Standing under pressure: hemodynamic effects of abdominal compression type and intensity in healthy adults.

Introduction: Abdominal compression is recommended to manage orthostatic intolerance in dysautonomia, but the hemodynamic effects of different compression parameters remain poorly understood. This study investigated how surface area and pressure magnitude of abdominal compression affect blood pressure and heart rate responses during active stand tests in healthy volunteers. Understanding how abdominal compression modulates hemodynamics during standing in healthy individuals will help us better understand how compression can be optimized to benefit those with dysautonomia.

Atrial Mechanics in Heart Failure With Preserved Ejection Fraction: Effect of a No-Implant Interatrial Shunt.

Background: The atria play an important role in the pathophysiology of heart failure with preserved ejection fraction. Decreased left atrial strain is associated with worse clinical outcomes. The impact of no-implant interatrial shunting on atrial structure and function has not been described.

Sudden cardiac death in newly diagnosed non-ischaemic or ischaemic cardiomyopathy assessed with a wearable cardioverter-defibrillator: the German nationwide SCD-PROTECT study.

Background And Aims: Patients with newly diagnosed non-ischaemic cardiomyopathy (NICM) or myocardial infarction/coronary artery disease (MI/CAD) face an increased risk of sudden cardiac death (SCD) during the early phase of guideline-recommended medical therapy initiation and up-titration. Aim is to evaluate the risk in this population by assessing sudden cardiac arrest (SCA) due to ventricular tachycardia/ventricular fibrillation (VT/VF).

Methods: All patients in Germany who received a wearable cardioverter-defibrillator (WCD) between December 2021 and May 2023 were enrolled in the observational multicentre SCD-PROTECT study (NCT06883383).

Comparison of supine and sitting pulmonary pressures in ambulatory heart failure patients using the novel Cordella pulmonary pressure system.

Aims: The aim of this study is to examine the relationship between supine and seated pulmonary artery pressure (PAP) measurements using the CordellaTM HF management system (Cordella) in patients with heart failure (HF).

Method And Results: Paired supine and seated PAP readings from the SIRONA 2 and PROACTIVE-HF trials were included. A total of 504 NYHA class III HF patients contributed 40 115 paired measurements.

Trends and disparities in mortality due to hypertensive disease and coexisting obesity in the USA: 1999-2023.

Background: Hypertensive disease and obesity frequently coexist and synergistically increase the risk of cardiovascular morbidity and mortality in the USA. Despite this intersection, national trends and disparities in mortality attributable to both conditions remain underexplored.

Methods: We conducted a retrospective analysis using the Centers for Disease Control and Prevention Wide-ranging Online Data for Epidemiologic Research Multiple Cause of Death database.

Digital twins for noninvasively measuring predictive markers of right heart failure.

Digital twins offer a promising approach to advancing healthcare by providing precise, noninvasive monitoring and early detection of diseases. In heart failure (HF), a leading cause of mortality worldwide, they can improve patient monitoring and clinical outcomes by simulating hemodynamic changes indicative of worsening HF. Current techniques are limited by their invasiveness and lack of scalability.

Impact of changes in conventional risk factors induced by once-weekly GLP-1 receptor agonist exenatide on cardiovascular outcomes: an EXSCEL post hoc analysis.

Background: The objective of this study was to examine the degree to which conventional cardiovascular (CV) risk factor changes induced by once-weekly exenatide (EQW) might explain the placebo-controlled differences in CV outcomes observed in the Exenatide Study of Cardiovascular Event Lowering (EXSCEL).

Methods: We entered participant-level risk factor values over time into a validated type 2 diabetes-specific clinical outcomes model to estimate event rates, and compared simulated with observed relative risk changes in EXSCEL. We performed simulations for each participant to minimize uncertainty and to optimize confidence interval precision around risk point estimates.

The Impact of Obesity on Pressure-Volume Relationship in Ambulatory Heart Failure.

Assessment of volume status is essential in heart failure (HF) management, yet the relationship between cardiac filling pressures and true intravascular volume remains unclear, especially in patients with obesity. We analyzed 262 ambulatory HF patients who underwent blood volume analysis (BVA) and same-day right heart catheterization. Patients were stratified by BMI into non-obese (n = 104), obese (n = 121), and morbidly obese (n = 37).

