Clinical epidemiology of heart failure

Novel sodium-hydrogen exchanger 1 inhibitors with diphenyl ketone scaffold: Design, Synthesis, mechanism and evaluation in mice model of heart failure

Sodium-hydrogen exchanger 1 (NHE1) is a potential target for drug discovery of heart failure (HF). Cardioprotection effect of empagliflozin (EMPA) was reported to be related to binding with NHE1 protein. Herein, a series of NHE1 inhibitors bearing benzhydryl and diphenyl ketone skeleton were rationally designed and efficiently synthesized. Cell viability assay and pH recovery experiment based on H9c2 cells were conducted and compound 7g was found to have equal NHE1 inhibitory activity to cariporide (0.64 μM) with the IC50 values of 0.78 μM. In vitro, 7g at 1 μM effectively rescued glucose deprivation (GD)-induced cellular damage by decreased overload of Ca2+ concentration and reactive oxygen species (ROS), improved mitochondrial dysfunction and autophagy. In vivo, compared with the clinically approved drug empagliflozin (30 mg/kg), 7g alleviated left ventricular systolic dysfunction in a heart failure model induced by isoproterenol (ISO) at lower concentration (10 mg/kg). In summary, this study supplies a promising lead compound with novel scaffold for NHE1 inhibitor and also provide a feasible strategy for HF drug discovery.

Triple cardiovascular disease detection with an artificial intelligence-enabled stethoscope (TRICORDER): design and rationale for a decentralised, real-world cluster-randomised controlled trial and implementation study

INTRODUCTION

Early detection of cardiovascular disease in primary care is a public health priority, for which the clinical and cost-effectiveness of an artificial intelligence-enabled stethoscope that detects left ventricular systolic dysfunction, atrial fibrillation and cardiac murmurs is unproven but potentially transformative.

METHODS AND ANALYSIS

TRICORDER is a pragmatic, two-arm, multi-centre (decentralised), cluster-randomised controlled trial and implementation study. Up to 200 primary care practices in urban North West London and rural North Wales, UK, will be randomised to usual care or to have artificial intelligence-enabled stethoscopes available for use. Primary care clinicians will use the artificial intelligence-enabled stethoscopes at their own discretion, without patient-level inclusion or exclusion criteria. They will be supported to do so by a clinical guideline developed and approved by the regional health system executive board. Patient and outcome data will be captured from pooled primary and secondary care records, supplemented by qualitative and quantitative clinician surveys. The coprimary endpoints are (i) difference in the coded incidence (detection) of heart failure and (ii) difference in the ratio of coded incidence of heart failure via hospital admission versus community-based diagnostic pathways. Secondary endpoints include difference in the incidence of atrial fibrillation and valvular heart disease, cost-consequence differential, and prescription of guideline-directed medical therapy.

ETHICS AND DISSEMINATION

This trial has ethical approval from the UK Health Research Authority (23/LO/0051). Findings from this trial will be disseminated through publication of peer-reviewed manuscripts, presentations at scientific meetings and conferences with local and national stakeholders.

TRIAL REGISTRATION NUMBER

NCT05987670.

Nicotinamide N-methyltransferase in cardiovascular Diseases: Mechanistic insights and therapeutic potential

Cardiovascular diseases (CVDs), including conditions like ischemic heart disease, heart failure (HF), and atherosclerosis (AS), have complex pathogenesis that involves both behavioral and metabolic factors. Nicotinamide N-methyltransferase (NNMT) is an enzyme involved in the methylation of nicotinamide (NAM), and its increased activity is associated with disruptions in the NAD+ and methionine cycles. These disruptions are considered significant risk factors for cardiovascular diseases, though the specific mechanisms of NNMT remain unclear. This review discusses the role of NNMT in cardiovascular diseases by modulating NAD+ and methionine metabolism, including mechanisms such as NAD+ depletion, mitochondrial energy crisis, SIRTs deactivation, PARP hyperactivation, as well as hyperhomocysteinemia and epigenetic dysregulation. NNMT is linked to diseases such as atherosclerosis, pulmonary arterial hypertension, heart failure, and coronary heart disease, playing a critical role in their progression. Moreover, the potential of NNMT as a therapeutic target for cardiovascular diseases is explored. RNAi therapies, NNMT small-molecule inhibitors, and exercise therapies are promising treatment approaches, but there are limitations in current research, including discrepancies between animal models and human tissue expression, the dual role of NNMT, and the dose-dependent effects of NNMT inhibitors. Future studies should further clarify NNMT's mechanisms and assess its feasibility as a therapeutic target, aiming to develop more effective treatments and enhance prevention and treatment strategies for cardiovascular diseases.

Exercise prescriptions for ischemic cardiomyopathy: a scoping review

This review explores the critical role of exercise as a non-pharmacological intervention in managing ischemic cardiomyopathy (ICM), a leading cause of heart failure. It highlights the profound cardiovascular benefits of exercise, such as improved cardiopulmonary parameters, decreased morbidity and mortality, and enhanced functional capacity. It also critically evaluates existing literature on the efficacy of various exercise types and intensities, including aerobic, resistance, and high-intensity interval training. There is a significant gap in current clinical guidelines, which lack specific exercise prescriptions tailored to the unique pathophysiology of ICM. By synthesizing data from both older and contemporary studies, this review highlights specific, evidence-based exercise regimens and promotes supervised cardiac rehabilitation programs. This review also addresses potential barriers to cardiac rehabilitation participation and proposes future directions, which include the use of technology to improve adherence and outcomes.

Risk factors of mortality among heart failure patients in Jordan: the Jordanian Heart Failure Registry (JoHFR)

Background

Heart failure is one of the most common medical burdens facing the healthcare system worldwide. Based on our knowledge, only two heart failure registries have been conducted in the Middle East. Therefore, we decided to conduct this heart failure registry to investigate the follow-up results of patients with both acute and chronic heart failure in Jordan.

Methods

This study is a prospective observational multicenter national registry encompassing 21 health institutes in Jordan, comprising university hospitals, private hospitals, and private clinics. The criteria of inclusion were patients visiting the cardiology clinic or inpatients who were admitted due to acute decompensated HF. The primary outcome was 30-day mortality.

Results

The total number of enrolled patients in the study was 2128, with a total number of deaths during the follow-up of 204. Multivariate analysis demonstrated that smoking (odds ratio [OR] = 3.214; 1.005-5139), positive family history of premature coronary artery disease (OR = 2.686; 1.504-4.798), insulin (OR = 2.300; 1.356-3.899), hyponatremia at presentation (OR = 7.058; 1.698-29.342) and increased left ventricular diameter (OR = 1.009; 1.002-1.016) were significantly associated with higher odds of mortality.

Conclusion

Smoking, positive family history of premature coronary artery disease, insulin use, hyponatremia on presentation, and increased left ventricular diameter were associated with patients' mortality. Physicians should monitor these factors among patients to identify patients who are at higher risk of detrimental outcomes.

Home-based telemonitoring care and executive function in patients with heart failure

Enhancement of self-care ability is essential for patients with heart failure (HF), and executive function plays a critical role. We investigated the clinical influence of a home-based remote care program using telemonitoring and telecoaching on executive function in patients with HF and assessed the relationship between executive functional status and clinical outcomes. This prospective study enrolled outpatients with HF, and they received home-based remote care program with telemonitoring and telecoaching using self-measured physical data. Executive function was assessed using the Trail Making Test Part B (TMT-B). The incidences of HF hospitalization and all-cause death were also compared according to baseline executive function status based on TMT-B test performance. Forty-one participants were enrolled in this study (mean age: 64.8 ± 13.8 years; male 68.3%; New York Heart Association [NYHA] class II/III: 78.0/22.0%). Twelve months after the initiation of the program, TMT-B significantly improved (p = 0.039), accompanied by an obvious amelioration of HF symptoms as assessed by the NYHA class (p = 0.027). During a median follow-up of 20.5 months, the incidence of HF hospitalization was significantly higher in patients with executive dysfunction than in those without (hazard ratio: 4.97, 95% confidence interval: 1.15-21.4, p = 0.031). This was unchanged even in a subcohort without cognitive dysfunction, as assessed using the Mini-Mental State Examination. Telemonitoring and telecoaching at home may be effective in improving executive function in patients with HF. Further studies are needed to assess whether supportive care assisting executive functioning improves clinical outcomes in patients with HF.

Heavy metals and cardiovascular health: Uncovering links and health challenges

BACKGROUND

Heavy metals, including lead, mercury, cadmium, and arsenic, along with emerging contaminants, pose significant threats to cardiovascular health. These metals are linked to oxidative stress, endothelial dysfunction, inflammation, and epigenetic alterations, contributing to various cardiovascular diseases.

AIM

This review synthesizes current research on the pathways by which heavy metal exposure affects cardiovascular health, highlighting epidemiological trends, vulnerable populations, and potential preventive strategies.

METHODS

A comprehensive review of molecular mechanisms, epidemiological studies, and public health data was conducted to elucidate the links between heavy metal exposure and cardiovascular health.

RESULTS

Mechanisms of Toxicity: Heavy metals induce oxidative stress and inflammation, impair endothelial function, and disrupt calcium signaling. These effects culminate in hypertension, atherosclerosis, myocardial dysfunction, and other cardiovascular pathologies. Epidemiological Trends: Evidence links even low-level exposures to increased Cardio Vascular Disease risk. Regional trends show elevated risks in areas with significant industrial activity or contaminated water supplies. Vulnerable Populations: Children, the elderly, and individuals in low-income or industrially polluted regions exhibit heightened susceptibility. Preventive Strategies: Regulatory actions, improved water safety, dietary interventions, and community awareness are critical in mitigating exposure and its health impacts.

CONCLUSIONS

Environmental exposure to heavy metals significantly elevates cardiovascular disease risk, particularly among vulnerable groups. Urgent public health measures and further research are needed to address the cumulative and synergistic effects of these toxicants.

The Effect of Recombinant Human Brain Natriuretic Peptide Combined with Xinmailong on Heart Failure and Its Impact on Cardiac Function and Inflammatory Response

Objective

To analyze the effect of recombinant human brain natriuretic peptide (rhBNP) combined with Xinmailong on heart failure and its impact on cardiac function and inflammatory response.

