertia, limited knowledge of monitoring response to therapy and concerns of potential adverse effects as well as integration of its routine use during an era of in-person and telehealth hybrid ambulatory care. This review provides an overview of vericiguat therapy and proposes an evidence-based and practical guidance strategy towards implementing its use in various clinical settings. This review additionally summarizes patient counseling points for its initiation and maintenance.</AbstractText><br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 15 Dec 2022; epub ahead of print</small></div>
Rao VN, Diez J, Gustafsson F, Mentz RJ, ... Jankowska EA, Bauersachs J
J Card Fail: 15 Dec 2022; epub ahead of print | PMID: 36529314
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<div><h4>Hand grip strength predicts mortality and quality of life in heart failure: Insights from the Singapore Cohort of Patients with Advanced Heart Failure: Grip strength predicts mortality and quality of life in heart failure.</h4><i>Dai KZ, Laber EB, Chen H, Mentz RJ, Malhotra C</i><br /><b>Background</b><br />Frailty is prevalent among patients with heart failure (HF) and is associated with increased mortality and worse patient-centered outcomes. Hand grip strength (GS) has been proposed as a single-item marker of frailty and a potential screening tool to identify patients most likely to benefit from therapies that target frailty to improve quality of life (QoL) and clinical outcomes. We assessed the association of longitudinal decline in GS with all-cause mortality and QoL.<br /><b>Hypothesis</b><br />Decline in GS is associated with increased risk of all-cause mortality and worse overall and domain-specific (physical, functional, emotional, social) QoL among patients with advanced HF.<br /><b>Methods</b><br />We used data from a prospective, observational cohort of patients with New York Heart Association class III or IV HF in Singapore. Patients\' overall and domain-specific QoL were assessed and GS was measured every four months. We constructed a Kaplan-Meier plot with GS at baseline dichotomized into categories of weak (≤5th percentile) and normal (>5th percentile) based on the GS in a healthy Singapore population of the same sex and age. Missing GS measurements were imputed using chained equations. We jointly modeled longitudinal GS measurements and survival time, adjusting for comorbidities. We used mixed effects models to evaluate the associations between GS and QoL.<br /><b>Results</b><br />Among 251 patients (mean age 66.5 ± 12.0 years; 28.3% female), all-cause mortality occurred in 58 (23.1%) patients over a mean follow-up duration of 3.0 ± 1.3 years. Patients with weak GS had decreased survival compared to those with normal GS (log-rank P = 0.033). In the joint model of longitudinal GS and survival time, a decrease of one unit in GS was associated with a 12% increase in rate of mortality (hazard ratio: 1.12; 95% confidence interval: 1.05 to 1.20; P = <0.001). Higher GS was associated with higher overall QoL (β (SE) = 0.36 (0.07); P = <0.001) and higher domain-specific QoL, including physical (β (SE) = 0.13 (0.03); P = <0.001), functional (β (SE) = 0.12 (0.03); P = <0.001), and emotional QoL (β (SE) = 0.08 (0.02); P = <0.001). Higher GS was associated with higher social QoL, but this was not statistically significant (β (SE) = 0.04 (0.03); P = 0.122).<br /><b>Conclusions</b><br />Among patients with advanced HF, longitudinal decline in GS was associated with worse survival and QoL. Further studies are needed to evaluate whether incorporating GS into patient selection for HF therapies leads to improved survival and patient-centered outcomes.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 13 Dec 2022; epub ahead of print</small></div>
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<div><h4>Low Rates of Psychotherapy Referrals in Heart Failure Patients with Depression.</h4><i>Latif Z, Vaughan K, Mladenovik V, Warraich H, Mukamal K</i><br /><b>Background</b><br />Depression is common among heart failure (HF) patients and can impact patients\' outcomes. In this study, we evaluated the rates of psychotherapy referrals for HF patients with depression.<br /><b>Methods</b><br />Using the National Ambulatory Medical Care Survey (NAMCS) from 2008-2018, we examined visits for patients with depression and concurrent HF or coronary artery disease (CAD). We estimated the likelihood of referral for psychotherapy using survey weights to provide nationally representative estimates.<br /><b>Results</b><br />Among 1797 visits for patients with HF or CAD and depression, only 9.4% (95% confidence interval (CI), 7.2%-12.2%) were referred for psychotherapy including mental health counseling and stress management. Rates of referral were lowest among patients with depression and HF at 7.5% (95% CI 4.1%-13.2%). The odds of referral decreased over the years from 2008-2018 (OR per additional year 0.87, CI 0.77-0.98, P=0.022), with referral rates in 2008 of 12.8% compared to 4.8% in 2018.<br /><b>Conclusion</b><br />In this nationally representative study of ambulatory visits, patients with HF and depression were referred for psychotherapy in only 7.5% of visits and referral rates have declined over the years. Magnifying the value of psychotherapy and increasing referral rates are essential steps to improve care for HF patients with depression.<br /><br />Copyright © 2022 Elsevier Inc. All rights reserved.<br /><br /><small>J Card Fail: 12 Dec 2022; epub ahead of print</small></div>
