Search Results (63)

Heart failure (HF) is a well-known leading cause of mortality, associated with a high symptom burden in advanced stages, frequent hospitalizations, and increasing economic costs. HF is typically classified into three main subgroups, based on left ventricular ejection fraction (LVEF): HF with reduced ejection fraction (HFrEF), HF with mildly reduced ejection fraction (HFmrEF), and HF with preserved ejection fraction (HFpEF). Recently, two additional subgroups have been proposed: HF with improved ejection fraction (HFimpEF) and HF with supernormal ejection fraction (HFsnEF). These five phenotypes exhibit distinct risk factors, clinical presentations, therapeutic responses, and prognosis. However, the LVEF thresholds used to define these subgroups remain a subject of considerable debate, with significant differences in opinions among leading experts. A major criticism concerns the reliability of LVEF in accurately classifying HF subgroups. Due to substantial intra and interobserver variability, determining the appropriate therapy and prognosis can be challenging, particularly in patients with HFmrEF. Additionally, patients classified under HFpEF are often too heterogeneous to be effectively managed as a single group. This narrative review explores these issues, and suggests a possible need for a new approach to HF classification, one that involves revising the LVEF reference values for HF phenotypes and highlighting LVEF trajectories rather than relying on a single measurement. Moreover, in light of the relatively limited therapeutic options for patients with LVEF > 40%, a new, simplified classification may be proposed: HF with reduced EF (LVEF ≤ 40%), HF with below-normal EF (41% ≤ LVEF ≤ 55%), and HF with normal EF (LVEF > 55%). This mindset would better equip clinical cardiologists to manage the diverse spectrum of HF syndromes, always with the patient at the center. Full article

Background/Objectives:Pacing treatment of bradyarrhythmias is both to reduce symptoms and to prevent syncope and sudden cardiac death. The aim of our study was to analyze left bundle branch area pacing (LBBAP) in the prevention of new-onset AF and the improvement of echocardiographic parameters in patients with mildly reduced left ventricular ejection fraction (LVEF) compared to patients with bradyarrhythmias but preserved LVEF who underwent mid-septal right ventricular pacing. Methods: This research was structured as a retrospective observational cohort study that included 186 patients with LBBAP and 186 patients with RVP, enrolled for 3 years until March 2024 with a follow-up time of 1 year. The primary endpoint of our study was new-onset atrial fibrillation after pacemaker implantation. The secondary endpoint was the improvement of echocardiographic parameters. Results: We observed in the LBBAP group a mean QRS complex duration of 108.7 ± 8.83 ms (after pacemaker implantation), compared to a much longer duration in the RVP group (143.8 ± 9.851 ms, p = <0.0001). At 1 year of follow-up, 22 (11.82%) patients in the RVP group were diagnosed with new-onset atrial fibrillation, compared to 6 (3.22%) patients out of 186 included in the LBBAP group (p = 0.0017). Regarding LVEF, at follow-up, RVP patients had a decrease in LVEF compared to those in the LBBAP group who had an improved LVEF (54.54 ± 3.77%, p < 0.0001). Conclusions: LBBAP both prevents the onset of atrial fibrillation and improves echocardiographic parameters, especially left ventricular ejection fraction, thus contributing to significantly reducing the risk of developing/worsening advanced heart failure through pacing-induced cardiomyopathy. Full article

