Jan Krejci

Background: Population-level data on preclinical heart failure (HF) remain limited because most epidemiological studies focus on symptomatic HF. We therefore developed an administrative-data algorithm to classify HF stages across the national population and describe temporal trends, stage transitions, and mortality across the HF continuum. Methods: Using a claims-based staging framework adapted from the Universal Definition of HF, we classified HF stages from ICD-10 codes, prescription records, and medical procedures. We applied this algorithm to the Czech population, linking the National Registry of Reimbursed Health Services to National mortality records from 2015 to 2024. Results: In 2024, 27.8% of the Czech population met criteria for Stage A HF and 8.2% for Stage B. Over 10 years, the prevalence of both preclinical stages increased beyond what could be explained by population aging alone, with age-standardized prevalence rising by 9.5% for Stage A and 19.2% for Stage B. Age-standardized 1-year mortality showed a steep stepwise gradient, from 0.69% in Stage A to 1.69% in Stage B, 3.06% in Stage C, and 7.27% in Stage D. Among 52,172 individuals with incident clinical HF in 2024, more than 95% had previously met administrative criteria for Stage A or Stage B. Conclusion: Administrative surveillance of the HF continuum using routinely collected healthcare data provides a scalable administrative framework for population-level monitoring of HF burden. In Czechia, both preclinical and clinical HF burdens increased over time beyond population aging alone, underscoring the need for earlier preventive strategies targeting preclinical disease. Clinical Perspective: We developed a nationwide administrative-data algorithm that classifies the full heart failure continuum (Stages A–D) using routinely collected ICD-10 diagnoses, prescription claims, and procedure codes, showing that both preclinical and clinical HF burdens are rising beyond what population aging explains. More than 95% of individuals who developed clinical HF had previously met administrative criteria for Stage A or Stage B, suggesting that progression to overt disease is often preceded by an identifiable preclinical phase that may represent an opportunity for prevention. This scalable, low-cost surveillance framework enables health systems to identify at-risk populations, track HF trends over time, and target preventive strategies toward preclinical stages, an approach that could be adapted internationally to inform policy and resource allocation. Graphical Conclusion: A population-wide HF staging system based on administrative data enables surveillance of the HF epidemic. In Czechia, the burden of preclinical and clinical HF is increasing.

Recent-onset dilated cardiomyopathy (RODCM), defined as new DCM with heart failure (HF) symptoms appearing within six months, is a less documented form of HF. This study aims to evaluate pulmonary circulation imaging biomarkers (PCIB) obtained by cardiovascular magnetic resonance (CMR) in patients with RODCM to assess their association with pulmonary hypertension, systolic and diastolic function, and clinical improvement. Ninety RODCM patients with baseline and one-year follow-up CMR, clinical examination, and transthoracic echocardiography were retrospectively included. Twenty-six were excluded following a myocarditis diagnosis confirmed by endomyocardial biopsy (EMB). PCIB (pulmonary transit time (PTT), corrected PTT (PTTc), pulmonary transit beats (PTB), and pulmonary blood volume index (PBVI)) were assessed using a first-pass perfusion CMR sequence. Pulmonary hypertension, diastolic, and systolic function were assessed. Correlations between PCIB and echocardiographic changes were analyzed. Patients were classified as responders/non-responders based on left ventricular ejection fraction (LVEF) improvement. From baseline to follow-up, LVEF increased (25% to 40%), while EDD (65 mm to 61 mm), sPAP (24.2 mmHg to 20.0 mmHg), and E/e' ratio (13 to 9) significantly reduced. Thirty-three patients were labeled as responders. PTT, PTTc, and PTB correlated with ΔE/e', diastolic function improvement, and ΔsPAP. PBVI correlated with ΔsPAP. PTB correlated with ΔNYHA class. The PCIB could not predict whether a patient would be a responder. This study focused on PCIB as outcome predictors in patients with RODCM with EMB-excluded myocarditis. Our findings show that PTB and PTTc correlated with ΔE/e', diastolic function improvement, and ΔsPAP, while PTB additionally correlated with ΔNYHA class.