Latif Z, Vaughan K, Mladenovik V, Warraich H, Mukamal K
J Card Fail: 12 Dec 2022; epub ahead of print | PMID: 36521724
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<div><h4>Sudden Cardiac Death in Heart Failure: A 20-Year Perspective from a Mediterranean Cohort.</h4><i>Codina P, Zamora E, Levy WC, Cediel G, ... Lupón J, Bayes-Genis A</i><br /><b>Background</b><br />The prediction of sudden cardiac death (SCD) in heart failure (HF) remains an unmet need. The aim of our study was to assess the prevalence of SCD over 20 years in HF outpatients managed in a Mediterranean multidisciplinary HF Clinic, and to compare the proportion of SCD (SCD/all-cause death) to the expected proportional occurrence based on the validated Seattle Proportional Risk Model (SPRM) score.<br /><b>Methods</b><br />This prospective observational registry study included 2,772 HF outpatients admitted between August 2001 and May 2021. Patients were included when the cause of death was known and SPRM score was available.<br /><b>Results</b><br />Over the 20-year study period, 1,351 (48.7%) patients died during a median follow-up period of 3.8 years (interquartile range 1.6-7.6). Among these patients, the proportion of SCD out of the total of deaths was 13.6%, while the predicted by SPRM was 39.6%. This lower proportion of SCD was observed independently of left ventricular ejection fraction, ischemic etiology, and the presence of an implantable cardiac defibrillator.<br /><b>Conclusions</b><br />In a Mediterranean cohort of HF outpatients, the proportion of SCD was lower than expected based on the SPRM score. Future studies should investigate to what extend epidemiological and guideline-directed medical therapy patterns influence SCD.<br /><br />Copyright © 2022 Elsevier Inc. All rights reserved.<br /><br /><small>J Card Fail: 12 Dec 2022; epub ahead of print</small></div>
Codina P, Zamora E, Levy WC, Cediel G, ... Lupón J, Bayes-Genis A
J Card Fail: 12 Dec 2022; epub ahead of print | PMID: 36521725
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<div><h4>Comparing cardiac mechanics and myocardial fibrosis in DBD and DCD heart transplant recipients.</h4><i>Burrage MK, Cheshire C, Hey CY, Azam S, ... Weir-McCall JR, Kydd A</i><br /><b>Background</b><br />Heart transplantation (HTx) following donation after circulatory death (DCD) is an expanding practice but is associated with increased warm ischemic time. The impact of DCD HTx on cardiac mechanics and myocardial fibrosis has not been reported. We aimed to compare cardiac mechanics and myocardial fibrosis using cardiovascular magnetic resonance (CMR) imaging in donation after brain death (DBD) and DCD HTx recipients and healthy controls.<br /><b>Methods</b><br />Consecutive HTx recipients between March 2015-March 2021 who underwent routine surveillance CMR were included. Cardiac mechanics were assessed using CMR-feature tracking to compute global longitudinal (GLS), circumferential (GCS), and right ventricular free-wall longitudinal (RV-FWLS) myocardial strain. Fibrosis was assessed using late gadolinium enhancement imaging and estimation of extracellular volume (ECV).<br /><b>Results</b><br />82 (DBD n=42, DCD n=40) HTx recipients (age 53 [41,59] years; 24% female) underwent CMR at median 9 [6,14] months post-transplant. HTx recipients had increased ECV (29.7±3.6%) compared to normal ranges (25.9% [25.4,26.5]). Myocardial strain was impaired post-transplant compared to controls (GLS: -12.6±3.1% vs -17.2±1.8%, p<0.0001; GCS: -16.9±3.1% vs -19.2±2.0%, p=0.002; RV-FWLS: -15.7±4.5% vs -21.6±4.7%, p<0.0001). There were no differences in fibrosis burden (ECV 30.6±4.4% vs 29.2±3.2%; p=0.39) or cardiac mechanics (GLS: -13.1±3.0% vs -12.1±3.1%, p=0.14; GCS: -17.3±2.9% vs -16.6±3.1%, p=0.27; RV-FWLS: -15.9± 4.9% vs -15.5±4.1%, p=0.71) between DCD and DBD HTx.<br /><b>Conclusions</b><br />HTx recipients have impaired cardiac mechanics compared to controls, with increased myocardial fibrosis. There were no differences in early CMR imaging characteristics between DBD and DCD heart transplants, providing further evidence that DCD and DBD HTx outcomes are comparable.<br /><br />Crown Copyright © 2022. Published by Elsevier Inc. All rights reserved.<br /><br /><small>J Card Fail: 12 Dec 2022; epub ahead of print</small></div>
Burrage MK, Cheshire C, Hey CY, Azam S, ... Weir-McCall JR, Kydd A
