BNP

Screening for HFpEF in pacemaker patients: Study design and protocol of the PM-HFpEF study.

Elisabeth Santos, Rafael Teixeira, João Almeida +11 more

Heart failure with preserved ejection fraction (HFpEF) is common in older multimorbid patients and is associated with substantial morbidity and mortality. Pacemaker (PM) patients may be particularly vulnerable given the clustering of conventional HFpEF risk factors and the hemodynamic effects of long-term right ventricular pacing. Nevertheless, HFpEF is rarely systematically assessed in device clinics.

Sacubitril/Valsartan Improves Functional Capacity and Reverses LV Remodeling in Obese Patients with Hypertrophic HFpEF: A Randomized Open-Label Study.

Artem Ovchinnikov, Alexandra Potekhina, Anastasiya Shchendrygina +5 more

Background: Heart failure with preserved ejection fraction (HFpEF) has multiple phenotypic manifestations with heterogeneous treatment responses. Objective: To evaluate the effect of sacubitril/valsartan (Sac/Val) on functional capacity and cardiac remodeling in overweight/obese HFpEF patients with concentric left ventricular hypertrophy (LVH). Methods: Sixty-one overweight/obese HFpEF patients (body mass index ≥ 25 kg/m2) with hypertensive LVH (LV mass index ≥ 115 g/m2 for men or ≥94 g/m2 for women) were randomized to Sac/Val (100-400 mg a day; n = 30) versus the usual care group (n = 31) for 6 months. Changes in six-minute walk test distance (6MWTD) were the primary outcomes. Secondary outcomes included changes in echocardiographic parameters of cardiac structure and function, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Results: After 6 months of Sac/Val therapy, 6MWTD increased, and E/e' ratio, LV mass index, LA volume index, and NT-proBNP levels decreased compared with the usual care group (p < 0.05 for all). Conclusions: In overweight/obese patients with HFpEF and LVH, Sac/Val significantly improved functional capacity and reduced LV mass and filling pressure compared with standard medical therapy.

Complex CTO Revascularization in Patients with Ischemic Heart Failure and Reduced Ejection Fraction: An Illustrative Case Series.

Ioana Paula Blaj-Tunduc, Mihnea-Traian Nichita-Brendea, Vlad-Victor Babes +2 more

Background/Objectives: Revascularization of chronic total occlusions (CTO) in patients with heart failure and reduced ejection fraction (HFrEF) remains controversial, as randomized trials have not demonstrated a clear prognostic benefit. Methods: We present an imaging-guided case series of patients with ischemic HFrEF who underwent CTO percutaneous coronary intervention (PCI) following myocardial viability assessment using single-photon emission computed tomography (SPECT). Contemporary antegrade and retrograde techniques were employed. Results: At 6- and 12-month follow-ups, all patients demonstrated marked improvement in NYHA (New York Heart Association) functional class, significant reductions in NT-proBNP (N-terminal pro-brain natriuretic peptide) levels, and substantial improvement in quality of life assessed by the Minnesota Living with Heart Failure Questionnaire (MLHFQ). These benefits occurred despite only modest improvement in left ventricular (LV) ejection fraction (EF) and limited reverse remodeling. SPECT enabled identification of viable but ischemic myocardium, supporting individualized revascularization decisions. Conclusions: In selected high-risk patients with ischemic HFrEF, CTO-PCI was associated with meaningful clinical and biomarker improvement independent of substantial EF recovery. Careful patient selection, incorporating myocardial viability assessment, may refine individualized clinical decision-making in selected patients. These findings support an imaging-guided approach and warrant further prospective evaluation.

Comparative effects of sacubitril/valsartan versus enalapril on QRS duration and cardiac function in heart failure patients undergoing left bundle branch area pacing.

Rui Wang, Cuijun Hao, Zhiqin Fang +2 more

Left bundle branch area pacing (LBBaP) has emerged as a physiological pacing strategy for cardiac resynchronization therapy in patients with heart failure (HF) and left bundle branch block (LBBB). However, evidence comparing different pharmacological regimens following LBBaP implantation remains limited.

Extreme Heterophilic Antibody Interference in BNP Immunoassay: A Case Report and Systematic Investigation Protocol.

Huicong Yang, Yuanhai Zheng, Zhenhua Zeng +4 more

Heterophilic antibody (HA) interference remains a persistent challenge in immunoassay diagnostics. Human anti-mouse antibodies (HAMA) can cause spuriously elevated biomarker results, potentially leading to misdiagnosis and unnecessary clinical interventions. Brain natriuretic peptide (BNP) is critical for heart failure diagnosis, but false-positive results due to HAMA may trigger inappropriate clinical management.

Network pharmacology and experimental evaluation of Sanwei Tanxiang Tangsan in doxorubicin-induced heart failure.

Davaadagva Aruna, Battulga Dulan, Hua Damdinjav +3 more

Heart failure (HF) is a complex syndrome characterized by inflammation, oxidative stress, and cardiomyocyte apoptosis, for which effective and well-tolerated therapies remain limited. This study sought to explore the potential mechanisms by which Mongolian medicine Sanwei Tanxiang Tangsan (STX) may be associated with AKT1/p53-related signaling in the mitigation of HF, employing network pharmacology, molecular docking, and animal experimentation.

Genotype Predicts Heart Failure Independent of LVEF, Peak VO2, and NT-proBNP Levels in Hypertrophic Cardiomyopathy.

Athanasios Bakalakos, Alexandros Protonotarios, Menelaos Pavlou +11 more

Hypertrophic cardiomyopathy (HCM) is a myocardial disorder characterized by left ventricular hypertrophy and progression to heart failure (HF). Approximately 40% of cases are caused by variants in genes encoding sarcomere proteins.

Neutrophil Percentage-to-Albumin Ratio as a Novel Biomarker in Patients with Group 1 Pulmonary Arterial Hypertension.

I Aktaş, E Yaşar

Pulmonary arterial hypertension (PAH) is a progressive and life-threatening disease characterized by increased pulmonary vascular resistance, right ventricular failure, and systemic inflammation. Novel biomarkers reflecting disease severity and prognosis are needed for improved risk stratification in PAH.

Efficacy of Sacubitril/Valsartan in Treating Hemodialysis Patients with Reduced Ejection Fraction Heart Failure: A Retrospective Study.

Yan Guo, Weihua Li, Zongli Diao

Heart failure with reduced ejection fraction (HFrEF) is a prevalent and challenging complication among patients undergoing hemodialysis. Sacubitril/Valsartan (Sac-Val), an angiotensin receptor-neprilysin inhibitor, has shown promise in improving cardiac outcomes in HFrEF patients. This study aims to evaluate the efficacy and safety of Sac-Val in treating HFrEF in patients undergoing hemodialysis.

Risk factors and self-management predictors of activities of daily living in patients with heart failure: A 12-month prospective cohort study.

Meng Ning, Zhiyuan Li, Chong Zhang +2 more

Impaired activities of daily living (ADL) significantly affect the prognosis and quality of life in patients with heart failure (HF). We aimed to identify the key clinical and self-management predictors of ADL 12 months after hospital discharge. This prospective cohort study enrolled 162 hospitalized patients with HF stratified into low-ADL (ADL < 100, n = 66) and high-ADL (ADL = 100, n = 96) groups based on 12 months of follow-up. The baseline characteristics, comorbidities, biomarkers (B-type natriuretic peptide [BNP]), and self-management domains (psychological, drug, dietary, and symptom management) were compared. Logistic regression was used to identify ADL predictors. Subgroup analyses of left ventricular ejection fraction (LVEF) were performed. The low-ADL group had significantly higher rates of valvular heart disease (VHD; 12% vs 3%, P = .025) and diabetes mellitus (29% vs 16%, P = .043), elevated BNP levels (median 474.9 vs 398.0 pg/mL, P = .039), and poorer self-management scores (P < .05). Multivariable analysis confirmed that diabetes (adjusted odds ratio [aOR], 0.33; 95% confidence interval [CI], 0.14-0.80; P = .014) and VHD (aOR, 0.19; 95% CI, 0.04-0.80; P = .024) were independent negative predictors. Symptom management was the strongest positive predictor (crude OR, 12.71; 95% CI, 3.38-47.74; P < .001; aOR, 6.26; 95% CI, 1.44-27.19; P = .014). Stratification by LVEF revealed that diabetes mellitus disproportionately impaired ADL in patients with heart failure with reduced ejection fraction (HFrEF; defined as LVEF < 50%; OR, 0.21; 95% CI, 0.06-0.82). The factors influencing ADL scores changed over the 12-month follow-up period. Diabetes, VHD, and poor symptom management were key predictors of long-term ADL impairment in patients with HF. Targeted interventions addressing symptom management and comorbidity control, particularly in patients with HFrEF, may improve functional outcomes.

Comparative Utility of B-type Natriuretic Peptide (BNP) and N-terminal Pro-BNP (NT-proBNP) in the Management of Acute Heart Failure: A Study From a Tertiary Care Hospital in Kashmir, India.

