Badagliacca R, Tello K, D'Alto M
… +35 more, Ghio S, Argiento P, Brunetti ND, Casamassima V, Casu G, Cedrone N, Confalonieri M, Corda M, Correale M, D'Agostino C, De Michele L, Filomena D, Galgano G, Greco A, Lombardi CM, Madonna R, Manzi G, Mercurio V, Mihai A, Mulè M, Paciocco G, Papa S, Rako ZA, Recchioni T, Richter M, Romaniello A, Romeo E, Scelsi L, Stolfo D, Vitulo P, Yogeswaran A, Naeije R, Benza RL, Vizza CD, Italian Pulmonary Hypertension Network (iPHNET) and the Giessen PH Registry
BACKGROUND: Right ventricular functional adaptation to afterload is a major determinant of outcome in pulmonary arterial hypertension (PAH). We aimed to investigate if right ventricular-pulmonary artery (PA) coupling eva...BACKGROUND: Right ventricular functional adaptation to afterload is a major determinant of outcome in pulmonary arterial hypertension (PAH). We aimed to investigate if right ventricular-pulmonary artery (PA) coupling evaluated by the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (sPAP) improves risk assessment scores for survival prediction. METHODS: A total of 677 consecutive patients with PAH (55% idiopathic) were prospectively enrolled with follow-up clinical, right heart catheterization, and echocardiographic evaluations within 12 months (interquartile range, 180-344 days) after initiation of targeted therapies in 11 Italian centers. European Society of Cardiology/European Respiratory Society guidelines-derived risk scores and REVEAL 2.0 (US Registry to Evaluate Early and Long-Term PAH Disease Management 2.0) risk scores were collected at baseline and follow-up. 254 consecutive patients with PAH retrospectively enrolled in a German reference center served as a validation cohort. RESULTS: A low-risk status at a median of 3.7 years (interquartile range, 1.2-6.8) follow-up was significantly associated with each unit (0.1 mm/mm Hg) increase in TAPSE/sPAP under targeted therapies (European Society of Cardiology/European Respiratory Society score: odds ratio, 1.78; ≤0.001; REVEAL 2.0 score: odds ratio, 1.43; ≤0.001). At follow-up, the TAPSE/sPAP ratio increased the prognostic information of each risk stratum of the European Society of Cardiology/European Respiratory Society risk score, except the highest risk stratum, with 0.5 mm/mm Hg, 0.35 mm/mm Hg, and 0.30 mm/mm Hg, from the lowest to the intermediate-high risk score, identified as the best cutoff value. TAPSE/sPAP ratio increased the prognostic information of the REVEAL 2.0 score at follow-up, with 0.35 mm/mm Hg identified as the best cutoff value to discriminate within a score of 5 to 8, with no added value for scores <5 and >8. These results were confirmed in the validation cohort. CONCLUSIONS: Assessment of right ventricular-PA coupling by the TAPSE/sPAP ratio in PAH improves risk assessment scores except in the lowest or most advanced stage of the disease.
