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Better Management of Heart Failure: Contemporary Strategy and Future Perspective

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Dear Colleagues,

Heart failure (HF) refers to a complex clinical syndrome, which affects millions of people all over the world. Currently, research suggests optimizing guideline-directed medical therapy to reduce the risk of death and hospitalization due to HF. However, there remains several knowledge gaps concerning which interventions and cares contribute to the better management of HF.

Given the circumstances, we would like to organize a Special Issue entitled “Better Management of Heart Failure: Contemporary Strategy and Future Perspective” in Journal of Clinical Medicine, to invite original clinical research, meta-analyses, and state-of-the-art reviews related to diagnostics and therapeutics in the whole spectrum of heart failure and related medical issues. We welcome your submissions to advance the field of HF.

Prof. Dr. Koichi Node
Dr. Atsushi Tanaka
Guest Editors

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Keywords

heart failure (HF)
diagnosis
risk prediction
guideline-directed medical therapy
intervention
better management
prognosis

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14 pages, 1804 KiB

Open AccessArticle

Myocardial Work Assessment in Patients after Coronary Artery Bypass Grafting during Cardiac Rehabilitation

by Francesco Perone, Roberta Ancona, Fausto di Stasio, Vito La Gambina and Salvatore Comenale Pinto

J. Clin. Med. 2023, 12(24), 7540; https://doi.org/10.3390/jcm12247540 - 06 Dec 2023

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Abstract

Background: Myocardial work is an innovative echocardiographic tool to assess left ventricular performance. Emerging data have shown the added value of this method for evaluating cardiac function compared to traditional echocardiographic parameters and global longitudinal strain. However, few studies are present in the literature about the role of myocardial work during cardiac rehabilitation. Our aim was to assess the impact of a rehabilitation program on myocardial work indices in patients with preserved left ventricular ejection fraction and after coronary artery bypass grafting. In addition, we assessed the correlation between baseline myocardial work indices and their change after cardiac rehabilitation, establishing an optimal cut-off value to predict the improvement. Methods: An observational, single-center, and prospective study was conducted. We enrolled patients referred to cardiac rehabilitation after coronary artery bypass grafting and with preserved left ventricular ejection fraction. Before and after the cardiac rehabilitation program, a comprehensive patient assessment was performed, including traditional transthoracic echocardiography, myocardial work analysis, and a six-minute walk test. Results: Eighty-four patients were enrolled; the mean age was 67.96 (±7.42) years and 78.6% were male. The left ventricular ejection fraction was preserved in all patients, and the global longitudinal strain was −16.18 ± 2.55%, the global work index was 1588.56 ± 345 mmHg%, the global constructive work was 1771.27 ± 366.36 mmHg%, the global wasted work was 105.8 ± 72.02 mmHg%, and the global work efficiency was 92.63 ± 3.9% at baseline. After the cardiac rehabilitation program, the global work index, the global constructive work, and the six-minute walk test improved significantly (1588.56 ± 345 vs. 1960.2 ± 377.03 mmHg%, p-value < 0.001; 1771.27 ± 366.36 vs. 2172.01 ± 418.73 mmHg%, p-value < 0.001; 70.71 ± 40.2 vs. 437.5 ± 108.70 m, p-value < 0.001, respectively). Conclusions: Myocardial work indices, specifically global work index and global constructive work, improve after cardiac rehabilitation program in patients undergoing coronary artery bypass grafting with preserved left ventricular ejection fraction. Full article

(This article belongs to the Special Issue Better Management of Heart Failure: Contemporary Strategy and Future Perspective)

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12 pages, 1946 KiB

Open AccessArticle

The Influence of Food Intake and Preload Augmentation on Cardiac Functional Parameters: A Study Using Both Cardiac Magnetic Resonance and Echocardiography

by Lasse Visby, Rasmus Møgelvang, Frederik Fasth Grund, Katrine Aagaard Myhr, Christian Hassager, Niels Vejlstrup, Raj Mattu and Charlotte Burup Kristensen

J. Clin. Med. 2023, 12(21), 6781; https://doi.org/10.3390/jcm12216781 - 26 Oct 2023

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(1) Background: To investigate how food intake and preload augmentation affect the cardiac output (CO) and volumes of the left ventricle (LV) and right ventricle (RV) assessed using cardiac magnetic resonance (CMR) and trans-thoracic echocardiography (TTE). (2) Methods: Eighty-two subjects with (n = 40) and without (n = 42) cardiac disease were assessed using both CMR and TTE immediately before and after a fast infusion of 2 L isotonic saline. Half of the population had a meal during saline infusion (food/fluid), and the other half were kept fasting (fasting/fluid). We analyzed end-diastolic (EDV) and end-systolic (ESV) volumes and feature tracking (FT) using CMR, LV global longitudinal strain (GLS), and RV longitudinal strain (LS) using TTE. (3) Results: CO assessed using CMR increased significantly in both groups, and the increase was significantly higher in the food/fluid group: LV-CO (ΔLV-CO: +2.6 ± 1.3 vs. +0.7 ± 1.0 p < 0.001), followed by increased heart rate (HR) (ΔHR: +12 ± 8 vs. +1 ± 6 p < 0.001). LV and RV achieved increased stroke volume (SV) through different mechanisms. For the LV, through increased contractility, increased LV-EDV, decreased LV-ESV, increased LV-FT, and GLS were observed. For the RV, increased volumes, increased RV-EDV, increased RV-ESV, and at least for the fasting/fluid group, unchanged RV-FT and RV-LS were reported. (4) Conclusions: Preload augmentation and food intake have a significant impact on hemodynamic and cardiac functional parameters. This advocates for standardized recommendations regarding oral intake of fluid and food before cardiac assessment, for example, TTE, CMR, and right heart catheterization. We also demonstrate different approaches for the LV and RV to increase SV: for the LV by increased contractility, and for the RV by volume expansion. Full article

(This article belongs to the Special Issue Better Management of Heart Failure: Contemporary Strategy and Future Perspective)

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