Javeed A Ganie, Hyder H Lone, Mehraj Ul Islam +4 more

Background Among the various biomarkers, B-type natriuretic peptide (BNP) and N-terminal pro-BNP (NT-proBNP) have proved particularly useful in helping clinicians diagnose acute heart failure (AHF) and evaluate the risk a patient faces at the time of presentation. However, data from the Indian subcontinent, particularly from the Kashmir Valley, with its unique demographic profile and altitude-related cardiovascular burden, remain sparse. This study aimed to compare the utility of these biomarkers in the management of AHF in a tertiary care setting and to evaluate their relationship with disease severity parameters, including New York Heart Association (NYHA) functional class, ejection fraction, and lung ultrasound B-lines. Methods The study was a prospective observational study conducted at the Government Medical College, Srinagar, over a period of 18 months. A total of 223 patients admitted to the hospital with acute heart failure were included. Both BNP and NT-proBNP were measured simultaneously at admission. All patients underwent lung ultrasonography (LUS) for B-line quantification before and after diuretic therapy and echocardiography for ejection fraction assessment. Statistical analyses included Pearson and Spearman correlations, one-way ANOVA, paired t-tests, and receiver operating characteristic (ROC) curve analysis. Results The majority of patients were male, 133 (59.6%), with a mean age of 62.3 ± 10.7 years. Mean BNP and NT-proBNP levels were 581.5 ± 180.1 pg/mL and 1707.5 ± 629.5 pg/mL, respectively. The two biomarkers correlated strongly with each other (Pearson r = 0.750, p < 0.001), and both varied significantly across NYHA functional classes (BNP: F = 6.118, p = 0.001; NT-proBNP: F = 4.405, p = 0.005). Lung ultrasound B-lines showed a significant reduction following diuretic therapy (15.24 ± 1.07 vs 6.77 ± 1.06; p < 0.001). NT-proBNP showed non-significantly higher diagnostic performance over BNP for severe HF (area under the curve (AUC) 0.420 vs. 0.387). No significant difference was noted between the two biomarkers with respect to ejection fraction categories. Conclusion Both BNP and NT-proBNP are comparably effective in reflecting the haemodynamic and clinical severity of acute heart failure in the Kashmiri population. Their strong mutual correlation supports interchangeable use in clinical practice. Integration of lung ultrasound B-line monitoring with natriuretic peptide measurement provides superior assessment of decongestion. These findings have direct implications for resource-limited tertiary care settings, where single-biomarker assay selection is often dictated by cost and availability.

Long-Term Prognosis and Outcomes in Patients Undergoing His Bundle Pacing Implantation　- A Multicenter, Prospective Observational Study in Japan.

Satoshi Yanagisawa, Hiroyuki Kato, Yasunori Kanzaki +15 more

His bundle (HB) pacing (HBP) can achieve an ideal pattern of ventricular activation. The long-term efficacy and clinical outcomes of HBP in Japan remain unclear.

Combined Prognostic Value of Follow-Up Ejection Fraction and Natriuretic Peptide Measurements in Heart Failure With Reduced Ejection Fraction Following Initiation of Pharmacotherapy.

Nandan Kodur, Paul R Gunsalus, Alex Milinovich +2 more

Few studies have directly compared the prognostic value of left ventricular ejection fraction (LVEF) and NT-proBNP (N-terminal pro-B-type natriuretic peptide) in patients with heart failure (HF) with reduced EF who have initiated guideline-directed medical therapy. This study sought to assess the combined prognostic value of follow-up LVEF and NT-proBNP measurements taken following initiation of guideline-directed medical therapy in patients with HF with reduced EF.

Systematic identification of human anti-mouse antibody interference causing falsely elevated B-type natriuretic peptide: A case study.

Shunchang Li, Jifei Yao

B-type natriuretic peptide (BNP) is crucial for heart failure diagnosis. However, immunoassays are vulnerable to heterophilic antibody interference, which may lead to false-positive results and significant clinical mismanagement. Studies suggest such interference may account for a notable proportion of unexplained biomarker elevations. This report describes a case of a 36-year-old female with a markedly elevated BNP (2735.7 ± 54.3 pg/mL) incongruent with her clinical presentation. Therefore, we conducted a detailed analysis through a stepwise investigation, including serial dilution (showing non-linear recovery), cross-platform comparison (normal result on an alternative platform), and heterophilic blocking reagent treatment (partial correction). Ultimately, the addition of purified mouse IgG, but not anti-goat IgG or IgM blockers, normalized the BNP level in a dose-dependent manner, confirming human anti-mouse antibody (HAMA) interference. This case demonstrates that such interference is one of the potential causes of unexplained elevations in clinical immunoassay results. A systematic workflow was established in the case, ranging from suspicion to confirmation and ultimately to laboratory-adoptable conclusions. This process facilitates accurate diagnosis and helps clinicians avoid unnecessary interventions.

Utility of N-terminal pro-Brain Natriuretic Peptide Immunostaining of the Kidney in Forensic Diagnosis.

Shojiro Takasu, Sari Matsumoto

N-terminal pro-brain natriuretic peptide (NT-proBNP) is secreted by ventricular myocardial cells and released in response to ventricular wall stress conditions such as congestive heart failure (CHF). We previously reported the potential diagnostic efficacy of postmortem urine NT-proBNP concentrations for acute myocardial infarction, CHF, heat stroke, and sepsis. As urine is often unavailable in autopsy cases, alternative diagnostic methods are required. In this study, we conducted NT-proBNP immunostaining of the kidney, evaluated NT-proBNP positivity in the renal tubule in a series of forensic autopsy cases (n = 30), and compared the results to the urinary levels of NT-proBNP and urine Hounsfield unit (HU) values in postmortem computed tomography conducted before the autopsy. The results showed significantly higher urinary NT-proBNP levels in the CHF, sepsis, and heat stroke groups than in the control group. NT-proBNP positivity was also significantly higher in these groups. Moreover, a correlation between urinary NT-proBNP concentration and immunostaining results was observed. These results suggest that NT-proBNP immunostaining of the kidney could be considered as an alternative to NT-proBNP measurement in urine, which may, in turn, improve postmortem diagnosis. However, the association with postmortem urine HU values should be evaluated in further large-scale studies.

Heart Failure Phenotypes and the Prognostic Utility of NT-proBNP in Patients With Chronic Kidney Disease: A Propensity-Score Matched Cohort Study.

Chien-Chou Chen, Cai-Mei Zheng, Chih-Chin Kao +4 more

To evaluate the prognostic value of N-terminal pro-B-type natriuretic peptide (NT-proBNP) across different heart failure phenotypes in patients with chronic kidney disease (CKD).

Plasma proteomics enhances heart failure risk prediction among individuals with type 2 diabetes: a prospective cohort study.

Hancheng Yu, Jijuan Zhang, Frank Qian +17 more

Heart failure (HF) is a severe complication of type 2 diabetes (T2D), yet the association between plasma proteins and HF in individuals with T2D remains underexplored.

Severe Arrhythmia Complicating Takotsubo Cardiomyopathy Revealing an Underlying Pheochromocytoma: A Case Report.

Meryem Tabat, Zineb El Jaouhari, Abdnacer Drighil

Pheochromocytoma is a rare catecholamine-secreting tumor that can cause major cardiovascular complications, including acute heart failure, arrhythmias, and stress-induced cardiomyopathy. Takotsubo syndrome (TTS) is an acute non-ischemic cardiomyopathy characterized by transient left ventricular systolic dysfunction without obstructive coronary artery disease, often mimicking acute coronary syndrome. Catecholamine excess plays a central role in its pathophysiology, leading to myocardial stunning, hemodynamic instability, and arrhythmias. The association between pheochromocytoma and TTS is uncommon and frequently associated with severe clinical presentations. We report the case of a 52-year-old woman with poorly controlled hypertension treated with a calcium channel blocker, who presented with chest pain, dyspnea, and palpitations. On admission, blood pressure was 178/122 mmHg, and heart rate was 102 bpm. The patient described recurrent episodes of headache and palpitations occurring two to three times monthly and lasting 30 to 60 minutes, suggesting secondary hypertension. Electrocardiography showed 1 mm ST-segment elevation in the anterior leads without reciprocal changes and a prolonged QTc interval (480 ms). Peak high-sensitivity troponin reached 1880 ng/L (reference <35 ng/L), while brain natriuretic peptide (BNP) was 450 pg/mL (reference <125 pg/mL). Transthoracic echocardiography revealed a left ventricular ejection fraction of 45% with apical akinesia and basal hyperkinesia, consistent with Takotsubo syndrome. Left ventriculography confirmed typical apical ballooning, and coronary angiography showed no obstructive coronary artery disease. During hospitalization, the patient developed rapid atrial fibrillation with hemodynamic instability, requiring electrical cardioversion and amiodarone therapy. Labile blood pressure and paroxysmal symptoms raised suspicion of catecholamine excess, subsequently confirmed by elevated plasma and urinary metanephrines. Abdominal CT identified a 30 × 25 × 28 mm left adrenal mass with attenuation >10 HU and intense heterogeneous contrast enhancement, highly suggestive of pheochromocytoma. Preoperative treatment with phenoxybenzamine was progressively titrated to achieve hemodynamic stabilization before surgical resection. After surgery, left ventricular systolic function completely recovered, with ejection fraction improving to 58%. At the sixth-week follow-up, plasma and urinary metanephrines had normalized, confirming complete biochemical remission and successful tumor removal. Blood pressure also normalized postoperatively. This case highlights the importance of considering pheochromocytoma in patients with Takotsubo syndrome complicated by severe arrhythmias or labile hypertension, as early diagnosis may improve management and prognosis.

Red blood cell distribution width for prediction of new-onset heart failure in the general population.

Daniëlle J Noordermeer, Frank van Rooij, Maryam Kavousi +1 more

Red blood cell distribution width (RDW), a routine and inexpensive blood parameter, is widely available and may serve as a useful screening marker for heart failure (HF). This study aims to evaluate RDW's predictive value for new-onset HF in the general population and examine its incremental predictive performance alongside NT-proBNP.

Total NT-proBNP in heart failure with preserved vs reduced ejection fraction.

Camilla Hage, Anika Mang, Jean Claude Daubert +4 more

Commercially available NT-proBNP assays can underestimate concentration as the detecting antibody binds to NT-proBNP glycosylated epitopes, thereby underestimating the total NT-proBNP, impairing diagnostic and prognostic performance in heart failure (HF) patients.

