BACKGROUND AND AIMS:Clinical models incompletely capture the molecular pathways driving heart failure (HF) progression. This study evaluated whether molecular risk stratification provides incremental prognostic information beyond established clinical predictors in patients with HF. METHODS:A total of 2432 patients from the Global Congestive Heart Failure (G-CHF) registry with available genotyping, DNA methylation, and proteomic profiling were analysed. Three molecular scores were assessed: a composite cardiovascular polygenic risk score (PRS) from DNA sequence polymorphisms, a methylation risk score (MRS) derived from epigenome-wide associations, and a 23-protein-based score (ProteomicDeath23). Each score was tested individually and in combination with the clinical Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) risk score and N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels for mortality prediction. Validation was performed in an HF subset of the UK Biobank (UKB). RESULTS:Over a median follow-up of 3.0 years in G-CHF, 523 patients died from any cause (7.64 per 100 person-years [PY]). In multivariable analyses, ProteomicDeath23 was the strongest independent predictor of all-cause mortality (hazard ratio [HR] per 1 standard deviation, 2.23), outperforming NT-proBNP (HR 2.00), MRSMortality (HR 1.66), PRSmetaCVD (HR 1.10), and the MAGGIC score (HR 1.70). A model combining ProteomicDeath23 with MAGGIC and NT-proBNP achieved the highest discrimination for mortality (C-index, 0.77). Addition of MRSMortality to this proteomic-clinical model resulted in only small improvements in discrimination (ΔC-index, +0.004, P = .0039), while the PRSmetaCVD provided no incremental benefit. Among patients with low NT-proBNP/MAGGIC score, mortality rates increased from 1.71 to 8.12 per 100 PY across ProteomicDeath23 tertiles. Consistent results were observed in the UKB-HF validation cohort. CONCLUSION:A proteomic score was the strongest molecular predictor of mortality in HF. Integrating proteomic signatures with clinical risk factors significantly improved risk prediction.

Background: DNA methylation (DNAm) signatures capture cumulative lifestyle exposures and biological aging. This prospective study evaluated whether DNAm-based scores and epigenetic aging clocks are associated with clinical outcomes and mortality in a multinational cohort of patients with heart failure (HF). Methods: We studied 2,594 patients with HF from 40 countries in the Global Congestive Heart Failure (G-CHF) registry with whole-blood DNAm data. Fifteen published DNAm-based scores and epigenetic aging clocks reflecting lifestyle, environmental and physiological exposures, inflammation, frailty, mortality risk, and biological aging were derived. Associations with HF hospitalization, cardiovascular death, and all-cause death were assessed using multivariable Cox regression adjusted for age, sex, ancestry, the MAGGIC risk score, and NT-proBNP. Incremental prognostic value was compared to MAGGIC score and NT-proBNP. Extreme DNAm profiles were defined as scores or clocks exceeding ±1.5 standard deviations (s.d.) from the population mean. Results: Mean age was 62.7±14.0 years, 66.2% were male, and mean left ventricular ejection fraction was 40.1±14.1%. During a median follow-up of 3.0 years, 338 patients were hospitalized for HF, 349 died from cardiovascular causes, and 565 died from any cause. Higher epigenetic age and DNAm scores for CRP, frailty, and mortality were associated with increased risk, whereas higher diet-related DNAm scores were inversely associated. For all-cause death, adjusted hazard ratios per 1-s.d. were 1.36 (95% CI, 1.24-1.50) for GrimAge, 1.27 (95% CI, 1.17-1.38) for the DNAm score for CRP, 1.44 (95% CI, 1.28-1.63) for the DNAm score for frailty, and 1.48 (95% CI, 1.32-1.65) for the DNAm score for mortality, compared with 0.81 (95% CI, 0.75-0.88) and 0.86 (95% CI, 0.79-0.94) for the DNAm scores for Alternative Healthy Eating Index and Mediterranean Diet Score. These patterns were directionally consistent for cardiovascular death and weaker for HF hospitalization and were more pronounced among patients with lower clinical risk (MAGGIC<17, Pinteraction<0.05), particularly for all-cause death. Patients with 4-5 extreme-high DNAm scores or clocks had more than twice the risk of death (HR, 2.27; 95% CI, 1.65-3.13). Conclusions: DNAm-based scores and epigenetic aging clocks reflect multiple dimensions of biological vulnerability in HF and are associated with clinical outcomes and mortality beyond clinical risk factors.