Heart failure (HF) remains a global health burden with high morbidity and mortality, despite significant pharmacological advances. Vitamin D deficiency (VDD) is commonly observed in HF patients and may exacerbate disease progression through various pathophysiological mechanisms, including activation of the renin–angiotensin–aldosterone system, inflammation, oxidative stress, and impaired calcium homeostasis. While vitamin D (VD) supplementation may positively influence surrogate markers in selected patient groups—particularly those with reduced ejection fraction or severe vitamin D deficiency—its effect on primary endpoints such as mortality or HF-related hospitalization varies significantly across studies and patient populations. As a result, while VD supplementation may benefit VD-deficient HF patients, current evidence does not support routine administration across the whole HF population. It is still a matter of debate whether VDD belongs to prognostic markers of worse outcomes in HF or is instead their potential cause. Therefore, the clinical utility of VD in HF management remains underexplored. This review aims to assess the evidence regarding vitamin D status and its supplementation in the context of HF, with a focus on different HF phenotypes: reduced (HFrEF), mildly reduced (HFmrEF), and preserved ejection fraction (HFpEF). The aim is to synthesize findings from novel observational studies, randomized controlled trials, and meta-analyses that shed light onto this intricate relationship and may be valuable in everyday clinical practice. Full article

Background/Objectives: Low-grade systemic inflammation, characteristic of heart failure (HF), is a nonspecific inflammatory syndrome that affects the entire body. Macrophage migration inhibitory factor 1 (MIF-1) is a pro-inflammatory cytokine, a key mediator of the innate immune response, and may serve as a potential biomarker of monocyte homing and activation in HF with reduced and mildly reduced ejection fraction (HFrEF, HFmrEF). Methods: We evaluated 70 hemodynamically stable patients with left ventricular EF (LVEF) < 50% by means of echocardiography and blood sampling. Results: We report significant correlations between MIF-1, LVEF (r = −0.33, p = 0.005), LV global longitudinal strain (LVGLS, r = 0.41, p = 0.0004), and tricuspid annular plane systolic excursion (TAPSE, r = −0.37, p = 0.001). MIF-1 levels in HFrEF patients were relatively higher, but not significantly different from those observed in HFmrEF. MIF-1 showed significant associations with TAPSE to systolic pulmonary artery pressure ratio (TAPSE/sPAP, p < 0.0001). Also, patients with TAPSE/sPAP < 0.40 mm/mmHg had significantly higher levels of MIF-1 (p = 0.009). Moreover, ischemic cardiomyopathy (ICM) was more frequent in patients with MIF-1 concentrations above 520 pg/mL (57.1% MIF-1^hi vs. 28.6% MIF-1^lo, p = 0.029). In terms of congestion, MIF-1 showed significant associations with the presence of peripheral edema (p = 0.007), but none was found with self-reported dyspnea (p = 0.307) and New York Heart Association (NYHA) class (p = 0.486). Also, no relationship was reported with N-terminal pro-B-type natriuretic peptide concentrations (NT-proBNP, r = 0.14, p = 0.263). However, the six-minute walk distance was greater in individuals in the MIF-1^lo group when compared to those in the MIF-1^hi group (404.0 ± 127.4 vs. 324.8 ± 124.1 m, p = 0.010). Conclusions: Beyond identifying inflammatory biomarkers related to disease severity, linking MIF-1 to various pathophysiological mechanisms may highlight the active involvement of the monocyte-macrophage system in HF. This system holds notable significance in congestion-related conditions, acting as a major source of reactive oxygen species that perpetuate inflammation. Full article

Background/Objectives: The impact of cold temperature on heart failure (HF) decompensations in continental climate zones is unclear. We aimed to evaluate the association between daily temperature and the subsequent frequency of HF decompensations in an emergency department (ED) in Eastern Austria. Methods: A systematic retrospective medical chart review of all admissions to the ED of a tertiary care center within 12 months was conducted. Maximal daily temperature and further meteorological data were obtained from the National Institute for Meteorology and Geodynamics. Results: Among 32.028 ED admissions, there were 1.248 HF decompensations. Median maximal daily temperature ranged from 4.3 °C in January to 28.7 °C in August, and the frequency of decompensations ranged from 65 in August to 143 in January. Maximal daily temperature correlated negatively with the number of decompensations on the subsequent day (beta = −0.07 [95% confidence interval, −0.09 to −0.05], p < 0.001). The association remained significant in a multivariate linear regression model adjusted for other meteorological parameters (adjusted beta = −0.07 [−0.10 to −0.04], p < 0.001). Moreover, it was present across HF with preserved (n = 375; beta = −0.08 [−0.14 to −0.03], p = 0.004) and reduced (n = 331; beta = −0.08 [−0.13 to −0.02], p = 0.005) ejection fraction, but not with mildly reduced ejection fraction (n = 160; beta = −0.03 [−0.07 to 0.01], p = 0.200). Conclusions: In a European continental climate zone region, lower temperature was associated with a linear increase in subsequent HF decompensations. The sequelae of climate change on HF decompensations may burden healthcare systems in the future and should be systematically investigated in further studies. Full article