Methods

A retrospective analysis was conducted on the clinical data of 60 heart failure patients treated in our hospital from January 2023 to March 2024. The patients were included as research subjects to ensure the sample was representative. According to the different treatment methods, the patients were divided into two groups: the control group received only rhBNP treatment, and the experimental group received combined treatment with rhBNP and Xinmailong injection, with 30 patients in each group. The clinical effects, cardiac function, inflammatory response, and ventricular remodeling indicators of the two groups before and after treatment were observed and compared.

Results

The total clinical effective rate of the experimental group was significantly higher than that of the control group (P<0.05). After treatment, the NT-proBNP level in the experimental group was significantly lower than that in the control group (P<0.05). After treatment, the levels of IL-6, TNF-α, and CRP in the experimental group were significantly lower than those in the control group (P<0.05). After treatment, the LVESD and LVEDD levels in the experimental group were significantly lower than those in the control group, while the LVEF level was higher in the experimental group than in the control group (P<0.05). There was no significant difference in the adverse event incidence between the two groups (P>0.05). The 6-minute walk test (6 MWT) level in the experimental group was significantly higher than in the control group (P<0.05).

Conclusion

Recombinant human brain natriuretic peptide combined with Xinmailong is effective in treating heart failure, significantly improving cardiac function, reducing inflammatory responses, and reversing ventricular remodeling. It is also safe and beneficial for the patients' prognosis.

Unveiling the Systemic Impact of Congestion in Heart Failure: A Narrative Review of Multisystem Pathophysiology and Clinical Implications

Congestion is a key clinical feature of heart failure (HF), contributing to hospitalizations, disease progression, and poor outcomes. While traditionally considered a hemodynamic issue, congestion is now recognized as a systemic process affecting multiple organs. Renal dysfunction arises from impaired perfusion and sodium retention, leading to maladaptive left ventricular remodeling. Hepatic congestion contributes to cholestatic liver injury, while metabolic disturbances drive anemia, muscle wasting, and systemic inflammation. Additionally, congestion disrupts the intestinal barrier and immune function, exacerbating HF progression. Given its widespread impact, effective congestion management requires a shift from a cardiovascular-centered approach to a comprehensive, multidisciplinary strategy. Targeted decongestive therapy, metabolic and nutritional optimization, and immune modulation are crucial in mitigating congestion-related organ dysfunction. Early recognition and intervention are essential to slow disease progression, preserve functional capacity, and improve survival. Addressing HF congestion through personalized, evidence-based strategies is vital for optimizing long-term care and advancing treatment paradigms.

Application of human cardiac organoids in cardiovascular disease research

With the progression of cardiovascular disease (CVD) treatment technologies, conventional animal models face limitations in clinical translation due to interspecies variations. Recently, human cardiac organoids (hCOs) have emerged as an innovative platform for CVD research. This review provides a comprehensive overview of the definition, characteristics, classifications, application and development of hCOs. Furthermore, this review examines the application of hCOs in models of myocardial infarction, heart failure, arrhythmias, and congenital heart diseases, highlighting their significance in replicating disease mechanisms and pathophysiological processes. It also explores their potential utility in drug screening and the development of therapeutic strategies. Although challenges persist regarding technical complexity and the standardization of models, the integration of multi-omics and artificial intelligence (AI) technologies offers a promising avenue for the clinical translation of hCOs.

Global longitudinal strain is a predictor of mortality in patients with cardiogenic shock

AIMS

Cardiogenic shock (CS) is a critical manifestation of severe cardiac dysfunction, necessitating precise evaluation of left ventricular (LV) function by transthoracic echocardiography. The prognostic value of global longitudinal strain (GLS) has not been examined in patients with CS. Therefore, we aimed to assess the prognostic significance of GLS in patients with CS.

METHODS AND RESULTS

This was a retrospective study of patients with CS from 2007 to 2018 who had a transthoracic echocardiography performed within 24 h of admission. GLS was measured, and conventional parameters were obtained. LV dysfunction was categorized by GLS: > 9.7% (Quartile 1), 7.0% < GLS ≤ 9.7% (Quartile 2), 5.0% < GLS ≤ 7.0% (Quartile 3), and ≤5.0% (Quartile 4). Outcomes included in-hospital and 1-year all-cause mortality. Among 623 patients with CS with the median LVEF of 31% [inter-quartile range (IQR): 24-41%] and the median GLS of 7.0% (IQR: 5.0-9.7%), in-hospital mortality was 29%. Mortality increased across GLS quartiles: Quartile 1: 17%; Quartile 2: 22%; Quartile 3: 35%; and Quartile 4: 42%. GLS remained the only independent echocardiographic predictor of in-hospital mortality after adjusting for clinical covariates (adjusted odds ratio: 1.23 per 1% decrease, 95% confidence interval: 1.04-1.46, P = 0.015). GLS independently predicted 1-year all-cause mortality (P < 0.001). The prognostic value of GLS was superior in cases with acute coronary syndrome. A classification and regression tree analysis identified GLS as the most important echocardiographic variable for predicting in-hospital mortality.

CONCLUSION

GLS independently predicted short- and long-term mortality in patients with CS, surpassing conventional echocardiographic parameters in prognostic value, supporting its potential role in risk stratification in this population.

Which screening tool performs best in identifying malnutrition risk among hospitalized older adults with cardiovascular disease? A diagnostic accuracy study comparing six different screening tools with GLIM criteria

PURPOSE

This study aimed to compare the performance of six different screening tools with the GLIM criteria in identifying malnutrition risk among older adults with cardiovascular diseases.

METHODS

In this diagnostic accuracy study, data from 669 patients aged 65 and older, hospitalized at Bandırma Training and Research Hospital diagnosed with cardiovascular disease, were evaluated. The data were obtained using a questionnaire that included a Demographic Information Form, Global Leadership Initiative on Malnutrition (GLIM) Criteria, Malnutrition Screening Tool (MST), Malnutrition Universal Screening Tool (MUST), Short Nutritional Assessment Questionnaire (SNAQ), Mini Nutritional Assessment-Short Form (MNA-SF), Nutritional Risk Screening-2002 (NRS-2002), and Graz Malnutrition Screening (GMS) tool. GLIM criteria were used as gold standard and six screening tools were used as index tests. Receiver Operating Characteristic (ROC) curve analysis was conducted to calculate the Area Under the Curve (AUC), and the sensitivity, specificity, accuracy, and Cohen's Kappa (κ) coefficient of the index tests were assessed.

RESULTS

The mean age of the patients was 75.5 ± 7.7 years, 55.2% were female. According to the GLIM criteria, the prevalence of malnutrition was calculated as 22.0%. The AUC calculated by ROC indicated that MST (AUC: 0.905) had excellent predictive value, while MUST (AUC: 0.874), SNAQ (AUC: 0.851), MNA-SF (AUC: 0.842), and GMS (AUC: 0.820) demonstrated good predictive value. Among the screening tools, GMS had the highest sensitivity (92.5%), whereas MNA-SF exhibited the highest specificity (91.6%). MNA-SF also demonstrated the highest agreement with the GLIM criteria (Cohen's κ: 66.8) and the highest accuracy (88.3%).

CONCLUSION

This study found that the MNA-SF tool outperformed other comprehensive screening tools when evaluating malnutrition risk in light of the GLIM criteria.

Addressing 'Residual Congestion' to Improve Prognosis After Acute Heart Failure Decompensation

Congestion is the hallmark and the main therapeutic target in patients with decompensated heart failure (HF). Residual clinical congestion is defined as a high left ventricular diastolic pressure associated with signs and symptoms of HF, such as dyspnoea, rales and oedema, persisting despite guideline-directed medical treatment. Residual congestion in the predischarge and early post-discharge phase is the major risk factor for HF readmission and mortality. Therefore, prompt recognition of congestion and rapid optimisation of medical and device therapy are crucial to induce remission in this malignant process. In this paper we discuss the definitions, prevalence and prognosis of HF decompensation; the significance of assessing residual congestion in HF patients; the results of observational and randomised clinical trials to detect and treat residual congestion; and the current guidelines to prevent recurrent HF decompensation in the context of residual congestion. Strategies to detect and address residual congestion are crucial to stopping readmissions after an acute HF hospitalisation and improving long-term prognosis.

Inhibition of Egr2 Protects against TAC-induced Heart Failure in Mice by Suppressing Inflammation and Apoptosis Via Targeting Acot1 in Cardiomyocytes

Heart failure (HF) is a clinical syndrome caused by structural or functional abnormalities in heart. Egr2 has been reported to be protective for multiple diseases, but its effect on HF remains unknown. The present study intended to investigate the potential role of Egr2 in HF and its possible downstream effectors. High Egr2 expression in heart was observed in HF mice. Egr2 knockdown alleviated cardiac damage and function in HF mice. Egr2 knockdown inhibited myocardial inflammation and apoptosis both in vivo and in vitro. Egr2 inhibited Acot1 transcription expression via directly binding to its promoter. Acot1 overexpression reduced Lipopolysaccharide (LPS)-induced cardiomyocyte inflammation and apoptosis. Functional rescue experiments revealed that Acot1 reversed the effects of Egr2 on LPS-induced cell apoptosis and inflammation. Overall, Egr2 knockdown might ameliorate HF by inhibiting inflammation and apoptosis in cardiomyocytes by targeting Acot1. This study might provide evidence to better understand the molecular mechanisms of HF pathogenesis.

Clinical Predictors of Heart Failure after STEMI: Data from a Middle-Income Country with Limited Access to Percutaneous Coronary Intervention

BACKGROUND

Heart failure (HF) is a common complication of ST-elevation myocardial infarction (STEMI) in low- and middle-income countries (LMICs), where cardiovascular mortality is disproportionately high. Primary percutaneous coronary intervention (PCI) has reduced post-STEMI HF incidence in high-income countries. However, access to this standard of care is poor in LMICs, and data in these settings remain scarce.

OBJECTIVE

To identify predictors of HF following STEMI in a LMIC with limited access to PCI, aiming at better management and outcomes.

METHODS

This retrospective cohort study analyzed 2,467 STEMI patients admitted to two Brazilian public hospitals between January/2015 and February/2020. All participants received pharmacological thrombolysis and underwent coronarography within 48h post-admission. The primary outcome was symptomatic HF, defined as dyspnea with chest X-ray evidence of congestion, from 48h post-admission until discharge. Stepwise binary logistic regression was used to identify HF predictors. Significance was defined as p-values<0.05.

