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Advances in Therapy for Heart Failure

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A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Molecular and Translational Medicine".

Deadline for manuscript submissions: closed (31 October 2022) | Viewed by 30907

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Dr. Robert Zymliński

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Department of Heart Diseases, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland
Interests: heart failure (HF); HFrEF; pathogenesis; sodium-glucose co transporter; ferric carboxymaltose; vericiguat; omecamtiv
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Dear Colleagues,

Heart failure (HF) is common and is associated with high morbidity, mortality and high health expenditure. Traditionally, the ability of HF therapies has been examined by their effect on death and time to first unscheduled hospitalization. Treatment of HF patients with reduced ejection fraction (HFrEF) has significantly evolved over the last few years. Currently new evidence based supporting novel therapies are introduced. It should be pointed out that never before there been such an opportunity to positively impact outcome with drug therapy for patients with HFrEF. Within last years, treating HFrEF patients was based on beta-blockers (BB) or ivabradine if sinus heart rhythm is not well controlled, angiotensin-converting enzyme inhibitors (ACEi), or angiotensin receptor blockers (ARB) in case of ACEi intolerance, mineralocorticoid receptor antagonists (MRA), digoxin, diuretics, and devices. However in less than one decade, more therapies with diverse mechanisms of action (MOA) have been developed with great impact on prognosis and quality of life if are early introduced. The novel particles such as sacubitril/valsartan, sodium–glucose co-transporter 2 inhibitors (SGLT2i), ferric carboxymaltose, vericiguat and omecamtiv mecarbil, have been recommended in European Society of Cardiology Guidelines for heart failure treatment to achieve positive impact on mortality and/or morbidity in HFrEF patients.

Also notable progress has been accomplished in device-based therapy used in chronic HF (CHF) and acute HF (AHF) including unique decongestion techniques, advancements in ventricle restoration strategies, device based strategies to improve cardiac output, kidney perfusion, monitoring systems are developed. However, despite the obvious progress in HFrEF assessment substantial challenges have arisen in HF, especially in HFpEF and acute HF (AHF), including the optimal diagnostic and therapeutic strategy.

Because there still it is a great need of interest we cordially invite authors and investigators within this complex field to submit original research or review articles pertaining this special issue. Studies and opinions related to the development of HFrEF or HFpEF and AHF, aspects of its pathogenesis, the status of disease modifying therapies preventing the progression and improving the outcome, new promising therapeutic concepts and what is foreseen in the horizon in HF area.

Dr. Robert Zymliński
Guest Editor

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Research

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17 pages, 988 KiB

Open AccessArticle

Levels of TNF-α and Soluble TNF Receptors in Normal-Weight, Overweight and Obese Patients with Dilated Non-Ischemic Cardiomyopathy: Does Anti-TNF Therapy Still Have Potential to Be Used in Heart Failure Depending on BMI?

by Elżbieta Lazar-Poloczek, Ewa Romuk, Wojciech Jacheć, Wiktoria Stanek, Bartosz Stanek, Monika Szołtysik, Tomasz Techmański, Maja Hasterok and Celina Wojciechowska

Biomedicines 2022, 10(11), 2959; https://doi.org/10.3390/biomedicines10112959 - 17 Nov 2022

Cited by 4 | Viewed by 1470

Abstract

Background. We sought to measure the levels of adipokines, TNF-α and soluble receptors (sTNFr1, sTNFr2) in heart failure patients with reduced ejection fraction (HFrEF) due to non-ischemic cardiomyopathy (nDCM). Methods. A total of 123 patients with HFrEF due to nDCM were divided into three groups according to BMI: 34 (27.6%) normal weight, 56 (45.5%) overweight and 33 (26.8%) obese. A six-minute walk test, echocardiography and right heart catheterization were performed. Serum concentrations of adiponectin, leptin, NT-proBNP, blood hemoglobin, sodium, creatinine, ALAT, AspAT, bilirubin, CRP, lipids, TNF-α, sTNFr1 and sTNFr2 receptors were measured. Results. Obese patients had the lowest NT-proBNP concentrations, significantly higher leptin levels and higher leptin/adiponectin ratios. The concentration of sTNFr1 was higher in normal-weight patients. In all groups, TNF-α concentrations correlated positively with sTNFr1 (p < 0.001). Higher levels of sTNFr1 were associated with higher sTNFr2 (p < 0.001) and CRP (p < 0.001). Moreover, the concentration of sTNFr2 positively correlated with CRP (p < 0.05) and adiponectin (p < 0.001). Levels of TNF-α were not associated with elevated CRP. Conclusion: This study demonstrated that changes in the concentrations of TNF and its receptors differ between groups of patients with different BMI. These findings suggest that the effective use of anti-TNF therapy is dependent not only on BMI, but also on concentrations of TNF-α receptors and other laboratory parameters. Full article