BACKGROUND:The HFA-PEFF and H2FPEF scores are widely used for diagnosing heart failure with preserved ejection fraction (HFpEF). However, HFpEF is a heterogeneous condition with multiple phenotypes influenced by comorbidities and etiologies. OBJECTIVES:This study aimed to evaluate the performance and agreement of these scoring systems across different HFpEF phenotypes and identify additional echocardiographic and clinical parameters that may improve phenotyping. METHODS:A total of 194 HFpEF patients were classified into three phenotypes: (1) common metabolic group, (2) atrial fibrillation (AF)-predominant group, and (3) hypertension with left ventricular hypertrophy group. The clinical, laboratory, and echocardiographic characteristics of these phenotypes were analyzed. The agreement and performance between HFA-PEFF and H2FPEF scores for phenotypes in HFpEF patients were assessed. RESULTS:A total of 194 HFpEF patients were included. While 92.3% of patients had a high HFA-PEFF score, only 42.8% had a high H2FPEF score. The agreement between these scoring methods was low across all phenotypes. Phenotype-specific differences were observed: interventricular septal thickness was highest in phenotype 3, systolic pulmonary artery pressure (SPAP) was highest in phenotype 2, and left atrial reservoir strain (LASr) and right ventricular free wall longitudinal strain (RV-FWLS) were lowest in phenotype 2. CONCLUSION:The HFA-PEFF and H2FPEF scores showed limited agreement in distinguishing HFpEF phenotypes. Additional echocardiographic parameters such as IVS thickness, SPAP, LASr, and RV-FWLS may enhance phenotypic differentiation and improve HFpEF classification. A more refined diagnostic approach incorporating these parameters could guide personalized treatment strategies.

INTRODUCTION:Early detection of heart failure (HF), particularly in asymptomatic individuals, is essential for timely intervention. This study aimed to determine the prevalence of HF among high-risk individuals in primary care using N-terminal probrain natriuretic peptide (NT-proBNP) screening. METHODS:A prospective cohort of 874 participants aged ≥40 years with at least one HF risk factor but no prior HF diagnosis was analysed. NT-proBNP levels were measured, and all participants underwent comprehensive cardiac evaluations, including laboratory tests, electrocardiography and echocardiography. RESULTS:The mean age of the cohort was 62.5 ± 9.1 years, and 51.9% were female. Based on ACC/AHA HF staging, 69.1% of participants were classified as Stage A, 21.9% as Stage B and 9.0% as Stage C. Elevated NT-proBNP levels were detected in 84.8% of Stage B and 100% of Stage C patients. Among Stage C patients, 92.4% had HF with preserved ejection fraction (HFpEF). NT-proBNP levels correlated positively with left atrial volume index (r = 0.273, P < 0.001), left ventricular mass index (r = 0.207, P < 0.001), E/e' ratio (r = 0.182, P < 0.001) and estimated systolic pulmonary artery pressure (r = 0.124, P < 0.001), while showing a negative correlation with estimated glomerular filtration rate (r = -0.222, P < 0.001). CONCLUSIONS:A significant proportion of high-risk individuals in primary care had undiagnosed HF, particularly Stage B (pre-HF) and early symptomatic Stage C HF. The predominance of HFpEF highlights the need for targeted management. NT-proBNP screening is a valuable tool for early identification and risk stratification, especially for detecting Stage B HF, where it serves as an effective standalone method in the absence of imaging.