RESULTS

The population was 61.9% male, mean age was 58.3±12.6 years, and 39.9% developed post-STEMI HF. HF was more common among older men with cardiovascular-kidney-metabolic (CKM) disease, larger infarcts, and left anterior descending artery involvement. Medications were often underprescribed at discharge, especially aldosterone antagonists (11.0%). HF was notably more frequent among individuals with failed thrombolysis (47.0%).

CONCLUSIONS

This regionally representative cohort from a LMIC with limited access to PCI showed that older men with CKM disease are particularly vulnerable to post-STEMI HF, and that HF pharmacotherapy at discharge needs optimization. The high HF incidence among patients with failed thrombolysis highlights the need to expand PCI availability.

Does the Naples Prognostic Score Predict Long-Term Mortality in Patients with Advanced-Stage Heart Failure?

Background

Inflammation and malnutrition have negative effects on heart failure. The Naples Prognostic Score (NPS) is a new scoring system that incorporates these two parameters.

Objectives

Our aim was to investigate the relationship between the NPS and long-term mortality in patients with advanced-stage heart failure.

Methods

The study included 148 patients with advanced-stage heart failure. The patients were divided into two groups: those who died, and those who survived. Demographic, clinical, and laboratory characteristics of the groups were compared. The impact of NPS on mortality was examined.

Results

The patients were further classified into three groups according to NPS. The patients with NPS 3 had a higher mortality rate compared to those with NPS 1 and NPS 2 (died vs. survived respectively, NPS 3: 75% vs. 25%, NPS 1: 31.1% vs. 68.9%, NPS 2: 48.9% vs. 51.1%, p < 0.001). In multivariate regression analysis, NPS 3 was found to be an independent predictor [odds ratio: 0.13, 95% confidence interval (CI): 0.051-0.333; p = 0.0001]. Receiver operating characteristic analysis revealed that NPS had a sensitivity of 82% and specificity of 53% for mortality, with an area under curve of 0.699 (95% CI: 0.614-0.784, p = 0.0001). Kaplan-Meier survival analysis demonstrated a higher mortality rate in those with a high NPS (long-rank: 5.29, p = 0.021). In patients with advanced-stage heart failure, NPS may be considered a determinant of long-term mortality.

Conclusions

This study demonstrated an association between NPS and long-term mortality in patients with advanced-stage heart failure. NPS, indicating inflammation and nutritional status, can be utilized as a long-term prognostic indicator in patients with advanced-stage heart failure.

Effect of traditional Chinese medicine on cardiovascular death and all-cause death among patients with heart failure and/or atrial fibrillation

We tried to define the association of adverse cardiovascular (CV) events, such as CV death and all-cause death among patients with heart failure (HF) and/or atrial fibrillation (AF) receiving traditional Chinese medicine (TCM) or not. We used data from the Taiwan National Health Insurance Research Database in a retrospective cohort study using propensity scoring (PS) matching. We matched 54,859 and 18,307 patients each to the treatment vs. non-treatment group and found a significantly decreased risk of adverse CV events after PS score matching, suggesting that TCM reduces the risk of these adverse outcomes. Compared to HF patients without AF in non-TCM user, HF patients without AF in TCM user and HF patients with AF in TCM user had decreased risk of CV death by 0.50 times (95% CI 0.49, 0.52) and 0.84 times (95% CI 0.49,0.52), respectively. HF patients without AF in TCM user and HF patients with AF in TCM user had decreased risk of all-cause death relative to HF patients without AF in non-TCM user by 0.53 times (95% CI 0.52, 0.54) and 0.74 times (95% CI 0.72,0.76), respectively. The results said that there is significant reduction of decrease in risk of CV death and all death among the patients receiving TCM, especially those without AF.

Butyrate increases cardiac output and causes vasorelaxation in a healthy porcine model

BACKGROUND

Butyrate, a short-chain fatty acid, has shown potential to improve left ventricular (LV) function and induce vasorelaxation in rodents. Butyrate may either be produced by the microbiome in the colon, be ingested or administered intravenously. This study aimed to evaluate effects of butyrate on cardiac output (CO) and associated hemodynamic variables in a porcine model.

METHODS

In a randomized, blinded crossover study, ten healthy 60-kg pigs were given three hour infusions of 600 mM butyrate and equimolar sodium chloride (control). CO was measured by thermodilution via a pulmonary artery catheter. LV contractility was assessed using pressure-volume admittance catheterization. Additionally, isolated porcine coronary arteries were exposed to butyrate in a wire myograph to evaluate vasorelaxation.

RESULTS

Butyrate infusion increased plasma butyrate concentration to 0.53 mM (95 % confidence interval (CI): 0.49 to 0.58 mM, P < 0.58 mM, P < 0.001) and CO by 1.6 L/min (95 % CI: 1.0 to 2.1 L/min, P < 0.001) compared with the control. Heart rate, LV ejection fraction, cardiac efficiency and dP/dtmax rose, while systemic vascular resistance, arterial elastance, mean arterial pressure and LV end-systolic volume decreased. Load-independent LV contractility and stroke volume did not significantly differ. In the myograph, porcine coronary arteries relaxed in response to butyrate in a concentration-dependent manner.

CONCLUSION

Butyrate increases cardiac output and lowers vascular resistance in a large animal model, through increased HR and systemic vasorelaxation. Load-independent LV contractility was not significantly altered. We observed indices of increased end-organ perfusion. These potentially beneficial cardiovascular properties of butyrate should be further studied.

Miglustat ameliorates isoproterenol-induced cardiac fibrosis via targeting UGCG

BACKGROUND

Cardiac fibrosis is significant global health problem, which is associated with numerous cardiovascular diseases, and ultimately leads to the progression to heart failure. β-adrenergic receptor (β-AR) overactivation play a role in the development of cardiac fibrosis. Miglustat (Mig) has shown anti-fibrosis effects in multiple fibrotic diseases. However, it is unclear whether and how Mig can ameliorate cardiac fibrosis induced by β-AR overactivation.

METHODS

In vivo, mice were injected with isoproterenol (ISO) to induce cardiac fibrosis and treated with Mig. In vitro, primary cardiac fibroblasts were stimulated by ISO and treated with Mig. Levels of cardiac fibrosis, cardiac dysfunction, activation of cardiac fibroblasts were evaluated by real-time polymerase chain reaction, western blots, sirius red staining, immunohistochemistry staining and echocardiography. Through GEO data and knockdown UDP-glucose ceramide glycosyltransferase (UGCG) in primary cardiac fibroblasts, whether Mig alleviates cardiac fibrosis by targeting UGCG was explored.

RESULTS

The results indicated that Mig alleviated ISO-induced cardiac dysfunction. Consistently, Mig also suppressed ISO-induced cardiac fibrosis. Moreover, Mig attenuated ISO-induced cardiac fibroblasts (CFs) activation. To identify the protective mechanism of Mig on cardiac fibrosis, several classical β-AR downstream signaling pathways, including ERK, STAT3, Akt and GSK3β, were further analyzed. As expected, ISO activated the ERK, STAT3, Akt and GSK3β in both CFs and mouse hearts, but this effect was reversed pretreated with Mig. Besides, Mig ameliorates ISO-induced cardiac fibrosis by targeting UDP-glucose ceramide glycosyltransferase (UGCG) in CFs.

CONCLUSIONS

Mig ameliorates β-AR overactivation-induced cardiac fibrosis by inhibiting ERK, STAT3, Akt and GSK3β signaling and UGCG may be a potential target for the treatment of cardiac fibrosis.

Amyloid-β and heart failure in Alzheimer's disease: the new vistas

Alzheimer's disease (AD) is the most common cause of dementia and represents 75% of all dementia types. AD neuropathology is due to the progressive deposition of extracellular amyloid-beta (Aβ) peptide and intracellular hyperphosphorylated tau protein. The accumulated Aβ forms amyloid plaques, while the hyperphosphorylated tau protein forms neurofibrillary tangles (NFTs). Both amyloid plaques and NFTs are hallmarks of AD neuropathology. The fundamental mechanism involved in the pathogenesis of AD is still elusive, although Aβ is the more conceivable theory. Aβ-induced neurodegeneration and associated neuroinflammation, oxidative stress, endoplasmic reticulum stress (ER), and mitochondrial dysfunction contribute to the development of cognitive impairment and dementia. Of note, Aβ is not only originated from the brain but also produced peripherally and, via the blood-brain barrier (BBB), can accumulate in the brain and result in the development of AD. It has been shown that cardiometabolic conditions such as obesity, type 2 diabetes (T2D), and heart failure (HF) are regarded as possible risk factors for the development of AD and other types of dementia, such as vascular dementia. HF-induced chronic cerebral hypoperfusion, oxidative stress, and inflammation can induce the development and progression of AD. Interestingly, AD is regarded as a systemic disease that causes systemic inflammation and oxidative stress, which in turn affects peripheral organs, including the heart. Aβ through deranged BBB can be transported into the systemic circulation from the brain and accumulated in the heart, leading to the development of HF. These findings suggest a close relationship between AD and HF. However, the exact mechanism of AD-induced HF is not fully elucidated. Therefore, this review aims to discuss the link between AD and the risk of HF regarding the potential role of Aβ in the pathogenesis of HF.

Integrin beta-like 1 is regulated by DNA methylation and increased in heart failure patients

AIMS

Dynamic alterations in cardiac DNA methylation have been implicated in the development of heart failure (HF) with evidence of ischaemic heart disease (IHD); however, there is limited research into cell specific, DNA methylation sensitive genes that are affected by dysregulated DNA methylation patterns. In this study, we aimed to identify DNA methylation sensitive genes in the ischaemic heart and elucidate their role in cardiac fibrosis.

METHODS

A multi-omics integrative analysis was carried out on RNA sequencing and methylation sequencing on HF with IHD (n = 9) versus non-failing (n = 9) left ventricular tissue, which identified Integrin beta-like 1 (ITGBL1) as a gene of interest. Expression of Itgbl1 was assessed in three animal models of HF; an ischaemia-reperfusion pig model, a myocardial infarction mouse model and an angiotensin-II infused mouse model. Single nuclei RNA sequencing was carried out on heart tissue from angiotensin-II infused mice to establish the expression profile of Itgbl1 across cardiac cell populations. Subsequent in vitro analyses were conducted to elucidate a role for ITGBL1 in human cardiac fibroblasts. DNA pyrosequencing was applied to assess ITGBL1 CpG methylation status in genomic DNA from human cardiac tissue and stimulated cardiac fibroblasts.