(This article belongs to the Special Issue Advances in Therapy for Heart Failure)

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13 pages, 2357 KiB

Open AccessArticle

Noninvasive Hemodynamic Monitoring in Advanced Heart Failure Patients: New Approach for Target Treatments

by Gianfranco Piccirillo, Federica Moscucci, Andrea Corrao, Myriam Carnovale, Ilaria Di Diego, Ilaria Lospinuso, Cristina Caltabiano, Martina Mezzadri, Pietro Rossi and Damiano Magrì

Biomedicines 2022, 10(10), 2407; https://doi.org/10.3390/biomedicines10102407 - 26 Sep 2022

Cited by 4 | Viewed by 2255

Abstract

Using bio-impedance to deduce some hemodynamic parameters combined with some short-term ECG temporal dispersion intervals, and measuring myocardial depolarization, intraventricular conduction, and repolarization. A total of 65 in-hospital patients (M/F:35/30) were enrolled, 39 with HFrEF and 26 HFpEF, in New York Heart Association (NYHA) class IV. Stroke volume (SVI), cardiac indexes (CI), left ventricular ejection fraction (LVEF_BIO), end diastolic volume (LV-EDV), and other systolic and diastolic parameters were noninvasively obtained at enrollment and at hospital discharge. At the same time, QR, QRS, QT, ST, Tpeak-Tend (Te) interval mean, and standard deviation (SD) from 5 min ECG recordings were obtained. At baseline, HFrEF patients reported significantly lower SVI (p < 0.05), CI (p < 0.05), and LVEF (p < 0.001) than HFpEF patients; moreover, HFrEF patients also showed increased LV-EDV (p < 0.05), QR, QRS, QT, ST, and Te means (p < 0.05) and standard deviations (p < 0.05) in comparison to HFpEF subjects. Multivariable logistic regression analysis reported a significant correlation between hospital mortality and Te mean (odds ratio: 1.03, 95% confidence limit: 1.01–1.06, p: 0.01). Fifty-seven percent of patients were considered responders to optimal medical therapy and, at discharge, they had significantly reduced NT-proBNP, (p < 0.001), heart rate (p < 0.05), and Te_SD (p < 0.001). LVEF, obtained by transthoracic echocardiography, and LVEF_BIO were significantly related (r: 0.781, p < 0.001), but these two parameters showed a low agreement limit. Noninvasive hemodynamic and ECG-derived parameters were useful to highlight the difference between HFrEF and HFpEF and between responders and nonresponders to the optimal medical therapy. Short-period bioimpedance and electrocardiographic data should be deeply evaluated to determine possible advantages in the therapeutic and prognostic approach in severe CHF. Full article

(This article belongs to the Special Issue Advances in Therapy for Heart Failure)

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10 pages, 744 KiB

Open AccessArticle

Serum Osmolarity and Vasopressin Concentration in Acute Heart Failure—Influence on Clinical Course and Outcome

by Mateusz Guzik, Mateusz Sokolski, Magdalena Hurkacz, Agata Zdanowicz, Gracjan Iwanek, Dominik Marciniak, Robert Zymliński, Piotr Ponikowski and Jan Biegus

Biomedicines 2022, 10(8), 2034; https://doi.org/10.3390/biomedicines10082034 - 20 Aug 2022

