Resumo Fundamento O escore Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) é uma ferramenta de estratificação de risco utilizada para prever mortalidade na insuficiência cardíaca (IC). Entretanto, possíveis diferenças relacionadas ao sexo em seu desempenho e sua aplicabilidade à população brasileira permanecem incertas. Objetivos Avaliar diferenças baseadas no sexo no desempenho do escore MAGGIC e validar o escore em uma coorte brasileira de IC. Métodos Este estudo de coorte retrospectivo incluiu 866 pacientes acompanhados em um ambulatório de IC. O desfecho primário foi mortalidade por todas as causas em 3 anos. O escore MAGGIC foi calculado para cada paciente. A discriminação foi avaliada por meio da área sob a curva característica de operação do receptor, e a calibração foi avaliada pelo teste de Hosmer-Lemeshow. As análises foram realizadas para a coorte total e estratificadas por sexo. Considerou-se valor de p < 0,05 como estatisticamente significativo. Resultados A taxa global de mortalidade em 3 anos foi de 33,4% (36,4% em homens e 27,8% em mulheres; p = 0,010). A mortalidade predita foi de 20,9% (escore médio de 18,3 ± 7), sendo 22,7% em homens e 19,1% em mulheres. O escore demonstrou boa discriminação (área sob a curva = 0,72; intervalo de confiança de 95%: 0,686-0,754), com desempenho semelhante em homens (0,704 [0,661-0,747]) e mulheres (0,733 [0,674-0,792]). A calibração mostrou boa concordância: qui-quadrado (χ2) global = 1,1 (p = 0,998), χ2 para homens = 0,9 (p = 0,999) e χ2 para mulheres = 1,3 (p = 0,995). A mortalidade observada foi maior nos grupos de risco moderado, sem diferença significativa entre os grupos de risco moderado e alto (p = 0,236). Conclusão O escore MAGGIC apresentou bom desempenho em uma coorte brasileira de IC, sem diferenças significativas relacionadas ao sexo, embora tenha sido identificada maior mortalidade observada entre pacientes de risco moderado.

BACKGROUND:Treatment with intravenous iron has been shown to improve symptoms, functional capacity, and quality of life in patients with heart failure with reduced ejection fraction (HFrEF) and iron deficiency. However, the mechanisms underlying these beneficial effects remain unknown. Sodium-glucose cotransporter-2 inhibitor (SGLT2i) seems to alter hematocrit and other hematologic markers of iron content. This study aims to measure cardiac magnetic resonance changes in myocardial iron content after the administration of intravenous iron with or without SGLT2i and to assess changes in left ventricular function in patients with HFrEF and iron deficiency. METHODS:Outpatients with symptomatic HFrEF, left ventricular ejection fraction (LVEF) <40%, SGLT2i-naive, and iron deficiency will be assigned to receive intravenous iron + SGLT2i; intravenous iron + a placebo of SGLT2i; or placebo of both therapies for 30 days. The total sample size was calculated to be 99 patients. Myocardial iron will be evaluated by T2-star cardiac magnetic resonance sequence before intravenous iron infusion. After 30 days, all patients will be reassessed with T2-star cardiac magnetic resonance sequencing. The primary endpoint will be changes in LVEF and myocardial iron content at 30 days. Secondary endpoints will include correlations of these changes with myocardial iron content, functional capacity, quality of life, and cardiac biomarkers. CONCLUSIONS:This study will determine the effect of ferric carboxymaltose and its combination with SGLT2i on LVEF and its relationship with measures of myocardial iron content, functional capacity, and biomarkers in HFrEF and iron deficiency.

BACKGROUND:The Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score is a risk stratification tool used to predict mortality in heart failure (HF). However, potential sex-related differences in its performance and its applicability to the Brazilian population remain uncertain. OBJECTIVES:To evaluate sex-based differences in the performance of the MAGGIC score and to validate the score in a Brazilian HF cohort. METHODS:This retrospective cohort study included 866 patients followed at a HF outpatient clinic. The primary outcome was 3-year all-cause mortality. The MAGGIC score was calculated for each patient. Discrimination was assessed using the area under the receiver operating characteristic curve, and calibration was evaluated using the Hosmer-Lemeshow test. Analyses were performed for the overall cohort and stratified by sex. A p-value < 0.05 was considered statistically significant. RESULTS:The overall 3-year mortality rate was 33.4% (36.4% in men and 27.8% in women; p = 0.010). Predicted mortality was 20.9% (mean score 18.3 ± 7), with 22.7% for men and 19.1% for women. The score demonstrated good discrimination (area under the curve = 0.72; 95% CI: 0.686-0.754), with similar performance in men (0.704 [0.661-0.747]) and women (0.733 [0.674-0.792]). Calibration showed good agreement: overall chi-square (χ2) = 1.1 (p = 0.998), men χ2 = 0.9 (p = 0.999), and women χ2 = 1.3 (p = 0.995). Observed mortality was higher in moderate-risk groups, with no significant difference between moderate- and high-risk groups (p = 0.236). CONCLUSION:The MAGGIC score showed good performance in a Brazilian HF cohort, with no significant sex-based differences, although higher observed mortality was identified among moderate-risk patients.

