Background:Acute decompensated heart failure (ADHF) causes multi-organ damage associated with congestion, hypoperfusion, or both. However, its impact on pancreatic exocrine function (PEF), which can be associated with impaired digestion and absorption and contribute to malnutrition, remains unclear. Thus, in this proof-of-concept study, we investigated whether hospitalized patients with ADHF have impaired PEF. Methods and Results:Patients admitted to the cardiac intensive care unit were enrolled. Following initial stabilization, the N-benzoyl-L-tyrosyl-p-aminobenzoic acid (BT-PABA) test, which is the only clinically available PEF test in Japan, was performed. Data from 51 patients (age 73.3±9.8 years; 80.4% men; body mass index 23.9±5.0 kg/m2) were assessed. Patients hospitalized for ADHF (n=33) exhibited significantly lower levels of urinary PABA excretion rate (i.e., pancreatic function diagnostic [PFD] value) than in those hospitalized for other cardiovascular conditions (52.4±20.1% vs. 66.4±17.3%; P=0.022). Simple regression analyses revealed that decreased PFD values were associated with advanced age, increased hemoglobin A1c level, impaired kidney function, low urinary volume in the BT-PABA test, and ADHF-related hospitalization. Multiple regression analysis revealed that only reduced estimated glomerular filtration rate (coefficient 0.319; P=0.031) and ADHF-related hospitalization (coefficient -0.326; P=0.027) were associated with poor PFD values. Conclusions:PEF was impaired in hospitalized patients with ADHF. Our findings could inform further hypotheses regarding how improved PEF in hospitalized patients with ADHF affects their nutritional status.

AIM:Quantifying skeletal muscle mass is essential for patients with heart failure; however, common modalities, such as bioelectrical impedance analysis, can be distorted by fluid retention. The total body muscle mass (TBMM), a creatinine-cystatin C-derived marker, has been proposed as a practical blood-based surrogate of muscle mass; however, its relationship with muscle mass and its prognostic value in acute heart failure remain uncertain. Therefore, we aimed to assess whether TBMM is associated with skeletal muscle mass indices in heart failure and postdischarge all-cause mortality in patients hospitalized for acute heart failure. METHODS:This single-center retrospective study included patients hospitalized for acute heart failure at Juntendo University Hospital (January 2015-December 2021). TBMM was calculated from body weight, serum creatinine, and cystatin C, and classified using prespecified sex-specific cut-offs (men, < 38.846; women, < 26.476). RESULTS:Among the 550 patients, 271 had low TBMM. Over a median follow-up of 2.6 years, 134 deaths occurred (low-TBMM, 79; high-TBMM, 55). Patients with low TBMM showed significantly lower survival and a higher risk of postdischarge mortality after adjustment. Findings were consistent across the left ventricular ejection fraction strata (< 50% and ≥ 50%). TBMM correlated strongly with appendicular skeletal muscle mass index, estimated using both anthropometric and biomarker-based models. CONCLUSIONS:In patients hospitalized for acute heart failure, TBMM was strongly correlated with estimated muscle mass and independently associated with postdischarge all-cause mortality. Therefore, TBMM may complement routine risk stratification and help identify patients with heightened vulnerability related to muscle impairment.

Obstructive sleep apnea (OSA) is closely associated with obesity and fluid retention. Our previous study suggested that, in patients with heart failure, the sodium-glucose cotransporter 2 inhibitor, tofogliflozin, promotes diuresis and weight loss and improves OSA severity. However, whether changes in the apnea-hypopnea index (AHI) are chronologically associated with body composition parameters remains unclear. We enrolled 10 patients (six men) with OSA. They received tofogliflozin (20 mg) daily for 6 months. The AHI was assessed using WatchPAT® at baseline, 3, and 6 months. Body composition, including water content and fat mass, was also measured. AHI changes measured using the WatchPAT peripheral arterial tonometry-derived AHI (pAHI) and their correlations with changes in body composition parameters were analyzed. Tofogliflozin administration significantly reduced pAHIs at 3 and 6 months compared to baseline, but more at 3 months, whereas body weight and body water content decreased over time. The