A porcine model of acute rejection for cardiac transplantation.

machine perfusion has been growing in utility for preserving donor organs prior to transplantation. This modality has tremendous potential for bioengineering and conditioning organs prior to transplantation using small molecule or advanced therapeutics. To safely translate potential interventions, well characterized models of disease are crucial for testing the therapeutic and possible side effects that could manifest from the interventions.

Cardiac CT and PET for Surveillance of Heart Transplant Recipients: Systematic Review and Bayesian Meta-Analysis.

Background: For noninvasive surveillance of cardiac allograft vasculopathy (CAV), cardiac computed tomography (cardiac computed tomography [CT]) and positron emission tomography (PET) received a Class IIa recommendation by the 2023 ISHLT (International Society for Heart and Lung Transplantation) guidelines. However, implementation has lagged behind because of concerns about their ability to rule out disease and stratify risk.

Objectives: The purpose of this study was to define the diagnostic and prognostic ability of PET and cardiac CT in cardiac transplant recipients.

Clinical and Engagement Results of a Nationwide Comprehensive Remote Patient Care Hypertension Program.

Background: Traditional methods for treating hypertension have been ineffective. Remote patient care (RPC) can transform how we provide longitudinal care for patients with hypertension.

Objectives: The purpose of this study was to determine whether an RPC hypertension program can provide a scalable solution for optimizing hypertension management, especially among rural/underserved patients.

Sympathetic Nervous System in Heart Failure: Targets for Treatments.

Purpose Of Review: Heart failure (HF) is characterized by a significant imbalance of the autonomic nervous system (ANS), with chronic sympathetic nervous system (SNS) overactivity leading to maladaptive cardiac remodeling, arrhythmia, and hemodynamic instability. In this review, we aim to discuss current and emerging therapies and the potential path forward for developing future novel neuromodulatory therapies in HF.

Recent Findings: Neuromodulatory therapies including splanchnic nerve modulation (SNM), vagal nerve stimulation (VNS), baroreflex activation therapy (BAT), and renal denervation (RDN) reduce sympathetic output in individuals with HF, leading to improved cardiac function, neurohormonal regulation, and vascular resistance.

Cardio-microcurrent device treatment for heart failure with reduced ejection fraction: Results from the C-MIC II open-label randomized controlled trial.

Aims: In patients with heart failure, alterations in electrical fields generated within the myocardium have been associated with myocardial oedema which can act as a substrate for left ventricular dysfunction. Safety and efficacy of a direct microcurrent therapy using an implanted generator (C-MIC) remain uncertain.

Methods And Results: Ambulatory patients with non-ischaemic dilated cardiomyopathy with left ventricular ejection fraction (LVEF) of 25% to 35% and New York Heart Association (NYHA) class III-IV were randomized to C-MIC (device) or control group in addition to guideline-directed medical therapy.

Clinical endpoints in pragmatic heart failure trials: From data collection to clinical endpoint classification.

Clinical endpoint classification (CEC)-that is, evaluation of clinical events using pre-defined criteria-is commonly conducted in clinical trial operations to ensure systematic and consistent assessment of endpoints needed to assess the intervention's safety and efficacy. This is particularly relevant for heart failure (HF) trials given the subjective decision-making around hospitalizations and variation in how worsening HF events are managed (both in hospital and in ambulatory settings). Several CEC strategies have been adopted to address the growing need for pragmatic clinical trials that enhance generalizability and minimize research burden on trial sites and patients.

Two-year outcomes of a cardiac microcurrent device in chronic heart failure: A first-in-human pilot study.

Aims: In heart failure patients, altered myocardial electrical fields linked to oedema may impair left ventricular function. While short-term use of implanted microcurrent generators (C-MIC) has shown promise, long-term effects remain unclear. This study assessed the safety and efficacy of C-MIC use beyond the initial 6 month pilot period.

Determinants of Right Heart Hemodynamic Derangement in Patients With and Without Tricuspid Regurgitation.