Cited by 2 | Viewed by 1445

Abstract

Neurohormone activation plays an important role in Acute Heart Failure (AHF) pathophysiology. Serum osmolarity can affect this activation causing vasopressin excretion. The role of serum osmolarity and vasopressin concentration and its interaction remain still unexplored in AHF. The objective of our study was to evaluate the relationship of serum osmolarity with clinical parameters, vasopressin concentration, in-hospital course, and outcomes in AHF patients. The study group consisted of 338 AHF patients (male (76.3%), mean age of 68 ± 13 years) with serum osmolarity calculated by the equation: 1.86 × sodium [mmol/L] + (glucose [mg/dL]/18) + (urea [mg/dL]/2.8) + 9 and divided into osmolarity quartiles marked as: low: <287 mOsm/L, intermediate low: 287–294 mOsm/L, intermediate high: 295–304 mOsm/L, and high: >304 mOsm/L. There was an increasing age gradient in the groups and patients differed in the occurrence of comorbidities and baseline clinical and laboratory parameters. Importantly, analysis revealed that vasopressin presented a linear correlation with osmolarity (r = −0.221, p = 0.003) and its concentration decreased with quartiles (61.6 [44.0–81.0] vs. 57.8 [50.0–77.3] vs. 52.7 [43.1–69.2] vs. 45.0 [30.7–60.7] pg/mL, respectively, p = 0.034). This association across quartiles was observed among de novo AHF (63.6 [55.3–94.5] vs. 58.0 [50.7–78.6] vs. 52.0 [46.0–58.0] vs. 38.0 [27.0–57.0] pg/mL, respectively, p = 0.022) and was not statistically significant in patients with acute decompensated heart failure (ADHF) (59.5 [37.4–80.0] vs. 52.0 [38.0–74.5] vs. 57.0 [38.0–79.0] vs. 50.0 [33.0–84.0] pg/mL, respectively, p = 0.849). The worsening of renal function episodes were more frequent in quartiles with higher osmolarity (4 vs. 2 vs. 13 vs. 11%, respectively, p = 0.018) and patients that belonged to the quartiles with low and high osmolarity were characterized more often by incidence of worsening heart failure (20 vs. 9 vs. 10 vs. 22%, respectively, p = 0.032). There was also a U-shape distribution in relation to one-year mortality (31 vs. 19 vs. 23 vs. 37%, respectively, p = 0.022). In conclusion, there was an association of serum osmolarity with clinical status and both in-hospital and out-of-hospital outcomes. Moreover, the linear dependence between vasopressin concentration and serum osmolarity in the AHF population was identified and was driven mainly by patients with de novo AHF which suggests different pathophysiological paths in ADHF and AHF de novo. Full article

(This article belongs to the Special Issue Advances in Therapy for Heart Failure)

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12 pages, 1066 KiB

Open AccessArticle

SAR296968, a Novel Selective Na⁺/Ca²⁺ Exchanger Inhibitor, Improves Ca²⁺ Handling and Contractile Function in Human Atrial Cardiomyocytes

by Philipp Hegner, Marzena Drzymalski, Alexander Biedermann, Bernadette Memmel, Melanie Durczok, Michael Wester, Bernhard Floerchinger, Zdenek Provaznik, Christof Schmid, York Zausig, Lars S. Maier and Stefan Wagner

Biomedicines 2022, 10(8), 1932; https://doi.org/10.3390/biomedicines10081932 - 09 Aug 2022

Cited by 7 | Viewed by 1752

Abstract

Background: In reverse-mode, cardiac sodium-calcium exchanger (NCX) can increase the cytoplasmic Ca²⁺ concentration in response to high intracellular Na⁺ levels, which may contribute to diastolic contractile dysfunction. Furthermore, increased spontaneous Ca²⁺ release from intracellular stores can activate forward mode NCX. The resulting transient inward current causes delayed afterdepolarization (DAD)-dependent arrhythmias. Moreover, recently, NCX has been associated with impaired relaxation and reduced cardiac function in heart failure with preserved ejection fraction (HFpEF). Since NCX is upregulated in human chronic atrial fibrillation (AF) as well as heart failure (HF), specific inhibition may have therapeutic potential. Objective: We tested the antiarrhythmic, lusitropic and inotropic effects of a novel selective NCX-inhibitor (SAR296968) in human atrial myocardium. Methods and Results: Right atrial appendage biopsies of 46 patients undergoing elective cardiac surgery in a predominant HFpEF cohort (n = 24/46) were investigated. In isolated human atrial cardiomyocytes, SAR296968 reduced the frequency of spontaneous SR Ca²⁺ release events and increased caffeine transient amplitude. In accordance, in isolated atrial trabeculae, SAR296968 enhanced the developed tension after a 30 s pause of electrical stimulation consistent with reduced diastolic sarcoplasmic reticulum (SR) Ca²⁺ leak. Moreover, compared to vehicle, SAR296968 decreased steady-state diastolic tension (at 1 Hz) without impairing developed systolic tension. Importantly, SAR296968 did not affect the safety parameters, such as resting membrane potential or action potential duration as measured by patch clamp. Conclusion: The novel selective NCX-inhibitor SAR296968 inhibits atrial pro-arrhythmic activity and improves diastolic and contractile function in human atrial myocardium, which may have therapeutic implications, especially for treatment of HFpEF. Full article