Background and aims: In patients with heart failure (HF), differences in the association between estimated protein intake (PI) and prognosis in those with and without chronic kidney disease (CKD) remain to be clarified. This study aimed to investigate whether the prognostic effects of the estimated PI differ between patients with HF with and without CKD. Methods: We included patients who required hospitalisation owing to worsening HF between 2015 and 2019 and assessed the estimated PI based on the adjusted Maroni formula using the body mass index and urinary urea nitrogen level. Patients were stratified into the higher and lower estimated PI groups according to the median value of the estimated PI at the time of admission. The primary outcome was allcause mortality. Results: Among the 694 enrolled patients, 286 had CKD. A lower estimated PI was independently associated with a worse nutritional status. During a median follow-up period of 17.2 months, 175 allcause deaths occurred, including 99 and 76 in the lower and higher estimated PI groups, respectively. In the Kaplan-Meier curves, the lower estimated PI group was associated with higher overall mortality. However, lower estimated PI was significantly associated with all-cause mortality in patients without CKD, but not in those with CKD, after adjustment for covariates. A significant interaction in terms of prognostic effect was observed between the presence or absence of CKD and estimated PI. Conclusions: Among patients with HF, prognostic effect of the estimated PI may differ between patients with and without CKD. (c) 2024 European Society for Clinical Nutrition and Metabolism. Published by Elsevier Ltd. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

BACKGROUND:Anemia and renal failure, common comorbidities in patients with heart failure (HF), are associated with increased mortality. Hypoxia-inducible factor prolyl hydroxylase inhibitors, such as daprodustat, treat renal anemia by stimulating erythropoiesis and enhancing iron availability. However, its efficacy in treating HF with renal anemia remains to be determined. METHODS:This pilot, multicenter, open-label, randomized controlled trial was conducted in five hospitals in Japan. Patients with HF, anemia (hemoglobin, 7.5-11 g/dL), and renal impairment (estimated glomerular filtration rate, <60 mL/min/1.73 m2) not requiring hemodialysis were randomized 1:1 to receive daprodustat or standard of care. The primary endpoint was the hemoglobin level at 16 weeks. The secondary endpoints included blood transfusion rates, alleviation of HF symptoms, changes in N-terminal pro-B-type natriuretic peptide and iron-related biomarkers, and cardiac structural and functional changes. RESULTS:Twenty-one patients were randomized between March 2022 and November 2023. At 16 weeks, the mean hemoglobin level was significantly higher in the daprodustat group (12.1 ± 0.73 g/dL) than in the standard of care group (10.3 ± 0.97 g/dL, p < 0.001). Serum iron, ferritin, hepcidin, and transferrin saturation levels were significantly lower, whereas N-terminal pro-B-type natriuretic peptide levels were significantly higher in the daprodustat treatment group. Kansas City Cardiomyopathy Questionnaire Total Symptom Score improvement (44.4 % vs. 55.6 %, p = 0.99) and structural and functional cardiac parameters showed no significant differences. CONCLUSIONS:Daprodustat effectively increases hemoglobin levels and modifies iron metabolism by decreasing hepcidin levels and increasing iron utilization in patients with HF and renal anemia.

BACKGROUND:Heart failure (HF) is associated with frailty, and most frailty assessment methods are subjective and complex. The Essential Frailty Toolset (EFT) is a simple, objective, and comprehensive frailty assessment tool. This study aimed to investigate the clinical and prognostic values of the EFT in patients with HF. METHODS:Data from a multicenter, observational study on older (≥ 65 years old) patients hospitalized with HF, the FRAGILE-HF cohort, was used. The EFT includes a five-time chair stand test, cognitive function assessment, and hemoglobin and albumin measurements. Patients were divided into three groups based on their EFT points: robust (0 points), pre-frail (1-2 points), and frail (3-5 points). The primary endpoint was 2-year all-cause mortality. RESULTS:Of the total 1237 patients (80.1 ± 7.1 years; 43% females), the robust, pre-frail, and frail groups included 114 (11.6%), 606 (49.0%), and 487 (39.4%) patients, respectively. The prevalence of frailty, evaluated using the Fried phenotype model, increased with increased EFT points (p < 0.001). Within the 2-year follow-up period, 256 deaths occurred. The frail group was significantly associated with a higher risk of the primary endpoint than the robust group (adjusted hazard ratio [aHR], 2.01; 95% confidence interval [CI], 1.12-3.61; p = 0.019). The EFT point, as a continuous variable, was significantly associated with the primary endpoint (aHR, 1.19; 95% CI, 1.08-1.31; p < 0.001). A significant continuous net reclassification improvement was observed when the EFT groups were added to the conventional risk model. CONCLUSION:The EFT demonstrated valuable clinical and prognostic value in older patients with HF.