[Pulmonary Arterial Hypertension Impairs Duodenal Barrier Integrity in Rats].

Shouei Ishimaru, Satoshi Mizuno, Tomoya Tanada +4 more

Pulmonary arterial hypertension (PAH) is a progressive pulmonary vascular disease that leads to right heart failure and systemic venous congestion. Such congestion can impair multiple organs, including the gastrointestinal tract. Recent clinical studies have reported elevated circulating endotoxin levels in patients with PAH, suggesting a potential disruption of intestinal barrier function. However, whether PAH affects duodenal permeability remains unclear. This study aimed to elucidate the impact of PAH on duodenal barrier integrity. PAH was induced in rats through two subcutaneous injections of monocrotaline (20 mg/kg). Histological analysis was performed, and the mRNA expression levels of duodenal tight junction proteins were quantified using real-time PCR. Duodenal permeability was assessed by performing in situ and ex vivo experiments with paracellular probes. PAH rats exhibited characteristic signs of right heart failure, including reduced weight gain, elevated brain natriuretic peptide levels, and thickening of the right ventricular wall. Histological examination revealed duodenal villous atrophy and thickened muscularis mucosa. Claudin-1 mRNA expression in the duodenum of PAH rats was 70% lower than that in control rats. In situ permeability assays revealed 2.0- and 1.5-fold increases in the portal vein concentrations of polyethylene glycol 400 and 600, respectively. In addition, ex vivo experiments showed a 1.9-fold increase in the cumulative lactulose permeation from the luminal to the vascular side over 120 min. To the best of our knowledge, this is the first report to describe decreased duodenal barrier integrity caused by monocrotaline-induced PAH in rats.

The clinical efficacy of Astragalus-containing Chinese patent medicines in the effective treatment of heart failure: A systematic review and network meta-analysis.

Fangfang Rui, Yunfeng Di, Chun Li +2 more

The incidence of cardiovascular diseases, particularly heart failure, has been rising year by year. Traditional Chinese medicines containing Astragalus have been widely used in clinical research. However, there is no definitive research on the efficacy of proprietary Chinese medicines containing Astragalus. A network meta-analysis was conducted to investigate the efficacy and safety of oral traditional Chinese medicines containing Astragalus for the treatment of heart failure.

Dynamic degradation and glycoform heterogeneity of NT-proBNP in serum: Implications for biomarker quantification.

Junyi Wu, Xueting Ma, Yajing Dong +4 more

N-terminal pro-B-type natriuretic peptide (NT-proBNP) is a widely used biomarker for heart failure, yet its circulating molecular heterogeneity and susceptibility to ex vivo proteolysis complicate accurate and traceable quantification. In this study, we systematically investigated the degradation behavior of NT-proBNP in human serum and identified kinetically stable endogenous glycoforms using immunoaffinity enrichment coupled with MALDI-TOF mass spectrometry. Non-glycosylated recombinant NT-proBNP spiked into serum underwent rapid proteolytic processing, dominated by stepwise C-terminal truncation, with extensive fragmentation observed within hours even at 4 °C. Protease inhibition experiments performed under accelerated incubation conditions (37 °C, up to 48 h) confirmed that these changes were enzyme-driven. Against this dynamic background, two NT-proBNP-related peaks at m/z 9084 and 9517 remained qualitatively detectable throughout the entire incubation series, whereas labile non-glycosylated forms showed rapid attenuation. These peaks were reproducibly detected in the small NT-proBNP-positive sample set and were not detected in the small NT-proBNP-negative comparison set, supporting preliminary analytical specificity in this pilot dataset. Mass-balance modeling suggested that both species may correspond to proteolytically processed NT-proBNP backbones carrying clustered mucin-type O-glycosylation involving GalNAc, hexose, and sialic acid residues; these assignments should be regarded as putative compositions requiring orthogonal structural validation. Together, these results suggest that O-glycosylation may contribute to the qualitative persistence of specific NT-proBNP-related species in serum. The m/z 9084 and 9517 peaks should therefore be regarded as candidate, analytically persistent signals detected under the present 15F11-based immunoenrichment and MALDI-TOF MS workflow. Their potential use as robust analytical targets or anchors remains a hypothesis that will require orthogonal structural confirmation, quantitative validation, and evaluation in larger cohorts.

Early detection value of miR-29a in patients with acute myocardial infarction.

Yanqing Wang, Peng Gao, Yawei Duan +12 more

Early detection of myocardial remodeling, a critical precursor to heart failure in acute myocardial infarction (AMI), remains inadequate with current biomarkers. Preclinical studies suggest miR-29a plays a role in these processes, yet its diagnostic value in early AMI remains unclear. This study evaluates the diagnostic and prognostic potential of miR-29a as a marker for myocardial remodeling in AMI patients.

Risk Stratification in Pulmonary Embolism: The Expanding Role of Biomarkers.

Cyrus Moini, Piseth Lay, Sebastien Jochmans +4 more

Pulmonary embolism (PE) remains a frequent and potentially fatal condition, with early mortality largely driven by (RV) failure and hemodynamic collapse. Rapid and accurate prognostic assessment is therefore central to management. Current European Society of Cardiology (ESC) strategies rely first on hemodynamic status to identify high-risk patients requiring urgent reperfusion consideration, and then-when patients are normotensive-on a stepwise approach combining clinical risk scores, RV imaging, and circulating biomarkers. Clinical tools such as HESTIA and the Pulmonary Embolism Severity Index (PESI)/simplified PESI (sPESI) enable early identification of low-risk patients suitable for outpatient pathways and stratify 30-day mortality risk, but do not integrate biological data. Consequently, biomarkers have an expanding role in refining prognosis, particularly within the heterogeneous intermediate-risk group. This review provides a practical overview of established and emerging biomarkers for PE risk stratification. Conventional cardiac biomarkers-troponins and natriuretic peptides (BNP/NT-proBNP)-reflect RV myocardial injury and strain and, when combined with imaging evidence of RV dysfunction, allow discrimination between intermediate-low- and intermediate-high-risk PE, guiding monitoring intensity and escalation strategies. D-dimer, while essential in diagnostic algorithms because of its high negative predictive value, has only an adjunctive and indirect prognostic role. Beyond these markers, growing evidence supports additional biomarkers capturing complementary pathways: neurohormonal stress (copeptin), early myocardial injury (H-FABP), inflammation and hypoxia (GDF-15), tissue hypoperfusion (lactate), and molecular regulation (circulating microRNAs). Readily available inflammatory indices derived from blood counts (NLR, PLR, LMR), red cell distribution width, and hs-CRP may further contribute within multimarker models, although specificity and validation remain limitations. Future directions include multimodal and omics-driven biomarker profiling integrated with advanced imaging to enable more precise, dynamic, and personalized PE care, from acute risk prediction to long-term follow-up and prevention of chronic thromboembolic complications.

The double-edged sword of tumor-targeted treatment: the influence of targeted therapy on the heart.

Yexuan Huang, Liwen Chen, Cheng Ding +4 more

As an important means of modern cancer treatment, targeted therapy has significant efficacy, but cardiac toxicity cannot be ignored. From subclinical myocardial injury to severe heart failure (HF), it poses significant challenges to the long-term survival and quality of life of patients. This article summarizes the impact of targeted therapy drugs on cardiac function and their mechanisms, including cardiomyocyte damage, myocardial hypertrophy, and HF, and conducts in-depth research into potential molecular mechanisms. These include direct cardiomyocyte damage through targeted pathway inhibition [e.g., human epidermal growth factor receptor 2 (HER2), epidermal growth factor receptor (EGFR), fibroblast growth factor receptor (FGFR), and vascular endothelial growth factor receptor (VEGFR)], and off-target effects that lead to oxidative stress, mitochondrial dysfunction, iron deposition, and immune-mediated damage (e.g., checkpoint inhibitors). While the review also outlines strategies for preventing and treating cardiac toxicity of targeted therapy, these include pre-treatment cardiovascular risk stratification, advanced imaging modalities [such as speckle tracking echocardiography and cardiac magnetic resonance imaging (MRI)], biomarker-based monitoring [such as high-sensitivity cardiac troponin (hs-cTn), B-type natriuretic peptide (BNP)/N-terminal pro B-type natriuretic peptide (NT-proBNP)], timely drug intervention, and strategic modification of cancer treatment plans. The main objective of the review is to elucidate and enhance clinical understanding of the cardiotoxicity associated with contemporary targeted anti-cancer therapies. By deepening their understanding of the different mechanisms and clinical manifestations of drug-induced heart injury, early detection, multidisciplinary collaboration, and personalized treatment decisions can be promoted. Ultimately, this approach aims to optimize cancer treatment outcomes while maintaining patients' overall quality of life and cardiovascular health.

Peripartum dynamics of ischemia and heart failure biomarkers: the impact of delivery mode.

I Abou Tabikh, N Mawas, M Kappelmeyer +3 more

The uterus and its myometrium undergo several changes during delivery. In labor, the myometrium performs contractions to expel the newborn. In a cesarean section, however, the myometrium is incised. Little is known about labor-induced changes in biomarkers that are known to rise during injuries and exhaustion of another muscle, the heart. These markers can also be produced by the myometrium, especially damaged myometrium. Since labor is known to cause slight myocardial challenge, physiological changes in cardiac biomarkers in the context of labor versus after an incision of the uterus are of new interest. Here, we question whether cardiac biomarkers could also be produced by the uterus. If this were the case, the interpretation of the myocardial ischemic marker peripartum needed a revision. This study investigated whether cardiac biomarkers might be influenced by uterine activity or injuries from cesarean sections.

