Evidence map›Paper›PMID 30957868›Full record

ArticleEuropean heart journal2019

The continuous heart failure spectrum: moving beyond an ejection fraction classification.

Filippos Triposkiadis, Javed Butler, Francois M Abboud, Paul W Armstrong, Stamatis Adamopoulos, John J Atherton, Johannes Backs, Johann Bauersachs, Daniel Burkhoff, Robert O Bonow and 32 more

Registry-linked trialOpen access · bronzeAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in European heart journal, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. It is linked to trial NCT06299176 (Phase 1 Feasibility and Safety of Whole Heart Radiotherapy for End-stage Heart Failure), which is not on this map. Cited by 137 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
137citing papers in PubMed, 4 pooled it
26.2field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

NCT06299176 phase1enrolling by invitationnot on this mapstarted 2025, after this paper: background citation

Phase 1 Feasibility and Safety of Whole Heart Radiotherapy for End-stage Heart Failure: First In-human Treatments

TypeinterventionalSponsorMcGill University Health Centre/Research Institute of the McGill University Health CentreRan2025 to 2026Enrolled6ConditionsHeart Failure NYHA Class III, Heart Failure NYHA Class IV, End-stage Heart Failure, Heart Failure With Reduced Ejection FractionArmsWhole Heart Radiation Therapy
3 · Its place in the literature

Who cites it

137 citing papers in PubMed, 4 syntheses or guidelines pooled it, 251 citations in OpenAlex.

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77 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

42 authors at 20 institutions in 15 countries.

Filippos TriposkiadisDepartment of Cardiology, Larissa University Hospital, Larissa, Greece.
Javed ButlerDepartment of Medicine-L650, University of Mississippi Medical Center, Jackson, MS, USA.
Francois M AbboudAbboud Cardiovascular Research Center, University of Iowa, Iowa City, IA, USA.
Paul W ArmstrongCanadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada.
Stamatis AdamopoulosTransplant and Mechanical Circulatory Support Unit, Onassis Cardiac Surgery Center, Athens, Greece.
John J AthertonDepartment of Cardiology, Royal Brisbane and Women's Hospital, University of Queensland School of Medicine, Brisbane, Australia.
Johannes BacksDepartment of Molecular Cardiology and Epigenetics, Heidelberg University, Heidelberg, Germany.
Johann BauersachsDepartment of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Daniel BurkhoffCardiovascular Research Foundation, New York, NY, USA.
Robert O BonowBluhm Cardiovascular Institute, Northwestern University Feinberg School of Medicine, Northwestern Memorial Hospital, Chicago, IL, USA.
Vijay K ChopraDepartment of Cardiology, Medanta Medicity, Gurugram, Haryana, India.
Rudolf A de BoerDepartment of Cardiology, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
Leon de WindtDepartment of Cardiology, Faculty of Health, Medicine and Life Sciences, School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands.
Nazha HamdaniDepartment of Systems Physiology, Ruhr University Bochum, Bochum, Germany.
Gerd HasenfussDepartment of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Stephane HeymansDepartment of Cardiology, CARIM School for Cardiovascular Diseases Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
Jean-Sébastien HulotUniversité Paris-Descartes, Sorbonne Paris Cité, Paris, France.
Marvin KonstamThe CardioVascular Center of Tufts Medical Center, Boston, MA, USA.
Richard T LeeDepartment of Stem Cell and Regenerative Biology, Harvard Stem Cell Institute, Harvard University, Cambridge, MA, USA.
Wolfgang A LinkeInstitute of Physiology II, University of Münster, Münster, Germany.
Ida G LundeInstitute for Experimental Medical Research, Oslo University Hospital and University of Oslo, Oslo, Norway.
Alexander R LyonCardiovascular Research Centre, Royal Brompton Hospital, London, UK.
Christoph MaackComprehensive Heart Failure Center, University Clinic Würzburg, Würzburg, Germany.
Douglas L MannDepartment of Medicine, Center for Cardiovascular Research, Washington University School of Medicine, St. Louis Missouri, MO, USA.
Alexandre MebazaaDepartment of Anaesthesiology and Critical Care Medicine, AP-HP, Saint Louis and Lariboisière University Hospitals, Inserm U 942, Paris, France.
Robert J MentzDuke Clinical Research Institute, Durham, NC, USA.
Petros NihoyannopoulosImperial College London, NHLI, National Heart & Lung Institute, London, UK.
Zoltan PappDivision of Clinical Physiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary.
John ParissisHeart Failure Unit, Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, Athens, Greece.
Thierry PedrazziniExperimental Cardiology Unit, Department of Cardiovascular Medicine, University of Lausanne Medical School, Lausanne, Switzerland.
Giuseppe RosanoDepartment of Medical Sciences, IRCCS San Raffaele, Centre for Clinical and Basic Research, Pisana Rome, Italy.
Jean RouleauMontreal Heart Institute and University of Montreal, Montreal, Quebec, Canada.
Petar M SeferovicSchool of Medicine, Belgrade University, Belgrade, Serbia.
Ajay M ShahSchool of Cardiovascular Medicine & Sciences, British Heart Foundation Centre, King's College London, London, UK.
Randall C StarlingCleveland Clinic, Heart and Vascular Institute, Cleveland, OH, USA.
Carlo G TocchettiDepartment of Translational Medical Sciences, Federico II University, Naples, Italy.
Jean-Noel TrochuCIC INSERM 1413, Institut du thorax, UMR INSERM 1087, University Hospital of Nantes, Nantes, France.
Thomas ThumInstitute of Molecular and Translational Therapeutic Strategies, Hannover Medical School, Hanover, Germany.
Faiez ZannadInserm CIC 1433, Université de Lorrain, CHU de Nancy, Nancy, France.
Dirk L BrutsaertAntwerp University, Antwerp, Belgium.
Vincent F SegersLaboratory of Physiopharmacology, Antwerp University, Universiteitsplein 1, Building T, Wilrijk, Antwerp, Belgium.
Gilles W De KeulenaerLaboratory of Physiopharmacology, Antwerp University, Universiteitsplein 1, Building T, Wilrijk, Antwerp, Belgium.
Medizinische Hochschule Hannover · DEMaastricht University · NLUniversity of Antwerp · BEAssistance Publique – Hôpitaux de Paris · FRBritish Heart Foundation · GBCardiovascular Research Foundation · USCleveland Clinic · USClinical Research Institute · USFederico II University Hospital · ITHartcentrum Hasselt · BEHarvard Stem Cell Institute · USHeidelberg University · DEImperial College London · GBInserm · FRInstitut du Thorax · FRIstituti di Ricovero e Cura a Carattere Scientifico · ITMarqueurs cardiovasculaires en situation de stressMedanta The Medicity · INMontreal Heart Institute · CANational and Kapodistrian University of Athens · GR

