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Acute and Chronic Heart Failure: Biomarkers-Guided Therapy and Clinical Management

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (15 March 2022) | Viewed by 16705

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Dr. Nuria Farre

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Guest Editor

Heart Failure Unit, Department of Cardiology, Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
Interests: heart failure; biomarkers; prognosis; treatment; diagnosis; epidemiology; hospitalization

Special Issue Information

Dear Colleagues,

The prevalence of heart failure is increasing and prognosis continues to be bad. Nowadays, the main challenges in heart failure are establishing the diagnosis and prognosis and choosing the best treatment. Biomarkers, as indicators of a biological state that can be measured, may play a prominent role in heart failure management. They have been used to understand heart failure pathogenesis, to improve diagnosis and to guide treatment, though with conflicting results. Although treatment of heart failure has improved prognosis in heart failure with reduced ejection fraction, that has not been the case in heart failure with preserved ejection fraction. However, biomarkers could be useful in identifying subgroup of patients in whom a treatment might be useful. This Special Issue aims to provide researchers with an opportunity to publish original research related to biomarkers in heart failure, both acute and chronic, with a particular focus on predictive, diagnostic or prognostic value of classic and novel biomarkers.

Dr. Nuria Farre
Guest Editor

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Keywords

Heart failure
Biomarkers
Prognosis
Treatment
Diagnosis
Epidemiology
Hospitalization

Published Papers (7 papers)

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Research

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12 pages, 1604 KiB

Open AccessArticle

Impact of Daily Bedside Echocardiographic Assessment on Readmissions in Acute Heart Failure: A Randomized Clinical Trial

by Jean-Etienne Ricci, Sylvain Aguilhon, Bob-Valéry Occean, Camille Soullier, Kamila Solecki, Christelle Robert, Fabien Huet, Luc Cornillet, Laurent Schmutz, Thierry Chevallier, Mariama Akodad, Florence Leclercq, Guillaume Cayla, Benoît Lattuca and François Roubille

J. Clin. Med. 2022, 11(7), 2047; https://doi.org/10.3390/jcm11072047 - 6 Apr 2022

Viewed by 1608

Abstract

Acute heart failure (AHF) management is challenging, with high morbidity and readmission rates. There is little evidence of the benefit of HF monitoring during hospitalization. The aim of the study was to assess whether daily bedside echocardiographic monitoring (JetEcho) improved outcomes in AHF. In this prospective, open, two parallel-arm study (clinicaltrials.gov: NCT02892227), participants from two university hospitals were randomized to either standard of care (SC) or daily treatment adjustment including diuretics guided by JetEcho evaluating left ventricular filling pressure and volemia. The primary outcome was 30-day readmission rate. Key secondary outcomes were six-month cumulative incidence death, worsening HF during hospitalization and increasing of myocardial and renal biomarkers. From 250 included patients, 115 were finally analyzed in JetEcho group and 112 in SC group. Twenty-two (19%) patients were readmitted within 30 days in JetEcho group and 17 (15%) in SC group (relative risk [RR] 1.26; 95% confidence interval [CI], 0.70–2.24; p = 0.4). Worsening HF occurred in 17 (14%) patients in the JetEcho group and 24 (20%) in the SC group (RR 0.7; 95% [CI] 0.39 to 1.2; p = 0.2). No significant difference was found between the two groups concerning natriuretic peptides and renal function (p > 0.05 for all). The cumulative incidence rate of death from any cause at six months from discharge was 8.7% in the JetEcho group and 11.6% in the SC group (HR 0.63, 95% [CI] 0.3–1.4, p = 0.3). In AHF patients, a systematic daily bedside echocardiographic monitoring did not reduce 30-day readmission rate for HF and short-term clinical outcomes. Full article

(This article belongs to the Special Issue Acute and Chronic Heart Failure: Biomarkers-Guided Therapy and Clinical Management)

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10 pages, 2663 KiB

Open AccessEditor’s ChoiceArticle

Association between C-Reactive Protein Velocity and Left Ventricular Function in Patients with ST-Elevated Myocardial Infarction

by Ariel Banai, Dana Levit, Samuel Morgan, Itamar Loewenstein, Ilan Merdler, Aviram Hochstadt, Yishay Szekely, Yan Topilsky, Shmuel Banai and Yacov Shacham

