{"id":"55792f40b6a1","type":"article","url":"https://hartvaat.nl/2026/05/05/apture-shunt-verlaagt-hartfalen-heropnames-bij-patienten-met-hfpef-hfmref-alt-fl/","title":"APTURE-shunt verlaagt hartfalen-heropnames bij patiënten met HFpEF/HFmrEF — ALT-FLOW","title_en":"Predicted versus observed outcomes in the ALT-FLOW early feasibility study.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":[],"journal":"ESC heart failure","doi":"10.1093/eschf/xvag101","source_url":"https://doi.org/10.1093/eschf/xvag101","authors":["Francesco Fioretti","William A Gray","Benjamin Hibbert","JoAnn Lindenfeld","Ryan J Tedford","Firas Zahr","Javed Butler"],"significance":5,"published":"2026-07-30","source_date":"2026-05-05","image":"","kennis":["https://hartvaat.nl/kennis/hartfalen/hfref-hartfalen-met-verminderde-ejectie/","https://hartvaat.nl/kennis/hartfalen/hfmref-hartfalen-met-matig-verminderde-ejectie/"],"congress":"","summary_en":"In a post-hoc analysis of the ALT-FLOW early feasibility study, patients with heart failure with preserved or mildly reduced ejection fraction (LVEF >40%) who received an APTURE left atrial-to-coronary sinus shunt showed higher 1-year survival than predicted by the MAGGIC score (94.7% vs 87.0%; P=0.04). Heart failure hospitalizations dropped significantly from 37.9% before to 9.6% after implantation (P<0,0001), with consistent benefits across SGLT2 inhibitor subgroups and NT-proBNP strata. While these hypothesis-generating results are promising, confirmation in the ongoing sham-controlled ALT-FLOW II randomized trial is required before clinical adoption.","created":"2026-07-22T01:19:21Z","updated":"2026-08-10T10:37:52Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"In een post-hoc analyse van de ALT-FLOW feasibilitystudie bleek dat patiënten met een licht verminderde of behouden ejectiefractie (LVEF >40%) die een APTURE-shunt kregen, een hogere 1-jaars overleving hadden dan voorspeld door de MAGGIC-score (94,7% versus 87,0%; P=0,04). Daarnaast daalde het aantal hartfalen-heropnames van 37,9% naar 9,6% na implantatie (P<0,0001), ongeacht het gebruik van SGLT2-remmers of de uitgangswaarde van NT-proBNP. Deze hypothese-genererende resultaten suggereren een klinisch voordeel van de shunt, maar bevestiging in de lopende gerandomiseerde ALT-FLOW II-trial is noodzakelijk voordat de therapie breed toegepast kan worden.","abstract_original":"BACKGROUND AND AIMS: Whether hemodynamic and symptomatic benefits of the APTURE left atrial-to-coronary sinus shunt translate into clinical outcome benefit in heart failure with left ventricular ejection fraction >40% remains unknown. METHODS: In this post hoc analysis of ALT-FLOW EFS patients undergoing APTURE implantation, Meta-Analysis Global Group in Chronic Heart Failure (MAGGIC) score-predicted 1-year all-cause mortality was compared with observed mortality by Kaplan-Meier analysis of adjudicated events. Heart failure hospitalization (HFH) rates were compared for the 12 months before vs after implantation. Additional analyses included stratification by baseline sodium-glucose cotransporter 2 inhibitor (SGLT2i) use and N-terminal pro-B-type natriuretic peptide (NT-proBNP), recurrent HFH cumulative hazard estimation (Nelson-Aalen), and H2FPEF score calculation. RESULTS: Among 95 patients (mean age 70.9 ± 8.5 years; 50% women; 93% New York Heart Association Class III; 85.9% with H2FPEF score >3), MAGGIC-predicted 1-year mortality was 13.0%. Observed 1-year survival was significantly higher than predicted (94.7% vs 87.0%; P=0.04), consistent across SGLT2i subgroups (log-rank P=0.59). The proportion of patients with HFH declined from 37.9% pre implantation to 9.6% post implantation (P<0.0001), with event rates falling from 0.61 to 0.21 per patient-year (P<0.001) and a 1-year cumulative hazard of recurrent HFH of 0.19 (95% confidence interval, 0.12-0.31). HFHs were evenly distributed across NT-proBNP strata. CONCLUSIONS: In ALT-FLOW EFS, observed 1-year mortality was lower than MAGGIC-predicted mortality, and post implantation HFH rates were lower than pre implantation rates. These hypothesis-generating findings will require confirmation in the randomized, sham-controlled ALT-FLOW II trial."}