Relationship between comorbidity and health outcomes in patients with heart failure: a systematic review and meta-analysis

Disease Network-Based Approaches to Study Comorbidity in Heart Failure: Current State and Future Perspectives

PURPOSE OF REVIEW

Heart failure (HF) is often accompanied by a constellation of comorbidities, leading to diverse patient presentations and clinical trajectories. While traditional methods have provided valuable insights into our understanding of HF, network medicine approaches seek to leverage these complex relationships by analyzing disease at a systems level. This review introduces the concepts of network medicine and explores the use of comorbidity networks to study HF and heart disease.

RECENT FINDINGS

Comorbidity networks are used to understand disease trajectories, predict outcomes, and uncover potential molecular mechanisms through identification of genes and pathways relevant to comorbidity. These networks have shown the importance of non-cardiovascular comorbidities to the clinical journey of patients with HF. However, the community should be aware of important limitations in developing and implementing these methods. Network approaches hold promise for unraveling the impact of comorbidities in the complex presentation and genetics of HF. Methods that consider comorbidity presence and timing have the potential to help optimize management strategies and identify pathophysiological mechanisms.

Prognostic value of anion gap for patients with heart failure: a systematic review and meta-analysis

BACKGROUND

Heart failure (HF) is among the cardiovascular diseases with high morbidity and mortality worldwide. Due to the high burden of HF, finding easy-to-use prognostic factors has become important. Studies have investigated the correlation between anion gap (AG) and the HF prognosis. In this systematic review and meta-analysis, we aimed to evaluate the association between AG association with HF prognosis.

METHODS

PubMed, Embase, Scopus, and the Web of Science were systematically searched for studies evaluating AG in HF prognosis. Standardized mean difference (SMD) and pooled hazard ratio (HR) in addition to 95% confidence intervals (CIs) were calculated using random-effect meta-analyses to compare survivors vs. non-survivors.

RESULTS

Nine studies were included in this systematic review. In a random-effect meta-analysis comparing AG levels in those who died and survivors, non-survivors had significantly higher levels of AG (SMD 0.57, 95% CI 0.42 to 0.71, P < 0.0001, I2 = 46.4%). Meta-analysis of HRs for assessment of mortality revealed that high AG levels had significantly higher hazards of mortality, compared with low AG group (HR 1.64, 95% CI 1.35 to 1.99, P < 0.0001). Finally, a study investigated the association between intensive care unit (ICU) length of stay and AG in patients with HF which showed no significant association.

CONCLUSION

This study found that higher AG levels are associated with higher mortality in patients with HF which could be used in clinical settings and for patient management due to its ease of measurement and calculation. If confirmed in future studies, using this easy-to-measure index in clinical settings could provide useful information for clinicians in determining the risk of HF patients.

CLINICAL TRIAL NUMBER

Not applicable.

A nomogram for predicting short-term mortality in ICU patients with coexisting chronic obstructive pulmonary disease and congestive heart failure

OBJECTIVE

This study aimed to develop and validate a nomogram for predicting 28-day and 90-day mortality in intensive care unit (ICU) patients who have chronic obstructive pulmonary disease (COPD) coexisting with congestive heart failure (CHF).

METHODS

An extensive analysis was conducted on clinical data from the Medical Information Mart for Intensive Care IV database, covering patients over 18 years old with both COPD and CHF, who were were first-time ICU admissions between 2008 and 2019. The least absolute shrinkage and selection operator (LASSO) regression method was employed to screen clinical features, with the final model being optimized using backward stepwise regression guided by the Akaike Information Criterion (AIC) to construct the nomogram. The predictive model's discrimination and clinical applicability were evaluated via receiver operating characteristic (ROC) curves, calibration curves, the C-index, and decision curve analysi s (DCA).

RESULTS

This analysis was comprised of a total of 1948 patients. Patients were separated into developing and validation cohorts in a 7:3 ratio, with similar baseline characteristics between the two groups. The ICU mortality rates for the developing and verification cohorts were 20.8 % and 19.5 % at 28 days, respectively, and 29.4 % and 28.3 % at 90 days, respectively. The clinical characteristics retained by the backward stepwise regression include age, weight, systolic blood pressure (SBP), respiratory rate (RR), oxygen saturation (SpO2), red blood cell distribution width (RDW), lactate, partial thrombosis time (PTT), race, marital status, type 2 diabetes mellitus (T2DM), malignant cancer, acute kidney failure (AKF), pneumonia, immunosuppressive drugs, antiplatelet agents, vasoactive agents, acute physiology score III (APS III), Oxford acute severity of illness score (OASIS), and Charlson comorbidity index (CCI). We developed two separate models by assigning weighted scores to each independent risk factor: nomogram A excludes CCI but includes age, T2DM, and malignant cancer, while nomogram B includes only CCI, without age, T2DM, and malignant cancer. Based on the results of the AUC and C-index, this study selected nomogram A, which demonstrated better predictive performance, for subsequent validation. The calibration curve, C-index, and DCA results indicate that nomogram A has good accuracy in predicting short-term mortality and demonstrates better discriminative ability than commonly used clinical scoring systems, making it more suitable for clinical application.