Aims:To investigate whether early combined changes in venous excess ultrasound (VExUS) and lung ultrasound (LUS) were associated with outcomes in acute decompensated heart failure (ADHF). Methods and results:We prospectively enrolled 104 patients with ADHF [mean age 64.3 ± 13.5 years, 69.2% male, median left ventricle ejection fraction 24.5% (18.0, 32.0)]. VExUS score and LUS were performed within 24 h of admission and after 72 h. Changes in congestion were integrated into a single metric (ΔVExPLUs = [2 × ΔVExUS] + ΔLUS), with ΔVExUS multiplied by two to balance its narrower scoring range. The primary outcome was in-hospital mortality. Secondary outcomes included 30-day all-cause mortality and a composite of 30-day all-cause mortality, heart transplantation and left ventricular assist device implantation. Patients with greater ΔVExPLUs improvement had lower rates of in-hospital mortality (3% vs. 46%; P < 0.001), 30-day mortality (12% vs. 50%; P = 0.007), and the composite outcome (19% vs. 64%; P = 0.002). In multivariable analysis, ΔVExPLUs ≥ 1 was independently associated with in-hospital mortality [odds ratio (OR): 0.65; 95% confidence interval (CI): 0.51, 0.83; P < 0.001], 30-day mortality (OR: 0.78; 95% CI: 0.65, 0.94; P = 0.009), and the composite outcome (OR: 0.76; 95% CI: 0.64, 0.92; P = 0.004). For in-hospital mortality, ΔVExPLUs achieved the highest area under the curve (AUC) (0.76), with a sensitivity of 95.6% and a negative predictive value of 97.0%, compared with ΔVExUS (AUC: 0.70) and ΔLUS (AUC: 0.65). Conclusion:Serial integration of systemic and pulmonary ultrasound parameters through ΔVExPLUs is independently associated with short-term outcomes in ADHF and may improve early risk stratification.

BACKGROUND:Patisiran rapidly knocked down transthyretin and preserved functional capacity in patients with transthyretin amyloidosis with cardiomyopathy (ATTR-CM) in the global Phase 3 APOLLO-B study (NCT03997383). OBJECTIVES:To evaluate patisiran efficacy and safety in post hoc analysis of the Brazilian subpopulation of APOLLO-B. METHODS:Patients were randomized 1:1 to patisiran 0.3 mg/kg or placebo every 3 weeks for 12 months. The primary endpoint was the change from baseline (CFB) in functional capacity (6-minute walk test [6MWT]) at Month 12. Secondary endpoints included CFB to Month 12 in the Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS) score. Exploratory endpoints included CFB in cardiac biomarkers and Perugini grade of cardiac uptake during technetium-99m scintigraphy. RESULTS:Forty-two patients enrolled in Brazil (patisiran, n=20; placebo, n=22). Patisiran showed benefit in 6MWT and KCCQ-OS scores vs. placebo; CFB (95% confidence interval [CI]) in 6MWT (median) and KCCQ-OS scores (least squares mean) was -2.0 m (-58.5, 42.9) and 9.37 (1.93, 16.81) points with patisiran vs. -30.1 m (-72.2, 3.5) and 2.62 (-4.68, 9.92) points for placebo. For cardiac biomarkers, the mean fold-change from baseline (95% CI) for N-terminal prohormone B-type natriuretic peptide and troponin I was 1.31 (1.06, 1.61) and 1.12 (0.94, 1.34) for patisiran, and 1.71 (1.39, 2.10) and 1.28 (1.08, 1.53) for placebo, respectively. Perugini grade improved in 11/18 (61.1%) and 0/10 evaluable patients with patisiran and placebo, respectively. There were no deaths in the patisiran group vs. 3 in the placebo group.

