Chronic kidney disease and contemporary guideline-directed medical therapy during hospitalization in patients with heart failure: Insights from PRE-UPFRONT-HF.

Background: Chronic kidney disease (CKD) strongly affects prognosis in patients with heart failure (HF). However, the difference in the implementation of guideline-directed medical therapy (GDMT) during HF-related hospitalization between patients with and without CKD and its association with worsening heart failure (WHF) events remain unclear.

Methods: A post-hoc analysis was conducted using data from a retrospective, multicenter, observational registry of patients hospitalized for HF with a left ventricular ejection fraction (LVEF) of <50 %.

Should exogenous ketone body supplementation be considered in patients hospitalized for acute heart failure? Rationale and design of the KETO-AHF trial.

Background: Acute heart failure (AHF) is associated with high mortality and contemporary medical treatments provide limited benefits in survival. Emerging evidence suggests that exogenous ketone bodies may have beneficial cardiovascular effects in patients with heart failure. The KETO-AHF trial is designed to assess the clinical benefits of initiating ketone supplementation with 1,3-butanediol compared with placebo in patients hospitalized for AHF with reduced ejection fraction.

Use of a Pulmonary Artery Catheter in Patients With Cardiogenic Shock - A Systematic Review and Meta-Analysis.

Background: A pulmonary artery catheter (PAC) provides detailed hemodynamic data, and managing a patient with cardiogenic shock (CS) using a PAC potentially improves patient outcomes. Therefore, in this systematic review and meta-analysis we aimed to evaluate whether a PAC is associated with better outcomes in patients with CS.

Methods And Results: Studies comparing PAC and non-PAC management in patients with CS were identified from the PubMed, Web of Science, and CENTRAL databases.

Hemodynamic integration of pulmonary artery pulsatility index and compliance for risk stratification in patients with heart failure with reduced ejection fraction.

Background: Right ventricular dysfunction (RVD) and right ventricular (RV) afterload are recognized prognostic factors in patients with heart failure with reduced ejection fraction (HFrEF). Hemodynamic phenotyping based on RVD and RV afterload may help identify clinically meaningful subgroups within the HFrEF population. This study aimed to investigate the prognostic associations of pulmonary artery pulsatility index (PAPi) and pulmonary arterial capacitance (PAC) in patients with HFrEF.

Association of trace element abnormalities and adverse outcomes in patients with acute heart failure.

Background: Trace elements, including zinc, copper, and selenium may influence heart failure prognosis due to their roles in mitochondrial function. Previous studies have reported associations between individual trace element abnormalities-such as low serum zinc, high serum copper, and low selenium levels-and adverse clinical outcomes, including reduced exercise capacity in patients with heart failure. However, the impact of multiple trace element abnormalities remains poorly understood.

The Impact of Hospital-Level Median Door-to-Extracorporeal Cardiopulmonary Resuscitation Time on the Prognosis of Patients With Refractory Out-of-Hospital Cardiac Arrest.

Objectives: To evaluate the impact of hospital-level median door-to-extracorporeal cardiopulmonary resuscitation (ECPR) time on survival and neurologic outcomes in patients with out-of-hospital cardiac arrest (OHCA) requiring ECPR.

Design: Secondary analysis of the Japanese Association for Acute Medicine OHCA registry, a nationwide Japanese database of OHCA patients.

Setting: Fifty-three hospitals across Japan.

A Case of Atypical HeartWare Ventricular Assist Device Outflow Graft Obstruction.

External outflow graft obstruction (EOGO) is a known complication in left ventricular assist devices (LVADs), particularly around limited spaces such as the bend relief in HeartMate pumps. While EOGO in HeartMate 3 commonly occurs due to accumulation of biodebris between the bend relief and outflow graft, the incidence of EOGO in the HeartWare Ventricular Assist Device (HVAD) is much lower (0.006 events per patient-year) than that in HeartMate 3 because of the unique grid-like strain relief structure.

Prognostic value of symptom burden as a simple patient-reported outcome measure in older patients with heart failure.

This study was performed to investigate the prognostic value of assessing symptom burden using the Edmonton Symptom Assessment System (ESAS) in older patients with Heart Failure (HF). This prospective cohort study was performed in consecutive patients ≥ 60 years old hospitalized with HF at a university hospital between September 2020 and June 2023. ESAS was used to assess nine common symptoms at hospital discharge (total score: 0-90) with higher scores indicating greater severity.

Race and Ethnicity in Heart Failure Trials: Time to Update Recommended Categories for Global Relevance.

Background: The collection of race and ethnicity data in clinical trials using standardized categories is recommended by the US Food and Drug Administration, although this is primarily for domestic reasons. The applicability and understanding of the categories in multinational trials are uncertain.

Methods: We analyzed patient-level data from 13 major heart failure trials, examining race and ethnicity data recorded by country, as recommended by the Food and Drug Administration: "American Indian or Alaska Native," "Asian," "Black or African American," "Native Hawaiian or Other Pacific Islander," and "White" for race and "Hispanic or Latino" as a minimum for ethnicity (with an expanded list of ethnicities available).

Clinical impact of pulmonary artery pulsatility index in patients with atrial fibrillation and heart failure.

Background: Both atrial fibrillation (AF) and right ventricular dysfunction (RVD) are prognostic factors in patients with heart failure (HF). However, the association between AF and RVD in patients with HF is not fully understood. The pulmonary artery pulsatility index (PAPi), obtained right heart catheterisation, is a hemodynamic index of the right ventricular function.