Distinct Metabolomic and Clinical Phenotypes of Depression in Heart Failure　- Pilot Exploratory Analysis.

Yoshiharu Kinugasa, Hiroko Kamitani-Noguchi, Kensuke Nakamura +8 more

Depression is common among patients with heart failure (HF) and worsens prognosis, but its metabolic heterogeneity remains unclear.

Optimizing heart failure care: A machine learning-based prediction of hospital length of stay for heart failure patients.

Arthur De Souza, Ray Opoku

Heart failure represents a significant global health burden, with prolonged length of stay (LoS) tied to increased mortality and costs. Accurate prediction of hospital LoS is crucial for improving resource allocation, lowering mortality and readmission rates, and enhancing patient care.

Diagnostic and management challenges of severe heart failure with reduced ejection fraction in a patient with extreme morbid obesity: a case report.

Mafaz Mansoor, Peyton Matt, Monica Mohanty +2 more

Morbid obesity is a growing global health crisis that significantly increases cardiovascular morbidity and mortality. Patients with extreme obesity present unique diagnostic and therapeutic challenges, particularly in the management of heart failure with reduced ejection fraction (HFrEF).

[The impact of obesity on natriuretic peptide cut-off values for the diagnosis of heart failure].

Karim Taha, M Louis Handoko

Measurement of natriuretic peptides (BNP and NT-proBNP) has an important role in diagnosing heart failure. However, in patients with obesity, circulating levels of these peptides are consistently lower, yet current diagnostic cut-off values do not account for this. This article discusses the implications of obesity on natriuretic peptide interpretation, particularly in heart failure with preserved ejection fraction (HFpEF). Recent data show that the conventional rule-out threshold (<125 ng/L) lacks sensitivity in obese patients, potentially missing up to one-third of HFpEF cases. Lowering the cut-off in patients with obesity markedly improves diagnostic accuracy, while adjusted rule-in thresholds enhance specificity. These findings highlight the need for individualized interpretation of natriuretic peptide levels, incorporating body weight to avoid underdiagnosis of HFpEF in patients with obesity.

Assessment of Brain Natriuretic Peptide Levels in Patients Presenting to the Emergency Department With High Blood Pressure.

Cihangir Doruk

Hypertension is one of the leading causes of cardiovascular morbidity and mortality worldwide. Although patients presenting to emergency departments (EDs) with high blood pressure (BP) are frequently seen, it is difficult to distinguish patients with true hemodynamic or cardiac stress. Brain natriuretic peptide (BNP), secreted in response to ventricular wall strain, may serve as a useful biomarker. This study was conducted to evaluate BNP levels in patients presenting to the ED with high BP and to examine their relationship with systolic and diastolic pressures according to the antihypertensive treatment status.

Improving Pulmonary Edema Assessment in Pediatric Congenital Heart Disease: The Role of Lung Ultrasonography.

Yasemin Nuran Donmez, Derya Bako, Safak Alpat +2 more

Pulmonary edema is a clinically significant complication in children with congenital heart disease (CHD). It occurs more frequently in complex cases and is associated with prolonged hospital stays. Early identification is essential because of its direct impact on clinical outcomes.

Objective Assessment of Functional Capacity Improvement Following Transcatheter Tricuspid Valve Interventions.

Luca Cumitini, Ailia Giubertoni, Marco Mennuni +2 more

Transcatheter tricuspid valve interventions have recently emerged as effective therapeutic options for patients with severe tricuspid regurgitation (TR) and heart failure at high surgical risk. Despite evidence of post-procedural clinical improvement, data regarding changes in functional capacity remain limited. In this prospective, observational study we enrolled high-risk patients with at least severe TR and heart failure undergoing transcatheter tricuspid valve repair by the PASCAL® device or replacement with the EVOQUE® system. Functional capacity was evaluated by cardiopulmonary exercise testing (CPET), in addition to clinical, laboratory, and echocardiographic parameters, at baseline and 3 months post-procedure. The primary endpoint was the change in peak oxygen consumption (VO₂) by CPET at 3 months versus baseline. Secondary endpoints included changes in other CPET parameters, TR severity by transthoracic echocardiography, New York Heart Association (NYHA) class, daily furosemide dose, and pro-brain natriuretic peptide (pro-BNP) levels. A total of 10 patients were enrolled, with successful device implantation obtained in all cases. Peak VO₂ improved significantly from 14.7±3.7 at baseline to 16.4±2.9 ml/kg/min at 3 months (p=0.009). Peak oxygen pulse increased from 85.1±20.2% to 103.7±23.3% (p=0.022), and ventilation maximum rose from 39.9±10.3 L/min to 45.7±10.9 L/min (p=0.035). TR severity was reduced (p=0.002), NYHA class improved (p=0.016), and daily furosemide dose decreased (p=0.016). Although pro-BNP levels declined, this reduction was not statistically significant. No adverse event occurred during follow-up. In conclusion, among patients with severe TR and heart failure, TR reduction by transcatheter tricuspid valve interventions was associated with improved CPET-derived functional capacity, better functional class and reduced diuretic requirement during short-term follow-up.

From Healthy to Heart Failure in 24 Hours: Defining the upper limit of exercise induced cardiac fatigue.

Stephen J Foulkes, Mitchell Anderson, Kristel Janssens +7 more

This study sought to investigate the cardiac consequences of undertaking 12- and 24-hours of intense cycling as part of two successful world record-setting attempts in a former professional ultra-endurance athlete (12-hour attempt: March 2017, aged 41 yrs; 24-hour attempt: March 2018, aged 42 years). The athlete was comprehensively evaluated prior to- and at several timepoints following both attempts using cardiac imaging (echocardiography, rest and exercise cardiac magnetic resonance imaging, CMR), cardiac biomarkers (B-type natriuretic peptide, BNP; cardiac troponin-I, cTnI) and clinical evaluation. Following the 12-hour attempt, the athlete was physically exhausted but demonstrated no signs of respiratory distress or heart failure. Immediately post-attempt, BNP (166 ng/L) and cTnI (64 ng/L) were moderately increased, while left- (LV) and right-ventricular (RV) strain (LV: -12.2%; RV: -13.4%) and ejection fraction (LV: 43% RV: 43%) were moderately reduced. However, all parameters recovered within 14-days of the attempt. Following the 24-hour attempt, the athlete was in acute respiratory distress and showed signs of acute pulmonary edema. This coincided with pronounced biomarker elevations (BNP: 561 ng/L; cTnI: 394 ng/L) and marked reductions in myocardial strain (LV: -14.2%; RV: -13.8%) and bi-ventricular ejection fraction (LV: 37%; RV: 32%). Cardiac function only partially recovered 18-days post-attempt but had completely normalized by 5-months post-attempt. Overall, these findings provide the most definitive illustration of an exercise dose threshold that resulted in acute heart failure in a highly trained endurance athlete. The absence of persistent myocardial injury highlights the resilience of the heart to acute stress.

Cheyne-Stokes respiration detected via CPAP devices as a digital biomarker for heart failure in obstructive sleep apnoea: systematic review.

Nashe Marshall Mutombe, Kanchana Ekanayake, Chin Moi Chow

To synthesize evidence on the diagnostic, prognostic, surveillance, and monitoring potential of Cheyne-Stokes respiration (CSR) ventilatory patterns, as detected by continuous positive airway pressure (CPAP) devices, in patients with heart failure (HF) or at risk of HF-often with comorbid obstructive sleep apnoea.

The association of longitudinal NT-proBNP levels with echocardiographic measurements in heart failure with preserved ejection fraction: Insights from the PURSUIT-HFpEF registry.

Daisuke Sakamoto, Yuki Matsuoka, Daisaku Nakatani +17 more

In heart failure with preserved ejection fraction (HFpEF), the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and echocardiographic parameters and the influence of atrial fibrillation (AF) on the relationship remain poorly understood.

An experimental study of early cardiovascular disease and risk factors in a collagen-induced arthritis rat model.

Chun Yun Jiang, Da Li, Quan Jiang +2 more

This study investigated the pathological characteristics and risk factors of early cardiovascular disease (CVD) associated with rheumatoid arthritis (RA) using a collagen-induced arthritis (CIA) rat model.

Early mortality in multiple myeloma patients with renal impairment: a nested case-control study.

Yan Li, Wenjiao Tang, Bing Xiang +4 more

Renal impairment (RI) in multiple myeloma (MM) patients significantly impacts outcomes, yet the prevalence and causes of early mortality within 12 months of diagnosis in newly diagnosed MM (NDMM) with RI are understudied in the novel agent era.

Validation of NT-proBNP cutoff points for heart failure diagnosis in adults with CHD in the outpatient clinic and emergency department.

Ahmed E Ali, Zeyad Kholeif, Marwan Ahmed +2 more

Empirical data support the use of N-terminal pro-B-type brain natriuretic peptide (NT-proBNP) for heart failure (HF) rule-in and rule-out in patients with acquired heart disease, but similar data are lacking in adults with congenital heart disease (CHD). The purpose of this study was to assess diagnostic performance of conventional NT-proBNP cutoff points for HF diagnosis (rule-in and rule-out) in adults with CHD.

Clinical, Metabolic, and Behavioral Correlates of Nutritional Status in Chronic Heart Failure.

Katarzyna Lomper, Julia Buczkowska

Heart failure (HF) is a chronic condition associated with frequent hospitalizations and impaired quality of life. Malnutrition is common in HF and is linked to adverse clinical outcomes, while self-care is an important component of HF management. This study aimed to examine the associations between nutritional status, self-care behaviors, and clinical characteristics in patients with chronic HF.