Background/Objectives: Worsening renal function (WRF) during hospitalization for acute decompensated heart failure (ADHF) is associated with poor clinical outcomes. Data on the impact of WRF on clinical outcomes, considering blood urea nitrogen (BUN) level and its changes in patients with ADHF, are scarce. This study aimed to investigate the effects of BUN and its changes during hospitalization on the relationship between WRF during hospitalization and post-discharge clinical outcomes in patients with ADHF. Methods: A total of 509 patients with ADHF, hospitalized between 2007 and 2011, were included. WRF was defined as an absolute increase in serum creatinine level of >0.3 mg/dL, with a >25% increase during hospitalization. The risk of WRF for post-discharge clinical events, including death and rehospitalization, considering BUN levels, was assessed using three multivariable Cox regression models. Results: WRF was observed in 55 (10.8%) patients. The cumulative event-free survival was significantly worse in patients with WRF (p = 0.039). In Model 1 (excluding BUN changes), WRF was associated with a greater risk of post-discharge clinical events. In Model 2, which included both WRF and BUN changes, WRF was not a significant predictor. In Model 3, patients were subdivided according to WRF or BUN increase, and the subgroups were included instead of isolated WRF and BUN changes; only WRF with increased BUN level was associated with an increased risk of post-discharge clinical events. Conclusions: In patients with ADHF, WRF was associated with poor post-discharge clinical outcomes when accompanied by increased BUN levels during hospitalization.

BACKGROUND:Patients with bradyarrhythmia requiring pacemaker implantation often report disrupted sleep, which could be related to bradyarrhythmia, apprehension of having heart disease and undiagnosed sleep disorders, resulting in impaired quality of life (QOL). We aimed to assess the prevalence of poor subjective sleep quality in patients with bradyarrhythmia requiring pacemaker implantation and its effect on sleep quality. METHODS AND RESULTS:Patients undergoing permanent pacemaker implantation for bradyarrhythmia were evaluated for subjective sleep quality and health-related QOL using the Pittsburgh Sleep Quality Index (PSQI) and Short Form-8 (SF-8) before and after pacemaker implantation. Poor subjective sleep quality was defined as PSQI score ≥6. Of 89 enrolled patients, 54 (60.7%) reported poor subjective sleep quality. A greater PSQI score indicative of poor sleep quality was likely to be observed in patients who had greater left ventricular ejection fraction and were treated with calcium-channel blockers, as well as in patients with more frequent sleep disturbance-related complaints/symptoms. After pacemaker implantation, the PSQI score improved significantly (from a median score of 6.0 to 5.0; P=0.015) proportional to an improvement in the mental component summary score. CONCLUSIONS:Poor subjective sleep quality is common among patients with bradyarrhythmia, contributing to impaired QOL. Pacemaker implantation may have a favorable effect on subjective sleep quality, and QOL for such patients.

Purpose:Home sleep apnea tests (HSATs) using polygraphy devices are becoming increasingly important for evaluating obstructive sleep apnea. Alice NightOne, a widely used polygraphy device, includes automatic scoring software; however, more reliable scoring results can be provided by incorporating advanced algorithmic systems like Somnolyzer. Despite this, the accuracy of automatic scoring of this polygraphy device using such applications has not been specifically investigated. Thus, in this study, we aimed to compare the respiratory event indices (REIs) obtained via automatic scoring versus manual scoring. Patients and Methods:Data of eligible patients who underwent HSAT with this polygraphy device were retrospectively analyzed using the following three methods: 1) manual scoring; 2) default automatic scoring of the analysis software; and 3) automatic scoring with the Somnolyzer system. The REIs were calculated using these three methods and expressed as mREI, aREI, and sREI, respectively. Correlations and agreements between the aREI, sREI, and mREI were assessed. Results:Data from 20 patients were analyzed. The mean mREI, aREI, and sREI were 14.7±13.3, 13.7±11.8, and 14.3±13.4 events/h, respectively. A strong correlation was found between aREI and mREI (coefficient, 0.976; P<0.01), with a mean difference between them of 1.0 and a limit of agreement of -5.3 to 7.3. The correlation between sREI and mREI was more prominent (coefficient, 0.996; P<0.001); their mean difference was 0.1, with a limit of agreement of -2.1 to 2.9. Conclusion:Automatic scoring of REI using this polygraphy device showed good correlation and agreement with manual scoring. The favorable correlation and agreement were more pronounced with the Somnolyzer system.