BACKGROUND:Quantifying systemic venous congestion in acute decompensated heart failure (ADHF) is challenging. The Venous Excess Ultrasound (VExUS) score has emerged as a noninvasive tool for assessing venous congestion. Although higher VExUS values are linked to cardiorenal syndrome, its prognostic role in ADHF remains unclear. This study evaluated whether repeated VExUS measurements, obtained at 2 time points, predict in-hospital mortality in ADHF. METHODS:In this prospective cohort study, 104 patients with ADHF and left ventricular ejection fraction <50% were admitted to a cardiovascular intensive care unit between October 2022 and January 2024. Modified VExUS was assessed within 24 hours of admission and repeated at 72 hours using a modified protocol (mVExUS). ΔVExUS was defined as the 72-hour score minus the baseline score; improvement was defined as ΔVExUS ≥1. Complementary point-of-care ultrasound (POCUS) parameters and clinical markers of decongestion were also evaluated. Of the total, 97 patients had complete follow-up and were included in the ΔVExUS analysis. The primary outcome was in-hospital mortality. RESULTS:Patients with ΔVExUS ≥1 had greater urine output, more pronounced weight loss, and greater reduction in serum creatinine and clinical congestion score (all P < .05). In-hospital mortality was significantly lower in patients with mVExUS improvement (11.1% vs 36.4%, P = .007). ΔVExUS ≥ 1 remained independently associated with lower in-hospital mortality after adjustment for clinical and echocardiographic variables (adjusted odds ratio, 0.31; 95% CI, 0.14-0.68; P = .004). In multivariable analysis using least absolute shrinkage and selection operator regression, ΔVExUS emerged as an independent predictor of in-hospital mortality (odds ratio, 0.32; 95% CI, 0.13-0.74). CONCLUSIONS:A reduction of ≥1 point in the mVExUS score over the first 72 hours (ΔVExUS ≥ 1) was independently associated with lower in-hospital mortality and was accompanied by favorable clinical and laboratory markers of decongestion. This is the first study to identify ΔVExUS as a dynamic prognostic marker in ADHF, reinforcing its value as a practical tool for routine bedside application. These findings support the incorporation of repeated mVExUS assessments into standard practice to enhance risk stratification in patients with ADHF.

BACKGROUND Body composition is increasingly recognized as an important factor in the prognosis of patients with heart failure (HF). Variations in muscle mass, fat-free mass, and fat mass may influence survival outcomes, but the extent of these associations remains unclear. OBJECTIVES This study aims to evaluate the impact of body composition parameters on survival in patients with HF. METHODS Five databases were searched through January 2024. Eligible papers reported associations between body composition parameters and survival in HF patients. All-cause mortality was the primary outcome. Risk of bias was evaluated using the Newcastle-Ottawa scale. A random-effects model was used to calculate the 95% CI and HR, with heterogeneity assessed using Cochran's Q and I2 tests. RESULTS The analysis included 39 cohort studies involving 36,176 HF patients, with 21 studies included in the quantitative analysis. Low muscle mass (HR: 1.73 [95% CI: 1.32-2.26]; I2 = 47%) (7 studies) was significantly associated with increased all-cause mortality risk. The prognostic significance of low muscle mass remained consistent across sensitivity and subgroup analysis. Elevated fat mass was not associated with a risk of death (pooled adjusted HR: 0.75 [95% CI: 0.26-2.12]; I2 = 77%). Higher abdominal fat showed no significant mortality association. CONCLUSIONS The authors found a strong association between body composition parameters and all-cause mortality. Muscular wasting, measured by low muscle mass, was associated with increased mortality, strengthening the role of muscle mass in HF prognosis. In contrast, higher fat mass and abdominal adiposity showed no association. These findings underscore the importance of comprehensive body composition evaluation in HF prognosis. (Association of Body Composition with Overall Survival in Patients with Heart Failure: A Systematic Review and Meta-Analysis; CRD42023488040) (JACC Heart Fail. 2025;13:943-954) (c) 2025 by the American College of Cardiology Foundation.