Background/Objectives: This study aimed to investigate the prognostic value of the red cell distribution width-to-estimated glomerular filtration rate (RGR) ratio in patients hospitalized with chronic heart failure (CHF) and its potential interaction with NT-proBNP levels. By integrating anemia and renal dysfunction markers, the RGR may provide enhanced predictive insights regarding extended length of hospital stay (ELOS) > 7 days, in-hospital mortality, and 6-month all-cause mortality across specific CHF phenotypes. Methods: In this retrospective, single-center pilot observational study, 627 CHF admissions (January 2022–August 2024) were analyzed. Patients were classified according to the ESC guidelines into heart failure with reduced (HFrEF), mildly reduced (HFmrEF), or preserved ejection fraction (HFpEF). The RGR was calculated as red cell distribution width standard deviation (RDW-SD) divided by estimated glomerular filtration rate (eGFR). Predictive accuracy was evaluated using logistic regression, receiver operating characteristic (ROC) analyses, and stepwise Cox proportional hazard regression. Results: RGR was significantly higher in HFrEF than in HFpEF (p = 0.042) and predicted ELOS only in HFpEF (AUC = 0.619). In contrast, for in-hospital mortality, RGR achieved excellent discrimination in HFrEF (AUC = 0.945), outperforming RDW and NT-proBNP. In HFmrEF, RDW exhibited the highest predictive power (AUC = 0.826), whereas in HFpEF, NT-proBNP was the strongest predictor (AUC = 0.958), although RGR preserved good discrimination (AUC = 0.746). Across the entire cohort and HF phenotypes, RGR consistently emerged as a significant predictor in univariable analysis. In multivariable models, it improved the significance prognosis especially alongside NT-proBNP in the entire cohort and HFrEF. For 6-month all-cause mortality, RGR surpassed RDW in prediction in all HF phenotypes. Conclusions: The RGR independently predicts prolonged hospitalization, in-hospital, and 6-month mortality in CHF—often outperforming RDW and eGFR and being comparable to NT-proBNP, especially in HFrEF. These findings suggest that RGR may serve as a valuable risk stratification tool in CHF management. Full article

Objectives: Randomized evidence on the role of heart failure guideline-directed medical therapy for patients with functional mitral regurgitation (FMR) is lacking. The present meta-analysis sought to investigate the prognostic impact of different pharmacotherapy categories recommended in heart failure on subjects with FMR. Methods: A systematic literature review was conducted to identify studies reporting the association of renin angiotensin system inhibitors (RASi), beta-blockers (BB), and mineralocorticoid receptor antagonists (MRA) with outcomes in FMR. A random-effects meta-analysis was conducted to quantify the unadjusted and adjusted hazard ratios [(a)HRs] for all-cause death and the composite outcome in each medical category. Results: Twelve studies with 6,715 FMR patients were included. The use of RASi and BB was associated with a significantly lower risk of all-cause mortality (HR 0.52 [0.39–0.68]; p < 0.00001, I² = 62% and HR 0.62 [0.49–0.77]; p < 0.0001, I² = 44%, respectively) and the composite outcome (HR 0.54 [0.44–0.67]; p < 0.00001, I² = 33% and HR 0.62 [0.52–0.75], p < 0.00001, I² = 35%, respectively) in unadjusted models. Both RASi (aHR 0.73 [0.56–0.95], p = 0.02, I² = 52%) and BB (aHR 0.60 [0.41–0.88], p = 0.009, I² = 55%) retained their association with the composite outcome in pooled adjusted models. The prognostic benefit of using RASi or BB was retained in subgroup analyses including only (1) patients with moderate or severe FMR and (2) patients with reduced or mildly reduced left ventricular ejection fraction. MRA did not demonstrate a significant association with improved outcomes. Conclusions: RASi and BB administration appear to have a favorable prognostic impact on patients with FMR, regardless of the severity of regurgitation. Full article