Association Analyses Between the NPPB:rs198389 Gene Polymorphism, NT-proBNP Serum Concentrations and Phenotypic Features in Patients with Heart Failure.

Anna Gorący-Rosik, Jakub Rosik, Klaudyna Lewandowska +2 more

Heart failure (HF) is a complex disease and one of the major causes of morbidity and mortality in the world. Increased B-type natriuretic peptide (BNP) levels have been associated with HF. The NPPB:rs198389 (c.-381T > C) promoter polymorphism has been found to modulate BNP levels.

Effect of Yiqi Fumai lyophilized injection on B-type natriuretic peptide levels in patients with acute decompensated ischemic heart failure: a multicenter, open-label, blinded-outcome, randomized controlled trial.

Xianliang Wang, Zhiqiang Zhao, Jingyuan Mao +43 more

Patients with acute decompensated ischemic heart failure (ADIHF) often present with severe clinical symptoms and poor quality of life. In China, Yiqi Fumai lyophilized injection (YQFM) is widely used in the treatment of ADIHF. However, high-quality evidence is still needed to support its efficacy and safety.

Kynurenine-AhR-SLC39A10-Zn2+ signaling reprograms macrophages and enhances pirfenidone efficacy in pulmonary fibrosis.

Huihui Yue, Ruihan Dong, Jianhan He +13 more

Pulmonary fibrosis (PF) is an irreversible and lethal lung disease characterized by progressive scarring lacking safe and effective treatment options. Recent studies have underscored the role of macrophage polarization in fibrotic progression, yet the role of kynurenine (Kyn), a metabolite of tryptophan (Trp), in macrophages during PF progression remains elusive.

Adverse outcomes due to atrioventricular synchrony loss induced by temporary VVI pacing in patients with pre-existing DDD stimulation: insights from a device recall scenario.

Cristian Martignani, Giulia Massaro, Alberto Spadotto +5 more

Temporary reprogramming of dual-chamber (DDD) pacemakers to non-synchronous ventricular modes (VVI/VVIR) may be required in selected clinical scenarios, but short-term consequences of abrupt atrioventricular (AV) synchrony loss remain incompletely characterized.Leveraging a unique natural experiment, this study aimed to quantify the clinical and echocardiographic consequences of temporary VVI/VVIR pacing in patients in sinus rhythm chronically adapted to DDD stimulation.

Burden and clinical impact of anemia in heart failure: insights from a large observational cohort in Saudi Arabia.

Lama Alfehaid, Omar S Alkhezi, Joud Alfriah +1 more

Anemia is a common comorbidity in heart failure (HF) and is associated with adverse outcomes, yet contemporary real-world data describing its burden and relationship with biomarkers of HF severity remain limited.

Sushi, von Willebrand Factor Type A, EGF and Pentraxin Domain-Containing Protein 1: A Novel Fibroblast-Derived Circulating Biomarker Reflecting Cardiac Fibrosis.

Naoya Kuwahara, Manabu Nagao, Yu Izawa +9 more

Cardiac fibrosis is a hallmark of heart failure and can be quantified by the extracellular volume fraction (ECV) derived from diagnostic imaging. However, noninvasive assessment is limited by the lack of specific circulating biomarkers. Recent large plasma proteome analyses have identified SVEP1 (Sushi, von Willebrand factor type A, EGF, and pentraxin domain containing 1) as candidate molecules reflecting cardiac fibrosis. This study aimed to evaluate SVEP1 as a biomarker for cardiac fibrosis.

Prognostic value of cardiopulmonary exercise testing parameters in young heart failure patients with moderately reduced exercise capacity.

Shotaro Komeyama, Osamu Seguchi, Makoto Murata +10 more

Exercise capacity, evaluated using cardiopulmonary exercise testing (CPET), is an important prognostic factor in ambulatory heart failure (HF) patients. However, interpreting the results of CPET in young, ambulatory HF patients who tend to be optimistic about their prognosis is complicated. This study aimed to assess the clinical impact of CPET parameters in predicting the prognosis of young, ambulatory HF patients.

Correlates and Prognostic Value of Serial N-Terminal Pro-B-Type Natriuretic Peptide Assay in Congenitally Corrected Transposition of the Great Arteries.

Ahmed Bahnasy, Meena Bai, Sara Aboelmaaty +5 more

Cardiovascular biomarkers such as NT-proBNP (N-terminal pro-B-type natriuretic peptide) are used for heart failure risk stratification in patients with acquired heart disease, but there are limited data about its role in patients with congenitally corrected transposition of the great arteries. The current study aims to assess the role of serial NT-proBNP measurements for risk stratification in adults with congenitally corrected transposition of the great arteries.

A profile of heart failure in the James and Hudson's Bay region of Ontario: A retrospective cohort study.

Sabastian M B Koprich, Samuel J Petrie, Robert P Gagnon +5 more

The James and Hudson Bay (JHB) region in Northern Ontario is home to an estimated 12,000 people; the majority are Mushkegowuk Cree. To better respond to cardiovascular needs in the region and leverage existing partnerships between the Weeneebayko Area Health Authority's Minomathowin Department, ICES, and University Health Network, this study aimed to profile confirmed and possible heart failure (HF) prevalence among community members.

Warning indicators for heart transplantation requirement at the time of hypertrophic cardiomyopathy diagnosis.

Marc Ramos-Jovani, Ángela López-Sainz, Magí Brufau +12 more

Timely identification of hypertrophic cardiomyopathy (HCM) patients who may require a heart transplant (HT) in the future is crucial. Our study aimed to identify predictive factors associated with the need for HT in HCM patients.

High N-Terminal Pro-B-Type Natriuretic Peptide Levels Are Associated With Lower Physical Function Independent of Sarcopenia in Community-Dwelling Older Adults: The Shizuoka Study.

Michitaka Kato, Yoshihiro Tanaka, Takuji Adachi +10 more

Higher levels of N-terminal pro-B-type natriuretic peptide (NT-proBNP) have been shown to be associated with muscle deterioration and lower physical performance among patients with heart failure (HF). The aim of this study was to clarify the relationships between NT-proBNP levels, sarcopenia, and physical function among community-dwelling older adults.

Prognostic Value of Cystatin C Across Ejection Fraction Spectrum in Heart Failure With Normal to Mild Renal Dysfunction Original Investigation.

Lyu Lyu, Juan Xu, Qiang Yang +3 more

Cystatin C (CysC)'s predictive utility for long-term adverse outcomes in heart failure (HF) patients with normal to mild renal insufficiency remains unclear. This study investigates the relationship between CysC and adverse outcomes in HF patients across the whole ejection fraction (EF) spectrum with normal to mild renal insufficiency.

Optimal Ablation Strategies for Persistent Atrial Fibrillation With Heart Failure: Three-Year Follow-Up of a Prospective Multicenter Randomized Trial.

Kaige Li, Xinhua Wang, Mu Qin +13 more

Catheter ablation has been shown to improve prognosis in patients with heart failure (HF) and atrial fibrillation (AF); however, the optimal ablation strategy remains undefined.

Metoprolol-spironolactone combination for coronary heart disease with concurrent heart failure: impact on cardiac function.

Shujun Zhao, Jiwei Zhang, Yansha Zhao

This study intended to clarify the role of metoprolol-spironolactone combination in treating coronary heart disease (CHD) with concurrent heart failure (HF), focusing on its impact on cardiac function.

State-of-the-Art Strategies in Heart Failure Screening.

Mahmoud M Ramadan, Abdelrahman Nouh, Hamza Haj-Mohamed +5 more

Heart Failure (HF) is a major global health concern affecting approximately 64 million individuals. Because early asymptomatic stages are frequently overlooked, many patients are diagnosed late, after preventable morbidity and hospitalization. Screening that identifies high-risk individuals earlier may enable timely intervention and disease modification.

N-terminal proBNP adds prognostic value to high-sensitivity cardiac troponin I in elective thoracic surgery: an observational cohort study.

María Alonso, Ekaterine Popova, Marcos De Miguel +13 more

Perioperative myocardial injury (PMI) is a common complication following non-cardiac, particularly thoracic, surgery and is associated with increased cardiovascular risk. Although guidelines recommend cardiac biomarker monitoring to detect PMI, its implementation in routine clinical practice remains limited.

Restrictive filling pattern of transmitral inflow in acute decompensated heart failure with preserved ejection fraction: insights from the KCHF registry.

Yutaro Miyoshi, Takao Kato, Takeshi Morimoto +17 more

The restrictive filling pattern of transmitral inflow has been shown to be associated with a poor prognosis in patients with heart failure (HF) with reduced ejection fraction or myocardial infarction. We aimed to investigate the significance of restrictive filling pattern in patients with HF with preserved ejection fraction (HFpEF).

Machine learning-based risk stratification identifies heart failure with preserved ejection fraction as an independent predictor of adverse outcomes in hypertrophic cardiomyopathy.