J. Clin. Med. 2022, 11(2), 401; https://doi.org/10.3390/jcm11020401 - 13 Jan 2022

Cited by 11 | Viewed by 1442

Abstract

C-reactive protein velocity (CRPv), defined as the change in wide-range CRP concentration divided by time, is an inflammatory biomarker associated with increased morbidity and mortality in patients with ST elevation myocardial infarction (STEMI) treated with primary percutaneous intervention (PCI). However, data regarding CRPv association with echocardiographic parameters assessing left ventricular systolic and diastolic function is lacking. Echocardiographic parameters and CRPv values were analyzed using a cohort of 1059 patients admitted with STEMI and treated with primary PCI. Patients were stratified into tertiles according to their CRPv. A receiver operating characteristic (ROC) curve was used to evaluate CRPv optimal cut-off values for the prediction of severe systolic and diastolic dysfunction. Patients with high CRPv tertiles had lower left ventricular ejection fraction (LVEF) (49% vs. 46% vs. 41%, respectively; p < 0.001). CRPv was found to independently predict LVEF ≤ 35% (HR 1.3 CI 95% 1.21–1.4; p < 0.001) and grade III diastolic dysfunction (HR 1.16 CI 95% 11.02–1.31; p = 0.02). CRPv exhibited a better diagnostic profile for severe systolic dysfunction as compared to CRP (area under the curve 0.734 ± 0.02 vs. 0.608 ± 0.02). In conclusion, For STEMI patients treated with primary PCI, CRPv is a marker of both systolic and diastolic dysfunction. Further larger studies are needed to support this finding. Full article

(This article belongs to the Special Issue Acute and Chronic Heart Failure: Biomarkers-Guided Therapy and Clinical Management)

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10 pages, 834 KiB

Open AccessArticle

Determinants of In-Hospital Mortality in Elderly Patients Aged 80 Years or above with Acute Heart Failure: A Retrospective Cohort Study at a Single Rural Hospital

by Yusuke Watanabe, Kazuko Tajiri, Hiroyuki Nagata and Masayuki Kojima

J. Clin. Med. 2021, 10(7), 1468; https://doi.org/10.3390/jcm10071468 - 2 Apr 2021

Cited by 3 | Viewed by 1644

Abstract

Heart failure is one of the leading causes of mortality worldwide. Several predictive risk scores and factors associated with in-hospital mortality have been reported for acute heart failure. However, only a few studies have examined the predictors in elderly patients. This study investigated determinants of in-hospital mortality in elderly patients with acute heart failure, aged 80 years or above, by evaluating the serum sodium, blood urea nitrogen, age and serum albumin, systolic blood pressure and natriuretic peptide levels (SOB-ASAP) score. We reviewed the medical records of 106 consecutive patients retrospectively and classified them into the survivor group (n = 83) and the non-survivor group (n = 23) based on the in-hospital mortality. Patient characteristics at admission and during hospitalization were compared between the two groups. Multivariate stepwise regression analysis was used to evaluate the in-hospital mortality. The SOB-ASAP score was significantly better in the survivor group than in the non-survivor group. Multivariate stepwise regression analysis revealed that a poor SOB-ASAP score, oral phosphodiesterase 3 inhibitor use, and requirement of early intravenous antibiotic administration were associated with in-hospital mortality in very elderly patients with acute heart failure. Severe clinical status might predict outcomes in very elderly patients. Full article

(This article belongs to the Special Issue Acute and Chronic Heart Failure: Biomarkers-Guided Therapy and Clinical Management)

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11 pages, 978 KiB

Open AccessArticle

Impact of Canagliflozin in Patients with Type 2 Diabetes after Hospitalization for Acute Heart Failure: A Cohort Study

by Ernesto Martín, José López-Aguilera, Rafael González-Manzanares, Manuel Anguita, Guillermo Gutiérrez, Aurora Luque, Nick Paredes, Jesús Oneto, Jorge Perea and Juan Carlos Castillo

