Muzi Maseko

Heart failure (HF) is associated with substantial morbidity and mortality. Metabolic abnormalities are increasingly recognized as integral to HF pathophysiology and may provide incremental value for phenotyping and prediction of outcomes. However, a comprehensive synthesis of metabolic alterations and their prognostic implications remains limited. This scoping review aimed to map metabolic changes in HF, describe analytical methods, and evaluate their diagnostic and prognostic relevance for clinical risk assessment. Methods: We systematically searched PubMed, Scopus, Web of Science, Cochrane Central, and grey literature from January 2010 to December 2024 to identify studies evaluating metabolic profiling in patients with HF. Two independent reviewers screened studies using predefined inclusion criteria and data were extracted using a customized charting form. Discrepancies were resolved by consensus or a third reviewer. We reported and synthesized findings narratively in accordance with scoping review methodology. Results: Seventy-two studies (66 observational and 6 randomized) were included, encompassing HF phenotypes including HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF). The analytical approaches included mass spectrometry and nuclear magnetic resonance (¹H-NMR) platforms. The main metabolite classes that demonstrated prognostic significance were amino acids, acylcarnitines, and lipids, and gut-derived metabolites, which were associated with mortality, HF hospitalization, or disease progression. Several studies reported incremental prognostic value beyond conventional biomarker; however, most were exploratory, with modest sample sizes, limited external validation, and heterogeneous methodologies. Conclusions: Metabolomic profiling identifies biologically relevant alterations predicted worse clinical outcomes in HF and may complement existing risk assessment strategies. Nevertheless, standardized workflows and large prospective validation studies are required before clinical implementation can be considered.

Background: Non-cardiac comorbidities (NCCs) are highly prevalent among patients hospitalized for acute heart failure (HF). However, data from sub-Saharan Africa (SSA) on their distribution across HF phenotypes and association with in-hospital outcomes remain limited. Methods: We prospectively enrolled adults hospitalized with acute HF at a tertiary centre in South Africa between February and November 2023. Ten NCCs were assessed and patients were categorized according to comorbidity burden. The primary outcomes were all-cause in-hospital mortality and length of stay. Multivariable regression and sensitivity analyses were performed to identify predictors of outcomes. Results: Of the 406 patients (mean age 54.9 ± 15.8 years; 51% women), HF with reduced ejection fraction (HFrEF) accounted for 63%, HF with mildly reduced ejection fraction (HFmrEF) for 15%, and HF with preserved ejection fraction (HFpEF) for 21%. The most common NCCs were diabetes (47%), chronic kidney disease (CKD) (46%), obesity (45%), and anaemia (33%). Two-thirds had ≥2 NCCs. The median hospital stay was 8 days (IQR: 5–12) and in-hospital mortality was 3.4% (p > 0.05 across NCC groups). Higher heart rate predicted longer hospitalization, while renin angiotensin system inhibitor (RASi) therapy was associated with shorter stay. Lower Kansas City Cardiomyopathy Questionnaire (KCCQ) score (adjusted odds ratio [aOR] 1.009; 95% confidence interval [CI]: 1.003–1.015) and higher log-transformed NT-proBNP were independently associated with increased in-hospital mortality (aOR 1.85; 95% CI: 1.07–3.50; p = 0.026). Total comorbidity burden was not independently associated with length of stay or in-hospital mortality. Conclusions: Non-cardiac comorbidities are common in acute HF in SSA, and functional status and clinical markers were the strongest predictors of length of stay and in-hospital mortality.

Background: Non-cardiac comorbidities (NCCs) are key determinants of outcomes in patients hospitalized with acute heart failure (HF). However, data from sub-Saharan Africa (SSA) on the prevalence and their prevalence across HF phenotypes, HF with reduced ejection fraction (EF) (HFrEF), mildly reduced EF (HFmrEF), and preserved EF (HFpEF), and their impact on in-hospital outcomes remain limited. Methods: We consecutively evaluated patients admitted with acute HF at Charlotte Maxeke Johannesburg Academic Hospital, South Africa, between February and November 2023. Ten NCCs were assessed, and the patients were stratified by comorbidity burden. The primary outcomes were all-cause in-hospital mortality and the length of hospital stay. Logistic and linear regression analyses, complemented by propensity score-based inverse probability weighting, were used to identify predictors of outcomes. Results: Of the 406 patients included (mean age 54.9 ± 15.8 years; 51% women; 63.3% had HFrEF, 15.3% HFmrEF, and 21.4% HFpEF. The most common NCCs were diabetes, 47%; chronic kidney disease (CKD), 46%; obesity, 45%; and anaemia, 33%. Two-thirds had ≥2 NCCs, and 11.3% had four or more NCCs. Obesity and anaemia were more frequent in the patients with HFmrEF/HFpEF. Patients with a high burden (≥ 3 NCCs) were older and had worse renal function and higher body mass index. The median hospital stay was 8 days (IQR: 5-12) and in-hospital mortality was 3.4%, with a non-significant trend across NCCs groups. Higher heart rate was associated with longer length of stay (β = +0.05 days; 95% confidence interval (CI): 0.006-0.092; p = 0.025), whereas the use of renin-angiotensin system inhibitors (RASi) (β = -1.84 days; 95% CI: -3.78, -0.12; p = 0.049) and the presence of thyroid disorders β = -4.10 days; 95% CI: -7.75, -0.45; p = 0.028) were associated with shorter hospitalization. Lower KCCQ score with higher mortality (aOR 1.009; 95% CI: 1.003-1.015; p = 0.005) and higher N-terminal proB-type natriuretic peptide (NT-proBNP) levels (aOR 1.00007; 95% CI: 1.0002-1.00013; p = 0.014) were independently associated with increased mortality. Multivariable and sensitivity analyses showed no statistically significant associations between overall comorbidity burden and in-hospital outcomes. Conclusions: Among adults hospitalized with acute HF in South Africa, NCCs are highly prevalent, their overall burden was not independently associated with in-hospital outcomes. Clinical and functional markers, lower KCCQ and higher NT-proBNP predicted in-hospital mortality, while higher heart rate was linked to longer hospitalization. Conversely, the use of RASi, and the presence of thyroid disorders are associated with shorter hospital stays. These findings emphasize the complex interplay between multimorbidity, functional status, and treatment patterns in acute HF and highlight the importance of integrated, context-specific management strategies in SSA.

Previous studies conducted to investigate the relationship between sodium intake and blood pressure in our African population have yielded contradictory results. With the high prevalence of obesity in this population, it is possible that these contradictory findings are due to the masking effects of obesity on this relationship. We measured 24-hour ambulatory blood pressure and 24-hour urine excretion on 547 South Africans of African ancestry. A multivariate regression analysis revealed no independent relationship between 24-hour sodium excretion and blood pressure in the total population sample, but when participants were stratified according to body mass index (BMI) status, there was a significant association between 24-hour sodium excretion and blood pressure in the normal-BMI participants but not in the overweight/obese participants. We concluded that dietary salt intake, indexed by 24-hour urinary sodium excretion, was associated with increased ambulatory blood pressure but this relationship was masked because of a high proportion of overweight/obese individuals in this population.