Disproportionate right and left ventricular filling pressures, as measured using right atrial to wedge pressure (RA/WP) is a marker of right heart failure and worse outcomes in patients with heart failure (HF), but an invasive hemodynamic study is needed to measure RA/WP. Using echocardiography, an estimation of RA/WP (eRA/WP) could be calculated non-invasively. The aim of the present study was to understand the feasibility and usefulness of eRA/WP in the general HF population where invasive assessment is not routinely done. Estimated RA/WP was calculated using mitral E velocity, lateral and septal tissue Doppler velocities and inferior vena cava diameter. A second dataset obtained from patients undergoing cardiac catheterization was used to determine agreement between eRA/WP and catheter-derived RA/WP. Estimated RA/WP showed significant correlations with right atrial area (r = 0.27,p < 0.001), right ventricular diameter (r = 0.20,p = 0.006), right ventricular fractional area change (r=-0.19,p = 0.01) and systolic pulmonary artery pressure (r = 0.44,p < 0.001). Being in the highest quartile was significantly associated with the primary composite endpoint at 180 days in unadjusted (OR:2.28,95

Heart failure (HF) represents a significant global health burden, with approximately 10% of patients progressing to advanced stages characterized by severe symptoms and recurrent hospitalizations despite conventional treatments such as guideline-directed medical therapy, devices, and surgery. This clinical consensus statement from the Heart Failure Association of the European Society of Cardiology discusses the applications of imaging modalities in patients with advanced HF. Transthoracic echocardiography remains the cornerstone for initial diagnosis and monitoring, providing critical insights into cardiac volumes, function, and valvular integrity, as well as congestion status. Transoesophageal echocardiography offers detailed evaluations of valve pathology, essential for surgical or transcatheter planning. Cardiovascular magnetic resonance provides comprehensive assessments of biventricular size and function, tissue characterization, and flow dynamics, proving particularly useful for diagnosing specific HF aetiologies. Computed tomography offers valuable insights into pulmonary artery diameter, right ventricular volume, and valvular anatomy, which are crucial for guiding percutaneous procedures. Nuclear imaging techniques allow assessing viability and diagnosing non-ischaemic HF conditions, guiding revascularization decisions. Advanced imaging techniques have expanded the understanding and management of right ventricular dysfunction. The integration of these advanced imaging modalities enhances diagnostic accuracy, risk stratification, and therapeutic decision-making, ultimately improving the prognosis and quality of life for patients with advanced HF. This clinical consensus statement highlights the critical role of various imaging modalities in managing patients with advanced HF, excluding those needing mechanical circulatory support or heart transplantation, emphasizing the multifaceted approach required for effective management.

Heart failure (HF) is a complex clinical condition associated with significant morbidity and mortality. Early diagnosis and effective management at the primary care level are essential for improving patient outcomes and reducing the burden on the healthcare systems. The Eurasian Society of HF and the Turkish Association of Family Medicine developed a guideline that underscores the critical role of natriuretic peptides (NPs) in the early detection, diagnosis, and management of HF. NPs, particularly the N-terminal pro-B-type NP, are a reliable biomarker for identifying HF, guiding treatment decisions, and monitoring disease progression. This guideline emphasizes the importance of measuring the levels of these peptides in primary care so as to detect individuals at risk, confirm the diagnosis of HF in symptomatic patients, and evaluate the treatment response. The recommended thresholds for NP levels account for variations arising from factors such as age, gender, and the presence of other health conditions. B-type natriuretic peptides (BNP) levels ≥ 35 pg/ml or N-terminus-proBNP levels ≥ 125 pg/ml are used to confirm the likelihood of HF in symptomatic patients, enabling timely diagnosis and appropriate intervention. Incorporating NP testing into routine clinical practice enables timely referrals and ensures appropriate management at all stages of HF. Beyond diagnosis, the measurement of NPs provides valuable information about treatment effectiveness and prognosis, allowing clinicians to individualize the treatment. By integrating NP testing into primary care, healthcare providers can facilitate early detection, optimize treatment strategies, and improve the quality of life for patients with or at risk of HF. Thus, this guideline highlights the essential role of primary care physicians in addressing the growing challenges of HF through the effective and evidence-based use of NPs.