(1) Background: Left ventricular ejection fraction (LVEF) is traditionally used to assess prognosis in acute ST-elevation myocardial infarction (STEMI) patients. However, LV myocardial work (MW), evaluated echocardiographically, offers additional prognostic information by considering loading conditions. (2) Methods: This prospective study investigated the prognostic value of MW indices in 119 consecutive STEMI patients treated with primary percutaneous coronary angioplasty, stratified into three LVEF categories: reduced (≤40%), mildly reduced (41–49%), and preserved LVEF (≥50%). Transthoracic echocardiography was performed before discharge, and the primary endpoint included heart failure hospitalization, ventricular arrhythmias, all-cause mortality and new acute coronary syndromes. (3) Results: Patients with preserved or mildly reduced LVEF had higher global longitudinal strain, global work index, global constructive work (GCW), and global work efficiency, as well as lower global wasted work (GWW), compared to those with reduced LVEF. GCW was the strongest predictor of adverse outcomes in the preserved LVEF group (AUC = 0.730, p = 0.035), while GWW demonstrated robust predictive performance in the reduced LVEF group (AUC = 0.787, p = 0.001). (4) Conclusions: MW indices, particularly GCW and GWW, provide significant prognostic value in distinct LVEF categories in STEMI patients. These findings indicate that MW enhances risk stratification and informs management in this patient population. Full article

The initiation of sodium–glucose cotransporter 2 (SGLT2) inhibitor treatment was shown to reduce pulmonary artery pressure (PAP) in New York Heart Association (NYHA) class III heart failure (HF) patients with an implanted PAP sensor. We aimed to investigate the impact of SGLT2-I initiation on pulmonary vascular resistance (PVR), pulmonary capillary wedge pressure (PCWP), pulmonary arterial capacitance (PAC), and right ventricle (RV) to PA (RV-PA) coupling in a pilot cohort of HF with preserved/mildly reduced ejection fraction (HFpEF/HFmrEF) patients and whether PVR and PCWP can be serially calculated non-invasively using PAP sensor data during follow-up. Methods: Right heart catheterization parameters (PVR, PCWP, and PAC) were obtained at sensor implantation and echocardiographic assessments (E/E’, RV-PA coupling, and RV cardiac output) were made at baseline and every 3 months. SGLT2 inhibition was initiated after 3 months of telemedical care. Three methods for calculating PVR and PCWP were compared using Bland–Altman plots and Spearman’s correlation. Results: In 13 HF patients (mean age 77 ± 4 years), there were no significant changes in PAP, PVR, PCWP, RV-PA coupling, or PAC over 9 months (all p-values > 0.05), including after SGLT2-I initiation. PVR values were closely correlated across the three methods (PVR_New and PVR_{New Tedford} (r = 0.614, p < 0.001), PVR_Echo and PVR_{New Tedford} (r = 0.446, p = 0.006), and PVR_Echo and PVR_New (r = 0.394, p = 0.016)), but PCWP methods lacked reliable association (PCWP_Echo and PCWP_New (r = 0.180, p = 0.332). Conclusions: No changes in cardiopulmonary hemodynamics were detected after hemodynamic telemonitoring either prior to or following SGLT2-I initiation. Different PVR assessment methods yielded comparable results, whereas PCWP methods were not associated with each other. Further investigations with larger cohorts including repeated right heart catheterization are planned. Full article