RESULTS

ITGBL1 was >2-fold up-regulated (FDR adj P = 0.03) and >10-fold hypomethylated (FDR adj P = 0.01) in human HF with IHD left ventricular tissue compared with non-failing controls. Expression of Itgbl1 was up-regulated in three isolated animal models of HF and showed conserved correlation between increased Itgbl1 and diastolic dysfunction. Single nuclei RNA sequencing highlighted that Itgbl1 is primarily expressed in cardiac fibroblasts, while functional studies elucidated a role for ITGBL1 in cardiac fibroblast migration, evident in 50% reduced 24 h fibroblast wound closure occurring subsequent to siRNA-targeted ITGBL1 knockdown. Lastly, evidence provided from DNA pyrosequencing supports the theory that differential expression of ITGBL1 is caused by DNA hypomethylation.

CONCLUSIONS

ITGBL1 is a gene that is mainly expressed in fibroblasts, plays an important role in cardiac fibroblast migration, and whose expression is significantly increased in the failing heart. The mechanism by which increased ITGBL1 occurs is through DNA hypomethylation.

[Optimization of heart failure treatment in Abidjan heart institute]

INTRODUCTION

The aim of the study was to assess the level of treatment optimization after follow-up at discharge.

METHODS

We conducted a retrospective study carried out from January 1st, 2016 to December 31st, 2018 in Abidjan Heart Institute with patients hospitalized for heart failure and reviewed in consultation.

RESULTS

The study involved 350 patients with an average age of 53.53 ± 16.38 years (54% were males). The prescription of diuretics (92%) after optimization was at the mean and with maximum doses of 29.1% and 7.7%. ACEIs/ARBs (77.1%) had optimal and mean doses for ACEIs of 14.3% and 29.7%. With beta-blockers (72.6%) there was an improvement in doses at 35.4% for the average doses and 3.1%. for the maximum dose. Spironolactone (44.3%) kept the same average dose at 5.7% The median time of optimization was 287.05 days with a median of 140 days. Only 13.4% of patients were receiving optimal treatment at optimal doses. By logistic regression, the presence of LVEF ≤ 0,40 or LVEF= 0.41-0.49 or global heart failure (P < 0.001) favored drug optimization (OR = 24.68[7.15-82.22], P < 0.001); (OR = 11.39[3.25-39.86], P < 0.001) on the other hand, a high serum creatinine level was an obstacle for treatment optimization (OR = 0.92[0.88-0.96], P < 0.001).

CONCLUSION

The optimization of the treatment of heart failure is insufficient with too long delays in our context. The optimization time was so long. It could be improved by setting up a clinic to optimize the treatment of heart failure.

New Biomarkers in the Prognostic Assessment of Acute Heart Failure with Reduced Ejection Fraction: Beyond Natriuretic Peptides

Natriuretic peptides are established biomarkers related to the prognosis of heart failure. New biomarkers have emerged in the field of cardiovascular disease. The prognostic value of these biomarkers in heart failure with reduced left ventricular ejection fraction is not well-established. We conducted a prospective, single-centre study, including (July 2019 to March 2023) 104 patients being consecutively admitted with a diagnosis of acute heart failure with reduced ejection fraction decompensation. The median follow-up was 23.5 months, during which 20 deaths (19.4%) and 21 readmissions for heart failure (20.2%) were recorded. Plasma biomarkers, such as NT-proBNP, GDF-15, sST2, suPAR, and FGF-23, were associated with an increased risk of all-cause mortality. However, a Cox regression analysis showed that the strongest predictors of mortality were an estimated glomerular filtration rate (HR 0.96 [0.93-0.98]), GDF-15 (HR 1.3 [1.16-1.45]), and sST2 (HR 1.2 [1.11-1.35]). The strongest predictive model was formed by the combination of the glomerular filtration rate and sST2 (C-index 0.758). In conclusion, in patients with acute decompensated heart failure with reduced ejection fraction, GDF-15 and sST2 showed the highest predictive power for all-cause mortality, which was superior to other established biomarkers such as natriuretic peptides. GDF-15 and sST2 may provide additional prognostic information to improve the prognostic assessment.

Targeting senescence and GATA4 in age-related cardiovascular disease: a comprehensive approach

The growing prevalence of age-related cardiovascular diseases (CVDs) poses significant health challenges, necessitating the formulation of novel treatment approaches. GATA4, a vital transcription factor identified for modulating cardiovascular biology and cellular senescence, is recognized for its critical involvement in CVD pathogenesis. This review collected relevant studies from PubMed, Google Scholar, and Science Direct using search terms like 'GATA4,' 'cellular senescence,' 'coronary artery diseases,' 'hypertension,' 'heart failure,' 'arrhythmias,' 'congenital heart diseases,' 'cardiomyopathy,' and 'cardiovascular disease.' Additionally, studies investigating the molecular mechanisms underlying GATA4-mediated regulation of GATA4 and senescence in CVDs were analyzed to provide comprehensive insights into this critical aspect of potential treatment targeting. Dysregulation of GATA4 is involved in a variety of CVDs, as demonstrated by both experimental and clinical research, comprising CAD, hypertension, congenital heart diseases, cardiomyopathy, arrhythmias, and cardiac insufficiency. Furthermore, cellular senescence enhances the advancement of age-related CVDs. These observations suggested that therapies targeting GATA4, senescence pathways, or both as necessary may be an effective intervention in CVD progression and prognosis. Addressing age-related CVDs by targeting GATA4 and senescence is a broad mechanism approach. It implies further investigation of the molecular nature of these processes and elaboration of an effective therapeutic strategy. This review highlights the importance of GATA4 and senescence in CVD pathogenesis, emphasizing their potential as therapeutic targets for age-related CVDs.

Exploring Mortality and Prognostic Factors of Heart Failure with In-Hospital and Emergency Patients by Electronic Medical Records: A Machine Learning Approach

Purpose

As HF progresses into advanced HF, patients experience a poor quality of life, distressing symptoms, intensive care use, social distress, and eventual hospital death. We aimed to investigate the relationship between morality and potential prognostic factors among in-patient and emergency patients with HF.

Patients and Methods

A case series study: Data are collected from in-hospital and emergency care patients from 2014 to 2021, including their international classification of disease at admission, and laboratory data such as blood count, liver and renal functions, lipid profile, and other biochemistry from the hospital's electrical medical records. After a series of data pre-processing in the electronic medical record system, several machine learning models were used to evaluate predictions of HF mortality. The outcomes of those potential risk factors were visualized by different statistical analyses.

Results

In total, 3871 hF patients were enrolled. Logistic regression showed that intensive care unit (ICU) history within 1 week (OR: 9.765, 95% CI: 6.65, 14.34; p-value < 0.001) and prothrombin time (OR: 1.193, 95% CI: 1.098, 1.296; <0.001) were associated with mortality. Similar results were obtained when we analyzed the data using Cox regression instead of logistic regression. Random forest, support vector machine (SVM), Adaboost, and logistic regression had better overall performances with areas under the receiver operating characteristic curve (AUROCs) of >0.87. Naïve Bayes was the best in terms of both specificity and precision. With ensemble learning, age, ICU history within 1 week, and respiratory rate (BF) were the top three compelling risk factors affecting mortality due to HF. To improve the explainability of the AI models, Shapley Additive Explanations methods were also conducted.

Conclusion

Exploring HF mortality and its patterns related to clinical risk factors by machine learning models can help physicians make appropriate decisions when monitoring HF patients' health quality in the hospital.

Use of mHealth Technology for Improving Exercise Adherence in Patients With Heart Failure: Systematic Review

BACKGROUND

The known and established benefits of exercise in patients with heart failure (HF) are often hampered by low exercise adherence. Mobile health (mHealth) technology provides opportunities to overcome barriers to exercise adherence in this population.

OBJECTIVE

This systematic review builds on prior research to (1) describe study characteristics of mHealth interventions for exercise adherence in HF including details of sample demographics, sample sizes, exercise programs, and theoretical frameworks; (2) summarize types of mHealth technology used to improve exercise adherence in patients with HF; (3) highlight how the term "adherence" was defined and how it was measured across mHealth studies and adherence achieved; and (4) highlight the effect of age, sex, race, New York Heart Association (NYHA) functional classification, and HF etiology (systolic vs diastolic) on exercise adherence.

METHODS

We searched for papers in PubMed, MEDLINE, and CINAHL databases and included studies published between January 1, 2015, and June 30, 2022. The risk of bias was analyzed.

RESULTS

In total, 8 studies (4 randomized controlled trials and 4 quasi-experimental trials) met our inclusion and exclusion criteria. A moderate to high risk of bias was noted in the studies. All studies included patients with HF in NYHA classification I-III, with sample sizes ranging from 12 to 81 and study durations lasting 4 to 26 weeks. Six studies had an equal distribution of male and female participants whose ages ranged between 53 and 73 years. Videoconferencing was used in 4 studies, while 4 studies used smartphone apps. Three studies using videoconferencing included an intervention that engaged participants in a group setting. A total of 1 study used a yoga program, 1 study used a walking program, 1 study combined jogging with walking, 1 study used a cycle ergometer, 2 studies combined walking with cycle ergometry, and 1 study used a stepper. Two studies incorporated resistance exercises in their program. Exercise programs varied, ranging between 3 and 5 days of exercise per week, with exercise sessions ranging from 30 to 60 minutes. The Borg rating of perceived exertion scale was mostly used to regulate exercise intensity, with 3 studies using heart rate monitoring using a Fitbit. Only 1 study implicitly mentions developing their intervention using a theoretical framework. Adherence was reported to the investigator-developed exercise programs. All studies were mostly feasibility or pilot studies, and the effect of age, sex, race, and NYHA classification on exercise adherence with the use of mHealth was not reported.

CONCLUSIONS

The results show some preliminary evidence of the feasibility of using mHealth technology for building exercise adherence in patients with HF; however, theoretically sound and fully powered studies, including studies on minoritized communities, are lacking. In addition, the sustainability of adherence beyond the intervention period is unknown.