J Card Fail: 12 Dec 2022; epub ahead of print | PMID: 36521726
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<div><h4>Post-Discharge Noninvasive Telemonitoring and Nurse Telephone Coaching Improve Outcomes in Heart Failure Patients with High Burden of Comorbidity.</h4><i>Kimchi A, Aronow HU, Ni YM, Ong MK, ... Kedan I, BEAT-HF Research Group</i><br /><b>Background</b><br />Noninvasive telemonitoring and nurse telephone coaching (NTM-NTC) is a promising post-discharge strategy in heart failure (HF). Comorbid conditions and disease burden influence health outcomes in HF, but how comorbidity burden modulates the effectiveness of NTM-NTC is unknown. This study aims to identify HF patients who may benefit from post-discharge NTM-NTC based on their burden of comorbidity.<br /><b>Methods</b><br />In the Better Effectiveness After Transition - Heart Failure trial, patients hospitalized for acute decompensated HF were randomized to post-discharge NTM-NTC or usual care. In this secondary analysis of 1,313 patients with complete data, comorbidity burden was assessed by scoring complication/coexisting diagnoses from index admissions. Clinical outcomes included 30-day and 180-day readmissions, mortality, days alive, and combined days alive and out of the hospital.<br /><b>Results</b><br />Patients had a mean of 5.7 comorbidities and were stratified into low (0-2), moderate (3-8), and high comorbidity (9+) subgroups. Increased comorbidity burden was associated with worse outcomes. NTM-NTC was not associated with readmission rates in any comorbidity subgroup. Among high comorbidity patients, NTM-NTC was associated with significantly lower mortality at 30 days (hazard ratio (HR): 0.25; 95% confidence interval (CI): 0.07-0.90) and 180 days (HR: 0.51; 95% CI: 0.27-0.98), as well as more days alive (160.1 vs 140.3, p=0.029) and days alive out of the hospital (152.0 vs 133.2; p=0.044) compared to usual care.<br /><b>Conclusions</b><br />Post-discharge NTM-NTC improved survival among HF patients with high comorbidity burden. Comorbidity burden may be useful for identifying patients likely to benefit from this management strategy.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 12 Dec 2022; epub ahead of print</small></div>
Kimchi A, Aronow HU, Ni YM, Ong MK, ... Kedan I, BEAT-HF Research Group
J Card Fail: 12 Dec 2022; epub ahead of print | PMID: 36521727
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Abstract
<div><h4>The Association between Beta-Blocker and Renin Angiotensin System Inhibitor Use After HFrEF Hospitalization and Outcomes in Older Patients.</h4><i>Gilstrap L, Solomon N, Chiswell K, James O\'Malley A, ... Yancy CW, DeVore AD</i><br /><b>Introduction</b><br />Beta-blockers (BB) and renin angiotensin system inhibitors (RASi) are foundational for the treatment of heart failure with reduced ejection fraction (HFrEF). However, given the increased risk of side effects in older patients, uncertainly remains as to whether, on net, older patients benefit as much as the younger patients studied in trials.<br /><b>Methods</b><br />Using the GWTG-HF registry linked with Medicare data, overlap propensity weighted Cox proportional hazard models were used to examine the association between BB and RASi use at hospital discharge 30-day and 1-year outcomes among patients with HFrEF.<br /><b>Results</b><br />Among the 48,711 patients (age ≥65 years) hospitalized with HFrEF, there were significant associations between BB and/or RASi use at discharge and lower rates of 30-day and 1-year mortality, including those over age 85 (30-day HR=0.56 [95% CI 0.45, 0.70]; 1-year HR=0.69 [95% CI 0.61, 0.78]). In addition, the magnitude of benefit associated with BB and/or RASi use after discharge did not decrease with increasing age. Even among the oldest patients, those over age 85, with hypotension, renal insufficiency or frailty, BB and/or RASi at discharge was still associated with lower 1-year mortality or readmission.<br /><b>Conclusions</b><br />Among older patients hospitalized with HFrEF, BB and/or RASi use at discharge is associated with lower rates of 30-day and 1-year mortality across all age groups and the magnitude of this benefit does not appear to decrease with increasing age. These data suggest that, absent a clinical contraindication, BB and RASi should be considered in all patients hospitalized with HFrEF before or at hospital discharge, regardless of age.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 11 Dec 2022; epub ahead of print</small></div>
Gilstrap L, Solomon N, Chiswell K, James O'Malley A, ... Yancy CW, DeVore AD
J Card Fail: 11 Dec 2022; epub ahead of print | PMID: 36516937