This review will discuss heart failure, introduce a new drug finerenone, and discuss clinical studies with a focus on its effects on heart failure. Heart failure is a condition or syndrome characterized by an impairment of the pumping ability of the heart, thus no longer keeping up with the demands of the body. There are several types of heart failure; among them are heart failure with reduced ejection fraction, with mildly reduced ejection fraction and with preserved ejection fraction. Heart failure can be caused by several factors including lifestyle factors and diseases such as hypertension, type 2 diabetes mellitus and other cardiovascular diseases. Chronic kidney disease is also a risk factor of heart failure, as it leads to a state of inflammation that can impair the cardiovascular system over time. The novel nonsteroidal mineralocorticoid receptor antagonist finerenone antagonizes the mineralocorticoid receptor and thereby decreases the amount of fibrosis and inflammation that is observed in many heart failure patients. It shows an equal tissue distribution among heart and kidney, a high affinity and selectivity for the mineralocorticoid receptor and little risk of hyperkalemia and feminization. It also exhibits a reduction in the incidence of cardiovascular outcomes among patients with chronic kidney disease and type 2 diabetes mellitus. Therefore, finerenone has been proposed as a beneficial medication for reducing heart failure, especially in patients with diabetes and chronic kidney disease. Further studies are to be conducted to clarify the effects of finerenone alone and in combination with other drugs. Full article

Background/Objectives: Transthyretin amyloid (ATTR) cardiomyopathy mimics left ventricular hypertrophy (LVH) and has been identified as a specific cause of heart failure (HF). The aim of this study was to assess the prevalence of ATTR among patients presenting to the Emergency Department (ED) with acute HF (AHF) and LVH and explore their clinical characteristics and outcomes. Methods: Of 127 AHF patients with LVH, 95 completed the diagnostic protocol, which included monoclonal paraprotein testing and technetium-99 m pyrophosphate scintigraphy. Patients were followed for 6 months, and adverse events, including mortality and HF-related hospitalizations, were recorded. Results: ATTR was diagnosed in 8.4% of patients. The mean left ventricular ejection fraction (EF) was 46 ± 7% in ATTR subjects, with 25% classified as HF with reduced EF, 37.5% HF with mildly reduced EF, and 37.5% HF with preserved EF. N-terminal pro b-type natriuretic peptide (NT-proBNP) and high sensitivity troponin T (hs-TnT) were higher in ATTR compared to the non-ATTR group [NT-proBNP: 5863 (6519–12382) pg/mL versus 3586 (1393.5–6322) pg/mL, p = 0.007; hs-TnT: 35.9 (47.9–83.8) pg/mL versus 30.0 (19.4–49.5) pg/mL, p = 0.0006]. During follow-up, twenty-three patients from the cohort died: six in the ATTR and seventeen in the non-ATTR group. The estimated survival rate was significantly lower in ATTR versus non-ATTR patients (log-rank p < 0.0001). Conclusions: In this cohort of AHF patients with LVH presenting to the ED, ATTR cardiomyopathy was detected in 8.4%. Using routinely used cardiac biomarkers and basic echocardiography allows for the raising of suspicion of the disease from the ED setting, potentially facilitating earlier diagnosis in this population. Full article