Potential diagnostic biomarkers in heart failure: Suppressed immune-associated genes identified by bioinformatic analysis and machine learning

Heart failure (HF) threatens tens of millions of people's health worldwide, which is the terminal stage in the development of majority cardiovascular diseases. Recently, an increasing number of studies have demonstrated that bioinformatics and machine learning (ML) algorithms can offer new insights into the diagnosing and treating HF. To further discover HF diagnostic genes, we utilized least absolute shrinkage and selection operator (LASSO) and Support Vector Machine (SVM) to identify novel immune-related genes. The HF dataset was obtained from the gene expression omnibus (GEO) database and three candidate genes (LCN6, MUC4, and TNFRSF13C) were finally screened. In addition, the myocardial infarction (MI) modeling experiments on mice were performed to validate the expression of LCN6, MUC4, and TNFRSF13C on experimental HF mice. Altogether, these three candidate genes are promising targets for the prediction of HF with immunological perspective.

Risk factors and characteristics of preoperative heart failure in elderly patients with hip fracture and the influence of anemia on prognosis

BACKGROUND

Patients with preoperative acute heart failure (AHF) after hip fracture in the elderly have a worse prognosis. We aim to investigate the characteristics, risk factors and postoperative complications of elderly patients with hip fracture complicated with preoperative AHF. We also looked at the effect of the severity of anemia at admission on the prognosis of the above people.

METHODS

A retrospective study of hip fracture patients (aged ≥ 65) admitted to the Department of Geriatric Orthopaedics, Third Hospital, Hebei Medical University, was conducted from January 2018 to October 2020. We used univariate and multivariate logistic regression to assess risk factors for preoperative AHF. The Kaplan-Meier survival curve shows the relationship between the severity of anemia on admission and all-cause mortality in elderly hip fracture patients with preoperative AHF.

RESULTS

Out of the 1092 patients, 503 had preoperative AHF and the incidence of it in hip fracture patients was 46.1%. Age, coronary artery disease, chronic atrial fibrillation, Age-Adjusted Charlson Comorbidity Index (ACCI), admission anemia, admission albumin < 40 g/dl, and admission C-reactive protein (CRP) were all significantly different between those with AHF and those without. Multivariate logistic regression analysis revealed that age ≥ 80 years (OR 1.740, 95% CI 1.309-2.313), coronary artery disease (OR 1.417, 95% CI 1.017-1.975), chronic atrial fibrillation (OR 4.010, 95% CI 1.757-9.152), admission anemia (OR 1.433, 95% CI 1.051-1.953) are the independent risk factors for preoperative AHF in elderly patients with hip fracture (p < 0.05). The HF group exhibited a higher incidence of postoperative complications, such as anemia, arrhythmia, NOAF (new-onset atrial fibrillation), AIS (acute ischemic stroke), electrolyte disturbance and hypoproteinemia. The moderate-to-severe anemia group had a higher incidence of postoperative complications, including deep vein thrombosis of the lower limbs, NOAF, and hypoproteinemia, as well as all-cause mortality.

CONCLUSION

Older patients combined with admission anemia, coronary artery disease, chronic atrial fibrillation are more likely to have preoperative AHF after hip fracture. For such patients, early and effective identification and strengthening perioperative management can avoid the occurrence of adverse events. For patients with moderate and severe anemia at admission, timely intervention is recommended to reduce postoperative complications and mortality.

A Contemporary Review on Heart Failure with Preserved Ejection Fraction: Epidemiology, Diagnosis, and Management

Heart failure with preserved ejection fraction (HFpEF) includes almost half of heart failure cases typified by a specific clinical syndrome. Despite diagnostic and management advances, HFpEF still presents a diagnostic challenge and a paucity of therapies specifically aimed at enhancing survival and improving quality of life is still lacking. This review elucidates the diagnostic complexity of HFpEF, highlighting the use of both subjective and objective criteria within algorithmic frameworks. It also examines the significant impact of comorbidities on the progression of HFpEF. Additionally, we explore the latest evidence on targeting these comorbidities therapeutically, although the benefits to mortality are still limited.

Back Up at the Pump? I Have a Gut Feeling About This: A Review of the Gastrointestinal Manifestations From Congestive Heart Failure

Heart failure, which is a clinical syndrome characterized by the heart's inability to maintain adequate cardiac output, is known to affect various organ systems in the body due to its ischemic nature and activation of the systemic immune response, but the resultant complications specifically on the gastrointestinal tract and the liver are not well discussed and poorly understood. Gastrointestinal-related phenomena are common symptoms experienced in patients with heart failure and frequently found to increase morbidity and mortality in these populations. The relationship between the gastrointestinal tract and heart failure are strongly linked and influence each other much so that the bidirectional association of the two is oftentimes referred to as cardiointestinal syndrome. Manifestations include gastrointestinal prodrome, bacterial translocation and protein-losing gastroenteropathy by gut wall edema, cardiac cachexia, hepatic insult and injury, and ischemic colitis. More attention is needed from a cardiology perspective to recognize these common presenting gastrointestinal phenomena that affect much of our patient population with heart failure. In this overview, we describe the association between heart failure and the gastrointestinal tract, the pathophysiology, lab findings, clinical manifestations and complications, and the management involved.

Assessing platelet-derived extracellular vesicles for potential as therapeutic targets in cardiovascular diseases

INTRODUCTION

Cardiovascular disease (CVD) is the leading cause of death worldwide. Platelet-derived extracellular vesicles (PEV) have attracted extensive attention in cardiovascular disease research in recent years because their cargo is involved in a variety of pathophysiological processes, such as thrombosis, immune response, promotion or inhibition of inflammatory response, promotion of angiogenesis as well as cell proliferation and migration.

AREAS COVERED

This review explores the role of PEV in various cardiovascular diseases (such as atherosclerosis, myocardial infarction, ischemia-reperfusion injury, and heart failure), with relation to its molecular cargo (nucleic acids, bioactive lipids, proteins) and aims to provide new insights in the pathophysiologic role of PEV, and methods for preventing and treating cardiovascular diseases based on PEV.

EXPERT OPINION

Studies have shown that the cargo of PEV may be dysregulated during cardiovascular disease and delivery to tissues can result in detrimental pathophysiologic effects. Counteracting this process might have the potential to inhibit inflammation, promote angiogenesis, and inhibit cardiomyocyte death. In addition, PEV have potential as biocompatible and autologous drug carriers. Therefore, better research on the mechanisms how PEV act during cardiovascular disease and could be implemented as a therapeutic will provide new perspectives for the treatment of cardiovascular disease.

Gender differences in efficiency of the telemedicine care of heart failure patients. The results from the TeleEduCare-HF study

Introduction

The aim of this study was to implement a model of healthcare for patients with heart failure (HF) and to assess the differences between men and women in the study population.

Material and methods

Through care and an extensive educational panel (dietary recommendations, physical activity, titration of diuretics, psychological support), emphasis was placed on prevention. All patients had a baseline cardiology consultation with recommendations regarding treatment, self-care, diet, and exercise. Based on regular measurements of weight and blood pressure HF patients were telemonitored by nurses, primary care physicians and referred to cardiologists when necessary. The questionnaire was conducted in all patients at baseline after enrollment to the study and after 3 months of telemonitoring and extensive educational process.

Results

The study finally included 140 men with an average age of 66 years (SD: 56-71) and 163 women with an average age of 64 years (58-72). The ischemic origin of HF was present in 78% of men and 73% of women (p = 0.40), and 31% of men and 16% of women declared myocardial infarction in the past (p = 0.002). Men more often survived sudden cardiac arrest (7.8% vs. 1.2%; p = 0.004) and had implantable cardiac devices compared to women (16% vs. 3%; p = 0.001). Male patients reported significantly more often alcohol consumption, smoking, and less frequently any physical activity. Women significantly more often than men suffered from cancer, depression, and thromboembolic events and less frequently from obstructive sleep apnea. The mean left ventricular ejection fraction (LVEF) was 43% (SD: 30-58) for men, and 57% (45-63) for women (p = 0.0001), and women suffered mainly from heart failure with preserved ejection fraction. There were no differences between genders regarding the number of hospitalizations in last 12 months. The men, despite lower LVEF, felt short of breath/tired when climbing the stairs up than women (3 [2-4] vs. 2 floors [1-3]; p = 0.001), had higher distance in meters when walking on flat ground (400 [200-400] vs. 300 m [100-400]; p = 0.0001), and less frequently had to get up to go to the toilet at night (p = 0.03). Men also suffered significantly less often from shortness of breath at rest, swelling of the lower limbs and shortness of breath that wakes them up at night. Only 35% of men and 19% of women had HF self-care training, and only 35% of men and 46% of women knew how to increase the dose of diuretic on their own if shortness of breath or swelling increases. Based on the EuroQol-5 dimensions 5-levels questionnaire, significantly more women than men reported moderate and serious problems with moving around, serious problems with performing ordinary activities independently as well as moderate and serious pain problem and a significant level of anxiety. Men more often than women reported serious problems with self-care.

Conclusions

Women suffer more often from HF symptoms and have worse quality of life assessed in EQ-5D-5L than men despite their higher LVEF.

Integration of Microarray Data and Single-Cell Sequencing Analysis to Explore Key Genes Associated with Macrophage Infiltration in Heart Failure

Background

Cardiac macrophages are a heterogeneous population with high plasticity and adaptability, and their mechanisms in heart failure (HF) remain poorly elucidated.

Methods

We used single-cell and bulk RNA sequencing data to reveal the heterogeneity of non-cardiomyocytes and assess the immunoreactivity of each subpopulation. Additionally, we employed four integrated machine learning algorithms to identify macrophage-related genes with diagnostic value, and in vivo validation was performed. To assess the immune infiltration characteristics in HF, we utilized the CIBERSORT and single sample gene set enrichment analysis (ssGSEA). An unsupervised consensus clustering algorithm was applied to identify the macrophage-related HF subtypes. Furthermore, the scMetabolism was employed to explore the specific metabolic patterns of the macrophage subtypes. Finally, CellChat was used to investigate cell-cell interactions among the identified subtypes.