Background It is imperative to maintain the use of sodium–glucose cotransporter‐2 inhibitors (SGLT‐2is) in patients with diabetes both after the index diagnosis of heart failure (HF) and even prior to the index diagnosis of HF. We aimed to investigate whether timing of SGLT‐2 is before the index diagnosis of HF, and second, adherence to SGLT‐2is in the form of the proportion of days covered metric matter in patients with HF and diabetes. Methods and Results All‐cause death up to 7 years were evaluated in HF with diabetes from the subgroup analysis of TRends‐HF (TRends in Heart Failure in Türkiye). Patients with HF and diabetes, who were prescribed an SGLT‐2i either before or after the index diagnosis of HF were identified, categorized according to duration of exposure before the index HF diagnosis and according to proportion of days covered after the index diagnosis of HF, and compared with nonusers. There were 1 229 833 patients with HF and diabetes in the cohort. A total of 247 987 were on an SGLT‐2i and had available timing data, and 14.06% had SGLT‐2i on board before the index HF diagnosis. Median duration of SGLT‐2i exposure before the index HF diagnosis was 417 days. Prognosis was the best among patients with diabetes who were prescribed an SGLT‐2i before the index diagnosis of HF with an exposure more than median duration. Of note, among patients who were prescribed an SGLT‐2i after the index HF diagnosis; there was a numerically graded increase in all‐cause mortality rate such that a >10% decrease in SGLT‐2i proportion of days covered was associated with a 59% increase in all‐cause death (hazard ratio, 1.21–2.09). Conclusions Regardless of time or adherence, SGLT‐2is offer a remarkable all‐cause death benefit to patients with HF and diabetes. SGLT‐2is' all‐cause death benefit for patients with HF and diabetes was greatest when it was prescribed before the HF index diagnosis. Poor adherence to SGLT‐2is was associated with worsening survival in patients with HF and diabetes following the diagnosis of index HF.

This clinical consensus statement outlines the vital role of multimodality imaging in managing patients with advanced heart failure (HF), particularly those receiving mechanical circulatory support (MCS) and heart transplantation (HT). For both temporary and durable MCS, multimodality imaging, primarily echocardiography, is crucial for selecting candidates, ensuring proper device placement, and monitoring in the post-implantation period. Preoperatively, it helps to identify HF phenotypes, assess ventricular functions, detect intracardiac thrombi, and evaluate valvular conditions. Key measurements include ventricular size, ejection fraction, and cardiac output. Intraoperative imaging ensures optimal device placement and complication detection. Post-implantation echocardiography gives an impression of the interplay between heart and MCS, detects early complications, and evaluates ventricular unloading and right ventricular function. Serial imaging evaluations are essential for the management of the patient and the device and for diagnosing and treatment of complications. In temporary MCS, imaging is vital in the weaning process. Imaging is crucial across various post-transplant phases, from early postoperative monitoring to long-term follow-up. Echocardiography is the first-line technique. Cardiovascular magnetic resonance provides detailed evaluation of cardiac structure and function, offering insights into fibrosis, oedema, and myocardial perfusion. Coronary computed tomography angiography and positron emission tomography are possible alternatives for assessing coronary allograft vasculopathy. Overall, multimodality imaging is pivotal for comprehensive management of patients potentially eligible to or undergoing MCS or HT, enhancing diagnostic accuracy and guiding therapeutic decisions.