BACKGROUND: Although the effects of various combinations of treatments on mortality and morbidity outcomes in heart failure with reduced ejection fraction (HFrEF) have been evaluated, the impact on quality of life is unk...BACKGROUND: Although the effects of various combinations of treatments on mortality and morbidity outcomes in heart failure with reduced ejection fraction (HFrEF) have been evaluated, the impact on quality of life is unknown. This study evaluated and compared the composite impact of pharmacological therapies on quality of life in HFrEF using a frequentist network meta-analysis and systematic review methodology. METHODS: We searched MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials for randomized controlled trials published between January 1, 2021 and August 10, 2024. We included all contemporary and efficacious HFrEF therapies used in adults. The primary outcome was change in quality of life measured through the Kansas City Cardiomyopathy Questionnaire and the Minnesota Living with Heart Failure Questionnaire, expressed as mean difference (MD). RESULTS: We identified 41 randomized controlled trials representing 41 145 patients (76.5% male). The trials had a median of 276 participants (105-464), a mean left ventricular ejection fraction of 28%, and a median follow-up time of 5 months (3-8). A combination of angiotensin receptor blocker/neprilysin inhibitors (ARNi)+β-blockers (BB)+sodium-glucose cotransporter 2 inhibitors (SGLT2i; MD, +5.3 [+0.4, +10.3]) was the most effective at improving quality of life followed by ARNi+BB+mineralocorticoid receptor antagonists (MRA)+SGLT2i (MD, +7.1 [-1.0 to +15.2]), ACE inhibitor+BB+MRA+SGLT2i (MD, +5.3 [-2.6, to +13.3]), and ACE inhibitor+BB+MRA+ivabradine (MD, +5.2 [-3.1 to +13.6]), which were not statistically significant. Individually, the most effective treatments for improving quality of life were SGLT2i (MD, +3.4 [+1.4 to +5.30]), ivabradine (MD, +3.3 [+0.1 to +6.4]), ARNi (MD, +2.6 [-3.2 to +8.5]), and MRA (MD, +1.8 [-4.8 to +8.4]). CONCLUSIONS: A composite of ARNi+BB+SGLT2i or ARNi+BB+MRA+SGLT2i was the most effective at improving quality of life in patients with HFrEF.
BACKGROUND: Doxorubicin (DOX) cardiotoxicity increases cardiovascular risk in cancer patients, mainly through mitochondrial damage. However, the underlying mechanisms remain unclear, and whether mitochondrial short open...BACKGROUND: Doxorubicin (DOX) cardiotoxicity increases cardiovascular risk in cancer patients, mainly through mitochondrial damage. However, the underlying mechanisms remain unclear, and whether mitochondrial short open reading frame-encoded peptides can mitigate DOX-induced cardiotoxicity is unknown. METHODS: Five adeno-associated viruses expressing mitochondrial short open reading frame-encoded peptides under the cardiac troponin T promoter, including MODICA (mito-SEP protector against DOX-induced cardiac injury), were screened in a DOX-induced cardiotoxicity mouse model (n=3-5 per group). Male and female mice were randomized to adeno-associated virus-CTRL or adeno-associated virus-MODICA, respectively, combined with saline or DOX treatment. Sample sizes were: males-saline-CTRL (n=4), saline-MODICA (n=4), DOX-CTRL (n=11), DOX-MODICA (n=10); females-saline-CTRL (n=8), saline-MODICA (n=10), DOX-CTRL (n=10), DOX-MODICA (n=13). MODICA-heterozygous mice generated by CRISPR/Cas9 were also included: saline-WT (n=7), saline-heterozygous (n=4), DOX-WT (n=11), DOX-heterozygous (n=8). Echocardiography was performed at baseline and after 2 weeks of DOX treatment; myocardial tissue and serum samples were collected for molecular and histological analyses. RESULTS: The mitochondrial short open reading frame-encoded peptide MODICA was identified through biochemical analysis and functional screening in a DOX-induced cardiac injury model. MODICA localizes to the outer mitochondrial membrane and is significantly downregulated by DOX (1.00±0.08 versus 0.42±0.09; <0.001). Cardiac-specific overexpression of MODICA via adeno-associated viruses significantly attenuated DOX-induced cardiac injury in both males and females (fractional shortening: males 38.86% versus 51.54%, <0.001; females 39.81% versus 51.39%, <0.001, DOX-CTRL versus DOX-MODICA) and was supported by bulk RNA-seq analysis. Conversely, MODICA deficiency exacerbated DOX-induced injury, resulting in reduced fractional shortening (40.37% versus 31.85%, <0.001; DOX-WT versus DOX-heterozygous) and increased cardiac fibrosis (=0.009). Proteomic analyses revealed that MODICA interacts with apoptosis-related voltage-dependent anion channel proteins, inhibiting their DOX-induced oligomerization (<0.001) on the outer mitochondrial membrane, thereby reducing mitochondrial permeability, decreasing cardiomyocyte apoptosis and improving calcium handling. CONCLUSIONS: Our study shows that the mitochondrial short open reading frame-encoded peptide MODICA alleviates DOX-induced cardiac dysfunction and may represent a therapeutic target against DOX cardiotoxicity.