Results

The immunoreactivity score of macrophages in the HF was higher than that in the other cell types. GSEA of macrophage clusters indicated a significant enrichment of leukocyte-mediated immune processes, antigen processing, and presentation. The intersection of the results from machine learning revealed that SERPINA3, GPAT3, ANPEP, and FCER1G can serve as feature genes and form a diagnostic model with a good predictive capability. Unsupervised consensus clustering algorithms reveal the immune and metabolic subtypes of macrophages. The metabolic heterogeneity of macrophage subpopulations can lead to macrophage polarization into different types, which may be related to the metabolic reprogramming between glycolysis and mitochondrial oxidative phosphorylation. Cellular communication revealed that macrophages form a network of interactions with neutrophils to support each other's functions and maintenance. The complex efferent and afferent signals are closely associated with myocardial fibrosis.

Conclusion

SERPINA3, GPAT3, ANPEP, and FCER1G can potentially serve as immune therapeutic targets and central biomarkers. The immunological and metabolic heterogeneity of macrophages may offer a more precise direction to explore the mechanisms underlying HF and novel immunotherapies.

Network pharmacology integrated with experimental validation to elucidate the mechanisms of action of the Guizhi-Gancao Decoction in the treatment of phenylephrine-induced cardiac hypertrophy

CONTEXT

The mechanisms of Traditional Chinese Medicine (TCM) Guizhi-Gancao Decoction (GGD) remain unknown.

OBJECTIVE

This study explores the mechanisms of GGD against cardiac hypertrophy.

MATERIALS AND METHODS

Network pharmacology analysis was carried out to identify the potential targets of GGD. In vivo experiments, C57BL/6J mice were divided into Con, phenylephrine (PE, 10 mg/kg/d), 2-chloroadenosine (CADO, the stable analogue of adenosine, 2 mg/kg/d), GGD (5.4 g/kg/d) and GGD (5.4 g/kg/d) + CGS15943 (a nonselective adenosine receptor antagonist, 4 mg/kg/d). In vitro experiments, primary neonatal rat cardiomyocytes (NRCM) were divided into Con, PE (100 µM), CADO (5 µM), GGD (10-5 g/mL) and GGD (10-5 g/mL) + CGS15943 (5 µM). Ultrasound, H&E and Masson staining, hypertrophic genes expression and cell surface area were conducted to verify the GGD efficacy. Adenosine receptors (ADORs) expression were tested via real-time polymerase chain reaction (PCR), western blotting and immunofluorescence analysis.

RESULTS

Network pharmacology identified ADORs among those of the core targets of GGD. In vitro experiments demonstrated that GGD attenuated PE-induced increased surface area (with an EC50 of 5.484 × 10-6 g/mL). In vivo data shown that GGD attenuated PE-induced ventricular wall thickening. In vitro and in vivo data indicated that GGD alleviated PE-induced hypertrophic gene expression (e.g., ANP, BNP and MYH7/MYH6), A1AR over-expression and A2aAR down-expression. Moreover, CADO exerts effects similar to GGD, whereas CGS15943 eliminated most effects of GGD.

DISCUSSION AND CONCLUSIONS

Our findings suggest the mechanism by which GGD inhibits cardiac hypertrophy, highlighting regulation of ADORs as a potential therapeutic strategy for HF.

The Icelandic Heart Failure Registry-A nationwide assessment tool for HF care and intervention in HF treatment

INTRODUCTION

The incidence of heart failure (HF) is increasing, largely because populations are both ageing and growing. Most clinical HF treatment trials are conducted on selected cohorts, only a few of which include elderly patients, among whom HF is common. HF registries can include all HF patients, independent of age or comorbidity profile, and thus reflect reality in healthcare management.

METHODS

The Icelandic Heart Failure Registry (IHFR) was created in the autumn of 2019 and has operated since 1 January 2020. Based on the Swedish Heart Failure Registry (SwedeHF), it quickly acquired several extensions. All patients admitted for HF to the Department of Cardiology (DC) at Landspítali - The National University Hospital of Iceland are included. Several variables are collected, including the aetiology of HF, comorbidities, clinical assessment at admission, blood tests, imaging results, treatment given and medical therapy at discharge.

RESULTS

During the 3 years from 2020 to 2022, the DC admitted 1890 patients. As some were readmitted during the study period, the true total was 2384 admissions. Because the IHFR 2023 edition includes 327 variables, automation of many of them is imperative for data collection.

CONCLUSION

HF is a heterogenous disease with numerous underlying factors. HF management differs among HF phenotypes. A registry can serve as an unbiased indicator of care quality and has the potential to be studied in the future to assess the long-term effects of HF treatment. A registry like the IHFR, therefore, can impact the treatment of all patients recorded in it, reduce the rate of readmissions and even optimize HF management costs.

Utility of cardiac implantable electronic device algorithm for detecting severe sleep-disordered breathing in cardiomyopathy

Background

Half of patients with heart failure are estimated to have sleep-disordered breathing (SDB). However, many are undiagnosed as they do not report typical symptoms. This study aims to evaluate the implantable cardiac defibrillator (ICD) sleep-disordered breathing algorithm in a cohort of multi-racial Asian patients for detection of SDB against polysomnography (PSG).

Methods

In this prospective pilot study, participants who fulfill the American College of Cardiology (ACC) indication for ICD were recruited. The ICD algorithm uses transthoracic impedance sensing to calculate respiratory disturbance index (RDI).

Results

Twenty-four patients were enrolled between August 2020 and December 2021. All patients underwent PSG exams and were followed up for up to 12 months. Eighteen participants completed the PSG study as of August 23, 2022. Severe SDB (defined as PSG-AHI ≥30 episodes/h) was diagnosed in 66.7% of the patients. No significant direct linear correlation was found between the PSG-AHI measurements and the RDI measurements (adjusted r 2 = .224, r = .473, p = .027). Applying a binary threshold cut-off RDI value of 32 episodes/h for the detection of severe SDB yielded a sensitivity of 91.7% and specificity of 16.7%.

Conclusions

Transthoracic impedance sensing with an advanced inbuilt algorithm may be helpful as a screening test in detecting severe SDB in patients with heart failure and cardiomyopathy, potentially by applying a binary threshold cut-off value. This is the first study known to validate the algorithm in an exclusively multi-ethnic Asian population with heart failure.

Mesenchymal stromal cells to treat patients with non-ischaemic heart failure: Results from SCIENCE II pilot study

AIMS

Allogeneic stem cell therapy is more logistically suitable compared with autologous cell therapy for large-scale patient treatment. We aim to investigate the clinical safety and efficacy profile of the allogeneic adipose tissue derived mesenchymal stromal cell product (CSCC_ASC) as an add-on therapy in patients with chronic non-ischaemic heart failure with reduced left ventricular ejection fraction (HFrEF) < 40%.

METHODS AND RESULTS

This is a single-centre investigator-initiated randomized phase I/II study with direct intra-myocardial injections of 100 million allogeneic CSCC_ASC. A total of 30 HFrEF patients with New York Heart Association (NYHA) class ≥II despite optimal anticongestive heart failure medication and plasma NT-proBNP > 300 pg/mL (>35 pmol/L) were included and randomized 2:1 to CSCC_ASC or standard care. The primary endpoint left ventricular end systolic volume (LVESV) and other echo related parameters were analysed by an investigator blinded for treatment allocation. No difference in serious adverse events was observed between groups. LVESV decreased significantly from baseline to 6 months follow-up in the ASC group (153.7 ± 53.2 mL and 128.7 ± 45.6 mL, P < 0.001) and remained unchanged in the standard care group (180.4 ± 39.4 mL and 186.7 ± 48.9 mL, P = 0.652). There was a significant difference between the groups in LVESV change (31.3 ± 11.0 mL, P = 0.009). The difference from baseline to follow-up between the two groups in left ventricular end diastolic volume (LVEDV) was 18.7 ± 12.4 mL, P = 0.146 and in left ventricular ejection fraction (LVEF) -7.8 ± 2.1%, P = 0.001. Considering the baseline values of LVESV, LVEDV and LVEF as covariates, the difference between groups for change from baseline to follow-up resulted in a P-value of 0.056, 0.076, and 0.738, respectively. NYHA class and self-reported health did also improve significantly in the ASC group compared with the standard care group (0.7 ± 0.2, P = 0.001 and -12.8 ± 5.3, P = 0.025; respectively). There was no difference in NT-proBNP (-371 ± 455 pmol/L, P = 0.422) or in 6 min walk test (12 ± 31 m, P = 0.695) between groups.

CONCLUSIONS

Intramyocardial injections of allogeneic CSCC_ASC in patients with chronic non-ischaemic HFrEF was safe and improved LVESV, LVEF, NYHA class, and self-reported health compared with standard care group.

Obesity paradox in patients with reduced ejection fraction eligible for device implantation - an observational study

AIMS

Patients with obesity have an overall higher cardiovascular risk, at the same time obesity could be associated with a better outcome in a certain subgroup of patients, a phenomenon known as the obesity paradox. Data are scarce in candidates for cardiac resynchronization therapy (CRT). We aimed to investigate the association between body mass index (BMI) and all-cause mortality in patients eligible for CRT.

METHODS

Altogether 1,585 patients underwent cardiac resynchronization therapy between 2000-2020 and were categorized based on their BMI, 459 (29%) patients with normal weight (BMI < 25 kg/m2), 641 (40%) patients with overweight (BMI 25- < 30 kg/m2) and 485 (31%) with obesity (BMI ≥ 30 kg/m2). The primary endpoint was all-cause mortality, heart transplantation, and left ventricular assist device implantation. We assessed periprocedural complications and 6-month echocardiographic response.

