Heart failure (HF) remains a major cause of morbidity, mortality, impaired quality of life and healthcare expenditure worldwide. The global burden of HF continues to increase due to population aging, improved survival, and the growing prevalence of cardiovascular, renal, and metabolic comorbidities. Simultaneously, the pace of scientific progress in HF has accelerated considerably. Recent advances have refined our understanding of HF epidemiology, prognosis, and disease trajectories, including emerging concepts of HF improvement, remission, and recovery. The Second Universal Definition of HF has also updated the classification framework, moving beyond the traditional ejection fraction-based categories. HF is now broadly classified into two major phenotypes: heart failure with reduced ejection fraction (HFrEF) and heart failure with preserved ejection fraction (HFpEF). Novel mechanistic insights highlight the role of inflammation, immune activation, metabolic dysfunction, mitochondrial biology, and multisystem interactions in HF progression. There has also been significant progress in the characterization and management of major comorbidities, including chronic kidney disease (CKD), diabetes, obesity, atrial fibrillation (AF), pulmonary hypertension, frailty, malnutrition, and cancer. Diagnostic innovations include novel biomarkers, multi-omics technologies, artificial intelligence-based approaches, advanced imaging techniques, congestion assessment tools, and emerging digital health solutions. Important advances have occurred in specific HF aetiologies, including cardiomyopathies, cardiac amyloidosis (CA), myocarditis, arrhythmia-induced cardiomyopathy (AiCM), and Chagas cardiomyopathy. Therapeutic developments continue to reshape HF management across the spectrum of left ventricular ejection fraction. Recent evidence has focused on optimization of guideline-directed medical therapy in HFrEF, expansion of evidence-based therapies in HFpEF, and growing roles for sodium-glucose cotransporter-2 inhibitors, finerenone, incretin-based therapies, and transcatheter valve interventions. Collectively, these advances support the transition from a predominantly phenotype-based approach towards a more personalized and biologically informed model of HF care, with the potential to further improve outcomes across the entire HF spectrum.
Valentino Liguori, Angelica Rizzello, M. Adamo et al.· ESC Heart Failure· 0 citations
BACKGROUND
Evidence regarding the role of N-terminal pro-brain natriuretic peptide (NTproBNP) in chronic coronary syndrome (CCS) remains limited. We aimed to investigate the association between plasma NTproBNP levels and the presence and extent of coronary artery disease (CAD) in a prospective real-world cohort.
METHODS
This prospective observational cross-sectional study included 676 consecutive patients (mean age 67 ± 7 years; 20% women) referred for elective coronary angiography for suspected CCS, as part of the BNP-CAD study (ClinicalTrials.govNCT07013344). Patients with conditions known to elevate NTproBNP were excluded. Obstructive CAD was defined as stenosis ≥70% (≥50% for the left main). Prognostically significant CAD was defined as involvement of the left main or proximal LAD artery.
RESULTS
Obstructive CAD was identified in 432 patients (64%). NTproBNP levels were significantly higher in patients with obstructive CAD compared to those without (124 vs. 96 pg/mL, p < 0.001) and increased with the number of vessels involved and degree of stenosis. After adjustment for clinical confounders and high-sensitivity troponin T, NT-proBNP remained independently associated with obstructive CAD (OR per 100 pg/mL increase: 1.18; 95% CI: 1.03-1.36; p = 0.021). Prognostically significant CAD was present in 197 patients (46% of those with obstructive CAD) and was associated with higher NT-proBNP levels (133 vs. 107 pg/mL; p = 0.006), although discriminatory performance remained modest (AUC: 0.60; 95% CI: 0.55-0.64).
CONCLUSION
NT-proBNP was independently associated with obstructive CAD and correlated with coronary disease burden. However, its modest discriminatory performance precludes its use as a stand-alone diagnostic test for high-risk coronary anatomy.
Mirko Schivalocchi, R. Mazza, C. Gaspardone et al.· International Journal of Car...· 0 citations
Mitral regurgitation (MR) is the most prevalent valvular heart disease in developed countries, affecting approximately 1 in 50 individuals in the general population and about 1 in 10 individuals older than 75 years. Despite its frequency, MR remains a complex clinical challenge due to its heterogeneous etiology, variable natural history, and evolving therapeutic landscape. The 2025 ESC/EACTS guidelines have introduced a paradigm shift, transitioning from a purely morphological classification to a mechanism-based framework that distinguishes primary, ventricular secondary, and atrial secondary MR. This review provides a comprehensive overview of contemporary MR management. We discuss the updated classification system and the associated implications for risk stratification, emphasizing how the underlying mechanism of MR influences prognosis and guides treatment selection. The diagnostics section addresses multimodality imaging strategies, detailing the complementary roles of echocardiography, cardiac magnetic resonance (CMR), and cardiac computed tomography (CCT) in assessing severity, characterizing anatomy, and planning interventions. The management section addresses optimization of medical therapy, surgical techniques (repair versus replacement, including conventional and minimally invasive approaches), and transcatheter interventions, with particular focus on mitral transcatheter edge-to-edge repair (M-TEER) and emerging transcatheter mitral valve replacement technologies. We propose an integrated, stepwise management algorithm that incorporates early risk markers, including natriuretic peptides, to guide the timing of intervention before irreversible myocardial damage occurs. The critical role of multidisciplinary heart valve teams (HVTs) in individualizing treatment decisions is highlighted throughout. Early recognition of MR and timely intervention are paramount to prevent progression to irreversible left ventricular dysfunction and heart failure. The mechanism-based classification enables more precise patient phenotyping and treatment tailoring. Transcatheter therapies have expanded therapeutic options for high-risk surgical patients, although careful patient selection remains essential. Natriuretic peptides have emerged as valuable biomarkers for identifying candidates who may benefit from earlier intervention. Contemporary MR management requires the integration of advanced imaging, mechanism-based classification, and collaborative decision-making within HVTs. As therapeutic options continue to expand, optimal outcomes depend on matching the right intervention to the right patient at the right time.
C. Gaspardone, Paolo Costa, G. Barone et al.· Reviews in cardiovascular me...· 0 citations
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