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<div><h4>Angiotensin receptor neprilysin inhibitor use and blood pressure lowering in patients with heart failure with reduced ejection fraction across the spectrum of kidney function: An analysis of the Veterans\' Administrative Health System.: BP lowering with ARNI in HFrEF across eGFR.</h4><i>Gjyriqi G, York M, Abuazzam F, Herzog CA, ... Rangaswami J, Mathew RO</i><br /><b>Background</b><br />A substantial proportion of patients with HF and kidney disease have poorly controlled blood pressures. This study aimed to evaluate patterns of blood pressure after initiation of angiotensin receptor neprilysin inhibitor (ARNI) or angiotensin-converting enzyme inhibitor (ACEI) /angiotensin receptor blocker (ARB) across the spectrum of kidney function.<br /><b>Methods</b><br />Between 2016 and 2020, we evaluated 26,091 patients admitted to a Veterans Affairs hospital for an acute heart failure exacerbation with reduced ejection fraction. We assessed patterns of systolic and diastolic blood pressure among those started on ARNI or ACEI/ARB over 6 months, overall and across estimated glomerular filtration rate. To account for differential treatment factors, we applied 1:1 propensity score matching using 15 known baseline covariates.<br /><b>Results</b><br />There were 13,781 individuals treated with an ACEI or ARB, and 2,589 individuals with an ARNI prescription. After propensity score matching, 839 patients were matched in each of the ARNI and ACEI/ARB groups. Mean baseline eGFR was 63.8 (standard deviation 21.6) and 10% had stage 4 or 5 CKD. Patients in the ARNI group experienced greater SBP reduction at month 3 (-5.2 mmHg vs. -2.2 mmHg, ARNI vs. ACEI/ARB; p<0.001), and month 6 (-4.7 mmHg vs. -1.85 mmHg, ARNI vs. ACEI/ARB; p < 0.001). These differences in SBP by 6 months did not vary by eGFR above and below 60 ml/min/1.73m<sup>2</sup> or continuously across a wide range of eGFR (P<sub>interaction</sub>>0.10 for both).<br /><b>Conclusion</b><br />The use of ARNI was associated with significant BP reduction as compared with the ACEI/ARB group overall and across the eGFR spectrum, including in advanced CKD.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 11 Dec 2022; epub ahead of print</small></div>
Abstract
<div><h4>Inconsistent Outcome Reporting in Heart Failure Randomized Controlled Trials: Inconsistent Outcome Reporting in HF RCTs.</h4><i>Siddiqi TJ, Shahid I, Arshad MS, Greene SJ, ... Fonarow GC, Khan MS</i><br /><b>Background</b><br />Randomized controlled trials (RCTs) may report outcomes different from those prespecified on trial registration websites, protocols, and statistical analysis plans (SAPs). This study sought to investigate prevalence and characteristics of heart failure (HF) RCTs that report outcomes different from those prespecified.<br /><b>Methods and results</b><br />MEDLINE via PubMed was searched to include phase II-IV HF RCTs in nine high-impact journals from 2010 to 2020. Outcomes reported in trial publications were compared with pre-specified outcomes in protocols, registration websites, and SAPs.  Chi-squared or Fisher exact test were used to analyze correlations between trial characteristics and inconsistencies. Among 216 trials, 32 inconsistencies were observed in 28 trials (13.0%). Among 32 inconsistencies, 2 (6.3%) pertained to omission of prespecified primary outcomes, 4 (12.5%) pertained to omission of prespecified secondary outcomes, 2 (6.3%) pertained to changing prespecified primary outcomes to secondary outcomes, and 2 (6.3%) pertained to changing pre-specified secondary outcomes to primary outcomes. Three inconsistencies (9.4%) pertained to addition of new primary outcomes, 17 (53.1%) pertained to addition of new secondary outcomes, and 2 (6.3%,) pertained to change in timing of assessment of primary outcomes. Majority of the inconsistencies favored statistically significant findings., Seventy-eight (36.1%) were registered retrospectively. Single-center recruitment was associated with outcome inconsistencies (β=-0.14; 95% CI, -0.22 - -0.01,p=0.035).<br /><b>Conclusions</b><br />More than one in ten trials reported outcomes inconsistent with those specified in trial registration websites, SAPs, and protocols. An action plan is warranted to minimize selective reporting and improve transparency.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 10 Dec 2022; epub ahead of print</small></div>
Siddiqi TJ, Shahid I, Arshad MS, Greene SJ, ... Fonarow GC, Khan MS
J Card Fail: 10 Dec 2022; epub ahead of print | PMID: 36513272