Laufer-Perl M, Flint N, Arbel Y
… +6 more, Alenezi F, Kittipibul V, Yaranov D, Shaburishvili T, Amin R, Fudim M
Circ Heart Fail
· 2025 Oct · PMID 40899260
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BACKGROUND: The atria play an important role in the pathophysiology of heart failure with preserved ejection fraction. Decreased left atrial strain is associated with worse clinical outcomes. The impact of no-implant int...BACKGROUND: The atria play an important role in the pathophysiology of heart failure with preserved ejection fraction. Decreased left atrial strain is associated with worse clinical outcomes. The impact of no-implant interatrial shunting on atrial structure and function has not been described. METHODS: We characterized the left atrial (LA) and right atrial strain-pressure relationship at rest and during exercise, before and after creation of a no-implant interatrial shunt. We included patients with New York Heart Association class II, III, or ambulatory IV heart failure with a left ventricular ejection fraction ≥40% and elevated LA wedge pressure during supine ergometry (≥25 mm Hg). Exercise hemodynamics and echocardiographic measurements were analyzed at baseline, 1 month and 6 months (echo only) following transcatheter, transeptal creation of a 7 mm no-implant interatrial shunt. RESULTS: A total of 33 patients were enrolled/included in the study. At 1 month, LA pressure at rest was significantly reduced from 19.7±7.0 to 17.2±5.0 mm Hg (=0.044), and from 39.7±10.5 to 33.6±11.1 mm Hg (=0.002) during exercise. Reductions in LA pressure were associated with a mean decrease of 55.4 mm Hg/W·kg in LA work (<0.001). Echo measurements demonstrated significant improvements in LA reservoir strain of +4.0% (=0.015) and +4.1% (=0.046) at 1 and 6 months, respectively. Modest improvements were observed in LA conduit and contractile strain, with a similar overall trend in right atrial strain measurements. These findings were associated with a significant reduction in LA volumes and an increase in right atrial volume. There was no change in right atrial pressure or measures of right ventricular function. CONCLUSIONS: Hemodynamic and strain assessment in patients with heart failure with preserved ejection fraction suggests that a no-implant interatrial shunt can significantly improve the pressure-function relationship of the LA. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifiers: NCT04583527, NCT04838353, and NCT05501652.
BACKGROUND: Pulmonary hypertension (PH) is classified as precapillary, isolated postcapillary pulmonary hypertension (IpcPH), combined postcapillary and precapillary (CpcPH), or exercise PH. IpcPH associated with left he...BACKGROUND: Pulmonary hypertension (PH) is classified as precapillary, isolated postcapillary pulmonary hypertension (IpcPH), combined postcapillary and precapillary (CpcPH), or exercise PH. IpcPH associated with left heart disease can lead to pulmonary vascular remodeling and eventually CpcPH. Conversely, precapillary PH may be diagnosed in the presence of cardiovascular comorbidities, including left heart disease. Atrial functional impairment is a frequent finding in cardiopulmonary disease, reflecting both intrinsic atrial cardiomyopathy and congestion. Consequently, we sought to investigate this across the PH spectrum. METHODS: Patients referred to both right heart catheterization and cardiovascular magnetic resonance imaging were enrolled in this monocentric registry. Patients were classified by right heart catheterization according to current guideline recommendations. Cardiovascular magnetic resonance assessment included left/right ventricular and left atrial (LA)/right atrial volumes and deformation imaging. RESULTS: The study population consisted of N=209 patients (n=55 normal, n=72 precapillary, n=27 CpcPH, n=15 IpcPH, n=34 exercise, and n=6 unclassified PH). N=126 patients underwent additional exercise stress right heart catheterization. Median LA reservoir function was lowest and similar in IpcPH (10.0%) and CpcPH (10.0%), which were significantly impaired compared with normal hemodynamics (30.8%, both <0.001), precapillary (28.2%, both <0.001), and exercise PH (26.9%, IpcPH: =0.039, CpcPH: =0.048). LA reservoir function and left ventricular global longitudinal strain showed good diagnostic performance to identify patients with left cardiac involvement evident at rest (pulmonary capillary wedge pressure ≥15 mm Hg; area under the curve, 0.81 versus 0.77; =0.20), whereas LA reservoir function emerged superior for identification of exercise stress induced pulmonary capillary wedge pressure ≥25 mm Hg (area under the curve, 0.79 versus 0.70, =0.039). CONCLUSIONS: LA functional impairment is a sign of left heart involvement in patients with PH. Left atrial reservoir function emerged superior for the identification of left heart disease unmasked during exercise stress compared with left ventricular global longitudinal strain. Consequently, LA strain may become an innovative method to detect early-stage left heart disease in PH.