Pulmonary hypertension (PH) associated with heart failure with preserved ejection fraction (PH-HFpEF) represents a frequent form of PH related to left ventricular dysfunction. The pathophysiology of PH-HFpEF is intricate, and varied and includes vascular, cardiac, and pulmonary factors that contribute synergistically to developing this clinical syndrome. Improved knowledge of the pathophysiology of PH-HFpEF has paved the way for the use of new drugs such as angiotensin receptor neprilysin inhibitors (ARNIs), non-steroidal mineral corticoid receptor antagonist (nsMRA), sodium-glucose cotransporter inhibitors (SGLT2is), levosimendan, and glucagon-like peptide 1 (GLP-1) agonists. ARNIs are a widely used drug for the treatment of PH associated with heart failure with reduced ejection fraction. They have also recently been used in PH-HFpEF patients with hemodynamic benefits that need to be confirmed in future research. Finerenone is an innovative non-steroidal mineralocorticoid receptor antagonist that exhibits notable cardioprotective and renoprotective properties in individuals suffering from chronic diabetic kidney disease. It also enhances outcomes for patients with heart failure, whether they have mildly reduced or preserved ejection fraction. Moreover, in experimental studies, finerenone has been found to lower pulmonary artery pressure, reduce muscularization, and decrease the wall thickness of pulmonary arteries. SGLT2i have revolutionized the treatment of patients with heart failure irrespective of left ventricular ejection fraction, and their treatment is also associated with an improvement in the hemodynamics profile in patients with PH-HFpEF. Levosimendan is a widely used inodilator in the treatment of acute and advanced heart failure. In addition, its use in patients with PH-HFpEF (supported by the positive effects on pulmonary hemodynamics that levosimendan exerts) has recently demonstrated hemodynamic benefit in a small phase 2 study that paved the way for phase 3 studies and the creation of an oral formulation of levosimendan. Finally, GLP1 agonists are a class of drugs that, in preliminary evidence, have shown a positive effect on cardiac hemodynamics, mainly by facilitating left ventricular unloading. These effects, along with the reduction in insulin resistance and weight loss, likely lead to beneficial outcomes for PH-HFpEF patients, especially those with obesity as a comorbidity. Full article

Background: This study was conducted to address the lack of reports comparing the clinical outcomes of non-ST-segment elevation myocardial infarction (NSTEMI) and STEMI based on left ventricular ejection fraction (LVEF). Methods: A total of 9854 patients from the Korea Acute Myocardial Infarction Registry-National Institute of Health dataset were classified into three LVEF categories: heart failure (HF) with reduced ejection fraction (EF) (HFrEF, n = 1250), HF with mildly reduced EF (HFmrEF, n = 2383), and HF with preserved EF (HFpEF, n = 6221). Each group was further divided into NSTEMI and STEMI groups. The primary clinical outcome was the incidence of patient-oriented composite outcomes, defined as all-cause death, recurrent myocardial infarction, any repeat coronary revascularization, hospitalization for HF, and stroke. Results: Following adjustment, in-hospital mortality rates were comparable between the NSTEMI and STEMI groups in the HFrEF and HFmrEF groups. However, 3-year mortality rates were higher in the NSTEMI group. In contrast, in the HFpEF group, the STEMI group had higher rates of in-hospital all-cause death (p = 0.001) and cardiac death (p < 0.001) compared to the NSTEMI group, which was associated with increased 3-year all-cause death (p = 0.026) and cardiac death (p < 0.001) in the STEMI group. When in-hospital mortality was excluded, no difference in 3-year mortality rates was observed between the NSTEMI and STEMI groups in the HFpEF group. Conclusions: In-hospital mortality and 3-year outcomes varied across LVEF groups. Therefore, comparing NSTEMI and STEMI based on LVEF provides valuable insights into the differences in patient outcomes. Full article