BACKGROUND: No large registries of patients with acute eosinophilic myocarditis (EM) are available. However, EM is perceived as a cardiac disease with high mortality, affecting mainly young and middle-aged adults according to small series and case reports. Awareness of the clinical presentation, associated systemic conditions, treatments, and outcomes of this uncommon condition is an unmet need. METHODS: In this international, multicenter, retrospective cohort study, 53 centers screened 193 patients with histologically proven acute EM between 1992 and 2023. After the exclusion of patients with insufficient data (n=10), symptoms lasting >30 days (n=19), or histological diagnosis not confirmed after review (n=8), 156 patients were included. RESULTS: Median age at presentation was 48 years (first to third quartile, 34–59 years) with male predominance (67.3%), and only 2 were pediatric cases (≤16 years of age; 1.3%). The main signs and symptoms at presentation were dyspnea (75.6%), fever (61.3%), and chest pain (53.2%). Unexpectedly, peripheral eosinophilia was reported in only 57.4% of cases, with a median cell count of 630 eosinophils/μL. The median left ventricular ejection fraction at presentation was 32% (first to third quartile, 25%–48%). The disorders most frequently associated with EM were eosinophilic granulomatosis with polyangiitis (22.4% of cases) and hypersensitivity forms (14.1%). Idiopathic/undefined forms accounted for 44.9% of cases, and miscellaneous causes accounted for 18.6%. In-hospital death or need for heart transplantation (HTx) occurred in 23 patients (14.7%; 22 deaths and 1 HTx), despite 43.6% being treated with temporary mechanical circulatory support and 92.9% being treated with immunosuppressive agents. Estimated rates of death or HTx at 1 and 3 years were 19.0% and 23.8%. Increased age, decreased left ventricular ejection fraction on admission, and no immunosuppressive therapy during hospitalization were independent predictors of death or HTx. A nonsignificant higher occurrence of deaths or HTx was observed in the hypersensitivity form (46.1%) compared with the eosinophilic granulomatosis with polyangiitis–associated form (13.1%) at 3 years ( P =0.15). CONCLUSIONS: Acute EM can often present without peripheral eosinophilia, and rates of in-hospital and midterm mortality or HTx are high. Endomyocardial biopsy is required to reach the final diagnosis of EM because relying on peripheral eosinophilia can lead to missing diagnosis. In-hospital immunosuppression is associated with HTx-free survival, although tailored immunosuppressive therapies are needed to improve outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT06447935.

This study uncovers a previously unrecognized role for NAV3 in TGF-β1-driven cardiac fibroblast activation. We show that NAV3 facilitates profibrotic remodeling through noncanonical signaling and cell cycle arrest, independently of SMAD2/3. These findings position NAV3 as a novel regulator of fibroblast phenotype and a potential modulator of cardiac fibrosis.

Heart failure (HF) with reduced (HFrEF) or mildly reduced ejection fraction (HFmrEF) frequently coexists with atrial fibrillation (AF), leading to worse prognosis and greater therapeutic complexity. Although beta-blockers (BBs) are a cornerstone of HF treatment, their benefit in patients with AF remains unclear. We analyzed 1088 patients with stable chronic HF and left ventricular ejection fraction < 50% enrolled in the multicentre FAR NHL registry. Patients were stratified by the presence of AF and achieved BB dose: low ( < 25%), medium (25-49%), or high (≥50% of target). The primary endpoint was a composite of all-cause mortality, hospitalization for acute HF, left ventricular assist device (LVAD) implantation, or heart transplantation. AF was present in 379 patients (34.5%). BBs were prescribed to 94% of patients, but only 17% achieved high-dose therapy. The event rate was higher in AF patients (28.0%) than in those without AF (20.5%, p = 0.005). High BB dose was independently associated with a lower risk of the primary endpoint (HR 0.62, 95% CI 0.48-0.80; p < 0.001), consistently across both rhythm group. Higher BB doses were associated with improved outcomes in patients with chronic HF, regardless of AF status. These real-world data support up-titration of BBs as a key component in optimized guideline-directed therapy, even in patients with coexisting AF.

Introduction: Iron deficiency (ID) is a common comorbidity in patients with heart failure (HF). It is associated with reduced performance, frequent hospitalizations and low quality of life. There is an ongoing debate about the correct definition of ID in HF. Purpose: Refinement of the ID determination in patients with advanced HF. Evaluation of the association of iron metabolism parameters with other clinical characteristics. Patients and methods: One hundred-two patients with advanced HF were included, 48 in-patients, out-patients without LVAD and 25 of patients with LVAD implanted. In addition to conventional tests, we monitored iron metabolism parameters. The prevalence of ID was compared according to both the original and the updated ID definition. Correlations between individual iron markers and patients’ functional capacity were measured. Results: The prevalence of ID in patients with advanced HF was 65%. There was no statistically significant difference in individual iron parameters between the groups. All parameters except ferritin correlated with NT-proBNP in the in-patient group. Serum iron correlated most strongly with NT-proBNP and CRP across all groups. The sTfR parameter correlated the most with right heart catheterization parameters, serum iron and TSAT were the most specific parameters related to functional status. Conclusion: Patients with more advanced HF and severe limitation of functional capacity had worse iron parameters. Ferritin seems to be the less specific marker of ID, while detecting ID using serum iron and TSAT seems to be reliable. The correlation of ferritin with functional status or haemodynamics was the weakest of all the parameters studied. Graphical

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was | POSTER

**Author Listing - Lead/ Submitting Author (we will be communicating with this individual): Name, Institution, City and State where the work was | POSTER

Purpose of Review An evidence for lipid lowering therapy in heart failure is briefly summarized in this review. Recent Findings Heart failure therapy is based on recent guidelines for diagnosis and treatment of acute and chronic heart failure. The question of the importance of hypolipidemic treatment in heart failure remains insufficiently answered. We still rely only on results of two randomized controlled trials that did not show significant benefit of statins on mortality in these patients. In contrast, some meta-analysis, prospective or retrospective cohorts, found some positive effects of this therapy. Recently, the role of inflammation and the possibility of its influence by hypolipidemics have been discussed. PCSK9 inhibitors, new lipid lowering drugs, are very effective in LDL-cholesterol lowering and atherosclerotic cardiovascular diseases prevention. The role of PCSK9 inhibitors in heart failure treatment is investigated. Summary Based on current knowledge, hypolipidemics are not generally recommended in heart failure therapy, unless there is another indication for their use.