(This article belongs to the Special Issue Advances in Therapy for Heart Failure)

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12 pages, 1564 KiB

Open AccessArticle

Soluble (Pro)Renin Receptor Levels Are Regulated by Plasma Renin Activity and Correlated with Edema in Mice and Humans with HFrEF

by Inna P. Gladysheva, Ryan D. Sullivan, Kodangudi Ramanathan and Guy L. Reed

Biomedicines 2022, 10(8), 1874; https://doi.org/10.3390/biomedicines10081874 - 03 Aug 2022

Cited by 1 | Viewed by 1560

Abstract

Symptomatic heart failure with reduced ejection fraction (HFrEF) is characterized by edema and chronic pathological activation of the classical renin–angiotensin–aldosterone system (RAAS). The soluble (pro)renin receptor (s(P)RR) is released into circulation by proteolytic cleavage of tissue expressed (P)RR and is a candidate biomarker of RAAS activation. However, previous studies linked elevated levels of s(P)RR in patients with HFrEF to renal dysfunction. Utilizing prospectively enrolled patients with comparable rEF, we show that increased plasma levels of s(P)RR are associated with symptomatic HF (characterized by edema), independent of chronic renal dysfunction. We also found that s(P)RR levels were positively correlated with patient plasma renin activity (PRA). Normotensive mice with dilated cardiomyopathy (DCM) and HFrEF, without renal dysfunction, showed plasma s(P)RR and PRA patterns similar to human HFrEF patients. Plasma s(P)RR levels positively correlated with PRA and systemic edema, but not with EF, resembling findings in patients with HFrEF without chronic kidney dysfunction. In female DCM mice with elevated PRA levels and plasma s(P)RR levels, a randomized, blinded trial comparing the direct renin inhibitor, aliskiren vs. vehicle control, showed that direct renin inhibition normalized PRA, lowered s(P)RR, and prevented symptomatic HFrEF. Considered in light of previous findings, these data suggest that, in HFrEF, in the absence of renal dysfunction, elevation of plasma s(P)RR levels is caused by increased PRA and associated with the development of systemic edema. Full article

(This article belongs to the Special Issue Advances in Therapy for Heart Failure)

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20 pages, 1358 KiB

Open AccessEditor’s ChoiceArticle

Novel Phenotyping for Acute Heart Failure—Unsupervised Machine Learning-Based Approach

by Szymon Urban, Mikołaj Błaziak, Maksym Jura, Gracjan Iwanek, Agata Zdanowicz, Mateusz Guzik, Artur Borkowski, Piotr Gajewski, Jan Biegus, Agnieszka Siennicka, Maciej Pondel, Petr Berka, Piotr Ponikowski and Robert Zymliński

Biomedicines 2022, 10(7), 1514; https://doi.org/10.3390/biomedicines10071514 - 27 Jun 2022

Cited by 8 | Viewed by 3320

Abstract

Acute heart failure (AHF) is a life-threatening, heterogeneous disease requiring urgent diagnosis and treatment. The clinical severity and medical procedures differ according to a complex interplay between the deterioration cause, underlying cardiac substrate, and comorbidities. This study aimed to analyze the natural phenotypic heterogeneity of the AHF population and evaluate the possibilities offered by clustering (unsupervised machine-learning technique) in a medical data assessment. We evaluated data from 381 AHF patients. Sixty-three clinical and biochemical features were assessed at the admission of the patients and were included in the analysis after the preprocessing. The K-medoids algorithm was implemented to create the clusters, and optimization, based on the Davies-Bouldin index, was used. The clustering was performed while blinded to the outcome. The outcome associations were evaluated using the Kaplan-Meier curves and Cox proportional-hazards regressions. The algorithm distinguished six clusters that differed significantly in 58 variables concerning i.e., etiology, clinical status, comorbidities, laboratory parameters and lifestyle factors. The clusters differed in terms of the one-year mortality (p = 0.002). Using the clustering techniques, we extracted six phenotypes from AHF patients with distinct clinical characteristics and outcomes. Our results can be valuable for future trial constructions and customized treatment. Full article