RESULTS

Normal-weight patients were older compared to patients with overweight or obesity (70 years vs. 69 years vs. 68 years; P ‹0.001), respectively. Sex distribution, ischaemic aetiology, and CRT-D implantation rates were similar in the three patient groups. Diabetes mellitus (BMI < 25 kg/m2 26% vs. BMI 25- < 30 kg/m2 37% vs. BMI ≥ 30 kg/m2 48%; P ‹0.001) and hypertension (BMI < 25 kg/m2 71% vs. BMI 25- < 30 kg/m2 74% vs. BMI ≥ 30 kg/m2 82%; P ‹0.001) were more frequent in patients with overweight and obesity. During the mean follow-up time of 5.1 years, 973 (61%) reached the primary endpoint, 66% in the BMI < 25 kg/m2 group, 61% in the BMI 25- < 30 kg/m2 group and 58% in the BMI ≥ 30 kg/m2 group (log-rank P‹0.05). Patients with obesity showed mortality benefit over normal-weight patients (HR 0.78; 95%CI 0.66-0.92; P = 0.003). The obesity paradox was present in patients free from diabetes, atrial fibrillation, and ischemic events. Periprocedural complication rates did not differ in the three groups (BMI < 25 kg/m2 25% vs. BMI 25- < 30 kg/m2 28% vs. BMI ≥ 30 kg/m2 26%; P = 0.48). Left ventricular ejection fraction improved significantly in all patient groups (BMI < 25 kg/m2 median ∆ -LVEF 7% vs. BMI 25- < 30 kg/m2 median ∆ -LVEF 7.5% vs. BMI ≥ 30 kg/m2 median ∆ -LVEF 6%; P < 0.0001) with a similar proportion of developing reverse remodeling (BMI < 25 kg/m2 58% vs. BMI 25- < 30 kg/m2 61% vs. BMI ≥ 30 kg/m2 57%; P = 0.48); P = 0.75).

CONCLUSIONS

The obesity paradox was present in our HF cohort at long-term, patients underwent CRT implantation with obesity and free of comorbidities showed mortality benefit compared to normal weight patients. Patients with obesity showed similar echocardiographic response and safety outcomes compared to normal weight patients.

[Chronic Heart Failure: Focus on Differences Between Men and Women]

This review focuses on the sex-related differences of patients in etiological factors, clinical picture, and objective laboratory and instrumental signs of heart failure. The authors performed an analysis of the effectiveness of drug and non-drug treatments depending on the gender of patients with low and preserved left ventricular ejection fraction, which should improve the quality of medical care and outcomes in patients with heart failure.

Correlation of the FIB-4 Liver Biomarker Score with the Severity of Heart Failure

Background and Objectives: Heart failure is associated with high morbidity and mortality and linked with several pre-existing health conditions and risk factors. Early detection and prompt management in heart failure improves patient outcomes. Liver involvement is associated with heart failure disease progression, and hence liver biomarkers and liver fibrosis may have a prognostic impact. Several blood test based markers and scoring systems estimate liver fibrosis and hence can be useful prognostic tools. Materials and Methods: We retrospectively analyzed a series of 303 patients with decompensated heart failure in a city in western Romania over a period of 6 months. Several biochemical parameters were measured, the FIB-4 score was estimated and echocardiography was performed. Results for targeted variables are presented using descriptive statistics. Patients were analyzed based on their LVEF categories. Statistical analysis was based on ANOVA one-way tests for continuous variables and Chi-square tests for categorical variables. Pairwise comparisons were performed based on Bonferroni adjusted significance tests. The correlations between FIB-4 score, LVEF and NT-pro BNP in patients with and without diabetes and hypertension were explored using Spearman's correlation coefficient. Result: Age, gender, NYHA class, death, history of (h/o) type 2 diabetes mellitus (T2DM), h/o coronary artery disease (CAD), h/o arrhythmias, sodium, potassium, creatinine, eGFR, uric acid, NT-pro BNP, left atrial volume, LDL, HDL, and TG were analyzed by LVEF categories using ANOVA one-way tests, Chi-square tests, and Bonferroni correction comparisons. We found a strong statistically significant correlation between each of NT-pro BNP, left atrial volume, LDL, and HDL with the LVEF categories. Discussion: Early detection of cardiac dysfunction leads to better management in patients with cardiovascular risk factors including diabetes and hypertension. High LDL and low HDL levels contribute to a reduction in left ventricular (LV) function. Available literature suggests the FIB-4 score as superior to other non-invasive markers of fibrosis. It utilizes the patient's age, platelet count, AST, and ALT, which can be available retrospectively, making it an easy and inexpensive tool. FIB-4 score has a few limitations. Conclusions: Our study has shown a statistically significant positive correlation between severity categories of LVEF and FIB-4 score for heart failure patients with and without diabetes, and for heart failure patients with or without hypertension. We propose the implementation of FIB-4 score as a prognostic tool for heart failure.

The use of four-pillar regimen for heart failure management: results from the Jordanian Heart Failure Registry (JoHFR)

Background

Heart failure (HF) is a complex cardiovascular disease. Effective management typically involves four main medications: angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers, angiotensin receptor-neprilysin inhibitors, and mineralocorticoid receptor antagonists, along with sodium-glucose co-transporter-2 inhibitors (SGLT2i). The primary objective of this article is to assess and identify the utilization of four-pillar regimen for HF managment and explore the characteristics of the patients being on the four-pillar regimen in Jordan.

Methods

Data from the Jordanian HF registry (JoHFR) was analyzed, encompassing records of HF patients treated in various cardiology centers from 2021 to 2023.

Results

The medical records of 2,151 patients with HF who were admitted to cardiology centers throughout Jordan were collected. Males comprised 58.0% of the included patients. Moreover, 71.0% of patients had chronic HF, whereas the rest, 29.0%, had acute HF. Of these, only 0.6% received the complete four-pillar treatment of HF. Beta-blockers were the most frequently used medication, prescribed to 74% of patients, while SGLT2i were the least common, used by only 9%. Notably, patients with type 2 diabetes were more likely to be on the four-pillar regimen (P-value = 0.016). Additionally, patients with a glomerular filtration rate (GFR) below 60 were more likely to be treated using the four-pillar (P-values = 0.044). The analysis revealed no significant difference in mortality rates between the two groups (P-value = 0.475).

Conclusion

Our study demonstrated an overall low utilization of the four-pillar regimen for HF treatment in Jordan with several patients' characteristics associated with it. This highlight the need for enhanced collaborative effort and governmental initiatives to address the challenges of the low utilization of these medications.

Influence of an Alternative Diagnosis on the Diagnosis of Pulmonary Thromboembolism

BACKGROUND

The diagnosis of pulmonary embolism (PE) is based on the application of a priori probability scales such as the Wells scale or PERC. However, the clinical heterogeneity of this pathology results in the absence of a target population to apply these algorithms. The Wells score does consider the possibility of an alternative diagnosis, awarding an additional point if no other diagnosis is likely, yet the presence of objective alternative diagnoses can still complicate clinical assessment and lead to unnecessary testing or missed diagnoses.

OBJECTIVE

The aim of this study is to evaluate the discrimination capacity of clinical objective factors with a high negative predictive value for PE, compared to PERC in terms of reducing unnecessary testing across different risk strata of the Wells scale.

MATERIALS AND METHODS

This was a single-center retrospective cohort study, including patients who underwent chest CT angiography to rule out PE at a university hospital between 2008 and 2017, considering the presence of PE as the study outcome. The study collected demographic data, comorbidities, and clinical presentation data. The presence of objective criteria for pneumonia, heart failure, exacerbation of COPD, or the use of anticoagulation in non-oncological patients were considered a priori criteria with a high negative predictive value.

RESULTS

The analyses were performed on a cohort of 399 patients with an average age of 65 years and 53% females. A total of 139 patients were diagnosed with PE by CT angiography. The presence of factors with a high NPV showed a sensitivity of 100% in low-risk patients according to Wells, with sensitivity dropping below 50% in other populations. The association of these factors in the PERC plus criteria would allow a reduction of up to 34% in CT angiographies in patients with low risk according to the Wells scale.

CONCLUSIONS

The combination of risk stratification of the Wells scale and PERC plus criteria allows an absolute reduction of 34.3% in the performance of CT angiographies in patients classified as low risk with a sensitivity and a negative predictive value of 100%. The preexistence of an alternative diagnosis does not allow ruling out PE in patients with intermediate or high risk according to the Wells scale.

Impact and consequences of the error of estimated GFR in patients with heart failure

Heart failure is a highly prevalent disease, which courses with frequent readmissions, mainly by Acute Heart Failure (AHF). Reduced renal function is associated with increased mortality in patients with HF. Therefore, an accurate and precise evaluation of renal function in patients with HF is crucial. The error of estimated GFR (eGFR) is wide and common, showing a ± 30% variability compared to measured GFR (mGFR). However, there is no evidence on the error of formulas in reflecting real renal function and particularly the consequences of this error in patients with AHF. This is a prospective study comparing the impact of mGFR versus eGFR in the onset of cardiovascular (CV) outcomes in patients with AHF. This was tested with cox survival analysis. Measured GFR was determined by the plasma clearance of iohexol-dbs and eGFR by Cockroft-Gould, MDRD, CKD-EPI creatinine, CKD-EPI cystatin-C and CKD-EPI creatinine + cystatin-C equations formulas. Also the agreement between mGFR and eGFR was analyzed. A total of 90 patients were included. Average age was 66 (± 12 years) and 52 (58%) were male. Of them 53 patients (59%) had a cardiovascular event during follow-up, 22 fatal (41%). The agreement between mGFR and eGFR indicated moderate precision and accuracy (concordance correlation coefficient of 0.77; CI = 0.73-0.82). In multiple cox survival analysis, mGFR was significantly associated with cardiovascular events together with NTproBNP, BMI, LVEF and previous coronary artery disease (p = 0.037; HR = 0.98, 95% CI = 0.95-0.99). Estimated GFR by formulas was not significant. In patients with AHF the error of formulas is large, frequent and random, also, mGFR and not eGFR predicted future CV events. The error of eGFR may have clinical consequences in specific subpopulations.

Investigation of the efficacy of Dengzhan Shengmai capsule against heart failure with preserved ejection fraction

ETHNOPHARMACOLOGICAL RELEVANCE

Heart failure with preserved ejection fraction (HFpEF) has emerged as a condition with high incidence and mortality rates in recent years. Dengzhan Shengmai capsule (DZSMC) is a Chinese patent medicine based on the classic recipe "Shengmai powder". The relevant Chinese medicine ratio of Erigeron breviscapus (Vaniot) Hand.-Mazz., Panax ginseng C.A.Mey., Schisandra chinensis (Turcz.) Baill., and Ophiopogon japonicus (Thunb.) Ker Gawl. Is 30 : 6: 6 : 11. Traditional Chinese medicine (TCM) is being increasingly explored as a safe and effective treatment modality for HFpEF. Clinical studies have shown that DZSMCs can effectively treat heart failure, however, the mechanism of action of DZSMCs in the treatment of HFpEF are still not clear.