Funding

Tracking and Evaluation CoreU54GM115428 · NIGMS · UNIVERSITY OF MISSISSIPPI MED CTR · PI COMPRETTA, CAROLINE E. · 2016 to 2025
$38.2M
British Heart Foundation RG/13/11/30384NIGMS NIH HHS U54 GM115428
6 · The paper itself

Abstract

Randomized clinical trials initially used heart failure (HF) patients with low left ventricular ejection fraction (LVEF) to select study populations with high risk to enhance statistical power. However, this use of LVEF in clinical trials has led to oversimplification of the scientific view of a complex syndrome. Descriptive terms such as 'HFrEF' (HF with reduced LVEF), 'HFpEF' (HF with preserved LVEF), and more recently 'HFmrEF' (HF with mid-range LVEF), assigned on arbitrary LVEF cut-off points, have gradually arisen as separate diseases, implying distinct pathophysiologies. In this article, based on pathophysiological reasoning, we challenge the paradigm of classifying HF according to LVEF. Instead, we propose that HF is a heterogeneous syndrome in which disease progression is associated with a dynamic evolution of functional and structural changes leading to unique disease trajectories creating a spectrum of phenotypes with overlapping and distinct characteristics. Moreover, we argue that by recognizing the spectral nature of the disease a novel stratification will arise from new technologies and scientific insights that will shape the design of future trials based on deeper understanding beyond the LVEF construct alone.

Indexed as

Stroke VolumeComorbidityDisease ProgressionEndothelium, VascularHeart FailureHumansMyocytes, CardiacReference ValuesVentricular Dysfunction, LeftVentricular RemodelingEjection fractionEndotheliumHeart failurePathophysiology

Identifiers

PMID30957868
PMCPMC7963129
OpenAlexW2937704642

What OpenQuestion holds

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Registered trials

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.