Background/Objectives: Heart failure (HF) can damage organs because of poor perfusion and/or congestion. The interactions between HF and other organs have recently been studied; however, data on the interaction between HF and pancreatic exocrine function, which may affect fat and protein absorption and malnutrition, are scarce. We previously showed that the serum levels of pancreatic exocrine enzymes, as suggestive of pancreatic exocrine function, were low and associated with malnutrition or congestion in hospitalized patients with acute decompensated HF (ADHF). This study investigated the relationship between the serum levels of pancreatic exocrine enzymes and long-term outcomes in patients with ADHF. Methods: We collected serum levels of pancreatic exocrine enzymes (amylase and lipase) from patients who were admitted to the cardiac intensive care unit due to ADHF. Patients undergoing dialysis and those with neoplasms were excluded. Patients were categorized as having high or low pancreatic exocrine enzyme levels in the first quartile upon admission. The association between low serum pancreatic exocrine enzyme levels at admission and the composite of death and ADHF readmission was assessed. Results: Of the 146 patients, 37 (25.3%) and 36 (24.7%) had low amylase and lipase levels, respectively. Patients with low lipase levels showed worse cumulative event-free survival than those with high lipase levels (p < 0.001). A low lipase level was associated with worse outcomes (hazard ratio: 1.96; p = 0.012). Conclusions: These findings suggest that low serum lipase levels may be a predictor of long-term outcomes in patients with ADHF.

Background:Cardiac acoustic biomarkers (CABs) measured by acoustic cardiography support the diagnosis or monitoring of worsening heart failure (HF). Our previous observational study suggested that temporal changes in CABs in patients with acute decompensated HF may reflect changes in cardiac function during hospitalization and between discharge and the first follow-up visit. This study aimed to assess whether changes in CABs between discharge and the first follow-up visit in such patients are associated with cardiac events over a 1-year follow-up period. Methods:This study was a follow-up to our previous observational study. CABs assessed at discharge and the first clinic visit following discharge were examined. The incidence of cardiac events, defined as the composite of death and rehospitalization due to worsening HF following the first clinic visit, was investigated. Results:Among 60 patients enrolled in our previous study, 47 who had CAB data at discharge and their first clinic visit were monitored for 1 year. During a median follow-up period of 351 days, 17 of these 47 patients experienced cardiac events, including 4 deaths and 13 rehospitalizations. The cumulative event-free survival rate was significantly poorer in patients whose change in third heart sound (ΔS3) strength was ≥ 0.1 than in those whose ΔS3 strength was < 0.1. Multivariate Cox regression models indicated that the ΔS3 strength increase was significantly associated with increased risk of cardiac events. Conclusions:An increase in S3 as assessed using the CAB device between discharge and the first clinic visit may be a predictor of subsequent cardiac events in patients initially hospitalized for acute decompensated HF.

Background:Interactions between the heart and other organs have been a focus in acute decompensated heart failure (ADHF). However, the association between ADHF and pancreatic exocrine insufficiency (PEI), which may lead to malnutrition, remains unclear. We investigated the relationship between exocrine pancreatic enzymes and ADHF. Methods:We enrolled 155 and 46 patients with and without ADHF, respectively. Serum amylase and lipase levels were compared between the two groups. In the ADHF group, factors correlating with serum amylase or lipase levels were assessed using multiple regression analysis, and changes in their levels throughout the hospital course were determined. Results:Patients with ADHF exhibited significantly lower amylase and lipase levels. In the same group, the significant independent correlates of lower amylase levels included a lower blood urea-nitrogen level (partial correlation coefficient, 0.530; p < 0.001), lower albumin level (partial correlation coefficient, 0.252; p = 0.015), and higher uric acid level (partial correlation coefficient, -0.371; p < 0.001). The significant independent correlates of lower lipase levels included coexisting atrial fibrillation (coefficient, 0.287; p = 0.026), lower creatinine level (coefficient, 0.236; p = 0.042), and higher B-type natriuretic peptide level (coefficient, -0.257; p = 0.013). Both amylase and lipase levels significantly increased following the improvement in ADHF. Conclusions:In patients with ADHF, decreased serum amylase and lipase levels were associated with the congestion severity, suggesting that PEI may occur in patients with ADHF, potentially due to ADHF-related congestion.