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<div><h4>Extracorporeal Membrane Oxygenation for Graft Dysfunction Early after Heart Transplantation: A Systematic Review and Meta-analysis.</h4><i>Aleksova N, Buchan TA, Foroutan F, Zhu A, ... Billia F, Alba AC</i><br /><b>Introduction</b><br />Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a prevailing option for the management of severe early graft dysfunction (EGD). This systematic review and individual patient data (IPD) meta-analysis aims to evaluate: 1) mortality, 2) rates of major complications, 3) prognostic factors and 4) the effect of different VA-ECMO strategies on outcomes in adult heart transplant (HT) recipients supported with VA-ECMO.<br /><b>Methods and results</b><br />We conducted a systematic search and included studies of adults (≥18y) who received VA-ECMO during their index hospitalization after HT and reported on mortality at any timepoint. We pooled data using random-effects models. To identify prognostic factors, we analysed IPD using mixed effects logistic regression. We assessed the certainty in the evidence using the GRADE framework. We included 49 observational studies of 1477 patients who received VA-ECMO post-HT, of which 15 studies provided IPD for 448 patients. There were no differences in mortality estimates between IPD and non-IPD studies. The short-term (30-day/in-hospital) mortality estimate was 33% (moderate certainty, 95%CI: 28-39%) and 1-year mortality estimate 50% (moderate certainty, 95%CI: 43-57%). Recipient age (OR 1.02, 95% CI: 1.01-1.04) and prior sternotomy (OR 1.57, 95%CI 0.99-2.49) are associated with increased short-term mortality. There is low certainty evidence that early intraoperative cannulation and peripheral cannulation reduce the risk of short-term death.<br /><b>Conclusion</b><br />One third of patients who receive VA-ECMO for EGD do not survive 30 days or to hospital discharge, and half do not survive to 1-year after HT. Improving outcomes will require ongoing research focused on optimizing VA-ECMO strategies and care in the first year after HT.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 10 Dec 2022; epub ahead of print</small></div>
Aleksova N, Buchan TA, Foroutan F, Zhu A, ... Billia F, Alba AC
J Card Fail: 10 Dec 2022; epub ahead of print | PMID: 36513273
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<div><h4>Noninvasive Venous Waveform Analysis Correlates With Pulmonary Capillary Wedge Pressure and Predicts 30-Day Admission in Patients With Heart Failure Undergoing Right Heart Catheterization.</h4><i>Alvis B, Huston J, Schmeckpeper J, Polcz M, ... Hocking KM, Lindenfeld J</i><br /><b>Background</b><br />Heart failure is the leading cause of hospitalization in the elderly and readmission is common. Clinical indicators of congestion may not precede acute congestion with enough time to prevent hospital admission for heart failure. Thus, there is a large and unmet need for accurate, noninvasive assessment of congestion. Noninvasive venous waveform analysis in heart failure (NIVA<sub>HF</sub>) is a novel, noninvasive technology that monitors intravascular volume status and hemodynamic congestion. The objective of this study was to determine the correlation of NIVA<sub>HF</sub> with pulmonary capillary wedge pressure (PCWP) and the ability of NIVA<sub>HF</sub> to predict 30-day admission after right heart catheterization.<br /><b>Methods and results</b><br />The prototype NIVA<sub>HF</sub> device was compared with the PCWP in 106 patients undergoing right heart catheterization. The NIVA<sub>HF</sub> algorithm was developed and trained to estimate the PCWP. NIVA scores and central hemodynamic parameters (PCWP, pulmonary artery diastolic pressure, and cardiac output) were evaluated in 84 patients undergoing outpatient right heart catheterization. Receiver operating characteristic curves were used to determine whether a NIVA score predicted 30-day hospital admission. The NIVA score demonstrated a positive correlation with PCWP (r = 0.92, n = 106, P < .0001). The NIVA score at the time of hospital discharge predicted 30-day admission with an AUC of 0.84, a NIVA score of more than 18 predicted admission with a sensitivity of 91% and specificity of 56%. Residual analysis suggested that no single patient demographic confounded the predictive accuracy of the NIVA score.<br /><b>Conclusions</b><br />The NIVA<sub>HF</sub> score is a noninvasive monitoring technology that is designed to provide an estimate of PCWP. A NIVA score of more than 18 indicated an increased risk for 30-day hospital admission. This noninvasive measurement has the potential for guiding decongestive therapy and the prevention of hospital admission in patients with heart failure.<br /><br />Published by Elsevier Inc.<br /><br /><small>J Card Fail: 01 Dec 2022; 28:1692-1702</small></div>
Alvis B, Huston J, Schmeckpeper J, Polcz M, ... Hocking KM, Lindenfeld J
J Card Fail: 01 Dec 2022; 28:1692-1702 | PMID: 34555524