Phenotyping Heart Failure With Preserved Ejection Fraction Using Pulmonary Artery Pulsatility Index and Pulmonary Arterial Capacitance.

Background: Right ventricular dysfunction (RVD), driven by right ventricular (RV) afterload, is prognostic in patients with heart failure with preserved ejection fraction (HFpEF). Hemodynamic phenotyping based on RVD and RV afterload may provide useful information for the management of HFpEF. This study investigated the prognostic impacts of the pulmonary artery pulsatility index (PAPi) and pulmonary arterial capacitance (PAC) in patients with HFpEF.

Clinical utility of dynamic chest radiography as an auxiliary tool for atrial fibrillation detection in heart failure: a pilot study.

Background: Dynamic chest radiography (DCR) can estimate haemodynamic parameters in patients with heart failure (HF). Atrial fibrillation (AF) often coexists with HF; however, owing to its sometimes paroxysmal nature and minimal or absent symptoms, many patients with AF remain undiagnosed. Additional tools for AF diagnosis may be beneficial; therefore, we evaluated the ability of DCR to distinguish patients with HF in sinus rhythm (SR) from those with AF.

Contemporary Guideline-Directed Medical Therapy and Outpatient Worsening Heart Failure Events in Hospitalized Patients With Heart Failure - Preliminary Observational Study on Utilizing Predischarge Period for Optimizing Medications in Hospitalized Patients With Heart Failure (PRE-UPFRONT-HF).

Background: Adherence to contemporary guideline-directed medical therapy (GDMT) and its association with incident outpatient worsening heart failure (WHF) events after discharge in hospitalized patients with heart failure (HF) remain unclear.

Methods And Results: The PRE-UPFRONT-HF study was a retrospective multicenter observational registry of patients hospitalized for HF between June 2022 and March 2023 with a left ventricular ejection fraction <50%. Data on medications at admission, discharge, and 6 months after admission were collected.

The efficacy of finerenone on hierarchical composite endpoint analysed using win statistics in patients with heart failure and mildly reduced or preserved ejection fraction: A prespecified analysis of FINEARTS-HF.

Aims: FINEARTS-HF demonstrated the efficacy of finerenone in reducing total worsening heart failure (HF) events (first and recurrent) and cardiovascular death, compared to placebo, in patients with HF and mildly reduced or preserved ejection fraction. We examined the effect of finerenone on these events according to their clinical importance using win statistics.

Methods And Results: We developed a prespecified hierarchical composite endpoint including the components of the original primary outcome: cardiovascular death (tier 1), total HF hospitalizations (tier 2), and total urgent HF visits (tier 3).

Urocortin2 measurement for heart failure assessment.

Despite the efficacy of many therapies for heart failure, it remains a leading cause of morbidity and mortality worldwide, with many patients progressing to advanced stages of the condition. Since the standard treatment for heart failure includes small-molecule drugs targeting G protein-coupled receptors (GPCRs), GPCRs are still considered novel targets for the diagnosis and treatment of cardiovascular diseases. Corticotropin-releasing hormone receptor 2, a highly expressed GPCR in cardiomyocytes, and its ligand, urocortin2 (UCN2), have been reportedly associated with cardiovascular diseases; however, their clinical significance remains unclear.

Novel strategy to target glioblastoma-initiating cells using a braintropic adeno-associated virus carrying a miR-dependent genome-editing system.

Background: Since glioblastoma (GBM)-initiating cells (GICs) were identified as the cells-of-origin for GBM, various GIC factors have been analyzed as potential therapeutic targets. However, these targets are also present in normal cells outside of the brain, raising concerns about potential side effects when directly targeted. The aim of this study is to develop a novel method that specifically eradicates GICs with reducing side effects.

Eva1 deficiency prevents obesity-induced metabolic disorders by reducing visceral adipose dysfunction.

Aims: Epithelial V-like antigen 1 (Eva1) is a highly specific marker for brown adipose tissue (BAT) in both mice and humans, but its metabolic function remains unclear. We investigated the impact of Eva1 deletion on the development of obesity.

Methods: To assess the metabolic role of Eva1, we generated whole-body and adipocyte-specific Eva1 mice, which were subjected to a high-fat diet (HFD) for 12 weeks and characterized metabolic phenotypes.

Effects of Sacubitril/Valsartan According to Natriuretic Peptide Levels in Patients Enrolled in PARADIGM-HF and PARAGON-HF.

Background: Recent trials of new heart failure (HF) treatments suggest the effect of therapy may vary by N-terminal pro-B type natriuretic peptide (NT-proBNP) level.

Objectives: The authors examined the efficacy of sacubitril/valsartan according to NT-proBNP levels in patients with reduced, mildly reduced, and preserved left ventricular ejection fraction (LVEF) enrolled in PARADIGM-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor with Angiotensin-Converting-Enzyme Inhibitor to Determine Impact on Global Mortality and Morbidity in Heart Failure Trial) and PARAGON-HF (Prospective Comparison of Angiotensin Receptor-Neprilysin Inhibitor with Angiotensin-Receptor Blockers Global Outcomes in HF with Preserved Ejection Fraction).

Methods: Individual patient data from PARADIGM-HF and PARAGON-HF were pooled and participants were divided into categories defined by quintiles of NT-proBNP level.