Association between Sodium-Glucose Co-Transporter-2 Inhibitor Use and Prognosis in Underweight Patients with Diabetes Mellitus and Heart Failure.

Background & Aims: It remains unclear whether sodium-glucose co-transporter-2 (SGLT2) inhibitors are effective for patients with underweight. This study aimed to elucidate the association between SGLT2 inhibitors use and prognosis in underweight patients with diabetes mellitus (DM) and HF.

Methods: This study was a post-hoc analysis of data from the Japanese Registry of Acute Decompensated Heart Failure, a prospective, multicenter, observational, nationwide registry.

The Hemodynamic Reversal of Delayed-Onset Radiation-Induced Constrictive Pericarditis Obtained by Pericardiectomy: A Case Report.

Constrictive pericarditis (CP) is often underdiagnosed, partly because of the lack of established diagnostic criteria. Exaggerated ventricular interdependence during inspiration is a hallmark physiological feature of CP. We herein report the case of a 55-year-old patient with CP who demonstrated a hemodynamic improvement following pericardiectomy.

Prognostic value of ultrasound-assessed upper limb muscle thickness on mortality in older patients with heart failure: A post-hoc analysis of the SONIC-HF cohort study.

Background And Aims: Upper limb muscle thickness assessed by ultrasound could be useful to estimate whole body muscle mass. We investigated the association between low upper limb muscle thickness and prognosis in older patients with heart failure (HF).

Methods And Results: This study was a post-hoc analysis of a prospective multicenter cohort, namely, the SONIC-HF study.

Impact of early in-hospital initiation of sacubitril/valsartan on left ventricular reverse remodelling in acute heart failure.

Aims: The effect of initiating sacubitril/valsartan (Sac/Val) therapy during hospitalization for acute heart failure (AHF) on left ventricular (LV) remodelling remains unclear. This study aimed to assess the impact of Sac/Val on LV remodelling in patients in whom Sac/Val was initiated during AHF hospitalization.

Methods And Results: This study was a sub-analysis of the Program of Angiotensin-Neprilysin Inhibition in Admitted Patients with Worsening Heart Failure (PREMIER) study, which investigated the impact of initiating Sac/Val during hospitalization for AHF on echocardiographic parameters over an 8-week period, in comparison with the standard renin-angiotensin system inhibitor therapy (control).

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 %.

Determinants and Clinical Impact of Visit-to-visit Blood Pressure Variability in Patients with Heart Failure with Preserved Ejection Fraction.

Introduction: Blood pressure (BP) affects the prognosis of patients with heart failure with preserved ejection fraction (HFpEF). However, the implications of its variability are poorly understood. This study aimed to explore the determinants and prognostic significance of visit-to-visit BP variability (V2V-BPV) in HFpEF.

Prognostic value of Tc-pyrophosphate uptake in patients with suspected transthyretin cardiac amyloidosis.

Background: This study aimed to evaluate the prognostic value of myocardial Tc-pyrophosphate (PYP) uptake in patients undergoing PYP imaging for suspected transthyretin cardiac amyloidosis (ATTR-CA).

Methods: A retrospective analysis of 301 consecutive patients who underwent PYP imaging for suspected ATTR-CA was performed. Myocardial PYP uptake was graded visually using the Perugini classification (grade 0-3) and quantified by the heart-to-contralateral lung uptake (H/CL) ratio.

Diuretic resistance measured by sodium excretion and urine output in acute heart failure: The DIURESIS-AHF study.

Background: The dynamics and prognostic value of diuretic metrics in response to initial intravenous (IV) diuretic therapy in patients with acute heart failure (AHF) remain unclear. We assessed the association between urinary sodium concentration, diuretic response (DR) following IV furosemide administration, and their prognostic implications in patients with AHF.

Methods: The diuretic resistance measured by sodium excretion and urine output (DIURESIS)-AHF study was a prospective, multicenter, observational study that assessed spot urinary sodium concentrations at 0/1/2 h, total urine output, and urinary sodium excretion achieved within the first 6 h following initial IV furosemide administration.