AIM OF THE STUDY

To investigate the efficacy and underlying mechanisms of Dengzhan Shengmai capsule (DZSMC), in the treatment of HFpEF by focusing on its ability to treat microvascular inflammation.

MATERIALS AND METHODS

First, the efficacy of DZSMCs against HFpEF was predicted by network pharmacology. After 3 days of adaptive feeding in SPF-grade polypropylene cages, the mice in the Model group, DZSMC group, and Captopli group underwent single kidney resection, and micropumps were implanted in their backs for continuous infusion of aldosterone at a rate of 0.3 μg/h for 4 weeks. Moreover, the mice were given DZSMCs or Captopli via oral gavage for four weeks. Overall, cardiac function was evaluated in mice, and cardiac ultrasound and blood biochemical indices were evaluated in HFpEF mice.

RESULTS

DZSMCs can ameliorate myocardial hypertrophy and cardiomyocyte damage caused by excessive myocardial stress, ultimately mitigating long-term cardiac impairment; it aids in the restoration of myocardial fibre proliferation and enhances mitochondrial morphology and function. In a murine model of ventricular hypertrophy and left ventricular dysfunction, which are indicative of cardiac insufficiency, the administration of DZSMCs resulted in notable improvements. Echocardiographic and overall assessments of cardiac function revealed a reduction in cardiac dysfunction and ventricular hypertrophy post-DZSMC intervention. Moreover, intervention with DZSMCs led to a reduction in the serum levels of several markers associated with chronic systemic inflammation, such as sST2, IL1RL1, CRP, and IL-6. Simultaneously, the levels of indicators of microvascular inflammation, including VCAM and E-SELECTIN, also decreased following DZSMC intervention. These findings suggest the potential multifaceted impact of DZSMCs in alleviating cardiac abnormalities, mitigating systemic inflammation, and reducing microvascular inflammatory markers, highlighting their promising therapeutic role in managing myocardial health.

CONCLUSIONS

These results provide novel evidence that DZSMCs improve HFpEF by regulating microvascular inflammation.

Baricitinib alleviates cardiac fibrosis and inflammation induced by chronic sympathetic activation

Cardiac fibrosis is characterized by the over-proliferation, over-transdifferentiation and over-deposition of extracellular matrix (ECM) of cardiac fibroblasts (CFs). Cardiac sympathetic activation is one of the leading causes of myocardial fibrosis. Meanwhile, cardiac fibrosis is often together with cardiac inflammation, which accelerates fibrosis by mediating inflammatory cytokines secretion. Recently, the Janus kinase/signal transducer and activator of transcription (JAK/STAT3) signaling pathway has been confirmed by its vital role during the progression of cardiac fibrosis. Thus, JAK/STAT3 signaling pathway is thought to be a potential therapeutic target for cardiac fibrosis. Baricitinib (BR), a novel JAK1/2 inhibitor, has been reported excellent effects of anti-fibrosis in multiple fibrotic diseases. However, little is known about whether and how BR ameliorates cardiac fibrosis caused by chronic sympathetic activation. Isoproterenol (ISO), a β-Adrenergic receptor (β-AR) nonselective agonist, was used to modulate chronic sympathetic activation in mice. As expected, our results proved that BR ameliorated ISO-induced cardiac dysfunction. Meanwhile, BR attenuated ISO-induced cardiac fibrosis and cardiac inflammation in mice. Moreover, BR also inhibited ISO-induced cardiac fibroblasts activation and macrophages pro-inflammatory secretion. As for mechanism studies, BR reduced ISO-induced cardiac fibroblasts by JAK2/STAT3 and PI3K/Akt signaling, while reduced ISO-induced macrophages pro-inflammatory secretion by JAK1/STAT3 and NF-κB signaling. In summary, BR alleviates cardiac fibrosis and inflammation caused by chronic sympathetic activation. The underlying mechanism involves BR-mediated suppression of JAK1/2/STAT3, PI3K/Akt and NF-κB signaling.

Prognostic value of lymphocyte to C-reactive protein ratio for cardiovascular and all-cause mortality in adults with congestive heart failure in the United States: NHANES 1999-2010

Background

Lymphocyte to C-reactive protein ratio (LCR) is an emerging inflammatory biomarker, but its association with prognosis in individuals with congestive heart failure (CHF) remains unclear. We sought to evaluate the relationship between LCR and cardiovascular (CV) and all-cause mortality in individuals diagnosed with CHF.

Methods

We included 718 CHF individuals, using NHANES 1999-2010 data. ROC curves were used to compare the prognostic value of LCR, C-reactive protein, and lymphocyte counts for 3-year, 5-year, and 10-year CV and all-cause mortality risk. The population was divided into 4 groups based on the value of LCR according to the quartile. Prognosis analysis utilized the Kaplan-Meier method and Cox-regression analysis while accounting for NHANES recommended weights.

Results

Kaplan-Meier curves demonstrated a significantly worse prognosis in the low LCR group compared to the high LCR group (log-rank test; p < 0.001). For 3-year CV mortality, the multivariable-adjusted hazard ratios [95 % confidence interval] for LCR quartiles (Q 2,3,4 vs Q 1) were 0.43 (0.21-0.87), 0.38 (0.13-1.07), 0.34 (0.13-0.88), (P for trend = 0.033). For 3-year all-cause mortality, aHRs were 0.36 (0.22-0.60), 0.51 (0.29-0.89), 0.35 (0.18-0.64), (P for trend = 0.002). Similar findings were observed for 5- and 10-year CV and all-cause mortality.

Conclusions

Elevated LCR emerged as an independent prognostic factor for CV and all-cause mortality in individuals with CHF. Moreover, the implementation of anti-inflammatory therapy exhibits the potential to improve outcomes for decreased LCR patients with CHF.

Association between Long-Term Exposure to Traffic-Related Air Pollution and Cardio-Metabolic Phenotypes: An MRI Data-Based Analysis

Long-term exposure to traffic-related air pollution (TRAP) is associated with cardiometabolic disease; however, its role in subclinical stages of disease development is unclear. Thus, we aimed to explore this association in a cross-sectional analysis, with cardiometabolic phenotypes derived from magnetic resonance imaging (MRI). Phenotypes of the left (LV) and right cardiac ventricle, whole-body adipose tissue (AT), and organ-specific AT were obtained by MRI in 400 participants of the KORA cohort. Land-use regression models were used to estimate residential long-term exposures to TRAP, e.g., nitrogen dioxides (NO2) or particle number concentration (PNC). Associations between TRAP and MRI phenotypes were modeled using linear regression. Participants' mean age was 56 ± 9 years, and 42% were female. Long-term exposure to TRAP was associated with decreased LV wall thickness; a 6.0 μg/m3 increase in NO2 was associated with a -1.9% [95% confidence interval: -3.7%; -0.1%] decrease in mean global LV wall thickness. Furthermore, we found associations between TRAP and increased cardiac AT. A 2,242 n/cm3 increase in PNC was associated with a 4.3% [-1.7%; 10.4%] increase in mean total cardiac AT. Associations were more pronounced in women and in participants with diabetes. Our exploratory study indicates that long-term exposure to TRAP is associated with subclinical cardiometabolic disease states, particularly in metabolically vulnerable subgroups.

Loop diuretic therapy with or without heart failure: impact on prognosis

BACKGROUND AND AIMS

Many patients are prescribed loop diuretics without a diagnostic record of heart failure. Little is known about their characteristics and prognosis.

METHODS

Glasgow regional health records (2009-16) were obtained for adults with cardiovascular disease or taking loop diuretics. Outcomes were investigated using Cox models with hazard ratios adjusted for age, sex, socioeconomic deprivation, and comorbid disease (adjHR).

RESULTS

Of 198 898 patients (median age 65 years; 55% women), 161 935 (81%) neither took loop diuretics nor had a diagnostic record of heart failure (reference group), 23 963 (12%) were taking loop diuretics but had no heart failure recorded, 7844 (4%) had heart failure recorded and took loop diuretics, and 5156 (3%) had heart failure recorded but were not receiving loop diuretics. Compared to the reference group, five-year mortality was only slightly higher for heart failure in the absence of loop diuretics [22%; adjHR 1.2 (95% CI 1.1-1.3)], substantially higher for those taking loop diuretics with no record of heart failure [40%; adjHR 1.8 (95% CI 1.7-1.8)], and highest for heart failure treated with loop diuretics [52%; adjHR 2.2 (95% CI 2.0-2.2)].

CONCLUSIONS

For patients with cardiovascular disease, many are prescribed loop diuretics without a recorded diagnosis of heart failure. Mortality is more strongly associated with loop diuretic use than with a record of heart failure. The diagnosis of heart failure may be often missed, or loop diuretic use is associated with other conditions with a prognosis similar to heart failure, or inappropriate loop diuretic use increases mortality; all might be true.

Association between biomarkers of zinc and copper status and heart failure: a meta-analysis

AIMS

Previous studies have investigated the relationship between heart failure (HF) and levels of zinc and copper, but conflicting results have been reported. This meta-analysis aims to clarify the role of zinc and copper in HF progression by examining the associations between HF and concentrations of these minerals.

METHODS AND RESULTS

We utilized STATA 12.0 software to calculate the standard mean difference (SMD) and 95% confidence interval (CI) for serum zinc and copper levels in patients with HF compared with healthy controls (HCs). The meta-analysis indicated a lower serum zinc level in patients with HF compared with HCs, using a random effects model (SMD = -0.77; 95% CI: -1.01, -0.54; I2 = 61.9%, the P-value for Q test = 0.002). Additionally, the meta-analysis showed an increased serum copper level in patients with HF compared with HCs, using a random effects model (SMD = 0.66; 95% CI: 0.09, 1.23; I2 = 93.8%, the P-value for Q test < 0.001). Meta-regression analysis indicated that publication year, age, and gender were not responsible for heterogeneity across studies.

CONCLUSIONS

This meta-analysis demonstrates that patients with HF have lower serum zinc and higher copper concentrations compared with healthy subjects. However, the potential of zinc supplementation as a therapy for HF should be approached with caution. The heterogeneity among the included studies was found to be high. It is recommended that further well-designed large sample studies be conducted to validate these findings.