(This article belongs to the Special Issue Advances in Therapy for Heart Failure)

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Review

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29 pages, 2893 KiB

Open AccessReview

New Opportunities in Heart Failure with Preserved Ejection Fraction: From Bench to Bedside… and Back

by Alfredo Parra-Lucares, Esteban Romero-Hernández, Eduardo Villa, Sebastián Weitz-Muñoz, Geovana Vizcarra, Martín Reyes, Diego Vergara, Sergio Bustamante, Marcelo Llancaqueo and Luis Toro

Biomedicines 2023, 11(1), 70; https://doi.org/10.3390/biomedicines11010070 - 27 Dec 2022

Cited by 2 | Viewed by 3549

Abstract

Heart failure with preserved ejection fraction (HFpEF) is a growing public health problem in nearly 50% of patients with heart failure. Therefore, research on new strategies for its diagnosis and management has become imperative in recent years. Few drugs have successfully improved clinical outcomes in this population. Therefore, numerous attempts are being made to find new pharmacological interventions that target the main mechanisms responsible for this disease. In recent years, pathological mechanisms such as cardiac fibrosis and inflammation, alterations in calcium handling, NO pathway disturbance, and neurohumoral or mechanic impairment have been evaluated as new pharmacological targets showing promising results in preliminary studies. This review aims to analyze the new strategies and mechanical devices, along with their initial results in pre-clinical and different phases of ongoing clinical trials for HFpEF patients. Understanding new mechanisms to generate interventions will allow us to create methods to prevent the adverse outcomes of this silent pandemic. Full article

(This article belongs to the Special Issue Advances in Therapy for Heart Failure)

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39 pages, 1494 KiB

Open AccessReview

Stable Gastric Pentadecapeptide BPC 157 as Useful Cytoprotective Peptide Therapy in the Heart Disturbances, Myocardial Infarction, Heart Failure, Pulmonary Hypertension, Arrhythmias, and Thrombosis Presentation

by Predrag Sikiric, Mario Udovicic, Ivan Barisic, Diana Balenovic, Gordana Zivanovic Posilovic, Dean Strinic, Sandra Uzun, Suncana Sikiric, Ivan Krezic, Helena Zizek, Haidi Yago, Slaven Gojkovic, Ivan Maria Smoday, Luka Kalogjera, Hrvoje Vranes, Marija Sola, Sanja Strbe, Antun Koprivanac, Ivica Premuzic Mestrovic, Tomislav Mestrovic, Predrag Pavic, Anita Skrtic, Alenka Boban Blagaic, Martina Lovric Bencic and Sven Seiwerth Show full author list Hide full author list

Biomedicines 2022, 10(11), 2696; https://doi.org/10.3390/biomedicines10112696 - 25 Oct 2022

Cited by 10 | Viewed by 4748

Abstract

In heart disturbances, stable gastric pentadecapeptide BPC 157 especial therapy effects combine the therapy of myocardial infarction, heart failure, pulmonary hypertension arrhythmias, and thrombosis prevention and reversal. The shared therapy effect occurred as part of its even larger cytoprotection (cardioprotection) therapy effect (direct epithelial cell protection; direct endothelium cell protection) that BPC 157 exerts as a novel cytoprotection mediator, which is native and stable in human gastric juice, as well as easily applicable. Accordingly, there is interaction with many molecular pathways, combining maintained endothelium function and maintained thrombocytes function, which counteracted thrombocytopenia in rats that underwent major vessel occlusion and deep vein thrombosis and counteracted thrombosis in all vascular studies; the coagulation pathways were not affected. These appeared as having modulatory effects on NO-system (NO-release, NOS-inhibition, NO-over-stimulation all affected), controlling vasomotor tone and the activation of the Src-Caveolin-1-eNOS pathway and modulatory effects on the prostaglandins system (BPC 157 counteracted NSAIDs toxicity, counteracted bleeding, thrombocytopenia, and in particular, leaky gut syndrome). As an essential novelty noted in the vascular studies, there was the activation of the collateral pathways. This might be the upgrading of the minor vessel to take over the function of the disabled major vessel, competing with and counteracting the Virchow triad circumstances devastatingly present, making possible the recruitment of collateral blood vessels, compensating vessel occlusion and reestablishing the blood flow or bypassing the occluded or ruptured vessel. As a part of the counteraction of the severe vessel and multiorgan failure syndrome, counteracted were the brain, lung, liver, kidney, gastrointestinal lesions, and in particular, the counteraction of the heart arrhythmias and infarction. Full article

