Female patients have unique challenges and disparities in the management and outcomes of chest pain from cardiovascular causes compared to male patients.
Randomized controlled trial assesses the impact of ECG telemonitoring on health outcomes in acute myocardial infarction patients, suggesting potential benefits.
Meta-analysis of randomized trials finds NOAC reduces systemic embolic events risk in atrial fibrillation, indicating important clinical benefits.
A COMPASS substudy evaluates clinical benefits of dual pathway inhibition in patients with chronic coronary syndrome, implying nuances in risk classification.
Retrospective review demonstrates the use of intracardiac echocardiography in tricuspid valve replacement, suggesting implications for procedural efficiency and outcomes.
Cross-sectional research estimates myocardial infarction frequency in young patients, suggesting significant risk factors.
Structured narrative review explores extracellular vesicles' impact on cardiac amyloidosis, suggesting diagnostic and therapeutic potential.
BACKGROUND: The prevalence and prognostic significance of liver biomarkers in heart failure (HF) with mildly reduced or preserved ejection fraction are uncertain, with both potential hemodynamic and metabolic contributions to liver dysfunction in these patients. We evaluated the prevalence and prognostic value of liver biomarkers and assessed the effects of the nonsteroidal mineralocorticoid receptor antagonist finerenone on these biomarkers and clinical outcomes, in FINEARTS-HF (Finerenone Trial to Investigate Efficacy and Safety Superior to Placebo in Patients With Heart Failure). METHODS: FINEARTS-HF was a randomized, double-blind, placebo-controlled trial that enrolled 6001 patients with left ventricular ejection fraction ≥40%, evidence of structural heart disease, and elevated NT-proBNP (N-terminal pro-B-type natriuretic peptide) levels. Liver biomarkers examined were total bilirubin, alkaline phosphatase, alanine aminotransferase, and aspartate aminotransferase. RESULTS: Among 5873 patients with available baseline bilirubin measurements, 11.9% had elevated levels (1.0 mg/dL). Higher bilirubin levels were associated with a greater risk of total worsening HF events and cardiovascular death. Compared with placebo, finerenone rapidly reduced bilirubin and alkaline phosphatase levels (but not transaminase levels), with effects sustained over time. Finerenone reduced the risk of total worsening HF events and cardiovascular death across all bilirubin tertiles (T1 0.4 mg/dL, rate ratio 0.94 95% CI, 0.75–1.17; T2 0.5–0.6 mg/dL, 0.83 0.66–1.05; T3 ≥0.7 mg/dL, 0.77 0.62–0.97), with no significant interaction by bilirubin level ( P interaction =0.43). Consistent effects were observed for the components of the primary outcome, all-cause death, and improvement in the Kansas City Cardiomyopathy Questionnaire total symptom score. CONCLUSIONS: Baseline bilirubin concentration was an independent predictor of worse outcomes but did not modify the benefits of finerenone on morbidity and mortality in HF with mildly reduced or preserved ejection fraction. Finerenone reduced bilirubin and alkaline phosphatase, suggesting a possible decongestive effect in HF with mildly reduced or preserved ejection fraction. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT04435626.
Randomized controlled trial shows improved self-care and health outcomes in heart failure patients, indicating effective intervention.
Per-protocol analysis examines chlorthalidone's effectiveness in preventing cardiovascular events in older patients, suggesting implications for treatment choices.