INTRODUCTION:At present, existing risk scores together with traditional biomarkers such as troponin and brain natriuretic peptide are still unable to accurately predict cancer therapy-related cardiac dysfunction (CTRCD). MicroRNAs (miRNAs) have emerged as promising biomarkers for improved identification of high-risk patients; however, limited studies have been performed in patients with HER2-positive breast cancer. This study aimed to investigate the predictive potential of six serum-derived circulating miRNAs for CTRCD occurrence in patients with early-stage HER2-positive breast cancer receiving trastuzumab (TTZ). METHODS:A prospective cohort study was conducted involving consecutive female patients aged 18 years or older with HER2-positive early breast cancer, who attended the breast oncology outpatient clinic of the institution between March 2019 and March 2022. Blood samples were obtained prior to the initiation of TTZ therapy. CTRCD was defined as a reduction in left ventricular ejection fraction >10 percentage points, resulting in a value <53%. Quantification of miRNAs - including let-7f-5p, miR-1-3p, miR-20a-5p, miR-126-3p, miR-130-3p, and miR-210a-3p - was performed using quantitative real-time polymerase chain reaction. The optimal miRNA cutoff points were determined using the Youden index. CTRCD-free survival was analyzed using Kaplan-Meier curves, with group comparisons conducted via the log-rank test. RESULTS:A total of 47 patients (mean age 53.1 ± 13.2 years) were included and followed for a median of 14.2 months (IQR 10.9-24.5), corresponding to 71.5 patient-years of follow-up. Doxorubicin was administered as part of the treatment regimen in 22 patients (46.8%). Six patients (12.8%) developed CTRCD. Patients exhibiting high baseline expression levels of miR-20a-5p, miR-126-3p, miR-130-3p, and miR-210-3p prior to TTZ treatment demonstrated significantly reduced CTRCD-free survival (all p < 0.05). Elevated levels of miR-126-3p and miR-130-3p showed 100% sensitivity and specificities of 53.7% and 48.8%, respectively, for predicting the development of CTRCD. CONCLUSION:This pilot study suggests that elevated expression of some miRNA prior to TTZ treatment may be associated with lower CTRCD-free survival, but these findings require confirmation in larger, prospective studies. While high levels of miR-126-3p and miR-130a-3p were observed in all patients who developed CTRCD, their potential role as biomarkers of cardiotoxicity risk should be further explored in future research with broader patient cohorts.

BACKGROUND:Takotsubo cardiomyopathy is a transient left ventricular dysfunction mimicking acute coronary syndrome, typically occurring in postmenopausal women. Its association with acute pericarditis is rare, raising questions about causality and sequence. CASE SUMMARY:A 64-year-old woman presented with chest pain, elevated troponin, and echocardiographic findings consistent with Takotsubo cardiomyopathy. Coronary angiography showed no obstructive disease. Hours later, the patient developed pleuritic chest pain, and cardiac magnetic resonance confirmed pericardial involvement. She was treated with nonsteroidal anti-inflammatory drugs, colchicine, beta blocker, and supportive care, with full recovery of ventricular function at discharge. DISCUSSION:Reported cases of concomitant Takotsubo cardiomyopathy and pericarditis are scarce. Pericarditis may arise as a complication of TC via inflammatory spread or, conversely, act as a trigger through stress-induced catecholamine release. Cardiac magnetic resonance is crucial to differentiate Takotsubo cardiomyopathy from myocarditis. TAKE-HOME MESSAGE:This case illustrates the rare Takotsubo cardiomyopathy-pericarditis association and emphasizes the diagnostic value of advanced imaging for accurate management.

BACKGROUND:Transthyretin (TTR) amyloid cardiomyopathy (ATTR-CM) is the most common form of restrictive cardiomyopathy. Emerging pharmacological therapies aim to alter the natural history of disease and delay its advancement. However, data directly comparing the efficacy of different drug classes versus placebo remain limited. OBJECTIVES:This systematic review assessed the efficacy of TTR stabilizers and silencers compared with placebo on all-cause mortality, hospitalizations, functional outcomes, and serum levels of the biomarker NT-proBNP in patients with ATTR-CM. METHODS:A comprehensive search of PubMed, Embase, and Cochrane databases was conducted for randomized controlled trials (RCTs) published through April 2025. Eligible studies compared patisiran, tafamidis, inotersen, revusiran, acoramidis, or vutrisiran to placebo in patients with ATTR-CM. Analyses were stratified by drug class, and statistical significance was set at p<0.05. RESULTS:Seven RCTs involving 2,526 participants were included; 42.5% received TTR stabilizers and 57.5% received TTR silencers. Compared with placebo, TTR stabilizers significantly reduced all-cause mortality (RR: 0.71; 95% CI 0.59-0.87; p=0.0006) and hospitalizations (RR: 0.81; 95% CI 0.73-0.89; p<0,0001). TTR silencers did not significantly reduce mortality (RR: 0.79; 95% CI 0.37-1.68; p=0.54) or hospitalizations (RR: 1.11; 95% CI 0.83-1.48; p=0.48). Both therapies were associated with improvements in 6-minute walk distance, quality of life, and reductions in serum NT-proBNP levels. CONCLUSION:TTR stabilizers significantly reduced all-cause mortality and hospitalizations in patients with ATTR-CM compared with placebo. These benefits were not observed with TTR silencers, potentially due to shorter follow-up durations in the studies evaluated. Both therapies improved functional status and serum levels of NT-proBNP.