Association Between Mineralocorticoid Receptor Antagonist Use With Worsening Renal Function and Prognosis in Patients With Acute Heart Failure.

Background: Prognostic implications of mineralocorticoid receptor antagonist (MRA) initiation in the context of worsening renal function (WRF) in patients with acute heart failure (AHF) remain unknown.

Methods: This was a post hoc analysis using data from Japanese AHF registries (NARA-HF [Nara Registry and Analyses for Heart Failure], WET-HF [West Tokyo Heart Failure], REALITY-AHF [Registry Focused on Very Early Presentation and Treatment in Emergency Department of Acute Heart Failure]). MRA-naïve patients at baseline were included, comprising 1632 patients with HF with reduced ejection fraction (HFrEF) and 2407 with heart failure with mildly reduced or preserved ejection fraction (HFmr/pEF).

Global Innovations in the Care of Patients With Heart Failure.

The prevalence of heart failure (HF) is increasing in many regions of the world, particularly within the context of aging populations in many countries. The Heart Failure Society of America (HFSA) sought to explore areas of global HF innovation with the goal of exchanging ideas and best practices internationally. The HFSA Annual Scientific Meeting included roundtable discussions focused on the challenges faced by each of the participating regions and sharing innovative solutions.

Current findings and challenges on frailty, sarcopenia, and cachexia in older patients with heart failure: insights from the FRAGILE-HF study.

Frailty has increasingly been recognized as an important factor influencing the prognosis of older patients with heart failure (HF). While previous studies have primarily focused on physical frailty, the need for comprehensive frailty assessments, including assessments of cognitive and social aspects, has been emphasized for effective HF management. Although the importance of multidimensional frailty assessment has been highlighted in the past, specific indicators for defining multidimensional frailty and its relationship with prognosis have not been clearly established to date.

Clinical characteristics and outcomes of hospitalized patients with heart failure from the Japanese prospective registry.

Background: Recent studies showed that clinical parameters other than cardiac function, such as physical function, cognitive function, mental status, social status, and quality of life, were associated with heart failure (HF) prognosis. These parameters have not been extensively investigated in large Japanese cohorts. Furthermore, novel biomarkers to predict prognosis or treatment responses are required to provide individualized medicine.

Design, Rational, and Baseline Characteristics of the SONIC-HF Multicenter Registry.

Introduction: Skeletal muscle mass and function are crucial for assessing physical frailty, sarcopenia, and cachexia, which significantly impact the prognosis of geriatric patients with heart failure (HF). Ultrasound-based assessment of skeletal muscles offers a non-invasive, real-time alternative to traditional methods. The study (SONIC-HF) aimed to evaluate the feasibility and prognostic impact of ultrasound-based muscle assessment in geriatric patients with HF.

Uptitration of Sacubitril/Valsartan in Acute Heart Failure: Insight from the PREMIER Study.

Aims: This study investigated the effect of uptitration of sacubitril/valsartan (Sac/Val) compared with angiotensin-converting enzyme inhibitors or angiotensin receptor blockers (ACEIs/ARBs) on N-terminal pro-B-type natriuretic peptide (NT-proBNP) level within current guideline-directed medical therapy in acute heart failure (AHF).

Methods And Results: This was the secondary analysis in the Program Angiotensin-Neprilysin Inhibition in Admitted Patients with Worsening Heart Failure (PREMIER) study. AHF patients were allocated to switch to Sac/Val or ACEIs/ARBs, and the Sac/Val group was divided into Sac/Val with or without uptitration group (Sac/Val >24/26 mg or ≤24/26 mg twice daily at week 8).

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.

Sarcopenia in heart failure: Comparison of prognostic value between the Asian working Group for Sarcopenia 2014 and 2019 criteria.