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<div><h4>Improved Outcomes in Severe Primary Graft Dysfunction after Heart Transplantation following Donation After Circulatory Death Compared with Donation After Brain Death.</h4><i>Ayer A, Truby LK, Schroder JN, Casalinova S, ... Patel CB, DeVore AD</i><br /><b>Background</b><br />Primary graft dysfunction (PGD), the leading cause of early mortality after heart transplant, is more common following donation after circulatory death (DCD) than donation after brain death (DBD). We conducted a single-center, retrospective cohort study to compare the incidence, severity, and outcomes of patients experiencing PGD after DCD compared to DBD heart transplant.<br /><b>Methods and results</b><br />Medical records were reviewed for all adult heart transplant recipients at our institution between March 2016 and December 2021. PGD was diagnosed within 24 hours after transplant according to modified International Society for Heart and Lung Transplant criteria. A total of 459 patients underwent isolated heart transplant during the study period, 65 (14%) following DCD and 394 (86%) following DBD. The incidence of moderate or severe PGD in DCD and DBD recipients was 34% and 23%, respectively (p = 0.070). DCD recipients were more likely to experience severe, biventricular PGD than DBD recipients (19% vs. 7.4%, p = 0.004). Among patients with severe PGD, DCD recipients experienced shorter median (Q1, Q3) duration of post-transplant mechanical circulatory support (6 [4, 7] vs. 9 [5, 14] days, p = 0.039), shorter median post-transplant hospital length of stay (17 [15, 29] vs. 52 [26, 83] days, p = 0.004), and similar 60-day survival (100% [95% CI: 76.8-100%] vs. 80.0% [63.1-91.6%], p = 0.17) and overall survival (log-rank, p = 0.078) compared with DBD recipients.<br /><b>Conclusions</b><br />DCD heart transplant recipients were more likely to experience severe, biventricular PGD than DBD recipients. Despite this, DCD recipients with severe PGD spent fewer days on mechanical circulatory support and in the hospital than similar DBD patients. These findings suggest patterns of graft dysfunction and recovery may differ between donor types and support the expansion of the heart donor pool with DCD.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 05 Nov 2022; epub ahead of print</small></div>
Ayer A, Truby LK, Schroder JN, Casalinova S, ... Patel CB, DeVore AD
J Card Fail: 05 Nov 2022; epub ahead of print | PMID: 36351494
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<div><h4>Dynamic Invasive Hemodynamic Congestion Profile Impacts Acute Myocardial Infarction Complicated by Cardiogenic Shock Outcomes: A Real-World Single-Center Study.</h4><i>Ortega-Hernández JA, González-Pacheco H, Gopar-Nieto R, de la Cruz JLB, ... Hernández-Montfort J, Arias-Mendoza A</i><br /><b>Background</b><br />Cardiogenic shock (CS) commonly complicates the management of acute myocardial infarction (AMI) with high mortality. Pulmonary artery catheter (PAC) monitoring can be valuable for personalizing critical care interventions. We hypothesized that patients with AMI-CS experiencing persistent congestion measure in the first 24 h of the PAC installment would exhibit worse in-hospital survival.<br /><b>Methods and results</b><br />295 patients with AMI-CS, from January 2006-December 2021, first 24 h PAC-derived hemodynamic measures were divided by the congestion profiling and proposed 2022 SCAI classification. Biventricular congestion was the most common profile and was associated with the highest patient mortality at all time points (mean 56.6%). A persistent congestive profile was associated with increased mortality (HR=1.85; p=0.002) compared with patients who achieved a decongestive profile. Patients with SCAI stages D/E had higher levels of right atrial pressure (RAP; 14-15 mmHg) and pulmonary capillary wedge pressure (PCWP; 18-20 mmHg) compared with stage C (RAP, 10-11 mmHg, mean difference 3-5 mmHg; p<0.001; PCWP 14-17 mmHg; mean difference 1.56-4 mmHg; p=0.011). In SCAI stages D/E, the pulmonary artery pulsatility index (0.8-1.19) was lower than in those with grade C (1.29-1.63, mean difference 0.21-0.73; p<0.001).<br /><b>Conclusions</b><br />Continuous congestion profiling using the SCAI classification matched the grade of hemodynamic severity and the increased risk of in-hospital death. Early decongestion appears to be an important prognostic and therapeutic goal in patients with AMI-CS and warrants further study.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 04 Nov 2022; epub ahead of print</small></div>
Ortega-Hernández JA, González-Pacheco H, Gopar-Nieto R, de la Cruz JLB, ... Hernández-Montfort J, Arias-Mendoza A
J Card Fail: 04 Nov 2022; epub ahead of print | PMID: 36343784
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<div><h4>Atherosclerotic Cardiovascular Disease or Heart Failure: First Cardiovascular Event in Adults with Prediabetes and Diabetes.</h4><i>Sinha A, Ning H, Cameron N, Bancks M, ... Lloyd-Jones DM, Khan SS</i><br /><b>Background</b><br />Individuals with prediabetes and diabetes are at increased risk of atherosclerotic cardiovascular disease (ASCVD) and heart failure (HF). Whether ASCVD or HF is more likely to occur first in these populations within different race-sex groups is unknown.<br /><b>Objective</b><br />Determine the competing risk for the first cardiovascular event by subtype in Black and White men and women with prediabetes and diabetes.