BACKGROUND:The prediction of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) remains challenging despite its association with increased morbidity and thromboembolic risk. Left atrial late gadolinium enhancement (LALGE) on cardiac magnetic resonance (CMR) is a marker of atrial fibrosis and arrhythmogenic remodeling, but its role in HCM is not well-established. OBJECTIVE:This study aimed to assess the association between LALGE and AF in HCM, and its relationship with clinical and structural markers. METHODS:This retrospective, longitudinal cohort study included 78 patients with HCM followed at a tertiary center between 2009 and 2023. Clinical, echocardiographic, and CMR data were analyzed. LALGE was visually assessed, and its association with AF and structural remodeling was evaluated. Cox regression was performed to assess the risk of incident AF among sinus rhythm patients. RESULTS:Mean age was 58 ± 16 years; 43 (55%) were women. Obstructive HCM (gradient ≥30 mmHg) was present in 41 patients (53%). LALGE was identified in 14 (18%) and was more frequent in patients with AF (7/14 [50%] vs 11/64 [17%], P = .014). Among 68 patients in sinus rhythm without prior AF, the incidence of AF was higher in those with LALGE (9.1%/year), compared with those without (1.75%/year), P < .001. In adjusted Cox analysis, LALGE was independently associated with incident AF (hazard ratio 15.81, 95% confidence interval: 2.48-100.73, P = .003). LALGE also correlated with larger left atrial diameter, mitral regurgitation, and obstructive physiology. CONCLUSION:LALGE is independently associated with AF and reflects advanced atrial remodeling in HCM. It may serve as a valuable imaging biomarker for early identification of patients at increased risk of AF.

Resumo Fundamento A patisirana reduziu rapidamente a transtirretina e preservou a capacidade funcional em pacientes com amiloidose por transtirretina com cardiomiopatia (ATTR-CM) no estudo Fase 3 APOLLO-B (NCT03997383). Objetivos Avaliar a eficácia e segurança da patisirana (análise post hoc) na subpopulação brasileira do APOLLO-B. Métodos Pacientes foram randomizados 1:1 para patisirana 0,3 mg/kg ou placebo uma vez a cada 3 semanas por 12 meses. O desfecho primário foi a alteração em relação ao período basal (ARPB) na capacidade funcional (teste de caminhada de 6 minutos [6MWT]) no mês 12. Desfechos secundários incluíram ARPB no mês 12 do escore Kansas City Cardiomyopathy Questionnaire-Overall Summary (KCCQ-OS). Desfechos exploratórios incluíram ARPB em biomarcadores cardíacos e na escala de Perugini durante cintilografia com 99m-Tecnécio pirofosfato. Resultados Quarenta e dois pacientes foram incluídos no Brasil (patisirana, n=20; placebo, n=22). Patisirana demonstrou benefício no 6MWT e nos escores KCCQ-OS vs. placebo; ARPB (intervalo de confiança [IC] de 95%) no 6MWT (mediana) e escores KCCQ-OS (média dos mínimos quadrados) foram -2,0 m (-58,5; 42,9) e 9,37 (1,93; 16,81) pontos com patisirana vs. -30,1 m (-72,2; 3,5) e 2,62 (-4,68; 9,92) pontos para o placebo. Para biomarcadores cardíacos, a alteração média da razão em relação ao período basal (IC 95%) para peptídeo natriurético tipo B pró-hormonal N-terminal e troponina I foi de 1,31 (1,06; 1,61) e 1,12 (0,94; 1,34) para patisirana e 1,71 (1,39; 2,10) e 1,28 (1,08; 1,53) para placebo, respectivamente. A escala de Perugini melhorou em 11/18 (61,1%) pacientes e 0/10 pacientes com patisirana e placebo, respectivamente. Não houve mortes no grupo patisirana vs. 3 mortes no grupo placebo. Conclusão A eficácia e a segurança da patisirana em pacientes brasileiros com ATTR-CM foram consistentes com as da população global do APOLLO-B. Os achados são descritivos devido ao pequeno número de pacientes.

