Temporal Changes in Biomarkers, Functional Status, and Quality of Life Prior to Adverse Clinical Outcomes in Heart Failure With Mildly Reduced or Preserved Ejection Fraction.

Background: Mapping clinical, biomarker, and diuretic dosing trajectories before adverse clinical outcomes in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF) may inform population monitoring approaches.

Objectives: We assessed temporal patterns of 2 biomarkers (N-terminal pro-B-type natriuretic peptide [NT-proBNP] and estimated glomerular filtration rate [eGFR]), physician assigned functional status (NYHA functional class), a patient-reported outcome (Kansas City Cardiomyopathy Questionnaire Total Symptom Score [KCCQ-TSS]), and diuretic dosing leading up to a clinical event.

Methods: FINEARTS-HF was a double-blind, randomized clinical trial testing finerenone vs placebo in 6,001 patients with symptomatic HF and a left ventricular ejection fraction of ≥40%.

Mobile Health Applications for Secondary Prevention After Myocardial Infarction or PCI: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Mobile health applications have emerged as a novel tool to support secondary prevention after myocardial infarction (MI) or percutaneous coronary intervention (PCI). However, the impact of app-based interventions on clinically meaningful outcomes such as hospital readmissions remains uncertain. To systematically evaluate the effectiveness of smartphone app-based interventions in reducing unplanned hospital readmissions among post-MI/PCI patients.

Impact of mitral regurgitation severity on thromboembolic risk in atrial fibrillation: a comprehensive systematic review and meta-analysis.

Atrial fibrillation (AF) is associated with a heightened risk of thromboembolic events (TE). Whether severe mitral regurgitation (MR) has a protective effect against thrombus formation in AF remains unclear. We aimed to evaluate the impact of MR severity on thromboembolic risk in patients with AF.

Fasting Before Cardiac Catheterization: Still Necessary? A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

Background: Fasting before elective or nonurgent coronary angiography is commonly recommended to reduce the risk of adverse events, such as aspiration pneumonia. This systematic review and meta-analysis aimed to evaluate the impact of fasting versus nonfasting protocols on patient outcomes and satisfaction.

Methods: We systematically searched PubMed, Embase, and Cochrane Library databases for randomized clinical trials comparing fasting and nonfasting states before cardiac catheterization.

[Mitral valve regurgitation and heart failure: a dangerous synergy?].

This article explores the relationship between mitral regurgitation and heart failure, a dangerous combination with serious consequences. It reviews the pathophysiological mechanisms and current therapeutic options, ranging from medical treatments to percutaneous approaches, surgical interventions, and advanced modalities such as ventricular assist devices or heart transplantation. Recent studies exploring strategies to break this vicious cycle and improve patient outcomes are also reviewed.

Impact of Digoxin Utilization on Gastrointestinal Bleeding in Patients With Continuous-Flow Left Ventricular Assist Devices: A Systematic Review and Meta-Analysis.

Continuous-flow left ventricular assist devices (CF-LVADs) improve quality of life and survival in patients with advanced heart failure but are frequently complicated by gastrointestinal bleeding (GIB). Reduced pulsatile flow may induce mucosal hypoxia, upregulating factors such as hypoxia-inducible factor (HIF)-1α and triggering neo-angiogenesis, leading to the development of gastrointestinal angiodysplasias (GIADs), a common cause of GIB. Digoxin inhibits HIF-1α and may prevent GIAD development, although its impact on the incidence of GIB remains uncertain.

Prognostic Significance of Nutritional Scores in Patients With Heart Failure: Insights From the PARAGON-HF Trial.

Background: The Controlling Nutritional Status (CONUT) and Geriatric Nutritional Risk Index (GNRI) are indices that identify individuals at risk of malnutrition. Our study sought to examine the incidence and prognostic implications of abnormal CONUT and/or GNRI in patients with heart failure with preserved ejection fraction.

Methods And Results: The CONUT score and GNRI were serially analyzed in this post hoc analysis of the PARAGON-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Receptor Blockers Global Outcomes in Heart Failure With Preserved Ejection Fraction) trial.

Association between programmed electrical stimulation inducibility and arrhythmic risk in hypertrophic cardiomyopathy: a systematic review and meta-analysis.

Background: Risk stratification for sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) remains challenging. Programmed electrical stimulation (PES) is not endorsed by current guidelines, and its role in risk stratification is debated. We conducted a systematic review and meta-analysis to assess the association between PES inducibility and major arrhythmic events (MAE) in patients with HCM and evaluate its predictive value.

Current Trends and Future Challenges in Transcatheter Aortic Valve Replacement: Utility of Cardiac Computed Tomography Angiography.

Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis. As TAVR continues to evolve, precise pre-procedural planning and imaging have become increasingly critical. While transthoracic echocardiography remains indispensable for assessing the severity of aortic stenosis, cardiac computed tomography angiography (CCTA) has emerged as the benchmark imaging modality for pre-procedural planning for TAVR.

A clinician's guide to cardiovascular MRI referrals: a practical guide of ESC recommendations.

Cardiovascular Magnetic Resonance (CMR) is a noninvasive cardiac imaging modality with an increasing number of applications in cardiovascular medicine. The growth in its clinical indications is evident from the expanding recommendations by the European Society of Cardiology (ESC). The year 2024 marked a significant milestone for CMR, as the latest ESC guidelines incorporated several novel indications for its use.