Weijie Zhang, Huan Zhao, Zhuchang Tian +16 more

Heart failure with preserved ejection fraction (HFpEF) is increasingly recognized in hypertrophic cardiomyopathy (HCM); however, its prognostic significance, phenotypic heterogeneity, and optimal risk stratification strategies remain incompletely defined. In this multicenter retrospective cohort study, 2802 patients with HCM were enrolled from three tertiary centers. HFpEF was diagnosed using established criteria, and H₂FPEF score-based risk subgrouping was performed to further stratify patients. Propensity score matching was applied to balance baseline characteristics between HFpEF and Non-HFpEF patients. Event-free survival was assessed using Kaplan-Meier and multivariable Cox analyses. Restricted cubic spline modeling evaluated non-linear associations between B-type natriuretic peptide (BNP) levels and outcomes. Four machine learning models were developed for individualized risk prediction, with model interpretability assessed using SHAP analysis. HFpEF was present in 47.8% of patients with HCM and was independently associated with worse event-free survival after propensity score matching (HR = 2.612, 95% CI 2.188-3.118, P < 0.001). Higher H₂FPEF scores conferred graded risk, with HFpEF-High patients exhibiting substantially poorer outcomes (HR 2.925, 95% CI 2.210-3.701; P < 0.001). BNP demonstrated a significant non-linear relationship with adverse events, with risk accelerating at higher concentrations. Among machine learning models, the random forest achieved the best discrimination (AUC = 0.856), with SHAP analysis identifying HFpEF status and BNP as dominant contributors to risk prediction. HFpEF represents a prevalent, heterogeneous, and high-risk phenotype in HCM. Integrating H₂FPEF score-based risk subgrouping, non-linear biomarker modeling, and interpretable machine learning enhances personalized risk stratification and may, pending external validation, inform precision management strategies in HCM.

Dapagliflozin for cardiorenal protection after intensive care unit discharge: a protocol for a randomised controlled trial evaluating dapagliflozin at ICU discharge for cardiorenal protection (DAPA-ICU).

François Dépret, Benjamin Chousterman, Claire Roger +20 more

Patients discharged from intensive care units (ICUs) are at high risk of adverse long-term outcomes including cardiovascular and/or renal events and a 1-year mortality of approximately 22%. Plasma biomarkers measured at ICU discharge have demonstrated strong prognostic value, with elevated cardiac or renal biomarkers identifying patients at particularly high risk of poor outcomes. Sodium-glucose cotransporter 2 inhibitors are now widely recognised for their cardioprotective and nephroprotective effects in chronic conditions such as type 2 diabetes, heart failure or chronic kidney disease. These agents improve both morbidity and mortality across a range of high-risk populations. We hypothesise that a therapeutic strategy aimed at preventing the progression of cardiovascular and/or renal injury following ICU discharge may improve long-term outcomes in ICU survivors.

Growth Differentiation Factor 15 as a Biomarker of Cardiovascular Burden and Mortality in a Population-Based Cohort.

Beatriz Martín-Carro, Leticia Nieto-García, Clara Sánchez-Pablo +18 more

Growth differentiation factor 15 (GDF15) is a stress-responsive cytokine strongly associated with aging, multimorbidity, and cardiovascular disease. Although prior studies have established its prognostic value in high-risk populations, its role in the general population remains less defined. The aim of this study was to determine if there is an association between plasma GDF15 levels, heart disease and mortality in a representative population-based cohort. We analyzed 1532 participants (mean age 55 years; 54.6% women) with available baseline plasma GDF15 concentrations. Participants were stratified according to an optimal cutoff of 1081 pg/mL, derived from ROC curve analysis for mortality. Associations with prevalent heart disease were assessed using multivariable logistic regression models adjusted for cardiovascular risk factors and NT-proBNP. Mortality was analyzed using Cox proportional hazards models, with model performance evaluated by C-index and time-dependent ROC curves. Individuals with GDF15 > 1081 pg/mL were older and exhibited a more adverse cardiometabolic profile with higher prevalence of comorbidities. Elevated GDF15 was independently associated with ischemic cardiomyopathy (OR 3.34, 95% CI: 1.38-8.11), particularly in men (OR 4.26, 95% CI: 1.40-12.96), but not in women. No independent associations were observed with arrhythmias, valvulopathy, or heart failure after adjustment for NT-proBNP. During a median follow-up of 6.2 years, 51 deaths occurred. Elevated GDF15 independently predicted all-cause mortality (HR 2.47, 95% CI: 1.19-5.13), though the effect was attenuated after adjustment for NT-proBNP. GDF15 improved model discrimination (ΔC-index = +0.01; LRT p = 0.011) and showed robust time-dependent predictive ability, with AUCs of 0.76, 0.82, and 0.85 at 2, 4, and 6 years, respectively. In this population-based cohort, elevated GDF15 identified individuals with an adverse health profile, was independently associated with ischemic cardiomyopathy in men, and predicted mortality. Although its incremental predictive value over NT-proBNP was modest, GDF15 could provide complementary biological information and may enhance multimarker strategies for cardiovascular risk stratification in the general population.

A Multicenter Randomized Clinical Trial of Dapagliflozin in Patients Receiving Chronic Dialysis (The DARE-ESKD-2 Trial).

Joaquim Barreto, Marilia Paiva Martins, Cleide Aparecida Moreira Silva +18 more

Dapagliflozin reduces heart failure (HF) incidence and hospitalizations in chronic kidney disease (CKD), but its efficacy and safety in patients on maintenance dialysis remain uncertain.

Mitochondrial and Cardiolipin Adaptations to Ventricular Assist Device Support in Pediatric Versus Adult Failing Myocardium.

Caitlyn S Conard, Mariana Casa de Vito, Obed O Nyarko +11 more

Ventricular assist devices (VADs) are used as treatment for end-stage heart failure in children and adults. We previously demonstrated decreased mitochondrial function and changes in cardiolipin, a mitochondrial phospholipid, in explanted pediatric and adult failing hearts. In this study, we tested the hypothesis that VAD unloading of failing hearts leads to positive changes in myocardial cardiolipin in both pediatric and adult hearts.

Albumin-Bilirubin Score and Subclinical Right Ventricular Dysfunction After Repair of Tetralogy of Fallot.

Erhan Sönmez, Özge Pamukçu Akay, Yunus Emre Kum +3 more

Right ventricular (RV) dysfunction is a key determinant of long-term morbidity in patients following surgical repair of tetralogy of Fallot (TOF). Identifying practical biomarkers for early detection of right-sided heart failure remains clinically relevant, particularly in pediatric populations with subclinical disease. The albumin-bilirubin (ALBI) score, a simple and objective marker of hepatic function, has emerged as a potential surrogate of systemic congestion in heart failure. This study aimed to evaluate whether the ALBI score reflects right ventricular dysfunction in pediatric patients after TOF repair and to examine its relationship with N-terminal pro-brain natriuretic peptide (NT-proBNP) and echocardiographic indices.

Analyzing Vital Sign Variability in Remote Monitoring as a Predictor of 31-Day Heart Failure Readmission: A Retrospective Cohort Study.

Adeel Arif, Anshul Kumar, Michelle Elsener +2 more

Heart failure (HF) is a major cause of morbidity and early hospital readmission in the United States. Remote patient monitoring (RPM) is increasingly used to support postdischarge care, but evidence remains mixed, and the prognostic value of day-to-day vital sign variability is unclear. This study evaluated whether physiologic variability and patient engagement during RPM were associated with 31-day HF readmission.

B-type natriuretic peptide attenuates TLR-induced cytokine and chemokine secretion in monocyte-derived Langerhans cells.

Dorottya Horváth, Zsófia Pénzes, Petra Molnár +6 more

B-type natriuretic peptide (BNP) is a well-known cardiac hormone and biomarker of heart failure, but emerging evidence suggests that it also possesses immunomodulatory properties, including a role in inflammatory skin conditions like atopic dermatitis (AD). Langerhans cells (LCs), specialized epidermal antigen-presenting cells, orchestrate cutaneous immunity and are targets of neuropeptides. In the present study, we investigated how BNP treatment during differentiation affects the activation, cytokine profile, and interaction of immune cells with moLCs subsequently activated via Toll-like receptors (TLRs).

Efficacy and safety of sacubitril/valsartan in patients on peritoneal dialysis: a systematic review and meta-analysis.

Caio Lima da Silva, Pandora Eloa Oliveira Fonseca, Viviane Calice-Silva +3 more

Sacubitril/valsartan is a recommended medication for managing heart failure (HF). However, its role in peritoneal dialysis (PD) patients remains uncertain. We conducted this systematic review and singlearm meta-analysis to assess the efficacy and safety of sacubitril/valsartan in this population.

Sensing performance of ScTiO3 film-based EIS arrays through co-sputtering for pH sensing and heart failure biomarker monitoring.

Tung-Ming Pan, Chia-Yu Kuo, Jim-Long Her +1 more

In this work, a ScTiO3 sensing film array was fabricated on a p-type Si substrate using a co-sputtering technique and subsequently integrated into electrolyte-insulator-semiconductor (EIS) platforms for both pH sensing and N-terminal pro-B-type natriuretic peptide (NT-proBNP) detection, a clinically important biomarker for heart failure (HF) diagnosis. To evaluate the structural, interfacial, and sensing characteristics, the films underwent RTA at temperatures between 600 and 800 °C. Extensive material characterization, including X-ray diffraction, X-ray photoelectron spectroscopy, Auger electron spectroscopy, transmission electron microscopy, and atomic force microscopy, revealed a strong correlation between the microstructural evolution of the ScTiO3 films and their sensing performance. Superior sensing characteristics were observed in the film annealed at 700 °C, which recorded the highest sensitivity (65.07 mV/pH) alongside impressive stability metrics, including a 0.26 mV/h drift rate and 1.2 mV hysteresis. Furthermore, to enable specific NT-proBNP detection, the ScTiO3 surface was first functionalized with APTES and then conjugated with EDC/NHS-activated antibodies, facilitating precise antigen-antibody interactions. The resulting ScTiO3-based array EIS biosensor demonstrated excellent analytical performance, delivering a high sensitivity of 10.84 mV/pCNT-proBNP over a wide dynamic detection range from 10-4 to 106 pg/mL. Collectively, these results highlight the strong potential of a ScTiO3 sensing film array as high-performance platforms for reliable pH monitoring and advanced biomedical diagnostics, particularly for sensitive and accurate NT-proBNP detection in HF applications.