Obesity is a risk factor associated with cardiovascular diseases that may lead to heart failure (HF). However, in HF, overweight and obese patients have longer survival than underweight patients, a phenomenon known as the obesity paradox. MiRNAs play a fundamental role in gene regulation involved in obesity and HF. The main objective of this study was to identify and validate differentially expressed circulating miRNAs in HF-obese and HF-lean patients. This case-control study was carried out in two phases: discovery and validation. In the discovery phase, plasma samples from 20 HF patients and from 10 healthy controls were analyzed using the miRNA 4.0 Affymetrix GeneChip array. Differentially expressed miRNAs were ranked and selected for validation. In this phase, plasma miRNAs -451a, -22-3p, and -548ac from 80 patients and controls were analyzed by qPCR. Target analysis and functional enrichment analysis were performed. When comparing HF-lean and HF-obese groups compared to controls, miRNAs -451a and -22-3p were up-regulated in both discovery and validation phases, while -548ac was down-regulated in the discovery phase and up-regulated in the validation phase, indicating that miRNA changes are independent of obesity. These miRNAs regulate genes and different biological processes associated with metabolic, morphological, and functional outcomes.

BACKGROUND:Patients with heart failure with preserved ejection fraction (HFpEF) usually have physical effort intolerance, and may present inspiratory muscle weakness (IMW). Yoga is known to have significant benefits on cardiovascular and respiratory health. However, the effects of yoga and breathing techniques on HFpEF have not been reported. METHODS AND RESULTS:This study is a multicenter, randomized 1:1:1, outcome-blind, parallel-group, no-inferiority trial. Thirty-two patients with previous diagnosis of HFpEF (EF ≥ 50%) 45-75 years old, were randomized and allocated into groups: yoga group (Y = 11), breathing techniques (BT = 11) or the control group (C = 10) to evaluate the effects of an in-person program of 8-week of yoga and specific breathing techniques on inspiratory muscle responses, functional capacity, distinct features of the autonomic nervous system, natriuretic peptides, diastolic function, and quality of life. Data were analyzed using the Generalized Estimates equation model (GEE- GZLM). Yoga training resulted in 44.1% improvement in inspiratory muscle strength (Pthmax) [19 (7-29) vs 2(-2 to 5) in control group, (p < 0.05). Breathing techniques increase heart rate variability (HRV) (827.6 ± 46.7ms vs 936 ± 51.4 ms, in control group,(p < 0.05). There was neither improvement in PImax, functional capacity nor in parameters of diastolic function. CONCLUSIONS:In patients withHFpEF with and without IMW, yoga training was feasible and promoted increased respiratory muscle strength. Further studies should better address possible benefits on functional parameters. CLINICAL TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov; NCT03028168; Protocol study: Trials. 2018;7:19:405. https://doi.org/10.1186/s13063-018-2802-5.

IntroductionThe increasing cardiovascular events in cancer patients underscore the importance of identifying preexisting risk factors as predictors of heart disease outcomes. This study aimed to assess the predictive risk factors associated with cancer therapy-related cardiac dysfunction (CTRCD) in female patients with breast cancer undergoing treatment with anthracyclines and/or anti-HER-2 therapies.MethodsA cohort study was conducted at a university hospital outpatient clinic from 2019 to 2024. CTRCD was defined according to the European Society of Cardiology criteria as an absolute LVEF reduction of >10 percentage points to <50% during treatment.ResultsA total of 161 female patients were analyzed (mean age: 51.2 ± 11.6 years), with most being white/Caucasian (83.8%). The most prevalent cardiovascular risk factors were hypertension (47.2%), obesity (31.7%), smoking (31.0%), dyslipidemia (14.3%), and type 2 diabetes mellitus (12.4%). CTRCD occurred in 18 patients (11.1%), with a markedly higher prevalence (27.3%) in those with four or more cardiovascular risk factors. The median time (IQR) from the initiation of chemotherapy to CTRCD was 395 (248-674) days. Multivariable analysis identified the Charlson comorbidity index (HR 1.2; 95% CI: 1.0-1.4), chemotherapy duration (HR 1.0; 95%CI: 1.0-1.0) and LVEF before (HR 0.8; 95%CI: 0.7-0.9) and after chemotherapy (HR 0.8; 95%CI: 0.8-0.9) as independent factors for CTRCD. Breast cancer patients had a 17.7% risk of developing CTRCD within the first two years of antineoplastic treatment.ConclusionHypertension, obesity, and smoking were the most prevalent cardiovascular risk factors. Independent predictors of CTRCD included the Charlson comorbidity index, chemotherapy duration, and LVEF before and after treatment.