<br /><b>Design</b><br />Individual-level data from adults without ASCVD or HF were pooled from 6 population-based cohorts. We estimated the competing cumulative incidences of ASCVD, HF, and non-cardiovascular death as the first event in middle-aged (40-59 years) and older (60-79 years) adults, stratified by race and sex, with normal fasting plasma glucose (FPG <100 mg/dL), prediabetes (FPG 100-125 mg/dL) and diabetes (FPG ≥126 mg/dL or on antihyperglycemic agents) at baseline. Within each race-sex group, we estimated risk (aHR) of ASCVD, HF, and non-cardiovascular death in adults with prediabetes and diabetes relative to adults with normoglycemia after adjusting for cardiovascular risk factors.<br /><b>Results</b><br />In 40,117 participants with 638,910 person-years of follow-up, 5,781 cases of incident ASCVD and 3,179 cases of incident HF occurred. In middle-aged adults with diabetes, competing cumulative incidence of ASCVD as first event was higher than HF in White men (35.4% vs. 11.6%), Black men (31.6% vs. 15.1%), and White women (24.3% vs 17.2%), but not in Black women (26.4% vs 28.4%). Within each group, aHR of ASCVD and HF was significantly higher in adults with diabetes compared with adults with normal FPG. Findings were largely similar in middle-aged adults with prediabetes and older adults with prediabetes or diabetes.<br /><b>Conclusions</b><br />Black women with diabetes are more likely to develop HF as their first CVD event, while individuals with diabetes from other race-sex groups are more likely to present first with ASCVD. These results can inform tailoring primary prevention therapies for either HF- or ASCVD-specific pathways based on individual-level risk.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 04 Nov 2022; epub ahead of print</small></div>
Sinha A, Ning H, Cameron N, Bancks M, ... Lloyd-Jones DM, Khan SS
J Card Fail: 04 Nov 2022; epub ahead of print | PMID: 36343785
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<div><h4>Minimal Clinically Important Difference for Six-minute Walk Test in Patients with HFrEF and Iron Deficiency.</h4><i>Khan MS, Anker SD, Friede T, Jankowska EA, ... Ponikowski P, Butler J</i><br /><b>Background</b><br />The six-minute walk test (6MWT) is widely used to measure exercise capacity; however, the magnitude of change that is clinically meaningful for individuals is not well established in heart failure with reduced ejection fraction (HFrEF).<br /><b>Objective</b><br />To calculate the minimal clinically important difference (MCID) for change in exercise capacity on the 6MWT in iron-deficient HFrEF populations.<br /><b>Methods</b><br />In this pooled secondary analysis of FAIR-HF and CONFIRM-HF trials, mean changes in 6MWT from baseline to weeks 12 and 24 were calculated and calibrated against the Patient Global Assessment (PGA) tool [clinical anchor] to derive MCIDs for improvement and deterioration.<br /><b>Results</b><br />Of 760 patients included in the two trials, 6MWT and PGA data were available for 680 (89%) and 656 (86%) patients at weeks 12 and 24, respectively. The mean 6MWT distance at baseline was 281±103m. There was a modest correlation between changes in 6MWT and PGA from baseline to week 12 (r=0.31, p<0.0001) and week 24 (r=0.43, p<0.0001). Respective estimates (95% confidence intervals) for MCID in 6MWT at weeks 12 and 24 were 14m (5;23) and 15m (3;27) for a \"little improvement\" (vs no change), 20m (10;30) and 24m (12;36) for \"moderate improvement\" vs a \"little improvement\", -11m (-32;9.2) and -31m (-53;-8) for a \"little deterioration\" (vs no change), and -84m (-144;-24) and -69m (-118;-20) for \"moderate deterioration\" vs a \"little deterioration\".<br /><b>Conclusions</b><br />The MCID for improvement in exercise capacity on the 6MWT was 14-15m in patients with HFrEF and iron deficiency. These MCIDs can aid clinical interpretation of study data.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 01 Nov 2022; epub ahead of print</small></div>
Khan MS, Anker SD, Friede T, Jankowska EA, ... Ponikowski P, Butler J
J Card Fail: 01 Nov 2022; epub ahead of print | PMID: 36332897
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<div><h4>Galectin-3, acute kidney injury and myocardial damage in patients with acute heart failure.</h4><i>Horiuchi Y, Wettersten N, van Veldhuisen DJ, Mueller C, ... Maisel A, Murray PT</i><br /><b>Background</b><br />Galectin-3, a biomarker of inflammation and fibrosis, can be associated with renal and myocardial damage and dysfunction in patients with acute heart failure (AHF).<br /><b>Methods and results</b><br />We retrospectively analyzed 790 AHF patients enrolled in the AKINESIS study. During hospitalization, patients with galectin-3 elevation (> 25.9 ng/ml) on admission more frequently had acute kidney injury (assessed by KDIGO criteria), renal tubular damage (peak urine neutrophil gelatinase-associated lipocalin [uNGAL] >150 ng/dl) and myocardial injury (≥ 20% increase in the peak high sensitivity cardiac troponin I [hs-cTnI] value compared to admission). They less frequently had ≥ 30% reduction in B-type natriuretic peptide from admission to last measured value. In multivariable linear regression analysis, galectin-3 was negatively associated with estimated glomerular filtration rate and positively associated with uNGAL and hs-cTnI. Higher galectin-3 was associated with renal replacement therapy, inotrope use and mortality during hospitalization. In univariable Cox regression analysis, higher galectin-3 was associated with increased risk for the composite of death or HF rehospitalization and death alone at one-year. After multivariable adjustment, higher galectin-3 was only associated with death.