December 2022 at a glance: heart failure with preserved ejection fraction, sodium–glucose cotransporter 2 inhibitors and cardiac amyloidosis

Diagnosis and prognosis Biomarkers are the mainstay for heart failure (HF) management.1 Parvan et al.2 performed a systematic review and meta-analysis (n = 29 studies) with the aim of investigating the possible diagnostic role of circulating microRNAs (miRNAs) for the detection of different chronic HF phenotypes. A panel of eight miRNAs detected HF with reduced ejection fraction (HFrEF) with a sensitivity of 0.85, a specificity of 0.88 and an area under the curve (AUC) of 0.91. A panel of seven miRNAs identified HF with preserved ejection fraction (HFpEF) with a sensitivity of 0.82, a specificity of 0.61 and an AUC of 0.69. Among 625 patients with new-onset HF referred to a specialized nurse-led HF clinic for up-titration of guideline-directed medical therapy, right ventricular dysfunction, defined as tricuspid annular plane systolic excursion <17 mm, was found in 241 (38.6%) patients. It was associated with a higher risk of all-cause mortality or HF hospitalization. After a median follow-up of 9 months, right ventricular dysfunction normalized in 49% of the cases and this was associated with better outcome.3