Prospective cohort study of TIMP-1 and myocardial fibrosis in Chagas disease at a reference clinic in Pernambuco, Brazil: PTICH trial protocol.

Sílvia Marinho Martins, Carolina The Macedo, Cassio Santana Meira +7 more

Chagas disease affects millions of individuals across Latin America and imposes a substantial economic burden on healthcare systems, particularly in rural and underserved regions. Chronic Chagasic cardiomyopathy remains one of the leading causes of heart failure-related mortality in endemic countries. Tissue inhibitor of metalloproteinases-1 (TIMP-1) has emerged as a potential biomarker of myocardial fibrosis in cardiomyopathies. This study was designed to investigate the association between TIMP-1 and myocardial fibrosis in chronic Chagas disease and to assess its potential as an early biomarker of fibrotic remodelling.

Biomarker-Guided Versus Clinically Guided Management Strategies for Heart Failure: A Systematic Review and Meta-Analysis.

Hao Zhou, Ting Liu, Fuxia Lan +3 more

The clinical value of B-type natriuretic peptide (BNP) or N-terminal pro-B-type natriuretic peptide (NT-proBNP)-guided therapy for improving outcomes in patients with heart failure (HF) remains controversial. Thus, this meta-analysis synthesizes the available evidence from randomized controlled trials (RCTs) to determine whether a biomarker-guided strategy reduces all-cause mortality and HF-related hospitalizations compared with clinically guided management.

Prognostic value of cardiopulmonary exercise testing in connective tissue disease-associated pulmonary arterial hypertension at low and intermediate-low risk.

Yixin Zhang, Linwei Shan, Jiayi Dai +6 more

Pulmonary arterial hypertension (PAH) is a severe complication of connective tissue disease (CTD) and a leading cause of mortality in affected patients. Although the COMPERA 2.0 model is widely used for risk stratification in PAH, its ability to discriminate prognosis among low-risk patients remains limited. This study aimed to explore the prognostic predictive role of cardiopulmonary exercise testing (CPET) in CTD-PAH patients classified as low or intermediate-low risk by COMPERA 2.0.

Cardiac biomarkers response under angiotensin receptor-neprilysin inhibitor: a sub-analysis of the NATRIUM-HF study.

Jolie Bruno, Aziz Daghmouri, Malha Sadoune +13 more

Natriuretic peptides (NPs) are central to the diagnostic and therapeutic management of heart failure (HF), yet their short-term dynamics under sacubitril/valsartan (S/V) therapy and during acute volume changes remain incompletely characterized. We aimed to assess changes in circulating biomarkers and response to standardized acute intravascular volume expansion and diuretic treatment before and after S/V initiation.

Effects of intravenous furosemide plus small-volume hypertonic saline solutions on inflammatory, remodelling markers and epigenetics signatures of patients with congestive acute decompensated heart failure (ADHF).

Mario Daidone, Alessandra Casuccio, John Sebastian Soldano +14 more

In a randomised controlled trial (RCT), we compared the effects of treatment with furosemide + small volumes of hypertonic saline solution (HSS) with those of furosemide alone in patients with decompensated heart failure (HF), and their effects on inflammatory and remodelling markers and epigenetic signatures.

Insights into the renin-angiotensin-aldosterone system in transthyretin amyloid cardiomyopathy.

Christina Kronberger, Oliver Domenig, Noemi Pavo +14 more

This study aimed to characterize circulating renin-angiotensin-aldosterone system (RAAS) patterns in transthyretin amyloid cardiomyopathy (ATTR-CM), examine their relationship with clinical and echocardiographic parameters and determine their prognostic value.

Tanshinone-IIA Mediated Attenuation of Post-Infarction Myocardial Fibrosis via IL-33/ST-2 Signaling Changes in Rat Epicardial Adipose Tissue.

Kehan Gao, Xingming Xu, Minyan Sun +6 more

Myocardial infarction (MI), a severe form of coronary artery disease, often results in myocardial fibrosis, a key contributor to cardiac dysfunction and heart failure. Epicardial adipose tissue (EAT) is increasingly implicated in cardiovascular pathology through cytokine-mediated modulation of cardiac function. Tanshinone IIA (TanIIA), a lipophilic compound derived from Salvia miltiorrhiza, exhibits anti-inflammatory, antioxidant, and anti-fibrotic properties. This study aimed to evaluate the therapeutic potential of TanIIA in attenuating post-MI myocardial fibrosis and to explore its underlying mechanisms using an integrative approach combining in vivo experiments and in silico analyses. A murine MI model was established, and molecular docking was employed to assess TanIIA binding to key components of the interleukin-33/growth stimulation expressed gene 2 (IL-33/ST2) signaling pathway. Our results showed that TanIIA treatment significantly enhanced cardiac function, reduced histological injury, and mitigated myocardial fibrosis, alongside decreased serum levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin I (hs-cTnI). TanIIA also attenuated inflammatory responses and oxidative stress in the serum, myocardium, and EAT. Mechanistically, TanIIA downregulated IL-33 and ST2 expression, suppressed the myeloid differentiation factor 88 (MyD88)/nuclear factor kappa-B (NF-κB) pathway, and reduced transforming growth factor-β1 (TGF-β1) levels. In silico analyses further revealed that TanIIA exhibited strong binding affinities for IL-33, ST2, MyD88, and NF-κB p65, with the most stable interaction predicted for ST2. Collectively, these findings indicate that TanIIA alleviates MI-induced myocardial fibrosis by modulating EAT-associated inflammation and oxidative stress, potentially via multi-target inhibition of the IL-33/ST2 axis. These results support TanIIA as a promising therapeutic candidate for the management of post-infarction myocardial fibrosis.

Heart Failure Therapy Improves Outcomes in Adults With Congenital Heart Disease and Left Ventricular Dysfunction.

Zeyad M Kholeif, Mohamed Ellabbad, William R Miranda +5 more

There are limited data about the role of guideline-directed medical therapy (GDMT) in adults with congenital heart disease presenting with heart failure with reduced ejection fraction.

Serum malondialdehyde predicts mortality in patients with acute heart failure.

Marija Pinterić, Iva Klobučar, Margarete Lechleitner +7 more

Acute heart failure (AHF) is associated with high short- and long-term mortality, and early identification of patients at highest risk remains challenging despite the use of established biomarkers and clinical risk scores. Oxidative stress plays a central role in the pathophysiology of AHF but has been insufficiently investigated as a prognostic target. This study aimed to evaluate the prognostic value of serum oxidative stress biomarkers for predicting short- and long-term mortality in AHF patients and to determine whether they improve risk stratification beyond established tools.

Prognostic Value of a Low-Cost LDH-Hemoglobin-Albumin Biomarker Panel in Acute Heart Failure: A Real-World Cohort from a Resource-Limited Setting.

Can Baba Arin

Background: In many low- and middle-income countries, access to advanced cardiac biomarkers such as B-type natriuretic peptide (BNP) and NT-pro BNP remains limited, posing challenges for early risk stratification in patients hospitalized with acute heart failure (AHF). Identifying simple, inexpensive, and universally available laboratory markers with prognostic value is of practical clinical importance. Methods: Consecutive patients (≥18 years) hospitalized with acute heart failure (AHF) between May 2022 and November 2024 were retrospectively analyzed. After exclusion of patients with incomplete outcome data, in-hospital mortality was assessed using logistic regression analysis. Hemoglobin, serum albumin, lactate dehydrogenase (LDH), neutrophil-to-lymphocyte ratio (NLR), and the C-reactive protein-albumin-lymphocyte (CALLY) index were evaluated as potential predictors of in-hospital mortality. Results: A total of 211 patients were included in the mortality analysis, with an in-hospital mortality rate of 10.0%. Patients were stratified by anemia and hypoalbuminemia status, revealing significant differences in unadjusted mortality rates across groups (p = 0.04). However, after adjustment for age, sex, and chronic kidney disease, the prognostic impact of anemia and hypoalbuminemia was attenuated. Elevated LDH levels remained independently associated with in-hospital mortality (adjusted odds ratio 2.84, 95% confidence interval 1.01-8.02). Higher NLR values and lower CALLY index levels showed nonsignificant trends toward adverse outcomes. Conclusions: In this real-world cohort from a resource-limited setting, LDH emerged as a practical and independent predictor of in-hospital mortality in patients with AHF. When access to natriuretic peptides is limited, LDH-supported by routinely available laboratory parameters-may assist early risk stratification and clinical decision-making.

Comparative Long-Term Outcomes of Anatomical and Physiological Repair for Corrected Transposition.

Yuji Tominaga, Masashi Takeshita, Takuji Watanabe +5 more

The optimal surgical strategy for congenitally corrected transposition of the great arteries (ccTGA) remains debated. This study aimed to compare the long-term outcomes of each surgical approach and to explore the optimal management strategy.

Efficacy comparison of dapagliflozin combined with liraglutide versus monotherapy in obese patients with heart failure.

Guangzhi Zhou, Aijun Liu, Xiabing Hu +2 more

This study aimed to evaluate the efficacy and safety of dapagliflozin combined with liraglutide versus monotherapy in obese patients with heart failure with preserved ejection fraction (HFpEF). This retrospective study enrolled 360 obese patients with HFpEF, who were divided into 3 groups according to different treatment methods: the combination group (dapagliflozin + liraglutide), the dapagliflozin group, and the liraglutide group, with 120 patients in each group. The intervention duration was 24 weeks. The primary endpoints included changes in N-terminal pro-B-type natriuretic peptide levels, 6-minute walk distance, and cardiac structural parameters. Secondary endpoints included metabolic indicators (weight, blood glucose, etc) and safety outcomes. After 24 weeks of intervention, the combination group showed a more significant decrease in B-type natriuretic peptide levels (P < .05) and a greater improvement in 6-minute walk distance (P < .05) compared with the 2 monotherapy groups. In terms of metabolic indicators, the combination group had greater weight loss (P < .05) and better blood glucose control (P < .05). The incidence of major cardiovascular composite endpoints in the combination group was lower than that in the monotherapy groups (P < .05). The overall incidence of adverse events was similar among the 3 groups (P > .05). Dapagliflozin combined with liraglutide has a synergistic effect in improving cardiac function and metabolic disorders in obese patients with HFpEF, with good safety, providing a more effective therapeutic strategy for clinical practice.