[Some key points for understanding a transthoracic ultrasound report].

Transthoracic echocardiography (TTE) is one of the most performed cardiac examinations in internal medicine. It enables a quantitative evaluation of the cardiac morphology and function based on diameters, volumes and/or intracardiac blood flow velocity measurements. These measurements are systematically interpreted by a cardiologist and summarized into a concise and objective description that is useful for clinical management.

Comparison of cardiac computed tomography recommendations in recent ESC vs. ACC/AHA guidelines.

Cardiac computed tomography (CCT) continues to expand with increasing applications and technological advancements. Growing evidence on the clinical utility of CCT necessitates evaluating how this knowledge is incorporated into European Society of Cardiology (ESC) and American College of Cardiology (ACC)/American Heart Association (AHA) guidelines. We aimed to provide a comprehensive comparison of CCT indications between ESC and ACC/AHA guidelines to identify areas of consensus and divergence in the current landscape of CCT utilization.

Severe Heart Failure and Treatment With Dapagliflozin Across the Ejection Fraction Spectrum: DAPA-HF and DELIVER.

Background: Patients with severe heart failure (HF) experience debilitating clinical symptoms and worse cardiovascular (CV) outcomes with an excess mortality risk.

Objectives: The authors aimed to assess the prevalence, CV outcome risk, and treatment response to the sodium-glucose cotransporter 2 inhibitor (SGLT2i) dapagliflozin among patients with severe HF across the spectrum of left ventricular ejection fraction (LVEF) in DAPA-HF and DELIVER.

Methods: Severe HF was adapted from the ESC (European Society of Cardiology) HFA (Heart Failure Association) definition: NYHA functional class III/IV, evidence of HF with reduced, mildly reduced, or preserved LVEF, HF hospitalization within the previous 12 months, and adverse patient-reported symptom burden (Kansas City Cardiomyopathy Questionnaire-Total Symptoms Score <75).

Evolution of Coronary Microvascular Dysfunction Prevalence over Time and Across Diagnostic Modalities in Patients with ANOCA: A Systematic Review.

A considerable number of patients with angina undergo invasive coronary angiography, which might reveal non-obstructive coronary arteries (ANOCA). In this setting, they might have coronary microvascular disease (CMD). Its prevalence significantly varies in the literature.

Computed Tomography Angiography in the Catheterization Laboratory: A Guide Towards Optimizing Coronary Interventions.

Cardiac computed tomography (CT) has become an essential tool in the pre-procedural planning and optimization of coronary interventions. Its non-invasive nature allows for the detailed visualization of coronary anatomy, including plaque burden, vessel morphology, and the presence of stenosis, aiding in precise decision making for revascularization strategies. Clinicians can assess not only the extent of coronary artery disease but also the functional significance of lesions using techniques like fractional flow reserve (FFR-CT).

Systolic Blood Pressure and Pulse Pressure in Heart Failure: Pooled Participant-Level Analysis of 4 Trials.

Background: Hypertension is common in patients with heart failure with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF), and current guidelines recommend treating systolic blood pressure (SBP) to a target <130 mm Hg. However, data supporting treatment to this target are limited. Additionally, pulse pressure (PP), a marker of aortic stiffness, has been associated with increased risk of cardiovascular events, but its prognostic impact in HFpEF has not been extensively studied.

Multiparametric Assessment of Right Ventricular Dysfunction in Heart Failure: An Analysis From PARAGON-HF.

Background: This study aims to characterize right ventricular dysfunction (RVD) in heart failure (HF) with preserved ejection fraction and understand the cumulative prognostic value of abnormal RV echocardiographic parameters in HF with preserved ejection fraction.

Methods And Results: Data from 809 patients in the PARAGON-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor With Angiotensin-Receptor Blocker Global Outcomes in HF With Preserved Ejection Fraction) echocardiographic substudy (55% women, mean age 74±8 years) were analyzed. Correlates of RVD (defined as tricuspid annular plane systolic excursion <1.

Visit-to-visit changes in heart rate in heart failure: A pooled participant-level analysis of the PARADIGM-HF and PARAGON-HF trials.

Aims: Resting heart rate (HR) is a strong risk marker in patients with heart failure (HF), but the clinical implications of visit-to-visit changes in HR (ΔHR) are less well established. We aimed to explore the association between ΔHR and subsequent outcomes in a pooled dataset of two well-characterized cohorts of patients with HF across the full range of left ventricular ejection fraction (LVEF).

Methods And Results: PARADIGM-HF and PARAGON-HF were randomized trials testing sacubitril/valsartan versus enalapril or valsartan, respectively, in patients with HF and LVEF ≤40% (PARADIGM-HF) or LVEF ≥45% (PARAGON-HF).

Sacubitril/valsartan reduces incident anaemia and iron therapy utilization in heart failure: The PARAGON-HF trial.

Aims: Renin-angiotensin system inhibitors (RASi) have been shown to lower haemoglobin levels, potentially related to reductions in erythropoietin levels and haematopoiesis. We examined whether sacubitril/valsartan might attenuate this effect of RASi alone on incident anaemia in patients with heart failure (HF) with mildly reduced or preserved ejection fraction (HFmrEF/HFpEF).

Methods And Results: PARAGON-HF was a global, multicentre randomized clinical trial of sacubitril/valsartan versus the RASi valsartan in patients with HF and left ventricular ejection fraction ≥45%.