BACKGROUND:Renal dysfunction is significantly associated with poor prognosis in patients with heart failure. However, the prognostic significance of proteinuria as a potential marker of an impaired glomerular filtration barrier in acute heart failure (AHF) remains unclear. We aimed to investigate the prognostic value of urinary protein/creatinine ratio (PCR) in patients with AHF. METHODS:Urinary protein levels measured at admission were adjusted for urinary creatinine concentrations in 346 patients (75 ± 13 years; 61 % men) with AHF. Patients were categorized based on urinary PCR, adhering to the Japanese chronic kidney disease (CKD) guideline cut-offs for CKD staging: A1 (<0.15 g/gCr), A2 (0.15-0.49 g/gCr), and A3 (≥0.5 g/gCr). The primary endpoint was all-cause mortality. RESULTS:Overall, there were 85, 126, and 135 patients in the A1, A2, and A3 groups, respectively. Groups A2 and A3 were associated with lower hemoglobin levels, higher blood urea nitrogen and N-terminal pro-B-type natriuretic peptide levels, and poor renal function. Moreover, groups A2 and A3 had high cystatin C, alpha 1 microglobulin, and urinary liver-type fatty acid-binding protein (L-FABP) levels. Urinary PCR correlated more with tubular markers, alpha 1-microglobulin, and L-FABP than with the glomerular marker cystatin C. Over a median follow-up period of 434 (interquartile range: 89-753) days, 72 deaths occurred. Elevated urinary PCR was associated with higher mortality rates (log-rank test, p < 0.001), even after adjusting for other variables [A2 vs. A1: hazard ratio (HR) 2.59, 95 % confidence interval (CI) 0.71-9,55, p = 0.15; A3 vs. A1: HR 4.40, 95 % CI 1.17-16.6, p = 0.029]. CONCLUSIONS:Elevated urinary PCR is more prevalent in patients with AHF and is associated with a higher risk of all-cause mortality, independent of covariates, including glomerular function. Thus, urinary PCR at admission should provide prognostic information independent of glomerular function.

Background: Delirium is frequently observed in patients admitted to the intensive care unit, and is associated with mortality and morbidity. Although several studies have reported an association between polyunsaturated fatty acids (PUFAs) and cognitive disorders, the association between PUFA levels and development of delirium in patients with acute cardiovascular disease remains unknown. Objective: This study aimed to clarify the association between PUFA levels and development of delirium in the coronary intensive care unit (CICU). Methods: We enrolled 590 consecutive patients (mean age, 70 ± 14 years) admitted to the CICU of Juntendo University Hospital. Fasting serum PUFA levels were measured within 24 h of admission. Delta-5 desaturase activity was estimated as the ratio of arachidonic acid (AA) to dihomo-gamma-linolenic acid (DGLA). Furthermore, delirium was defined as patients having a delirium score of ≥4 using the Intensive Care Delirium Screening Checklist. Results: Delirium was observed in 55 patients. DGLA levels were significantly lower, and delta-5 desaturase activity was significantly higher in patients with delirium than in those without delirium (both p < 0.001). Conversely, AA alone and omega-3 PUFAs did not differ between the groups. Additionally, DGLA and AA levels, but not omega-3 PUFA levels, were negatively associated; delta-5 desaturase activity was positively associated with the delirium score (both p < 0.001). The duration of delirium was significantly associated with DGLA and AA levels (p = 0.001 and p = 0.004, respectively). Moreover, multivariate analysis showed that decreased DGLA and increased delta-5 desaturase activity remained significant predictors of delirium. Conclusions: Low omega-6 PUFA levels and high delta-5 desaturase activity on admission were significantly associated with the development of delirium in the CICU, indicating that the evaluation of low omega-6 PUFA levels and related enzymes may identify patients at a high risk of developing delirium.