J. Clin. Med. 2021, 10(3), 505; https://doi.org/10.3390/jcm10030505 - 1 Feb 2021

Cited by 7 | Viewed by 2878

Abstract

Background: Heart failure (HF) is one of the mayor contributors to cardiovascular morbidity and mortality in patients with diabetes. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated to reduce the risk of hospitalization for HF in patients with type 2 diabetes mellitus (T2D). We aimed to assess the risk for re-hospitalization in a cohort of patients hospitalized for HF according to whether or not they received canagliflozin at discharge, as well as changes in N-terminal pro–B-type natriuretic peptide (NT-ProBNP) concentration during follow-up. Methods: We conducted a retrospective longitudinal study at a tertiary centre including 102 consecutive T2D patients discharged for acute HF without contraindication for SGLT2 inhibitors. We compared adverse clinical events (HF rehospitalization and cardiovascular death) and NT-ProBNP changes according to canagliflozin prescription at discharge. Results: Among the 102 patients included, 45 patients (44.1%) were prescribed canagliflozin and the remaining 57 (55.9%) were not prescribed any SGLT2 inhibitors (control group). After a median follow-up of 22 months, 45 patients (44.1%) were hospitalized for HF. Most of the rehospitalizations occurred during the first year (37.3%). HF readmission at first year occurred in 10 patients (22.2%) in the canagliflozin group and 29 patients (49.1%) in the control group (hazard ratio (HR): 0.45; 95% confidence interval (CI): 0.21–0.96; p < 0.039). A composite outcome of hospitalization for HF or death from cardiovascular causes was lower in the canagliflozin group (37.8%) than in the control group (70.2%) (HR: 0.51; 95% CI: 0.27–0.95; p < 0.035). Analysis of NT-ProBNP concentration showed an interaction between canagliflozin therapy and follow-up time (p = 0.002). Conclusions: Canagliflozin therapy at discharge was associated with a lower risk of readmission for HF and a reduction in NT-ProBNP concentration in patients with diabetes after hospitalization for HF. Full article

(This article belongs to the Special Issue Acute and Chronic Heart Failure: Biomarkers-Guided Therapy and Clinical Management)

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14 pages, 1497 KiB

Open AccessArticle

Prognostic Implications of Chronic Heart Failure and Utility of NT-proBNP Levels in Heart Failure Patients with SARS-CoV-2 Infection

by Laia C. Belarte-Tornero, Sandra Valdivielso-Moré, Miren Vicente Elcano, Eduard Solé-González, Sonia Ruíz-Bustillo, Alicia Calvo-Fernández, Isaac Subinara, Paula Cabero, Cristina Soler, Héctor Cubero-Gallego, Beatriz Vaquerizo and Núria Farré

J. Clin. Med. 2021, 10(2), 323; https://doi.org/10.3390/jcm10020323 - 17 Jan 2021

Cited by 17 | Viewed by 2273

Abstract

Background: The prevalence and prognostic value of chronic heart failure (CHF) in the setting of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has seldom been studied. The aim of this study was to analyze the prevalence and prognosis of CHF in this setting. Methods: This single-center study included 829 consecutive patients with SARS-CoV-2 infection from February to April 2020. Patients with a previous history of CHF were matched 1:2 for age and sex. We analyze the prognostic value of pre-existing CHF. Prognostic implications of N terminal pro brain natriuretic peptide (NT-proBNP) levels on admission in the CHF cohort were explored. Results: A total of 129 patients (43 CHF and 86 non-CHF) where finally included. All-cause mortality was higher in CHF patients compared to non-CHF patients (51.2% vs. 29.1%, p = 0.014). CHF was independently associated with 30-day mortality (hazard ratio (HR) 2.3, confidence interval (CI) 95%: 1.26–2.4). Patients with CHF and high-sensitivity troponin T < 14 ng/L showed excellent prognosis. An NT-proBNP level > 2598 pg/mL on admission was associated with higher 30-day mortality in patients with CHF. Conclusions: All-cause mortality in CHF patients hospitalized due to SARS-CoV-2 infection was 51.2%. CHF was independently associated with all-cause mortality (HR 2.3, CI 95% 1.26–4.2). NT-proBNP levels could be used for stratification risk purposes to guide medical decisions if larger studies confirm this finding. Full article

(This article belongs to the Special Issue Acute and Chronic Heart Failure: Biomarkers-Guided Therapy and Clinical Management)