BACKGROUND: Influenza contributes substantially to disease burden in individuals with heart failure (HF) and is an established trigger of cardiovascular and HF events. Standard-dose inactivated influenza vaccine (SD-IIV)...BACKGROUND: Influenza contributes substantially to disease burden in individuals with heart failure (HF) and is an established trigger of cardiovascular and HF events. Standard-dose inactivated influenza vaccine (SD-IIV) is recommended for HF, though immune responses may be attenuated. High-dose inactivated influenza vaccine (HD-IIV) was developed to enhance immunogenicity, but its effectiveness compared with SD-IIV against hospitalization for influenza and cardiovascular disease by HF status remains uncertain. METHODS: This was a prespecified analysis of a pragmatic, prospective, individually randomized, open-label trial with registry-based end point-evaluation conducted in Denmark across the 2022/2023 to 2024/2025 influenza seasons. Citizens ≥65 years were randomized 1:1 to HD-IIV or SD-IIV. Outcomes included hospitalization for influenza-related illness, laboratory-confirmed influenza, any cardiovascular disease, cardio-respiratory disease, and HF, assessed by HF status. Effect of HD-IIV versus SD-IIV in reducing risk of outcomes assessed was expressed as risk ratios. RESULTS: The trial randomized 332 438 participants (48.6% female; mean age, 73.7±5.8 years), including 10 410 with HF at baseline (27.4% female; mean age, 76.0±6.3 years). Overall, HD-IIV was associated with a statistically significant lower incidence of hospitalization for influenza-related illness, laboratory-confirmed influenza, cardio-respiratory disease, cardiovascular disease, and HF compared with SD-IIV. In participants with HF, effect estimates were similar: risk ratio for influenza-related hospitalization was 0.48 (95% CI, 0.20-1.06; =0.64), for laboratory-confirmed influenza hospitalization 0.55 (95% CI, 0.29-1.02; =0.59), for cardio-respiratory hospitalization 0.89 (95% CI, 0.77-1.02; =0.34), for cardiovascular hospitalization 0.86 (95% CI, 0.72-1.02; =0.34), and for HF hospitalization 0.82 (95% CI, 0.61-1.11; =0.83). Findings were consistent across HF subgroups by disease duration, recency of hospitalization, most recent NT-proBNP (N-terminal pro-B-type natriuretic peptide), and presence of device therapy. CONCLUSIONS: In this prespecified exploratory analysis of the largest individually randomized influenza vaccine trial ever conducted, HD-IIV was associated with lower rates of influenza and cardiovascular hospitalizations compared with SD-IIV, with effect estimates similar across HF status at baseline and HF subgroups. REGISTRATION:URL: https://www.clinicaltrials.gov; Unique identifier: https://clinicaltrials.gov/study/NCT05517174.