Abstract Aims MitraScore is a novel, simple, and manually calculatable risk score developed as a prognostic model for patients undergoing transcatheter edge‐to‐edge repair (TEER) for mitral regurgitation. As its components are considered prognostic in heart failure (HF), we aimed to investigate the usefulness of the MitraScore in HF patients. Methods and results We calculated MitraScore for 1100 elderly patients (>65 years old) hospitalized for HF in the prospective multicentre FRAGILE‐HF study and compared its prognostic ability with other simple risk scores. The primary endpoint was all‐cause deaths, and the secondary endpoints were the composite of all‐cause deaths and HF rehospitalization and cardiovascular deaths. Overall, the mean age of 1100 patients was 80 ± 8 years, and 58% were men. The mean MitraScore was 3.2 ± 1.4, with a median of 3 (interquartile range: 2–4). A total of 326 (29.6%), 571 (51.9%), and 203 (18.5%) patients were classified into low‐, moderate‐, and high‐risk groups based on the MitraScore, respectively. During a follow‐up of 2 years, 226 all‐cause deaths, 478 composite endpoints, and 183 cardiovascular deaths were observed. MitraScore successfully stratified patients for all endpoints in the Kaplan–Meier analysis (P < 0.001 for all). In multivariate analyses, MitraScore was significantly associated with all endpoints after covariate adjustments [adjusted hazard ratio (HR) (95% confidence interval): 1.22 (1.10–1.36), P < 0.001 for all‐cause deaths; adjusted HR 1.17 (1.09–1.26), P < 0.001 for combined endpoints; and adjusted HR 1.24 (1.10–1.39), P < 0.001 for cardiovascular deaths]. The Hosmer–Lemeshow plot showed good calibration for all endpoints. The net reclassification improvement (NRI) analyses revealed that the MitraScore performed significantly better than other manually calculatable risk scores of HF: the GWTG‐HF risk score, the BIOSTAT compact model, the AHEAD score, the AHEAD‐U score, and the HANBAH score for all‐cause and cardiovascular deaths, with respective continuous NRIs of 0.20, 0.22, 0.39, 0.39, and 0.29 for all‐cause mortality (all P‐values < 0.01) and 0.20, 0.22, 0.42, 0.40, and 0.29 for cardiovascular mortality (all P‐values < 0.02). Conclusions MitraScore developed for patients undergoing TEER also showed strong discriminative power in HF patients. MitraScore was superior to other manually calculable simple risk scores and might be a good choice for risk assessment in clinical practice for patients receiving TEER and those with HF.

Background: Frailty is associated with a poor prognosis in older patients with heart failure (HF). However, multidomain frailty assessment tools have not been established in patients with HF, and the association between the frailty phenotype and the deficit-accumulation frailty index in these patients is unclear. We aimed to understand this relationship and evaluate the prognostic value of the deficit-accumulation frailty index in older patients with HF. Methods: We retrospectively analyzed FRAGILE-HF cohort, which consisted of prospectively registered hospitalized patients with HF aged >= 65 years. The frailty index was calculated using 34 health-related items. The physical, social, and cognitive domains of frailty were evaluated using a phenotypic approach. The primary endpoint was all-cause mortality. Results: Among 1027 patients with HF (median age, 81 years; male, 58.1%; median frailty index, 0.44), a higher frailty index was associated with a higher prevalence in all domains of cognitive, physical, and social frailty defined by the phenotype model. During the 2-year follow-up period, a higher frailty index was independently associated with all-cause death even after adjustment for Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score plus log B-type natriuretic peptide (per 0.1 increase: hazard ratio, 1.21; 95% confidence interval, 1.07-1.37; P = 0.002). The addition of the frailty index to the baseline model yielded statistically significant incremental prognostic value (net reclassification improvement, 0.165; 95% confidence interval, 0.012-0.318; P = 0.034). Conclusions: A higher frailty index was associated with a higher prevalence of all domains of frailty defined by the phenotype model and provided incremental prognostic information with pre-existing risk factors in older patients with HF.