Abstract Background Heart failure (HF) is a prevalent syndrome linked to significant morbidity and mortality, especially in those with comorbid conditions like diabetes, hypertension, and atherosclerotic cardiovascular disease. Early detection and intervention are crucial. Natriuretic peptides, particularly NT-proBNP, are promising biomarkers for identifying at-risk individuals, but their use in primary care settings is not fully understood. Methods This prospective cohort study enrolled 874 participants aged 40 and above with documented risk factors for HF, such as diabetes mellitus, hypertension, metabolic syndrome, obesity, atherosclerotic cardiovascular disease, genetic variants for cardiomyopathy, or exposure to cardiotoxic agents. NT-proBNP levels were measured in blood samples collected at primary care clinics, and participants underwent comprehensive cardiac evaluations at a referral hospital. Clinical characteristics, laboratory findings, electrocardiography, and echocardiography results were recorded. Results The study included 874 patients with at least one risk factor for HF, with a mean age of 62.5 ± 9.1 years and 51.9% female. According to the 2022 AHA/ACC/HFSA HF Guideline, 69.1% were Stage A HF, 21.9% Stage B HF, and 9% Stage C HF. Clinical characteristics, laboratory and echocardiographic findings are shown in Picture 1. The majority had hypertension (71.1%), while other prevalent comorbidities included diabetes mellitus (43.4%), dyslipidemia (35.2%), obesity (27.1%), and atherosclerotic cardiovascular disease (26.2%). Laboratory findings showed a significant decrease in HbA1C, eGFR, LDL, triglycerides, and hemoglobin from Stage A to C HF. Median NT-proBNP levels rose from Stage A to C HF (46.4 pg/mL in Stage A, 219 pg/mL in Stage B, and 268.5 pg/mL in stage C), with 84.8% of Stage B HF patients exhibiting elevated levels. NT-proBNP levels were correlated positively with left atrial volume index, left ventricular mass index, age, E/e’, and estimated systolic pulmonary artery pressure levels. Conversely, NT-proBNP levels showed a negative correlation with estimated glomerular filtration rate and left ventricular ejection fraction. Among Stage C patients, 92.4% had HFpEF. The Picture 2 depicted the study's design and outcomes, providing a comprehensive visual representation. Conclusion NT-proBNP screening in primary care settings identified a substantial proportion of individuals with undiagnosed HF, particularly those in Stage B and Stage C. The high prevalence of HFpEF underscores the need for comprehensive evaluation and management strategies targeting this population. Early detection facilitated by NT-proBNP screening may lead to timely interventions and improved outcomes in individuals at risk for HF.

Background/aim:Final diagnosis of heart failure (HF) relies on a combination clinical findings, laboratory and imaging tests. The aim of this study was to review the diagnostic approach to HF in Türkiye. Materials and methods:This study is a subanalysis of the nationwide TRends-HF study, based on anonymized data from National Electronic Database between January 1, 2016, and December 31, 2022. Variables including date of birth, sex, socioeconomic development index, place of initial HF diagnosis, comorbidities, investigations, and diagnostic procedures were reported. Laboratory variables, including complete blood count, natriuretic peptides (NP), estimated glomerular filtration rate, uric acid, electrolytes, albumin, lipid profile, ferritin and hemoglobin A1c levels, and other imaging techniques (coronary angiogram [CAG], transthoracic echocardiography [TTE], chest X-ray [CXR], etc.) during the initial diagnosis and/or follow-up of HF patients, were obtained from the National Electronic Database. The diagnostic test usage rates were analyzed according to years, geographical regions, and socioeconomic regions of Türkiye. Results:The study population consisted of 2,722,151 HF patients (51.7% female, mean age 68.33 ± 14.01 years). All HF patients had at least one electrocardiogram and one TTE examination, and all underwent routine biochemical tests at least once during the follow-up period. CXR utilization rate was 93.7%, while CAG utilization rate was 17.9%. Coronary computed tomographic angiography and cardiac magnetic resonance imaging were performed in only 1.8% and 0.3% of patients, respectively. Among all Turkish HF patients, 16.3% had at least one NP measurement. The highest rate of NP use was observed in the Central Anatolia Region (21.0%), while the lowest rate was in the Aegean Region (11.7%). NP measurement during HF diagnosis revealed a rising trend over time (12.3% in 2016 vs. 26.3% in 2021). Conclusion:The widespread use of TTE at the beginning of the diagnosis and during follow-up is important for providing quality care to HF patients in Türkiye. However, detailed laboratory tests and advanced imaging methods are not utilized sufficiently, which could lead to issues in patient management.