Background: The determinants of tricuspid regurgitation (TR) hemodynamic severity remain to be established. We explored the hemodynamic correlates of right atrial (RA) pressure and stroke volume (SV) in patients with and without TR, and assessed the reliability of the indirect Fick method in relation to TR severity.

Methods: In this observational study, right ventricular (RV) 3-dimensional echocardiography (3DE) was obtained simultaneously with direct Fick right heart catheterization.

Noninvasive Pulmonary Capillary Wedge Pressure Estimation in Heart Failure Patients With the Use of Wearable Sensing and AI.

Background: Remote hemodynamics-guided management of heart failure (HF) with implantable pulmonary artery pressure sensors has been shown to reduce HF hospitalizations. The widespread clinical adoption of this procedure is constrained by its invasive nature and high cost. We present a noninvasive technology based on a wearable sensor (CardioTag; Cardiosense) and machine learning (ML) for estimating pulmonary capillary wedge pressure (PCWP) in patients with heart failure with reduced ejection fraction (HFrEF).

Type 2 Diabetes Mellitus-Related Mortality in the United States, 1999 to 2023.

Background: The prevalence of type 2 diabetes mellitus (T2DM) has increased in the United States, contributing significantly to morbidity and mortality.

Objectives: This study analyzes trends in T2DM-related mortality focusing on demographic and regional disparities.

Methods: The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was utilized to extract death certificate data for adults aged 25 and older from 1999 to 2023.

Liver stiffness measurement for non-invasive assessment of central venous pressure in patients with heart failure: A multicentre pilot study.

Aims: Central venous pressure (CVP) is an important variable in assessing heart failure (HF) patients. However, invasive CVP measurement using right heart catheterization is associated with potential complications, and accurate measurement requires careful attention to technique. In this multicentre pilot study, we aimed to evaluate whether non-invasively measured liver stiffness can be used to assess CVP in patients with HF.

Heart rate variability in patients with cardiovascular diseases.

Heart rate variability (HRV) has been reported to predict overall mortality and the risk of cardiovascular disease events in patients, including those with heart failure. However, inconsistent methods of recording and analyzing HRV parameters, along with a lack of randomized data substantiating its clinical efficacy and potential to guide treatment decisions for improved patient outcomes, have limited its use in clinical settings. With the advancements in technologies such as artificial intelligence and machine learning, and emergence of ablation procedures that can alter autonomic function, this article re-explores HRV assessment methods, their potential for clinical application, the issues encountered in using them in clinical research, and potential approaches to studying HRV in the future (Graphical Abstract).

Subcutaneous sensors for monitoring congestion and to reduce heart failure hospitalizations-a viable middle ground between deep implantable intravascular monitoring devices and wearable technologies?

Congestive heart failure (CHF) remains a leading cause of hospitalization and mortality worldwide. Continuous monitoring is crucial for early detection of decompensation, potentially reducing hospital admissions and improving outcomes. Cardiac implantable electronic devices (CIEDs) have been established as useful therapeutic interventions that also support continuous monitoring in order to detect early signs of decompensation.

Sodium chloride versus glucose solute as a volume replacement therapy for more effective decongestion in acute heart failure (SOLVRED-AHF): A prospective, randomized, mechanistic study.

Aims: We questioned the long-standing paradigm that sodium/chloride restriction is essential for effective decongestion in acute heart failure (AHF). This study compared the decongestive effects of two isotonic infusion strategies: 5% glucose (for intravascular volume repletion only) versus 0.9% NaCl (providing additional sodium/chloride supplementation), both added to protocolized diuretic therapy.

The role of finerenone in the concomitant management of chronic kidney disease-type 2 diabetes and the implication for heart failure prevention and treatment.

The nonsteroidal mineralocorticoid receptor antagonist (MRA) finerenone is indicated in the United States for use in adults with chronic kidney disease (CKD) associated with type 2 diabetes (T2D). Results from the FIDELIO-DKD and FIGARO-DKD Phase 3 clinical trials showed a statistically significant reduction in the risk of CKD progression and cardiovascular events with finerenone versus placebo when added to maximally tolerated dose of an angiotensin-converting enzyme inhibitor or an angiotensin receptor blocker. The cardiovascular event risk reduction was primarily driven by the reduction in the risk of hospitalization for heart failure (HF).