Aim: Sarcopenia is a prevalent comorbidity among older patients with heart failure. This study aimed to evaluate the differences between sarcopenia diagnosed using the Asian Working Group for Sarcopenia (AWGS) 2014 and 2019 criteria in older patients with heart failure.

Methods: This study is a post hoc sub-analysis of data from the FRAGILE-HF study, a prospective, multicenter, observational study.

Association of Cardiovascular-Kidney-Metabolic Overlap with Physical Function and Prognosis in Older Patients with Heart Failure: A Post-hoc Analysis of the FRAGILE-HF and SONIC-HF.

Aims: The prevalence and impact of cardiovascular, kidney, and metabolic (CKM) overlap on physical function and prognosis in older patients with heart failure (HF) remain unclear. This study aimed to assess the impact of overlapping CKM conditions on physical function and prognosis in older patients with HF.

Methods: This post-hoc analysis of the FRAGILE-HF (main cohort) and SONIC-HF (validation cohort), both prospective multicentre studies, included patients aged ≥65 years who were hospitalised for HF.

Euglycemic Diabetic Ketoacidosis in a Patient with Type 2 Diabetes and Preserved Insulin Secretion on Empagliflozin.

As the use of sodium-glucose cotransporter 2 (SGLT2) inhibitors has become widespread, euglycemic diabetic ketoacidosis (EDKA), a rare but notable complication associated with SGLT2 inhibitor use, is gaining attention, although the underlying mechanisms of SGLT2 inhibitor-associated EDKA remain unclear. This report describes the case of a 77-year-old male with type 2 diabetes mellitus on an SGLT2 inhibitor who developed EDKA just after undergoing percutaneous coronary intervention following acute myocardial infarction, with only one day of fasting, despite sufficient insulin secretion. Our case report provides valuable insights into the mechanism and management of SGLT2 inhibitor-associated EDKA in urgent clinical settings.

Association of pre-admission exercise habit with post-discharge outcomes for older patients with heart failure.

Aims: The benefits of exercise in patients with heart failure are well documented. However, to date, the association between exercise habits and prognosis is yet to be evaluated. In this study, we investigated the association between pre-hospital exercise habits and post-discharge prognosis in older adult patients with heart failure.

Assessment of frailty in patients with heart failure: A new Heart Failure Frailty Score developed by Delphi consensus.

Aims: The Heart Failure Frailty Score (HFFS) is a novel, multidimensional tool to assess frailty in patients with heart failure (HF). It has been developed to overcome limitations of existing frailty assessment tools while being practical for clinical use. The HFFS reflects the concept of frailty as a multidimensional, dynamic and potentially reversible state, which increases vulnerability to stressors and risk of poor outcomes in patients with HF.

Racial differences in diuretic therapy, B-type natriuretic peptide values, and prognosis in acute heart failure.

Background: Whether variability of B-type natriuretic peptide (BNP) values between races affects its clinical integration as a marker for congestion and predictor of prognosis in acute heart failure (AHF) remains unknown. We aimed to investigate the relationship between diuretic therapy, change in BNP value, and prognosis in AHF in relation to racial differences.

Methods: This analysis combined data from the AKINESIS and REALITY-AHF studies.

Prognostic values of proteinuria in patients with acute heart failure.

Background: Renal dysfunction is significantly associated with poor prognosis in patients with heart failure. However, the prognostic significance of proteinuria as a potential marker of an impaired glomerular filtration barrier in acute heart failure (AHF) remains unclear. We aimed to investigate the prognostic value of urinary protein/creatinine ratio (PCR) in patients with AHF.

Effects of Acute Phase Intensive Exercise Training in Patients With Acute Decompensated Heart Failure.

Background: Acute decompensated heart failure (ADHF) leads to hospitalizations and functional decline in older adults. Although cardiac rehabilitation (CR) is effective for stable heart failure, its impact on ADHF patients, particularly those without frailty, is unclear.

Objectives: The goal of this study was to evaluate the efficacy and safety of early in-hospital CR for patients hospitalized with ADHF who are not frail.