Egbe AC, Abozied O, Abdelhalim AT
… +4 more, ElZalabany S, Kholeif Z, Reddy YNV, Borlaug BA
Circ Heart Fail
· 2025 Sep · PMID 40856614
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BACKGROUND: The purpose of this study was to assess the feasibility and prognostic value of cardiac output (CO) reserve assessment using exercise echocardiography in Fontan patients. We hypothesized that adults with Font...BACKGROUND: The purpose of this study was to assess the feasibility and prognostic value of cardiac output (CO) reserve assessment using exercise echocardiography in Fontan patients. We hypothesized that adults with Fontan palliation had lower CO reserve compared with controls, and impaired CO reserve was associated with greater congestion (NT-proBNP [N-terminal pro-B-type natriuretic peptide]) and cardiovascular events (death/transplant/heart failure hospitalization) in Fontan patients. METHODS: Thirty-seven Fontan patients and 61 controls underwent exercise echocardiography using a supine cycle ergometer. Doppler-derived CO and oxygen consumption (VO) were assessed at rest and every stage of exercise. CO reserve was calculated as ∆CO/Watt (∆CO/W) and ∆CO/∆VO. RESULTS: Assessment of CO reserve was feasible in 95% of the Fontan group with modest reproducibility. Although both groups had similar CO at rest, the Fontan group had lower CO reserve with exercise as evidenced by lower ∆CO/W ratio (46±17 versus 57±19 mL/W; <0.001) and lower ∆CO/∆VO ratio (4.48±1.02 versus 5.37±2.18 mL/mL; =0.03). There was a correlation between ∆CO/W ratio and log NT-proBNP (r=0.65; <0.001), and between ∆CO/∆VO ratio and log NT-proBNP (r=0.53; =0.009). Impaired CO reserve was associated with congestion and cardiovascular events and provided improved prognostication (higher area under the curve and C statistics) above conventional echocardiographic indices and treadmill peak VO. CONCLUSIONS: Patients with Fontan palliation had lower CO reserve, and impaired CO reserve was associated with congestion and cardiovascular events. Further studies are required to determine whether cardiac interventions can improve CO reserve and whether changes in CO reserve can be used as a surrogate end point for therapeutic response.
BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown beneficial effects in heart failure (HF) management, but data on their use in geriatric populations with high comorbidity remain limited. This obs...BACKGROUND: Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have shown beneficial effects in heart failure (HF) management, but data on their use in geriatric populations with high comorbidity remain limited. This observational study aimed to assess the real-world efficacy and safety of SGLT2i in elderly patients with HF. METHODS: This prospective multicenter study included 496 patients hospitalized for acute heart failure across 3 geriatric units. The mean age was 90 years, and the mean Charlson Comorbidity Index score was 8.2. Participants were divided into 2 groups: the SGLT2i group (n=260) receiving SGLT2i (empagliflozin or dapagliflozin) alongside standard HF treatment, and the Control group (n=236) receiving only standard HF treatment. The primary outcomes were all-cause mortality, HF rehospitalizations, and adverse events over 1 year. RESULTS: SGLT2i use was associated with lower risks of all-cause mortality (hazard ratio, 0.67 [95% CI, 0.46-0.98]; =0.031), HF rehospitalization (hazard ratio, 0.64 [95% CI, 0.42-0.97]; =0.037), and the composite outcome (hazard ratio, 0.60 [95% CI, 0.44-0.82]; =0.001) at 1 year, after multivariable adjustment. No significant interaction was observed between left ventricular ejection fraction status and SGLT2i use ( for interaction=0.12). Although urinary and genital infections were more frequently reported in the SGLT2i group, treatment discontinuation remained low (2.7%). CONCLUSIONS: In this elderly population with high comorbidity, SGLT2i therapy was associated with substantial reductions in mortality and HF rehospitalization, and showed good tolerability and an acceptable safety profile.