Background/aim:Despite Türkiye's relatively young population, there is an emerging trend of earlier diagnoses of chronic diseases, including heart failure (HF). This study aims to shed light on survival rates, potential influences of guideline-directed therapies, and sex-based differences necessitating personalized management in HF. Materials and methods:We conducted a nationwide retrospective cohort analysis of 2,722,151 patients with HF using deidentified data from the Turkish Ministry of Health's national electronic database. That cohort included 2,701,099 adult patients with HF. Adult patients were divided into two groups based on their outcomes as those who were deceased and those who survived and were then compared. Multivariate regression analysis was conducted to identify variables predicting mortality. The patients' hospital admissions and length of hospital stay were analyzed based on survival status and age. Results:Out of 2,722,151 HF patients, the overall mortality rate was 33.7%, with a difference observed according to sex (32.5% in female patients, 35.0% in male patients). Survival rates at 1, 5, and 7 years after the HF diagnosis were detailed. Deceased HF patients had more comorbidities, higher natriuretic peptides, and lower glomerular filtration rates. Hospitalization patterns varied, with 41% experiencing no hospitalization. The average length of hospital stay in 2022 was 6 days, with sex- and age-specific disparities. Conclusion:The survival rate of HF in Türkiye is similar to world data. The survival of female patients is better than that of male patients. Increased survival rates can likely be attributed to the widespread use of guideline-directed therapies. Finally, high healthcare utilization is observed, especially in emergency situations.

In the contemporary management of heart failure with reduced ejection fraction (HFrEF), the recommended quadruple guideline-directed medical therapy (GDMT) consists of angiotensin receptor-neprilysin inhibitor (ARNI), evidence-based beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), and sodium-glucose cotransporter-2 inhibitors (SGLT-2i). This study explored the impact of adding implantable cardioverter-defibrillator (ICD) therapy to this comprehensive regimen in HFrEF patients. Utilizing deidentified data from the National Electronic Database of the Turkish Ministry of Health, we conducted a nationwide retrospective cohort study on 5450 HFrEF patients receiving quadruple GDMT, including ARNI. Among them, 709 patients underwent additional ICD or cardiac resynchronization therapy defibrillator (CRT-D) implantation. Propensity score matching ensured balanced baseline characteristics between groups. Primary endpoint was determined as all-cause mortality. In the matched cohort, all-cause mortality occurred in 108 out of 619 patients (17.4

Background/aim:The epidemiological data on heart failure (HF) vary between regions within the same country. We aimed to investigate the epidemiological data on HF in Türkiye across all age groups regarding seven geographical regions. Materials and methods:We included all patients from the Turkish population who received a first diagnosis of HF between January 1, 2016 and December 31, 2022, using ICD-10 codes from the National Electronic Healthcare Database. The data were categorized by seven geographical regions of Türkiye. Results:The median age of index diagnosis of HF was 70 (60-78) years in all age groups and 4 (1-12) years in pediatric population. The prevalence rate of HF was the highest in the Black Sea Region at 3.103%, while the Southeastern Anatolia Region exhibited the lowest at 1.436%. In all age groups, female patients with HF were older and had a higher prevalence rate across all geographical regions than male patients. From 2017 to 2021, incidence rates of HF declined to 3.0 per 1000 person years, with a consistent decrease for each geographical region. The highest incidence rates of HF were seen in the Black Sea Region, while the Southeastern Anatolia Region had the lowest. Evaluating pediatric population with HF, prevalence of HF was 0.81 per 1000 people (female children: 0.77 per 1000 people, male children: 0.84 per 1000 people). Female children with HF demonstrated the highest prevalence in the Central Anatolia Region with a rate of 1.04 per 1000 people, while male pediatric population with HF exhibited the greatest prevalence of HF in the Mediterranean Region, reaching 0.89 per 1000 people. The lowest prevalence of children with HF in both sexes was observed in the Eastern Anatolia Region (female children: 0.62 per 1000 people, male children: 0.48 per 1000 people). Conclusion:Despite regional variations, prevalence of HF in Türkiye's regions aligns with global trends. Sex-based differences in HF prevalence were evident across all age groups, including pediatric population. Incidence rates of HF in each region exhibited a substantial decline by 2021.

