www.nature.com/articles/s41... FRESH-UP study. Fluid restriction to 1.5L vs liberal intake in HF.
NO difference in QoL over 3 months.
NO increase in HF hospitalisation, diuretic doses, BNP or weight.
BUT median NYHA II, mean EF 40%, median fruse 40mg.

www.jacc.org/doi/abs/10.1... I think the take home message here is "give more diuretics" but good to recap the different modalities, and I wonder if I under use tolvaptan?

www.ahajournals.org/doi/10.1161/...
XBP1 and EDEM2 identified as protective against myocardial lipid accumulation and downstream hypertrophy, fibrosis and myocardial stiffness in a rodent model of HFpEF. Metabolic answers for metabolic conditions!

And check this out - the capacity of these hearts to take up more energetic substrate - their mitochondrial flexibility - correlated with how much these hearts remodelled after 6 months of cardiac resynchronisation therapy.

For patients on an insulin-glucose infusion, switching on CRT shifted these patients to a greater proportion of lipid metabolism (the patients on a fat infusion presumably already maxed out!) [NEFA = non-esterified fatty acids]

We performed paired arteriovenous sampling on CRT implant patients while monitoring pressure volume loops and coronary artery flow

Delighted to be joint first author on this work published in
@ESC_Journals EHJ academic.oup.com/eurheartj/ad...

In mice, Cannabidiol prevented heart failure via various linked means (preserved contractility, preserved calcium dynamics, preserved mitochondrial function), apparently facilitated by PPAR-gamma receptor www.jacc.org/doi/10.1016/...

We're slowly unpicking immune mechanisms of heart failure. A remarkable finding here that patients with higher levels of chemokine-receptor-type-5 expression on circulating lymphocytes were less likely to respond to cardiac resynchronisation therapy www.jacc.org/doi/10.1016/...

Interesting article - Critical Care Cardiology, its models of care delivery and training structures.
www.ahajournals.org/doi/full/10....

www.nature.com/articles/s41... the heart is a metabolic omnivore... some evidence that supplementing ketone into cardiac metabolism leads to it being metabolised and increasing cardiac contractility - a novel approach using carbon-13 labelling technology

www.nejm.org/doi/full/10.... @nejm.org update on HFpEF from Theresa McDonagh incorporating an integrated approach to diagnosis and review of the treatments (check out those hazard ratios!)

doi.org/10.1001/jama... great editorial poking holes in our belief in Aspirin. Primary prevention evidence doesn't exist and secondary prevention evidence, as we see here, is very flimsy.

www.ahajournals.org/doi/10.1161/... Cytotoxic T Cells Drive Outcome in Inflammatory Dilated Cardiomyopathy
I'm not bright enough to be an immunologist but there is an interesting story developing about certain myocarditis being driven by T-cells and zoning in on Th17 cells.

Lots to think about in new directions for cardiomyopathy. In particular, how can we test better, and how can we personalise treatment for cardiomyopathies?
academic.oup.com/eurheartj/ar...