BACKGROUND: Sarcopenia is associated with adverse outcomes in patients with end-stage heart failure. Muscle mass can be quantified via manual segmentation of computed tomography images, but this approach is time-consumin...BACKGROUND: Sarcopenia is associated with adverse outcomes in patients with end-stage heart failure. Muscle mass can be quantified via manual segmentation of computed tomography images, but this approach is time-consuming and subject to interobserver variability. We sought to determine whether fully automated assessment of radiographic sarcopenia by deep learning would predict heart transplantation outcomes. METHODS: This retrospective study included 164 adult patients who underwent heart transplantation between January 2013 and December 2022. A deep learning-based tool was utilized to automatically calculate cross-sectional skeletal muscle area at the T11, T12, and L1 levels on chest computed tomography. Radiographic sarcopenia was defined as skeletal muscle index (skeletal muscle area divided by height squared) in the lowest sex-specific quartile. RESULTS: The study population had a mean age of 53±14 years and was predominantly men (75%) with a nonischemic cause of cardiomyopathy (73%). Mean skeletal muscle index was 28.3±7.6 cm/m for women versus 33.1±8.1 cm/m for men (<0.001). Cardiac allograft survival was significantly lower in heart transplant recipients with versus without radiographic sarcopenia at T11 (90% versus 98% at 1 year, 83% versus 97% at 3 years, log-rank =0.02). After multivariable adjustment, radiographic sarcopenia at T11 was associated with an increased risk of cardiac allograft loss or death (hazard ratio, 3.86 [95% CI, 1.35-11.0]; =0.01). Patients with radiographic sarcopenia also had a significantly increased hospital length of stay (28 [interquartile range, 19-33] versus 20 [interquartile range, 16-31] days; =0.046). CONCLUSIONS: Fully automated quantification of radiographic sarcopenia using pretransplant chest computed tomography successfully predicts cardiac allograft survival. By avoiding interobserver variability and accelerating computation, this approach has the potential to improve candidate selection and outcomes in heart transplantation.
Chitsazan M, Parekh JK, Kosyakovsky LB
… +16 more, Nemeth SM, Lau ES, Januzzi JL, Wang TJ, Levy D, Ndumele CE, Selvin E, Ballantyne CM, Psaty BM, Gottdiener JS, Kizer JR, deFilippi CR, Allen NB, de Boer RA, Shah SJ, Ho JE
Circ Heart Fail
· 2025 Oct · PMID 40832688
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BACKGROUND: The 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines introduced elevated natriuretic peptide (NP) levels as a criterion for defining stage B heart fai...BACKGROUND: The 2022 American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines introduced elevated natriuretic peptide (NP) levels as a criterion for defining stage B heart failure (HF), or pre-HF, to identify individuals at greatest risk for future HF. Given the known NP deficiency in obesity, we aimed to assess whether a single NP cut point would disproportionately up-classify individuals with versus without obesity to stage B HF. METHODS: Participants free of HF from 5 community-based cohorts were included. We examined the reclassification of individuals to stage B HF using the 2022 versus 2013 guidelines, stratified by obesity class. Cox proportional hazards models were used to assess the association of NPs with incident HF across obesity classes. RESULTS: Among 32 735 participants, 35% had normal weight, 40% were overweight, 17% had obesity class 1, and 8% had obesity class 2/3. When applying the 2022 versus 2013 criteria, the proportion of individuals up-classified to stage B HF using the NP criterion was 62% among those with normal weight, 51% for those overweight, 47% for individuals with obesity class 1, and 42% for individuals with obesity class 2/3. Over a median follow-up of 13 years, 3077 HF events occurred. Both higher NP and body mass index were associated with greater HF risk, as expected (<0.0001 for both). Importantly, body mass index modified the association of NP with HF risk, such that higher NP concentration was associated with greater HF risk among individuals with lower body mass index. The optimal NT-proBNP (N-terminal pro-B-type natriuretic peptide) cut point to predict future HF risk was lower among individuals with obesity (80 pg/mL; 95% CI, 53-121) compared with normal-weight individuals (109 pg/mL; 95% CI, 80-157). CONCLUSIONS: The application of a single NP cut point resulted in fewer individuals with obesity being up-classified to stage B HF compared with normal-weight individuals. Adjusting NP cut points for individuals with obesity may improve the accuracy of HF risk stratification.