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9 pages, 621 KiB

Open AccessArticle

Glasgow-Blatchford Score Predicts Post-Discharge Gastrointestinal Bleeding in Hospitalized Patients with Heart Failure

by Yu Hotsuki, Yu Sato, Akiomi Yoshihisa, Koichiro Watanabe, Yusuke Kimishima, Takatoyo Kiko, Tetsuro Yokokawa, Tomofumi Misaka, Takamasa Sato, Takashi Kaneshiro, Masayoshi Oikawa, Atsushi Kobayashi, Takayoshi Yamaki, Hiroyuki Kunii, Kazuhiko Nakazato and Yasuchika Takeishi

J. Clin. Med. 2020, 9(12), 4083; https://doi.org/10.3390/jcm9124083 - 17 Dec 2020

Cited by 2 | Viewed by 2105

Abstract

Background: The Glasgow-Blatchford Score (GBS) is one of the most widely used scoring systems for predicting clinical outcomes for gastrointestinal bleeding (GIB). However, the clinical significance of the GBS in predicting GIB in patients with heart failure (HF) remains unclear. Methods and Results: We conducted a prospective observational study in which we collected the clinical data of a total of 2236 patients (1130 men, median 70 years old) who were admitted to Fukushima Medical University Hospital for acute decompensated HF. During the post-discharge follow-up period of a median of 1235 days, seventy-eight (3.5%) patients experienced GIB. The GBS was calculated based on blood urea nitrogen, hemoglobin, systolic blood pressure, heart rate, and history of hepatic disease. The survival classification and regression tree analysis revealed that the accurate cut-off point of the GBS in predicting post-discharge GIB was six points. The patients were divided into two groups: the high GBS group (GBS > 6, n = 702, 31.4%) and the low GBS group (GBS ≤ 6, n = 1534, 68.6%). The Kaplan–Meier analysis showed that GIB rates were higher in the high GBS group than in the low GBS group. Multivariate Cox proportional hazards analysis adjusted for age, malignant tumor, and albumin indicated that a high GBS was an independent predictor of GIB (hazards ratio 2.258, 95% confidence interval 1.326–3.845, p = 0.003). Conclusions: A high GBS is an independent predictor and useful risk stratification score of post-discharge GIB in patients with HF. Full article

(This article belongs to the Special Issue Acute and Chronic Heart Failure: Biomarkers-Guided Therapy and Clinical Management)

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Review

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18 pages, 1507 KiB

Open AccessReview

Diagnosis and Management of Heart Failure in Elderly Patients from Hospital Admission to Discharge: Position Paper

by Thibaud Damy, Tahar Chouihed, Nicholas Delarche, Gilles Berrut, Patrice Cacoub, Patrick Henry, Nicholas Lamblin, Emmanuel Andrès and Olivier Hanon

J. Clin. Med. 2021, 10(16), 3519; https://doi.org/10.3390/jcm10163519 - 10 Aug 2021

Cited by 5 | Viewed by 3837

Abstract

Multidisciplinary management of worsening heart failure (HF) in the elderly improves survival. To ensure patients have access to adequate care, the current HF and French health authority guidelines advise establishing a clearly defined HF patient pathway. This pathway involves coordinating multiple disciplines to manage decompensating HF. Yet, recent registry data indicate that insufficient numbers of patients receive specialised cardiology care, which increases the risk of rehospitalisation and mortality. The patient pathway in France involves three key stages: presentation with decompensated HF, stabilisation within a hospital setting and transitional care back out into the community. In each of these three phases, HF diagnosis, severity and precipitating factors need to be promptly identified and managed. This is particularly pertinent in older, frail patients who may present with atypical symptoms or coexisting comorbidities and for whom geriatric evaluation may be needed or specific geriatric syndrome management implemented. In the transition phase, multi-professional post-discharge management must be coordinated with community health care professionals. When the patient is discharged, HF medication must be optimised, and patients educated about self-care and monitoring symptoms. This review provides practical guidance to clinicians managing worsening HF in the elderly. Full article

(This article belongs to the Special Issue Acute and Chronic Heart Failure: Biomarkers-Guided Therapy and Clinical Management)

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