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Clinical Frontiers in Heart Failure

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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 (20 June 2023) | Viewed by 15072

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Special Issue Editors

Prof. Dr. Mario J. Garcia

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Guest Editor

1. Cardiology Division, Montefiore Medical Center, Bronx, NY, USA
2. Albert Einstein College of Medicine, Bronx, NY, USA
Interests: early imaging biomarkers for heart diseases; novel imaging in the early diagnosis of heart failure for optimal medical management

Prof. Dr. Fatih Yalcin

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Guest Editor

Department of Cardiology, UCSF HEALTH, School of Medicine, Cardiac Imaging, San Francisco, CA, USA
Interests: stressed heart morphology; ultimate phases of hypertensive disease; hemodynamic stress and microscopic remodeling

Special Issue Information

Dear Colleagues,

Segmental analyses of geometric and functional cardiac tissue features could be beneficial for the early determination of cardiac diseases using novel cardiovascular imaging. Early stage remodeling is a comprehensive process and the details of progression to heart failure have recently been documented by microscopic ultrasonography. The remodeling process has been found to be correlated with hemodynamic stress and microscopic details of remodeling, which has contributed to the documentation of early and late phases of remodeling process.

Ultimate hypertensive heart disease phases have also been recently reported quantitatively. Stressed heart morphology, the new terminology for adaptive phase of remodeling, is developed by hemodynamic overload. These recent findings may support the importance of early geometric and functional findings of the adaptive phase to prevent maladaptation and heart failure.

This Special Issue of the Journal of Clinical Medicine aims to publish contributions from distinguished authors who actively experience innovations in the field and want to provide more solid scientific evidence. All researchers are invited to contribute original works and reviews (case reports and short reviews are not accepted).

Prof. Dr. Mario J. Garcia
Prof. Dr. Fatih Yalcin
Guest Editors

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Keywords

heart failure
early biomarkers
hypertensive heart disease
adaptive phase
maladaptation
novel imaging technologies
biomarkers for heart failure prognosis
optimal medical approach in the adaptive phase of remodeling
novel therapeutic options for heart failure
cardiac resynchronization therapy

Published Papers (10 papers)

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Editorial

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2 pages, 162 KiB

Open AccessEditorial

It Is Time to Focus on “Segmental Remodeling” with Validated Biomarkers as “Stressed Heart Morphology” in Prevention of Heart Failure

by Fatih Yalcin and Mario J. Garcia

J. Clin. Med. 2022, 11(14), 4180; https://doi.org/10.3390/jcm11144180 - 19 Jul 2022

Cited by 1 | Viewed by 911

Abstract

In cardiovascular medicine, hemodynamic stress with hypertension is a major risk [...] Full article

(This article belongs to the Special Issue Clinical Frontiers in Heart Failure)

Research

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15 pages, 2768 KiB

Open AccessArticle

Prognostic Value of Plasma Catestatin Concentration in Patients with Heart Failure with Reduced Ejection Fraction in Two-Year Follow-Up

by Łukasz Wołowiec, Joanna Banach, Jacek Budzyński, Anna Wołowiec, Mariusz Kozakiewicz, Maciej Bieliński, Albert Jaśniak, Agata Olejarczyk and Grzegorz Grześk

J. Clin. Med. 2023, 12(13), 4208; https://doi.org/10.3390/jcm12134208 - 22 Jun 2023

Viewed by 818

Abstract

The primary objective of the study was to evaluate the prognostic value of measuring plasma catestatin (CST) concentration in patients with heart failure with reduced ejection fraction (HFrEF) as a predictor of unplanned hospitalization and all-cause death independently and as a composite endpoint at 2-year follow-up. The study group includes 122 hospitalized Caucasian patients in NYHA classes II to IV. Patients who died during the 24-month follow-up period (n = 44; 36%) were significantly older on the day of enrollment, were more likely to be in a higher NYHA class, had lower TAPSE, hemoglobin concentration, hematocrit, and platelet count, higher concentrations of CST, NT-proBNP, troponin T, creatinine, and glucose, and higher red cell distribution width value and leukocyte and neutrocyte count than patients who survived the follow-up period. Plasma catestatin concentration increased with NYHA class (R = 0.58; p <0.001) and correlated significantly with blood NT-proBNP concentration (R = 0.44; p <0.001). We showed that higher plasma catestatin concentration increased the risk of all-cause death by more than five times. Plasma CST concentration is a valuable prognostic parameter in predicting death from all causes and unplanned hospitalization in patients with HFrEF. Full article

(This article belongs to the Special Issue Clinical Frontiers in Heart Failure)

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12 pages, 1074 KiB

Open AccessArticle

sST2 and Heart Failure—Clinical Utility and Prognosis

by Magdalena Dudek, Marta Kałużna-Oleksy, Jacek Migaj, Filip Sawczak, Helena Krysztofiak, Maciej Lesiak and Ewa Straburzyńska-Migaj

