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Aims: Heart failure with preserved ejection fraction (HFpEF) is associated with stiffened myocardium and elevated filling pressure that may be captured by heart sound (HS). We investigated the relationship between phonocardiography (PCG) and echocardiography in symptomatic patients suspected of HFpEF.
Methods And Results: Consecutive symptomatic patients with sinus rhythm and left ventricular ejection fraction >45% were enrolled. Echocardiography was performed to evaluate the patients' diastolic function, accompanied by PCG measurements. Phonocardiography features including HS amplitude, frequency, and timing intervals were calculated, and their abilities to differentiate the ratio between early mitral inflow velocity and early diastolic mitral annular velocity (/') were investigated. Of 45 patients, variable ratio matching was applied to obtain two groups of patients with similar characteristics but different /'. Patients with a higher /' showed higher first and second HS frequencies and more fourth HS and longer systolic time intervals. The interval from QRS onset to first HS was the best feature for the prediction of /' > 9 [area under the curve (AUC): 0.72 (0.51-0.88)] in the matched patients. In comparison, N-terminal pro-brain natriuretic peptide (NT-proBNP) showed an AUC of 0.67 (0.46-0.85), a value not better than any PCG feature ( > 0.05).
Conclusion: Phonocardiography features stratify /' in symptomatic patients suspected of HFpEF with a diagnostic performance similar to NT-proBNP. Heart sound may serve as a simple non-invasive tool for evaluating HFpEF patients.
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http://dx.doi.org/10.1093/ehjdh/ztac073 | DOI Listing |
JAMA Cardiol
September 2025
Seymour, Paul and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center and New York-Presbyterian Hospital, New York, New York.
Importance: Transthyretin cardiac amyloidosis (ATTR-CA) is an underdiagnosed but treatable cause of heart failure (HF) in older individuals that occurs in the context of normal wild-type (ATTRwt-CA) or an abnormal inherited (ATTRv-CA) TTR gene variant. While the most common inherited TTR variant, V142I, occurs in 3% to 4% of self-identified Black Americans and is associated with excess morbidity and mortality, the prevalence of ATTR-CA in this at-risk population is unknown.
Objective: To define the prevalence of ATTR-CA and proportions attributable to ATTRwt-CA or ATTRv-CA among older Black and Caribbean Hispanic individuals with HF.
JACC Case Rep
September 2025
Cardiovascular Division, Department of Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, Wisconsin, USA. Electronic address:
Baroreflex activation therapy (BAT) improves functional status, quality of life, and exercise capacity in patients with heart failure with reduced ejection fraction; however, its direct effects on reversing adverse cardiac remodeling as assessed by improvements in cardiac structure, function, and coupling with the arterial system remain unclear. We present 2 cases of patients who initially presented with decompensated heart failure, and despite initial medical therapy and continued outpatient follow-up, were unable to tolerate full escalation of guideline-directed medical therapy. The patients remained symptomatic, with high biomarker levels, poor functional capacity, severe heart failure symptoms, and objectively had decreased stroke volume, low left ventricular ejection fraction, and high left ventricular mass.
View Article and Find Full Text PDFJ Comp Eff Res
September 2025
British Heart Foundation, University of Glasgow, Glasgow, UK.
The first paper of this two-part series critically examined the role of composite endpoints in health technology assessments (HTAs) and outlined strategies for determining whether to employ the composite estimate of treatment effect or disaggregate into the component endpoints of the composite and apply separate treatment effects within a modeling framework. In this second paper, we expand the discussion beyond a pivotal trial and consider the way in which additional evidence from the same indication for different drugs in the same class, or the same drug for different indications, could be employed within HTAs. We offer a continuation of the case study of dapagliflozin for the treatment of heart failure with preserved or mildly reduced ejection fraction, where the evidence base was expanded to consider empagliflozin for the same indication, as well as both dapagliflozin and empagliflozin for heart failure with reduced ejection fraction.
View Article and Find Full Text PDFESC Heart Fail
September 2025
Institute of Cardiology, ASST Spedali Civili, Department of Medical and Surgical Specialties, Radiological Sciences, and Public Health, University of Brescia, Brescia, Italy.
Atrial functional mitral regurgitation (AFMR) is an increasingly recognized subtype of mitral regurgitation, characterized by left atrial remodelling and mitral annular dilation in the absence of primary mitral valve disease or left ventricular dysfunction. Closely linked to chronic atrial fibrillation and heart failure with preserved ejection fraction, AFMR is associated with poor clinical outcomes and represents a growing therapeutic challenge. This expert opinion paper summarizes current evidence on the epidemiology, pathophysiology, diagnosis and management strategies, including medical therapy and emerging data supporting surgical and transcatheter interventions in selected patients.
View Article and Find Full Text PDFKardiologiia
September 2025
Department of Cardiology, The Ninth Medical Center, Chinese PLA General Hospital.
Background Hyperuricemia (HUA) frequently coexists with coronary artery disease (CAD) and is linked to adverse cardiovascular outcomes. The long-term impact of urate-lowering therapy (ULT) on clinical outcomes, including all-cause mortality and major adverse cardiovascular events (MACEs), in CAD patients after percutaneous coronary intervention (PCI) has not been determined. That was the aim of this study.
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