Background Body composition is increasingly recognized as an important factor in the prognosis of patients with heart failure (HF). Variations in muscle mass, fat-free mass, and fat mass may influence survival outcomes, but the extent of these associations remains unclear. Objectives This study aims to evaluate the impact of body composition parameters on survival in patients with HF. Methods Five databases were searched through January 2024. Eligible papers reported associations between body composition parameters and survival in HF patients. All-cause mortality was the primary outcome. Risk of bias was evaluated using the Newcastle-Ottawa scale. A random-effects model was used to calculate the 95% CI and HR, with heterogeneity assessed using Cochran’s Q and I2 tests. Results The analysis included 39 cohort studies involving 36,176 HF patients, with 21 studies included in the quantitative analysis. Low muscle mass (HR: 1.73 [95% CI: 1.32-2.26]; I2 = 47%) (7 studies) was significantly associated with increased all-cause mortality risk. The prognostic significance of low muscle mass remained consistent across sensitivity and subgroup analysis. Elevated fat mass was not associated with a risk of death (pooled adjusted HR: 0.75 [95% CI: 0.26-2.12]; I2 = 77%). Higher abdominal fat showed no significant mortality association. Conclusions The authors found a strong association between body composition parameters and all-cause mortality. Muscular wasting, measured by low muscle mass, was associated with increased mortality, strengthening the role of muscle mass in HF prognosis. In contrast, higher fat mass and abdominal adiposity showed no association. These findings underscore the importance of comprehensive body composition evaluation in HF prognosis. (Association of Body Composition with Overall Survival in Patients with Heart Failure: A Systematic Review and Meta-Analysis; CRD42023488040)

Resumo Fundamento: A cardiomiopatia por amiloidose por transtirretina (ATTR-CM) é a forma mais comum de cardiomiopatia restritiva. Novas terapias farmacológicas buscam modificar a progressão natural da doença e retardar seu avanço. No entanto, ainda são escassos os dados que comparam diretamente a eficácia das diferentes classes de fármacos em relação ao placebo. Objetivos: Esta revisão sistemática e metanálise avaliou a eficácia dos estabilizadores e silenciadores de transtirretina (TTR), em comparação ao placebo, sobre a mortalidade e hospitalizações por todas as causas, desfechos funcionais e níveis do biomarcador NT-proBNP em pacientes com ATTR-CM. Métodos: Foram realizadas buscas nas bases de dados PubMed, Embase e Cochrane por ensaios clínicos randomizados (ECRs) publicados até abril de 2025, que avaliaram patisiran, tafamidis, inotersen, revusiran, acoramidis ou vutrisiran versus placebo em pacientes com ATTR-CM. As análises foram estratificadas por classe de fármaco, considerando significância estatística para p<0,05. Resultados: Foram incluídos sete ECRs, totalizando 2.526 participantes; 42,5% receberam estabilizadores de TTR e 57,5% receberam silenciadores de TTR. Em comparação ao placebo, os estabilizadores de TTR reduziram significativamente a mortalidade (RR: 0,71; IC 95% 0,59-0,87; p=0,0006) e e hospitalizações (RR: 0,81; IC 95% 0,73-0,89; p<0,0001), ambas por todas as causas. Já os silenciadores de TTR não reduziram significativamente nem a mortalidade (RR: 0,79; IC 95% 0,37-1,68; p=0,54) nem as hospitalizações (RR: 1,11; IC 95% 0,83-1,48; p=0,48). As duas abordagens terapêuticas melhoraram a distância percorrida no teste de caminhada de 6 minutos, a qualidade de vida e reduziram os níveis séricos NT-proBNP. Conclusão: Os estabilizadores de TTR reduziram significativamente a mortalidade e as hospitalizações por todas as causas em pacientes com ATTR-CM, em comparação ao placebo. Esses benefícios não foram observados com os silenciadores de TTR, possivelmente em função do tempo de seguimento mais curto nos estudos incluídos. Ambas as terapias, contudo, promoveram melhorias no estado funcional e na redução dos níveis séricos do biomarcador NT-proBNP.