(This article belongs to the Special Issue Advances in Therapy for Heart Failure)

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13 pages, 977 KiB

Open AccessEditor’s ChoiceReview

Vericiguat in Heart Failure: Characteristics, Scientific Evidence and Potential Clinical Applications

by Francesca Vannuccini, Alessandro Campora, Maria Barilli and Alberto Palazzuoli

Biomedicines 2022, 10(10), 2471; https://doi.org/10.3390/biomedicines10102471 - 03 Oct 2022

Cited by 11 | Viewed by 6922

Abstract

Despite recent advances in heart failure (HF) management, the risk of death and hospitalizations remains high in the long term. HF is characterized by endothelial dysfunction, inflammation and increased oxidative stress, due to a reduction in the activity of the nitric oxide (NO)-soluble guanylate cyclase (sGC)-cyclic guanosine monophosphate (cGMP) signaling pathway. All these factors contribute to direct damage at the myocardial, vascular and renal level. Vericiguat restores the deficiency in this signaling pathway, through stimulation and activation of sGC, aiming to increase cGMP levels, with a reduction in HF-related oxidative stress and endothelial dysfunction. Two main clinical trials were developed in this setting: the SOCRATES-REDUCED phase II study and the VICTORIA phase III study. They found that vericiguat is safe, well tolerated and effective with an absolute event-rate reduction in patients affected by HF with reduced ejection fraction (HFrEF) and recent cardiac decompensation. In patients with HF with preserved ejection fraction (HfpEF), the SOCRATES-PRESERVED trial demonstrated an improvement in quality of life and health status, but the proven beneficial effects with vericiguat are still limited. Further studies are needed to correctly define the role of this drug in heart failure syndromes. Our paper reviews the potential applications and pharmacological characteristics of vericiguat in HFrEF and HFpEF. Full article

(This article belongs to the Special Issue Advances in Therapy for Heart Failure)

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Other

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16 pages, 712 KiB

Open AccessSystematic Review

An Artificial Intelligence Approach to Guiding the Management of Heart Failure Patients Using Predictive Models: A Systematic Review

by Mikołaj Błaziak, Szymon Urban, Weronika Wietrzyk, Maksym Jura, Gracjan Iwanek, Bartłomiej Stańczykiewicz, Wiktor Kuliczkowski, Robert Zymliński, Maciej Pondel, Petr Berka, Dariusz Danel, Jan Biegus and Agnieszka Siennicka

Biomedicines 2022, 10(9), 2188; https://doi.org/10.3390/biomedicines10092188 - 05 Sep 2022

Cited by 7 | Viewed by 2538

Abstract

Heart failure (HF) is one of the leading causes of mortality and hospitalization worldwide. The accurate prediction of mortality and readmission risk provides crucial information for guiding decision making. Unfortunately, traditional predictive models reached modest accuracy in HF populations. We therefore aimed to present predictive models based on machine learning (ML) techniques in HF patients that were externally validated. We searched four databases and the reference lists of the included papers to identify studies in which HF patient data were used to create a predictive model. Literature screening was conducted in Academic Search Ultimate, ERIC, Health Source Nursing/Academic Edition and MEDLINE. The protocol of the current systematic review was registered in the PROSPERO database with the registration number CRD42022344855. We considered all types of outcomes: mortality, rehospitalization, response to treatment and medication adherence. The area under the receiver operating characteristic curve (AUC) was used as the comparator parameter. The literature search yielded 1649 studies, of which 9 were included in the final analysis. The AUCs for the machine learning models ranged from 0.6494 to 0.913 in independent datasets, whereas the AUCs for statistical predictive scores ranged from 0.622 to 0.806. Our study showed an increasing number of ML predictive models concerning HF populations, although external validation remains infrequent. However, our findings revealed that ML approaches can outperform conventional risk scores and may play important role in HF management. Full article

(This article belongs to the Special Issue Advances in Therapy for Heart Failure)

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