Mid-regional pro-atrial natriuretic peptide in managing cardiovascular and cerebrovascular diseases.

Xu-Lei Hao, Gjin Ndrepepa, Wen-Qi Zheng +1 more

Mid-regional pro-atrial natriuretic peptide (MR-proANP), along with B-type natriuretic peptide (BNP) and N-terminal pro-B-type natriuretic peptide (NT-proBNP), is a type of natriuretic peptide hormone that is released by atrial muscle cells upon stress. Previous studies have shown that MR-proANP has high diagnostic accuracy for heart failure (HF) in several clinical settings, and it also helps in the risk stratification of patients with HF. In the general population, elevated MR-proANP levels indicate a high risk of cerebrovascular and cardiovascular diseases, including stroke and atrial fibrillation. In patients with established cardiovascular and cerebrovascular diseases, elevated MR-proANP levels are associated with a poor prognosis. This review summarizes the value and the use of MR-proANP in assessing the risk, diagnosis, and prognosis of patients with cardiovascular and cerebrovascular disease(s).

Diagnostic Value of Serum sCD40L, CCL3, and NT-ProBNP Levels in Detection of Lower Limb Venous Thrombosis among Elderly Patients with Heart Failure.

Xuelian Liu, Lina Mu, Shasha Ma +1 more

The serum levels of soluble CD40 ligand (sCD40L), cytokine ligand 3 (CCL3), and N-terminal pro-brain natriuretic peptide (NT-proBNP) are closely associated with heart failure (HF).

Decoding the Heart Failure Peptidome.

Christian T Madsen, Jan C Refsgaard, Geert H D Voordes +8 more

Peptides such as angiotensin II and brain natriuretic peptide are pivotal in diagnosing and treating heart failure (HF). However, unbiased systematic studies of the peptidome in patients with HF are lacking. Deciphering the plasma peptidome might significantly improve the diagnosis, prognostication, and treatment of patients with HF.

Efficacy of rhBNP in heart failure with atrial fibrillation combined with poor conventional therapy response and recurrence risk factors.

Huijuan Shang, Xiaojun Wang, Xiaoyin Shi +1 more

To evaluate the efficacy of recombinant human brain natriuretic peptide (rhBNP) in patients with acute decompensated heart failure (ADHF) complicated with atrial fibrillation (AF) and poor response to conventional treatment.

Invasive Confirmation of Microvascular Recovery Parallel to Left Ventricular Functional Restoration.

Takumi Toya, Takumi Kondo, Otoya Sekine +7 more

Coronary microvascular dysfunction (CMD) is increasingly implicated in heart failure, but reversal with guideline-directed medical therapy (GDMT) is rarely documented using invasive physiology.

Effect of Fluid Restriction in Heart Failure: A Meta-Analysis of Randomized Controlled Trials.

Maryam Sajid, Shahzaib Ahmed, Taimor Mohammed Khan +6 more

Fluid restriction is frequently recommended for patients with heart failure (HF) to prevent volume overload, yet its clinical benefit remains uncertain. This meta-analysis compared the efficacy and safety of fluid restriction versus liberal fluid intake in HF by systematically searching PubMed, Scopus, and Cochrane CENTRAL through May 2025 for randomized controlled trials evaluating fluid restriction (≤1.5 L/d) compared with liberal intake in adults with HF. Outcomes included re-hospitalization, mortality, weight, thirst, quality of life (QoL), intravenous diuretic use, and serum biomarkers such as sodium, creatinine, and brain natriuretic peptide. Ten randomized controlled trials involving 1465 participants (731 fluid restriction; 734 liberal intake) were included. Fluid restriction was associated with a 29% relative reduction in re-hospitalization (relative risks [RR] 0.71; 95% confidence interval [CI], 0.50-1.02; P = 0.06; I2 = 52%) and mortality (RR 0.71; 95% CI, 0.43-1.18; P = 0.19; I2 = 0%), although neither reached statistical significance. Weight reduction favored fluid restriction (weighted mean difference [WMD] -1.58 kg; 95% CI, -3.92 to 0.76), but findings varied across studies. No significant differences were observed for thirst (WMD 4.96), QoL (standardized mean difference [SMD] 0.15), intravenous diuretic use, sodium levels (WMD 0.90 mmol/L), creatinine (WMD -0.10 mg/dL), or brain natriuretic peptide (WMD -51.41 pg/mL). Subgroup analysis showed that liberal fluid intake significantly reduced creatinine in chronic compensated HF, whereas no benefit was found in acute decompensated HF. Sensitivity analyses identified one outlier trial as the primary source of heterogeneity. Overall, fluid restriction does not significantly improve outcomes in HF, and liberal fluid intake appears safe, supporting more individualized fluid strategies.

Total body water to lean body mass ratio predicts mortality in patients with chronic heart failure: a prospective, observational study.

Linfeng Xie, Bryan Richard Sasmita, Yuhe Zhao +4 more

Malnutrition and sodium water retention are some of the most common complications of chronic heart failure (CHF). To date, several parameters or risk stratification tools have been established to predict one's volume or nutritional status. Unfortunately, there is no biomarker that may reflect both conditions, thus, in this study, we established a novel biomarker known as total body water (TBW) to lean body mass ratio (LBM) ratio (TLR). Accordingly, we also assessed the prognostic value of TLR in CHF patients.

Multimodal evidence chain of iron overload, inflammation, and dysfunction: an integrated predictive model of early cardiac injury in pediatric transfusion-dependent β-thalassemia.

Panyan Zhou, Caili Li, Xiaomei Gao +3 more

Despite standardized transfusion and chelation therapy, children with transfusion-dependent β-thalassemia (TDT) remain at high risk for cardiac dysfunction due to iron overload. Conventional ejection fraction assessment lacks sensitivity for early injury. This study evaluated multimodal indicators to develop a robust early-warning model.

Analgesic use and changes in renal function in patients with heart failure in a real-world setting: a descriptive study using an electronic medical record database.

Ryo Ishida, Toshio Takano, Hironobu Tokumasu +1 more

To evaluate the incidence of analgesic use and changes in the estimated glomerular filtration rate (eGFR) of patients with heart failure (HF), with and without analgesic use in a real-world Japanese setting.

The Postoperative Course of Troponin T and NT-proBNP Levels in the Pediatric Population Implanted with the HeartMate 3 Device.

Şeyma Şebnem Ön, Zülal Ülger Tutar, Eser Doğan +13 more

Cardiac troponin T (cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP) are key biomarkers reflecting myocardial injury and hemodynamic load in heart failure or after cardiac surgery. However, data on their postoperative course in pediatric HeartMate 3 (HM3) recipients are limited. This retrospective case series of ten pediatric patients aimed to evaluate the clinical significance of postoperative changes in these biomarkers.

Clinical Utility of Continuous Non-contact Cardiac Function Monitoring via Fiber-Optic Micro-Vibration Sensing System-based Myocardial Performance Index in Heart Failure Patients with Reduced Ejection Fraction.

Xiaoyan Wu, Jing Zhan, Chenze Li +7 more

Introduction Continuous monitoring of cardiac function may contribute to improving clinical outcomes in heart failure (HF) patients. A fiber-optic micro-vibration sensing system (FO-MVSS) that was previously developed by our group could make possible the non-contact and continuous measurement of the myocardial performance index (MPI) to assess cardiac function. However, the utility of MPI obtained by FO-MVSS (MPIFO-MVSS) in HF patients requires investigation. Methods Utilizing a case-control design, 72 HF patients and 72 control patients matched for age, gender and body mass index were recruited. Both FO-MVSS and echocardiography were used to measure the duration of the various phases of the cardiac cycle, thereby deriving the corresponding MPI. The MPIFO-MVSS of 23 hospitalized patients with HF was continuously monitored to evaluate its predictive value for the improvement of cardiac function. Results The MPIFO-MVSS was in excellent agreement with the MPI obtained by echocardiography (MPIecho) (intra-class correlation coefficient: 0.94, p<0.001). The MPIFO-MVSS exhibited statistically significant correlations with left ventricular ejection fraction (LVEF) (r=-0.78, p<0.001) and N-terminal prohormone brain natriuretic peptide (NT-proBNP) (r=0.66, p<0.001). The MPIFO-MVSS had an excellent performance in discriminating HF patients from control patients, with an area under the curve (AUC) of 0.98 (p<0.001). Moreover, among continuously monitored patients, the change in MPIFO-MVSS was predictive of clinical outcomes (the kappa coefficient: 0.91, p<0.001). Conclusion Our study presents a novel approach to using non-contact MPIFO-MVSS for continuous cardiac function evaluation in patients with HF. The MPIFO-MVSS may serve as an accurate, sensitive, and non-invasive indicator of cardiac dysfunction.

Sleep-disordered breathing in patients with heart failure with preserved left ventricular ejection fraction.

Cornelia Grimm, Christian Viniol, Mikail Degerli +5 more

Data on sleep-disordered breathing (SDB) in patients with heart failure with preserved left ventricular ejection fraction (HFpEF) are sparse. Therefore, we aimed to determine the prevalence and characteristics of SDB in a large patient cohort with HFpEF.