Fox DK, Waken RJ, Wang F
… +5 more, Avula K, Raymer DS, Vader JM, Schilling JD, Joynt Maddox KE
Circ Heart Fail
· 2025 Sep · PMID 40832678
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BACKGROUND: Socioeconomic inequities in access to heart transplantation, including those based on insurance coverage and race or ethnicity, are well documented. During the COVID pandemic, the federal government declared...BACKGROUND: Socioeconomic inequities in access to heart transplantation, including those based on insurance coverage and race or ethnicity, are well documented. During the COVID pandemic, the federal government declared a Public Health Emergency (PHE), which prevented states from disenrolling people from Medicaid. We sought to determine whether this policy was associated with changes in the insurance or racial composition of the heart transplant waiting list. METHODS: Using the United Network for Organ Sharing thoracic data set, we conducted an observational cohort study that analyzed weekly counts of adults (aged >17 years) added to the heart transplant waitlist between January 1, 2018 and December 31, 2022. We obtained ratios of pre-PHE to PHE waitlisting rates by payer and race while accounting for demographics, trends over time, and overdispersion using latent lognormal Poisson dynamic generalized linear models. RESULTS: There were 8224 heart transplant listings before the PHE and 12 261 during. We found no change in listing among privately insured (rate ratio [RR], 1.06 [95% CI, 0.91-1.24]), Medicare (RR, 1.11 [95% CI, 0.94-1.30]), or other government coverage listings (RR, 1.13 [95% CI, 0.91-1.39]), but did find an increase in Medicaid-covered listings (RR, 1.19 [95% CI, 1.01-1.42]). We found no increase in transplant listings during the PHE for patients who were White (RR, 1.03 [95% CI, 0.90-1.21]), but did find increases among patients who were Black (rate ratio, 1.20 [95% CI, 1.04-1.43]), Hispanic (RR, 1.24 [95% CI, 1.06-1.49]), and Asian/American Indian or Alaska Native/Hawaiian or Pacific Islander/multiracial (RR, 1.36 [95% CI, 1.14-1.66]). CONCLUSIONS: The COVID-related PHE was associated with changes in the insurance and racial composition of the heart transplantation waitlist that, if maintained, could reduce socioeconomic inequities in access to heart transplantation.
Circ Heart Fail
· 2025 Oct · PMID 40814784
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BACKGROUND: The performance of estimated glomerular filtration rate (eGFR) among patients with heart failure (HF) may be worse than in the general population due to a higher prevalence of confounding factors affecting cr...BACKGROUND: The performance of estimated glomerular filtration rate (eGFR) among patients with heart failure (HF) may be worse than in the general population due to a higher prevalence of confounding factors affecting creatinine and cystatin C. Studies in this area are scarce and not stratified by type of HF. We evaluated the performance of current creatinine and cystatin C equations (eGFRcr, eGFRcys, and eGFRcrcys) compared with measured GFR (mGFR) among patients with HF stratified by ejection fraction. METHODS: We pulled data on Mayo Clinic patients with an mGFR performed for clinical indications from 2011 to 2023, with serum creatinine and cystatin C measured within 7 days and an echocardiogram performed up to 1 year before the mGFR date. HF was identified by the presence of codes within 1 year before the mGFR and subgrouped into ejection fraction (EF) ≥50% (HFEF≥50%, n=182) or <50% (HFEF<50%, n=115) and compared with no-HF controls (n=1871). CKD-EPI (and EKFC) eGFRcr, eGFRcys, and eGFRcrcys equations were calculated and compared for bias (mGFR minus eGFR) and accuracy (1-P30, proportion of people with ≥30% difference between eGFR and mGFR). CIs were generated by bootstrapping. RESULTS: The HF groups were characterized by older age, higher proportion of males, more diabetes, higher creatinine, and higher cystatin C than controls. In terms of bias, eGFRcr overestimated mGFR to a greater extent in both HF groups compared with controls, whereas eGFRcys and eGFRcrcys showed similar bias in both HF groups and controls. In the HF groups, cystatin C-based equations were more accurate than eGFRcr, particularly within HFEF<50% (1-P30 of 28% and 34% for CKD-EPI eGFRcys and eGFRcrcys, respectively, versus 60% for eGFRcr), whereas eGFRcrcys was more accurate in controls. The CKD-EPI and EKFC equations were overall convergent, showing similar results. CONCLUSIONS: Among patients with HF, eGFRcr demonstrates inferior performance (more bias and less accuracy) compared with cystatin C-based eGFRs, with this effect being more pronounced in those with HFEF<50%.