Background and Objectives: Heart failure (HF) is one of the most common initial presentations of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM). There are different cardiac biomarkers related to the pathophysiological mechanisms of HF in T2DM. The current research aims to identify additional biomarkers that could improve the diagnosis and prognosis of HFpEF, which is currently assessed using NT pro-BNP levels. NT pro-BNP is a valuable tool for diagnosing heart failure but may not always correlate with clinical symptom severity or can present normal levels in certain cases, such as obesity. Biomarkers like FGF-21 and galectin-3 could provide greater insight into heart failure severity, especially in diabetic patients. The main objective of the current study is to assess the performance of NT-proBNP, FGF21, Galectin-3 and Copeptin to discriminate between advanced and mild HF. Materials and Methods: A total of 117 patients were enrolled in this study and divided into two groups: 67 patients in NYHA functional class I-II (mild HF) and 50 patients in NYHA III-IV (advanced HF). NT-pro BNP, FGF21, Galectin 3 and Copeptin serum levels were determined with the ELISA method. Receiver operating characteristic (ROC) analysis and binomial logistic regression analysis were used to measure the ability of the studied biomarkers to distinguish between advanced and mild HF patients. Results: In patients with T2DM with advanced HF, serum FGF21 level was significantly positively correlated with eGFR (ρ = 0.35, p = 0.0125) and triglycerides (ρ = 0.28, p = 0.0465) and significantly negatively correlated with serum levels of HDL cholesterol (ρ = −0.29, p = 0.0386) and with RV-RA gradient (ρ = −0.30, p = 0.0358). In patients with mild HF, serum FGF21 level was significantly negatively correlated with NT-proBNP levels (ρ = −0.37, p = 0.0022), E/e’ ratio (ρ = −0.29, p = 0.0182), TR velocity (ρ = −0.24, p = 0.0470) and RV-RA gradient (ρ = −0.24, p = 0.0472). FGF21 (AUC = 0.70, 95% CI: 0.60−0.79) and NT-proBNP (AUC = 0.73, 95% CI: 0.63–0.82) demonstrated significant predictive value to discriminate T2DM patients with advanced HF from those with mild HF. Elevated values for FGF21 (≥377.50 ng/mL) or NTproBNP (≥2379 pg/mL) were significantly associated with increased odds of advanced HF after adjusting for demographic and clinical covariates. Conclusions: NTpro-BNP and FGF21 have a similar ability to discriminate T2DM patients with advanced HF from those with mild HF. Univariable and multivariable logistic models showed that, FGF21 and NTproBNP were independent predictors for advanced HF in patients with preserved and mildly reduced ejection fraction and T2DM. Full article

Introduction: Finerenone, a third-generation non-steroidal mineralocorticoid receptor antagonist (MRA), offers a targeted approach to managing cardiovascular outcomes, particularly in patients with chronic kidney disease (CKD) and type 2 diabetes (T2D). Unlike traditional MRAs such as spironolactone and eplerenone, which can cause off-target hormonal side effects and hyperkalemia, Finerenone selectively binds to mineralocorticoid receptors, reducing these risks. Recent randomized controlled trials have demonstrated Finerenone’s potential to improve cardiovascular outcomes, making it a promising alternative in the management of heart failure and other cardiovascular conditions associated with CKD and T2D. Methods: We conducted a scoping review using PRISMA guidelines. A search for “Finerenone” in the PubMed, Embase, and Cochrane Library databases included randomized controlled trials (RCTs), post hoc analyses, and relevant meta-analyses on cardiovascular outcomes. Data were synthesized narratively, assessing study quality through strengths and limitations. Discussion: Finerenone has shown significant benefits and a superior safety profile compared with traditional MRAs like spironolactone and eplerenone in managing CKD, T2D, and heart failure. It effectively reduces cardiovascular and renal events while minimizing risks such as hyperkalemia and hormonal side effects associated with steroidal MRAs. Future studies, including the REDEFINE-HF, FINALITY-HF, and CONFIRMATION-HF trials, will further explore Finerenone’s potential across diverse heart failure phenotypes, including its role in heart failure with mildly reduced and preserved ejection fractions, potentially establishing it as a cornerstone therapy in heart failure management. Conclusions: Finerenone represents a significant advancement in MRA therapy, offering enhanced safety and efficacy in managing cardiovascular outcomes in CKD and T2D patients. The current evidence supports its use as a promising alternative to traditional MRAs, particularly in patients intolerant to steroidal MRAs. Further trials are needed to fully establish its potential across diverse patient populations, including those with varying heart failure phenotypes. Full article