CONCLUSION

The nomogram developed in this study offers an effective assessment of short-term mortality risk for ICU patients with COPD and CHF, proving to be a superior tool for predicting their short-term prognosis.

The Prevalence of Coronary Artery Disease and Its Prognostic Impact on the Management of Patients With Acute Decompensated Heart Failure: A Prospective Cohort Study With a Short-Term Follow-Up

Introduction Heart failure (HF) poses a major global health challenge, with acute decompensated heart failure (ADHF) representing a critical phase that requires immediate medical intervention. Coronary artery disease (CAD) plays a significant role in many HF cases, contributing to disease progression through myocardial ischemia and impaired ventricular function. While the connection between CAD and HF is well-established, its specific effect on short-term outcomes in patients with ADHF is less understood, especially in regions like the Middle East. This study aims to evaluate the influence of CAD on short-term outcomes in patients presenting with ADHF and identify key differences in demographics, clinical parameters, and outcomes, including intensive care unit (ICU) admissions and medications, between patients with and without CAD, addressing gaps in current understanding and offering insights to improve clinical management. Methods This prospective cohort study was conducted at King Saud University Medical City (KSUMC) in Riyadh, Kingdom of Saudi Arabia (KSA), from April 2023 to April 2024. We included a total of 144 known heart failure patients presenting with acute heart failure (AHF) to the emergency department (ED). Secondary data was collected from the KSUMC medical records database to track patient outcomes after six months. Significant coronary angiography lesions, defined as 70% stenosis or greater, or a history of myocardial ischemia were necessary as evidence of CAD to meet the inclusion criteria. Statistical analyses were conducted using Chi-squared tests for categorical variables and t-tests for continuous variables. All analyses were performed using RStudio version 4.3.1 (Posit Software, Boston, MA), with a significance threshold set at p < 0.05. Results The study included 144 known heart failure patients presenting with acute decompensation, with 83 (57.6%) patients having CAD. CAD patients were younger (median age: 66 versus 67 years, p = 0.026) and predominantly male (75.9% versus 59%, p = 0.031). Diabetes mellitus was significantly more prevalent among patients with CAD (74.7% versus 49.2%, p = 0.002). Ejection fraction (EF) was notably lower in the CAD group with a greater proportion having an ejection fraction of 40% or less (89.2% versus 62.3%, p < 0.001). Additionally, CAD patients had more frequent ICU admissions (37.3% versus 13.1%, p = 0.001) and were more likely to present with chest pain (38.6% versus 21.3%, p = 0.027), while weight loss and lower extremity edema were more common in non-CAD patients (p < 0.05). Despite these worse clinical signs, CAD patients did not have significantly higher mortality at 180 or 360 days. Conclusion Although there was no statistically significant difference in mortality, CAD patients exhibited more severe disease indicators, such as lower ejection fractions and increased ICU hospitalizations. These findings underscore the importance of early detection and tailored treatment strategies for CAD in ADHF patients. Clinicians should prioritize aggressive management of CAD to prevent disease progression and reduce the need for ICU admissions. Future studies should focus on long-term outcomes and explore the impact of specific interventions, such as early revascularization or optimized heart failure therapies, to better understand how CAD influences ADHF prognosis.

A study on the methylation patterns of DIO3 in patients with heart failure and its correlation with key clinical parameters

Objective

This study aimed to analyze the methylation pattern of deoxyribonucleic acid (CpG) sites in the DIO3_FA26 promoter region of patients with heart failure (HF) and explore the correlation between differential CpG methylation levels and various clinical parameters.

Methods

Peripheral blood specimens were collected from 20 patients with HF and 20 healthy individuals. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry was used to identify and detect the CpG sites in the DIO3_FA26 promoter region. CpG methylation levels were compared between patients with HF and healthy controls and patients with HF with different levels of cardiac function.

Results

The methylation level of DIO3_FA26_CpG_17.18 in patients with HF was significantly lower than that in the healthy control group (P = 0.0002). Among patients with HF and cardiac function levels of I/II and III/IV, methylation levels of DIO3_FA26_CpG_24.25.26.27 (P = 0.0168) were significantly lower in those with III/IV cardiac function compared to those with I/II cardiac function.

Conclusion

The methylation level of DIO3_FA26_CpG_17.18 is significantly reduced in patients with HF, and that of DIO3_FA26_CpG_24.25.26.27 is significantly decreased in patients with III/IV cardiac function. Variations in DIO3_FA26 methylation levels influence coagulation, liver and kidney functions, and routine blood indexes, including D-dimer, albumin, calcium, and hemoglobin. This study provides clinical evidence for the involvement of DIO3_FA26 methylation in the occurrence and development of HF and proposes novel targets for HF prevention and treatment.