BACKGROUND:Sodium-glucose cotransporter-2 inhibitors (SGLT2is) are breakthrough agents for the treatment of type 2 diabetes mellitus (T2DM) and heart failure (HF). However, among patients with HF and T2DM, some uncertainty remains about individual comparisons, including dosing. OBJECTIVES:We aimed to make a real-life individual comparison of SGLT2is among patients with HF and T2DM. METHODS:This was a subgroup analysis of the Turkish Ministry of Health's National Electronic Database for adult patients with HF (TRends-HF). All-cause mortality (ACM) data up to 7 years were evaluated. Patients with HF and T2DM who were prescribed an SGLT2i were identified, and individual doses of empagliflozin 25 mg, empagliflozin 10 mg, and dapagliflozin 10 mg were compared. For individual comparisons, propensity score-matching analysis was generated as 1:1:1, and disease-modifying therapies (DMTs) for HF were considered. RESULTS:In the triple-matched cohort, 1-, 5-, and 7-year survival rates were 95%, 81%, and 76% versus 94%, 78%, and 72% versus 94%, 80%, and 75% for empagliflozin 25 mg, empagliflozin 10 mg, and dapagliflozin 10 mg, respectively. Among patients who were on triple DMT for HF, 1-, 5-, and 7-year survival rates were 95%, 78%, and 70% for empagliflozin 25 mg, 95%, 74%, and 66% for empagliflozin 10 mg, and 94%, 77%, and 69% for dapagliflozin, respectively. Annual emergency department visits were slightly lower with empagliflozin 10 mg and dapagliflozin 10 mg than with empagliflozin 25 mg. A greater proportion of patients on dapagliflozin 10 mg did not experience hospitalization during the 7-year follow-up compared with both doses of empagliflozin, albeit with a small effect size. CONCLUSION:Among patients with HF and T2DM, SGLT2is are instrumental, and empagliflozin 10 mg remains significantly inferior to dapagliflozin 10 mg and empagliflozin 25 mg in terms of 5- and 7-year ACM.

Objective: Peripartum Cardiomyopathy (PPCM) is a life-threatening, rare disorder that occurs during the late stages of pregnancy or the early postpartum period. The ARTEMIS (A RegisTry of pEripartuM cardIomyopathy in Turkish patientS) aims to investigate the clinical characteristics and outcomes of PPCM in Turkiye, providing insights into its management within this specific population. Methods: The ARTEMIS registry retrospectively enrolled patients diagnosed with PPCM within the last five years at 44 cardiology centers across Turkiye. Eligible participants were women over 18 years old, diagnosed with PPCM and without other known cardiac pathology. Data collected included demographic information, clinical presentation, diagnostic modalities, treatment regimens, and outcomes. Results: The study included 293 patients, predominantly between 25 and 35 years old. The majority presented with symptoms such as dyspnea and palpitations, diagnosed postpartum via echocardiography. A low use of advanced diagnostic imaging was noted, relying primarily on echocardiography for evaluation. Common treatments included beta blockers (97.8%), angiotensin-converting enzyme (ACE) inhibitors (71.3%), and in severe cases, bromocriptine (6.9%). The study highlighted a mortality rate of 5.1%, with surviving patients often requiring continued management for heart failure. Diagnostic challenges and variations in treatment responses were noted, reflecting the complexity of PPCM diagnosis and care. Conclusion: The ARTEMIS registry provides valuable insights into the management of PPCM in Turkiye, highlighting the need for targeted educational programs for healthcare providers and patients. It also underscores the importance of national registries in understanding and improving outcomes for rare diseases like PPCM.