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Tzeis, Stylianos; Sepehri Shamloo, Alireza
doi: 10.1093/eurheartj/ehae375pmid: 39821327
Gonzalez-Lopez, Esther; Maurer, Mathew S; Garcia-Pavia, Pablo
doi: 10.1093/eurheartj/ehae811pmid: 39791537
Development of specific therapies addressing the underlying diseases’ mechanisms constitutes the basis of precision medicine. Transthyretin cardiac amyloidosis (ATTR-CM) is an exemplar of precise therapeutic approach in the field of heart failure and cardiomyopathies. A better understanding of the underlying pathophysiology, more precise data of its epidemiology, and advances in imaging techniques that allow non-invasive diagnosis have fostered the development of new and very effective specific therapies for ATTR-CM. Therapeutic advances have revolutionized the field, transforming a rare, devastating, and untreatable disease into a more common disease with several therapeutic alternatives available. Three main types of therapies (stabilizers, suppressors, and degraders) that act at different points of the amyloidogenic cascade have been developed or are currently under investigation. In this review, the key advances in pathophysiology and epidemiology that have occurred in the last decades along with the different therapeutic alternatives available or under development for ATTR-CM are described, illustrating the role of precision medicine applied to cardiovascular disorders. Pending questions that would need to be answered in upcoming years are also reviewed.
Bauersachs, Johann; Zieroth, Shelley; de Boer, Rudolf A
doi: 10.1093/eurheartj/ehaf017pmid: 39844351
Graphical AbstractGraphical AbstractThe year in cardiovascular medicine 2024: The top 10 papers in heart failure Left: Studies in heart failure with preserved/mildly reduced ejection fraction (HFpEF/mrEF). Right: Studies in heart failure with reduced ejection fraction (HFrEF). 6MWD, 6-minute walking distance; CSS, clinical summary score; CV, cardiovascular; GRMT, guideline-recommended medical therapy; HF, heart failure; HFpEF, heart failure with preserved ejection fraction; HFmrEF, heart failure with mildly reduced ejection fraction; HFrEF, heart failure with reduced ejection fraction; KCCQ, Kansas City Cardiomyopathy Questionnaire; LVAD, left ventricular assist device; LVEF, left ventricular ejection fraction; MR, mitral regurgitation; M-TEER, mitral valve transcatheter edge-to edge repair; NYHA, New York Heart Association; OS score, overall summary score; PA, pulmonary artery pressure; PH, pulmonary hypertension; PPCM, peripartum cardiomyopathy; SOC, standard of care; T2DM, type 2 diabetes mellitus; VKA, vitamin K antagonists.
doi: 10.1093/eurheartj/ehae875pmid: 39873231
Graphical AbstractGraphical AbstractPeripartum cardiomyopathy (PPCM): facts and challenges.
Sliwa, Karen; Jackson, Alice; Viljoen, Charle; Damasceno, Albertino; Mbanze, Irina; Farhan, Hassan Al; Yaseen, Israa Fadhil; Mbakwem, Amam; Dewi, Triwedya Indra; Dzielinska, Zofia; Abdullaev, Timur; Goland, Sorel; Hilfiker-Kleiner, Denise; Hahnle, Julia;
Agboola, Olayinka; Sharma, Garima
doi: 10.1093/eurheartj/ehae888pmid: 39950969
Graphical AbstractGraphical AbstractApproaching subsequent pregnancy in patients with peripartum cardiomyopathy.
Showing 1 to 10 of 16 Articles
doi: 10.1093/eurheartj/ehaf006pmid: 39936475
Background and AimsThe risk of heart failure progression or mortality in patients with peri-partum cardiomyopathy (PPCM) during subsequent pregnancies (SSPs) is a significant concern for patients, their families, and healthcare providers. However, there is limited contemporary, prospective data on SSP outcomes in PPCM patients from diverse ethnic and sociodemographic groups. This study aimed to assess maternal and neonatal outcomes in PPCM patients undergoing SSPs.MethodsThis is a sub-study on PPCM and SSPs of the global European Society of Cardiology PPCM Registry that recruited patients from 2012 to 2023. Maternal and neonatal outcomes were reported.ResultsFrom 332 patients with PPCM, there were 98 SSPs among 73 women. Of these, 25 (26%) SSPs ended prematurely due to therapeutic termination (20/25), miscarriage (4/25), and stillbirth (1/25). The median follow-up from the end of the SSP was 198 days (inter-quartile range 160–240). Left ventricular ejection fraction (LVEF) was persistently reduced to <50% prior to the SSP in 26% of patients, with only 6% having an LVEF <40%. Patient characteristics were similar, irrespective of SSP baseline LVEF. Clinical worsening [composite of all-cause death, cardiovascular rehospitalization, or decline in LVEF ≥10% (percentage points) and to <50%] occurred in 20% SSPs, with 2% all-cause maternal mortality. Signs/symptoms of heart failure and worsening of New York Heart Association class occurred in 26% and 22% of SSPs, respectively. At follow-up, the mean LVEF was 50% (±12%), and in 69% of SSPs, the LVEF was ≥50%. African women had similar outcome as the other ethnic groups. Pre-term delivery occurred in 24% of SSPs, 20% of babies were of low birth weight, and there was 3% all-cause neonatal mortality. Compared with women with SSP baseline LVEF <50%, fewer women with LVEF ≥50% were on heart failure pharmacotherapies prior to the SSP, and in this group of women, there was a significant decline in LVEF.ConclusionsMaternal morbidity and mortality rates were lower than anticipated. Baseline LVEF <50% was not associated with an increased frequency of adverse maternal outcomes, and no further decline in LVEF was observed in this group. In contrast, women with SSPs and a baseline LVEF ≥50% experienced a decline in LVEF, potentially attributable to reduced use of heart failure pharmacotherapy during pregnancy and the post-partum period. Therapeutic termination was performed in approximately a fifth of cases. The findings suggest that reclassification of a SSP with persisting mild left ventricular impairment from modified World Health Organization (mWHO) Class IV (contraindicated) to mWHO III may be considered, while remaining under the care of an experienced medical team and with appropriate pharmacological management.