Impact of Atrial Fibrillation Type on Outcomes of Transcatheter Aortic Valve Replacement for Aortic Stenosis: A Single-Center Analysis

Background

Atrial fibrillation (AF) is a recognized risk factor for mortality after transcatheter aortic valve replacement for severe aortic stenosis, but the impact of different types of AF on clinical outcomes remains unclear.

Methods

This retrospective study included 982 patients divided into 3 groups: no AF, paroxysmal AF, and nonparoxysmal AF (persistent or permanent). Clinical outcomes were analyzed using inverse probability weighting and multivariate models.

Results

There were 610, 211, and 161 patients in the no-AF, paroxysmal AF, and nonparoxysmal AF groups, respectively. For the entire cohort, the mean (SD) age was 82 (7.7) years, and the periprocedural, 1-year, and 5-year mortality rates were 2.0%, 12%, and 50%, respectively. After inverse probability weighting, the periprocedural mortality rate was higher in the nonparoxysmal AF group than in the no-AF group (odds ratio, 4.71 [95% CI, 1.24-17.9]). During 5 years of follow-up (median [IQR], 22 [0-69] months), all-cause mortality was higher in the nonparoxysmal AF group than in the no-AF group (hazard ratio [HR], 1.56 [95% CI, 1.14-2.14]; P = .006). The paroxysmal AF group was not associated with worse clinical outcomes than the no-AF group (HR, 1.02 [95% CI, 0.81-1.49]) for all-cause mortality. Stroke rates were comparable among the 3 groups. Multivariate analysis also showed increased all-cause mortality in the nonparoxysmal AF group compared with the no-AF group (adjusted HR, 1.43 [95% CI, 1.06-1.93]; P = .018), while all-cause mortality was comparable between the paroxysmal AF and no-AF groups (adjusted HR, 1.00 [95% CI, 0.75-1.33]).

Conclusion

In patients undergoing transcatheter aortic valve replacement for severe aortic stenosis, having nonparoxysmal AF was associated with a higher risk of periprocedural and all-cause mortality compared with having no AF. Paroxysmal AF showed no such association.

m6A epitranscriptomic modification of inflammation in cardiovascular disease

Cardiovascular disease is currently the number one cause of death endangering human health. There is currently a large body of research showing that the development of cardiovascular disease and its complications is often accompanied by inflammatory processes. In recent years, epitranscriptional modifications have been shown to be involved in regulating the pathophysiological development of inflammation in cardiovascular diseases, with 6-methyladenine being one of the most common RNA transcriptional modifications. In this review, we link different cardiovascular diseases, including atherosclerosis, heart failure, myocardial infarction, and myocardial ischemia-reperfusion, with inflammation and describe the regulatory processes involved in RNA methylation. Advances in RNA methylation research have revealed the close relationship between the regulation of transcriptome modifications and inflammation in cardiovascular diseases and brought potential therapeutic targets for disease diagnosis and treatment. At the same time, we also discussed different cell aspects. In addition, in the article we also describe the different application aspects and clinical pathways of RNA methylation therapy. In summary, this article reviews the mechanism, regulation and disease treatment effects of m6A modification on inflammation and inflammatory cells in cardiovascular diseases in recent years. We will discuss issues facing the field and new opportunities that may be the focus of future research.

Precision Cardiology: Phenotype-targeted Therapies for HFmrEF and HFpEF

Heart failure with mid-range ejection fraction (HFmrEF) and preserved ejection fraction (HFpEF) represent over half of heart failure cases but lack proven effective therapies beyond sodium-glucose cotransporter 2 inhibitor and diuretics. HFmrEF and HFpEF are heterogeneous conditions requiring precision phenotyping to enable tailored therapies. This review covers concepts on precision medicine approaches for HFmrEF and HFpEF. Areas discussed include HFmrEF mechanisms, anti-inflammatory and antifibrotic treatments for obesity-related HFpEF, If inhibition for HFpEF with atrial fibrillation, and mineralocorticoid receptor antagonism for chronic kidney disease-HFpEF. Incorporating precision phenotyping and matched interventions in HFmrEF and HFpEF trials will further advance therapy compared to blanket approaches.

Navigating Neurological and Cardiac Complexities: A Case Study on Viral Meningoencephalitis in a Patient With Ischemic Heart Disease

We present a case of viral meningoencephalitis in a 40-year-old male with ischemic heart disease, a combination that is rare and presents unique diagnostic and therapeutic challenges. The patient's symptoms included high-grade fever, severe headache, projectile vomiting, and altered consciousness. The diagnosis was supported by MRI and CSF analysis. Management, complicated by the patient's cardiac condition, required a personalized approach, including antiviral therapy, corticosteroids, and vigilant monitoring of cardiac and neurological status. Treatment adjustments were made in response to the patient's evolving condition, leading to improvement within a week. This case underscores the need for a multidisciplinary approach in such complex scenarios, highlighting the significance of tailored care for patients with neurological symptoms and concurrent cardiac comorbidities. The report contributes to the literature on managing meningoencephalitis in patients with significant cardiac histories, underscoring personalized medicine's role in successful outcomes.