BACKGROUND:Multi-parametric assessment, including heart sounds in addition to conventional parameters, may enhance the efficacy of noninvasive telemonitoring for heart failure (HF). We sought to assess the feasibility of self-telemonitoring with multiple devices including a handheld heart sound recorder and its association with clinical events in patients with HF. METHODS:Ambulatory HF patients recorded their own heart sounds, mono‑lead electrocardiograms, oxygen saturation, body weight, and vital signs using multiple devices every morning for six months. RESULTS:In the 77 patients enrolled (63 ± 13 years old, 84 % male), daily measurements were feasible with a self-measurement rate of >70 % of days in 75 % of patients. Younger age and higher Minnesota Living with Heart Failure Questionnaire scores were independently associated with lower adherence (p = 0.002 and 0.027, respectively). A usability questionnaire showed that 87 % of patients felt self-telemonitoring was helpful, and 96 % could use the devices without routine cohabitant support. Six patients experienced ten HF events of re-hospitalization and/or unplanned hospital visits due to HF. In patients who experienced HF events, a significant increase in heart rate and diastolic blood pressure and a decrease in the time interval from Q wave onset to the second heart sound were observed 7 days before the events compared with those without HF events. CONCLUSIONS:Self-telemonitoring with multiple devices including a handheld heart sound recorder was feasible even in elderly patients with HF. This intervention may confer a sense of relief to patients and enable monitoring of physiological parameters that could be valuable in detecting the deterioration of HF.

Sleep apnea (SA) is prevalent among patients with heart failure (HF) and contributes to a poor prognosis. Sodium–glucose cotransporter 2 (SGLT2) inhibitors have demonstrated efficacy in reducing the risk of serious clinical events in patients with HF. Additionally, SGLT2 inhibitors may reduce the risk of incident SA and mitigate its severity in patients with cardiovascular disease and T2DM. We aimed to investigate whether the SGLT2 inhibitor tofogliflozin reduced the severity of SA, as assessed using the apnea–hypopnea index (AHI), in patients with HF and T2DM and whether a decrease in AHI correlates with changes in body composition and cardiorenal function parameters. This is a single-arm, prospective pathophysiologic study involving patients with HF, T2DM, and SA, defined as having an AHI of 15 events/h and more. SA was assessed using polysomnography. Changes in AHI before and 6 months after starting oral administration of tofogliflozin (20 mg) were assessed. Additionally, body composition and cardiorenal functions were assessed before and 6 months after tofogliflozin administration. Ten patients with HF, T2DM, and SA were finally enrolled (60

MitraScore is a novel, simple, and manually calculatable risk score developed as a prognostic model for patients undergoing transcatheter edge-to-edge repair (TEER) for mitral regurgitation. As its components are considered prognostic in heart failure (HF), we aimed to investigate the usefulness of the MitraScore in HF patients. We calculated MitraScore for 1100 elderly patients (>65 years old) hospitalized for HF in the prospective multicentre FRAGILE-HF study and compared its prognostic ability with other simple risk scores. The primary endpoint was all-cause deaths, and the secondary endpoints were the composite of all-cause deaths and HF rehospitalization and cardiovascular deaths. Overall, the mean age of 1100 patients was 80 ± 8 years, and 58% were men. The mean MitraScore was 3.2 ± 1.4, with a median of 3 (interquartile range: 2–4). A total of 326 (29.6%), 571 (51.9%), and 203 (18.5%) patients were classified into low-, moderate-, and high-risk groups based on the MitraScore, respectively. During a follow-up of 2 years, 226 all-cause deaths, 478 composite endpoints, and 183 cardiovascular deaths were observed. MitraScore successfully stratified patients for all endpoints in the Kaplan–Meier analysis ( P  < 0.001 for all). In multivariate analyses, MitraScore was significantly associated with all endpoints after covariate adjustments [adjusted hazard ratio (HR) (95% confidence interval): 1.22 (1.10–1.36), P  < 0.001 for all-cause deaths; adjusted HR 1.17 (1.09–1.26), P  < 0.001 for combined endpoints; and adjusted HR 1.24 (1.10–1.39), P  < 0.001 for cardiovascular deaths]. The Hosmer–Lemeshow plot showed good calibration for all endpoints. The net reclassification improvement (NRI) analyses revealed that the MitraScore performed significantly better than other manually calculatable risk scores of HF: the GWTG-HF risk score, the BIOSTAT compact model, the AHEAD score, the AHEAD-U score, and the HANBAH score for all-cause and cardiovascular deaths, with respective continuous NRIs of 0.20, 0.22, 0.39, 0.39, and 0.29 for all-cause mortality (all P -values < 0.01) and 0.20, 0.22, 0.42, 0.40, and 0.29 for cardiovascular mortality (all P -values < 0.02). MitraScore developed for patients undergoing TEER also showed strong discriminative power in HF patients. MitraScore was superior to other manually calculable simple risk scores and might be a good choice for risk assessment in clinical practice for patients receiving TEER and those with HF.