Abstract Background Venous Excess Ultrasound Score (VExUS) has recently emerged as a non-invasive tool for venous congestion assessment in acute decompensated heart failure (ADHF). Although VExUS is associated with cardiorenal syndrome, the prognostic role regarding hard outcomes in ADHF is still unknown. Purpose To evaluate whether dynamic changes in VExUS within 72 hours after Cardiovascular Intensive Care Unit (CICU) admission is associated with in-hospital mortality in ADHF patients. Methods Prospective cohort study enrolling consecutive patients with ADHF admitted to CICU of a tertiary public hospital. VExUS evaluations ranging from 0 (no congestion) and 3 (severe congestion) and assessing the inferior vena cava, hepatic, and portal veins flow, were initially performed within 24 hours of admission and re-evaluated at 72 hours (third day) after treatment initiation. Changes in VExUS scores were compared between these two time points. Mann-Whitney test and logistic regression was performed to evaluate VExUS improvement association with mortality. Results Between October 2022 and January 2024, 81 patients were admitted to the CICU due to ADHF. Following the exclusion of 10 patients who were not assessed within the first 24 hours, 71 patients were included in the final analysis. Mean age was 65 ± 13.3 years, with 66.7% being male. Ischemic etiology was identified in 40.7%, and atrial fibrillation was present in 34.6%. Mean left ventricular ejection fraction was 27.4% ± 12.2, and 64.2% had right ventricular dysfunction. Upon admission, 73.2% were classified as B and 23.9% as C hemodynamic profiles. Overall in-hospital mortality was 25.9%. In-hospital mortality across VExUS categories assessed in the third day was 16.7%, 12.5%, 28.6% e 40%, for VExUS 0-3, respectively. The median VExUS variation between the two time points was greater in patients who survived [-1 vs. 0; p=0.030] and VExUS improvement at 72 hours was associated with a 46% decrease in hospital mortality for each class reduction (OR=0.536; 95% CI 0.29-0-81; p=0.043 - Figure 1). Conclusion Improvement in VExUS score between admission and 72 hours is associated with reduced in-hospital mortality. This finding highlights the potential role of dynamic VExUS monitoring for identifying delayed treatment response patients. Thus, changes in VExUS emerged as a prognostic tool offering a pathway to potentially intensify treatment strategies for high-risk patients with ADHF.VExUS score changes within 72 hours

A cardiomiopatia hipertrófica (CMH) é uma forma de doença do músculo cardíaco de causa genética, caracterizada pela hipertrofia das paredes ventriculares. O diagnóstico requer detecção por métodos de imagem (Ecocardiograma ou Ressonância Magnética Cardíaca) de qualquer segmento da parede do ventrículo esquerdo com espessura > 15 mm, sem outra causa provável. A análise genética permite identificar mutações de genes codificantes de diferentes estruturas do sarcômero responsáveis pelo desenvolvimento da CMH em cerca de 60% dos casos, permitindo o rastreio de familiares e aconselhamento genético, como parte importante do manejo dos pacientes e familiares. Vários conceitos sobre a CMH foram recentemente revistos, incluindo sua prevalência de 1 em 250 indivíduos, não sendo, portanto, uma doença rara, mas subdiagnosticada. A vasta maioria dos pacientes é assintomática. Naqueles sintomáticos, a obstrução do trato de saída do ventrículo esquerdo (OTSVE) é o principal distúrbio responsável pelos sintomas, devendo-se investigar a sua presença em todos os casos. Naqueles em que o ecocardiograma em repouso ou com Manobra de Valsalva não detecta gradiente intraventricular significativo (> 30 mmHg), devem ser submetidos à ecocardiografia com esforço físico para detecção da OTSVE. Pacientes com sintomas limitantes e grave OTSVE, refratários ao uso de betabloqueadores e verapamil, devem receber terapias de redução septal ou uso de novas drogas inibidoras da miosina cardíaca. Por fim, os pacientes adequadamente identificados com risco aumentado de morta súbita podem receber medida profilática com implante de cardiodesfibrilador implantável (CDI).