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Aims: Heart failure (HF) patients may lack improvement of left ventricular (LV) ejection fraction (LVEF) despite optimal HF medication comprising an angiotensin receptor-neprilysin inhibitor (ARNI). Therefore, we aimed to identify key predictors for LV functional enhancement and prognostic reverse cardiac remodelling in HF patients on ARNI treatment., Methods: We retrospectively analysed 294 consecutive patients with HF with reduced (HFrEF) or mildly reduced (HFmrEF) ejection fraction in our 'EnTruth' patient registry. LVEF was determined by echocardiography at initiation of ARNI and at 12 months of follow-up. We assessed the predictive value of clinically relevant patient-, HF- and treatment-related parameters in regard to changes in LVEF and all-cause mortality using medoid clustering and the XGBoost machine learning algorithm., Results: Cluster analysis integrating clinically relevant patient characteristics unveiled four characteristic sub-phenotypes of patients with HFrEF and HFmrEF, respectively. Distinct clusters exhibit a strong (P < 0.05) therapeutic response to ARNI treatment and enhanced LV function. Key patient criteria, such as duration and aetiology of HF, renal function and de novo ARNI treatment, were significantly (P < 0.05) associated with change of LVEF and independently predicted cardiac remodelling. By training various machine learning models on relevant clinical parameters, stratification of LVEF improvement by XGBoost resulted in a high prediction accuracy. The stratification of patients with HFrEF [area under the receiver operating characteristic curve (AUC) = 0.77] and HFmrEF (AUC = 0.70) led to an increased diagnostic accuracy of LVEF improvement in the validation cohort. Using machine learning, the likelihood of cardiac remodelling following ARNI treatment, as indicated by our newly established EnTruth score, was directly associated with absolute LVEF improvement in both HFrEF (r = 0.51, P < 0.0001) and HFmrEF (r = 0.42, P = 0.001). Ultimately, patients with HFrEF and a high EnTruth score have a lower risk of all-cause mortality (P < 0.05 in survival analysis)., Conclusions: Recognition of essential clinical factors by integrating machine learning and cluster analyses may help to identify HF patients benefiting from improvement of LVEF following ARNI treatment. Early identification of those patients with a high response to ARNI treatment may allow a more refined selection of patients benefiting from an early escalation of HF treatment or interventional therapy., (© 2024 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Aims: Heart failure (HF) and erectile dysfunction (ED) share numerous risk factors and pathogenetic mechanisms, resulting in a high prevalence of ED among male patients with HF. This questionnaire-based study aimed to better understand the patient's journey from a patient perspective and that of healthcare professionals (HCPs) regarding communication, education and treatment of ED as a recognized comorbid condition., Methods: Two independent online surveys were conducted between November 2021 and January 2022 in Germany. Analysis of the first patient-targeting survey comprised 927 male patients with HF. As part of this survey, 176 patients with HF and comorbid ED provided further information about their experiences and ED-related communication with HCPs. The second online survey collected the perspectives of 78 physicians including general practitioners (GPs), cardiologists and internists throughout Germany., Results: The average age of participating male patients with HF was 55 years. Both patients and HCPs considered sexual life as an important aspect of patients' quality of life (QoL). Fifty-six per cent of all patients with HF rated their sexual life as important, and 43% were unsatisfied with it. Patients' suffering due to ED was reported as moderate to severe by nearly all HCPs (92%) and patients themselves (82%). A communication gap and perceived imbalance in education were identified, with 27% of patients reporting consultations about ED, while 58% of HCPs claimed to proactively address the issue of ED during counselling. Thirty-nine per cent of HCPs felt that their patients were uncomfortable talking about ED, but only 7% of patients reported discomfort. As a possible result, 69% of male HF patients with ED felt left alone, and 74% stated that they would like to talk to an HCP. Due to inadequate education together with patients not considering their HF doctor as a contact for ED management, as few as 20% of patients with ED receive prescription drugs for ED management. HCPs reported that 32% of their patients are non-compliant with HF medication due to ED, highlighting the importance of sexual health for patients' QoL., Conclusions: The results of our surveys suggest that most of the male HF patients may be receiving incomplete ED management also affecting HF treatment, most likely due to impaired communication with their HCPs with barriers from both sides. HCPs giving patients advice on this topic are urgently needed to improve patients' QoL, reduce patient suffering and avoid discontinuation of HF medications for fear of side effects., (© 2025 The Author(s). ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Bacterial resistance is gaining ground and novel, unconventional strategies are required to improve antibiotic treatments. As a synthetic analog of planktonic bacilli, the natural bacterial swimmers that can penetrate bacterial biofilms, ultra-short propelling magnetic nanochains are presented as bioinspired magnetic nanorobots, enhancing the antibiotic treatment in biofilm-forming Staphylococcus epidermidis. Propelling nanochains, activated by a low intensity (<20 mT) and low frequency (<10 Hz) rotating magnetic field (RMF), prompt the otherwise resistant biofilm-forming bacteria to become sensitive to methicillin, resulting in the killing of 99.99% of bacteria. While magnetic force-driven spherical magnetic nanoparticles were previously reported as unidirectional biofilm channel diggers, propelling nanochains emerge as second-generation magnetic nanorobots, which, due to their magnetic core, shape anisotropy, and negative zeta potential, combine magnetic responsiveness, torque-driven movement, and attractive electrostatic interactions to attach to bacterial aggregates and multi-directionally protrude throughout the biofilm, indulging mechanical forces. These synergistic effects, in combination with an antibiotic drug, destroy the bacterial extracellular matrix and eradicate the formed biofilm, as confirmed with several complementary techniques., (© 2025 Wiley‐VCH GmbH.)