<br /><b>Conclusions</b><br />In patients with AHF, higher galectin-3 values were associated with renal dysfunction, renal tubular damage and myocardial injury, and predicted worse outcomes.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 01 Nov 2022; epub ahead of print</small></div>
Horiuchi Y, Wettersten N, van Veldhuisen DJ, Mueller C, ... Maisel A, Murray PT
J Card Fail: 01 Nov 2022; epub ahead of print | PMID: 36332898
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<div><h4>Incident Heart Failure with Mildly Reduced Ejection Fraction: Frequency, Characteristics and Outcomes.</h4><i>Kumar V, Redfield MM, Glasgow A, Roger VL, ... Chamberlain AM, Dunlay SM</i><br /><b>Background</b><br />Heart failure with EF 41-49% is recognized as HF with \"mildly reduced\" EF (HFmrEF). However, existing knowledge of the HFmrEF phenotype is based on HF clinical trial and registry cohorts that may be limited by multiple forms of bias.<br /><b>Methods and results</b><br />In a community-based, retrospective cohort study, adult residents of Olmsted County, Minnesota with validated (Framingham criteria) incident HF from 2007-2015 were categorized by echocardiographic EF at first HF diagnosis. Among 2035 adults with incident HF, 12.5% had HFmrEF, 29.9% had HFrEF, and 57.6% had HFpEF. Mean age and sex varied by EF group, with HFmrEF (75.6 years, 45.3% female), HFrEF (70.9 years, 36.5% female), and HFpEF (76.9 years, 59.7% female). Most comorbid conditions were more common in HFmrEF vs HFrEF, but similar in HFmrEF and HFpEF. After a mean (SD) follow-up of 4.6 (3.5) years, adjusting for age, sex and comorbidities, the risks of hospitalization and cardiovascular mortality did not differ by EF category. Of patients who began as HFmrEF, 26.9% declined to EF ≤ 40% and 44.8% improved to EF ≥50%.<br /><b>Conclusions</b><br />In this community cohort of incident HF, 12.5% have HFmrEF. Clinical characteristics in HFmrEF resemble HFpEF more than HFrEF. Adjusted hospitalization and mortality risks did not vary by EF group. Patients with incident HFmrEF usually transitioned to a different EF category on followup.<br /><br />Copyright © 2022 Elsevier Ltd. All rights reserved.<br /><br /><small>J Card Fail: 01 Nov 2022; epub ahead of print</small></div>
Kumar V, Redfield MM, Glasgow A, Roger VL, ... Chamberlain AM, Dunlay SM
J Card Fail: 01 Nov 2022; epub ahead of print | PMID: 36332899
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<div><h4>Sustained Reduction in Pulmonary Artery Pressures and Hospitalizations During 2 Years of Ambulatory Monitoring.</h4><i>Heywood JT, Zalawadiya S, Bourge RC, Costanzo MR, ... Stevenson LW, CardioMEMS™ Post-Approval Study Investigators</i><br /><b>Background</b><br />Therapy guided by pulmonary artery (PA) pressure monitoring reduces PA pressures and heart failure hospitalizations (HFH) during the first year, but durability of efficacy and safety out to two years is not known.<br /><b>Methods and results</b><br />The CardioMEMS Post-Approval Study investigated whether benefit and safety were generalized and sustained. Enrollment at 104 US centers included 1200 patients with NYHA Class III symptoms on recommended HF therapies with prior HFH. Therapy was adjusted toward PA diastolic pressure 8-20 mmHg. Intervention frequency and PA pressure reduction were most intense during first 90 days, with sustained reduction of PA diastolic pressure from baseline 24.7 mmHg to 21.0 at 1 year and 20.8 at 2 years, all patients. Patients surviving to 2 years (n=710) showed similar 2-year reduction (23.9 to 20.8 mmHg), with reduction in PA mean pressure (33.7 to 29.4 mmHg) in patients with reduced LVEF. The HFH rate was 1.25 events/patient/year prior to sensor implant, 0.54 at 1 year, and 0.37 at 2 years, with 59% of surviving patients free of HFH.<br /><b>Conclusions</b><br />Reduction in PA pressures and hospitalizations were early and sustained during 2 years of PA pressure guided management, with no signal of safety concern regarding the implanted sensor.<br /><br />Copyright © 2022. Published by Elsevier Inc.<br /><br /><small>J Card Fail: 01 Nov 2022; epub ahead of print</small></div>
Heywood JT, Zalawadiya S, Bourge RC, Costanzo MR, ... Stevenson LW, CardioMEMS™ Post-Approval Study Investigators
J Card Fail: 01 Nov 2022; epub ahead of print | PMID: 36332900
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This program is still in alpha version.