J. Clin. Med. 2023, 12(9), 3136; https://doi.org/10.3390/jcm12093136 - 26 Apr 2023

Cited by 3 | Viewed by 1338

Abstract

New parameters and markers are constantly being sought to help better assess patients with heart failure (HF). ST2 protein has gained interest as a potential biomarker in cardiovascular disease. It is known that the IL-33/ST2L system belongs to the cardioprotective pathway, which prevents the fibrosis, hypertrophy, and apoptosis of cardiomyocytes and also inhibits the inflammatory response. Soluble ST2 (sST2) is involved in the immune response and secreted in response to the mechanical overload of the myocardium, thus providing information on the processes of myocardial remodeling and fibrosis. A total of 110 hospitalized patients diagnosed with heart failure with reduced ejection fraction (HFrEF) were included in the study. Clinical and biochemical parameters were studied. During the follow-up, 30.9% patients died and 57.3% patients reached the composite endpoint. Using ROC curves, the reference cut-off point for sST2 was determined to be 45.818 pg/mL for all-cause deaths. Significantly higher concentrations of inflammatory parameters and natriuretic peptides were found in the group of patients with higher sST2 concentrations. sST2 protein is an independent risk factor for all-cause deaths of patients with HFrEF. Full article

(This article belongs to the Special Issue Clinical Frontiers in Heart Failure)

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10 pages, 518 KiB

Open AccessArticle

Isolated Subclinical Right Ventricle Systolic Dysfunction in Patients after Liver Transplantation

by Emel Celiker Guler, Mehmet Onur Omaygenc, Deniz Dilan Naki, Arzu Yazar, Ibrahim Oguz Karaca and Esin Korkut

J. Clin. Med. 2023, 12(6), 2289; https://doi.org/10.3390/jcm12062289 - 15 Mar 2023

Viewed by 1098

Abstract

Although hemodynamic alterations in end-stage liver disease (ESLD) and its association with porto-pulmonary hypertension have been well-established, the long-term effects of ESLD on RV systolic function in patients without porto-pulmonary hypertension remain disregarded. Here we aimed to assess the long-term effect of ESLD on RV function and its relationship with the use of NSBBs and clinical, laboratory and imaging parameters in end-stage liver disease. The use of NSBBs is still controversial due to concerns about reduced cardiac contractility and the possibility of increased mortality. Thirty-four liver transplant recipients were included. Demographic characteristics, laboratory and baseline echocardiography measures were obtained. Patients were recalled for transthoracic echocardiographic evaluation after transplantation. Right ventricle dysfunction was identified by having at least one value below the reference levels of RV S’, or TAPSE. Isolated subclinical RV dysfunction was observed at 20.6% of the sample population. The present study demonstrates hemodynamic circulation in cirrhosis and increased preload and afterload might have long-term effects on RV function, even the lack of porto-pulmonary hypertension. These findings underline the significance of cardiac function follow-up in cirrhotic patients after transplantation. In this study, patients treated with propranolol seemed to have better RV function and less gastrointestinal bleeding. We speculated that preoperative propranolol treatment might help preserve RV function by providing RAS suppression, improving endothelial function and hyperdynamic circulation seen in ESLD. This potential protective relationship between the use of propranolol and RV function might improve mortality or graft-failure during OLT and after liver transplantation in patients with cirrhosis. Full article

(This article belongs to the Special Issue Clinical Frontiers in Heart Failure)

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8 pages, 983 KiB

Open AccessArticle

Association between Remote Dielectric Sensing and Estimated Plasma Volume to Assess Body Fluid Distribution

by Teruhiko Imamura, Toshihide Izumida, Nikhil Narang, Hiroshi Onoda, Masaki Nakagaito, Shuhei Tanaka, Makiko Nakamura, Ryuichi Ushijima, Hayato Fujioka, Kota Kakeshita and Koichiro Kinugawa

J. Clin. Med. 2023, 12(2), 463; https://doi.org/10.3390/jcm12020463 - 06 Jan 2023

Cited by 1 | Viewed by 1142

Abstract

Background: Pulmonary congestion is quantified by a remote dielectric sensing (ReDS^TM) system, while systemic congestion is estimated by calculated plasma volume. The type of clinical patient profile as defined by the ReDS system and calculated plasma volume remains uncertain. Methods: Hospitalized patients with or without heart failure were included in this prospective study. On admission, ReDS values were measured and plasma volume status (PVS) was estimated using their body weight at the same time. Cutoffs of ReDS value and PVS were defined at 34% and −2.7%, respectively. The association between the two parameters was assessed. Results: A total of 482 patients (median 76 years, 288 men) were included. The median ReDS value was 28% (25%, 32%) and median PVS was −16.4% (−26.3%, −5.9%). Of the patients, 64 had high ReDS value (and low PVS) and 80 had high PVS (and low ReDS value). The high ReDS group had a higher prevalence of clinical heart failure with a more elevated echocardiographic E/e’ ratio, whereas the high PVS group had a higher prevalence of chronic kidney disease (p < 0.05 for all). Four out of a total of six patients with high ReDS value and high PVS had both heart failure and chronic kidney disease profiles. Conclusion: The combination of ReDS value and PVS was able to clinically stratify the types of body fluid distribution and patient profiles. Utilizing these tools may assist the clinician in constructing a therapeutic strategy for the at-risk hospitalized patient. Full article

(This article belongs to the Special Issue Clinical Frontiers in Heart Failure)

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15 pages, 1577 KiB

Open AccessArticle

Impact of SGLT2 Inhibitor Therapy on Right Ventricular Function in Patients with Heart Failure and Reduced Ejection Fraction

by Ivona Mustapic, Darija Bakovic, Zora Susilovic Grabovac and Josip A Borovac

J. Clin. Med. 2023, 12(1), 42; https://doi.org/10.3390/jcm12010042 - 21 Dec 2022

Cited by 8 | Viewed by 2470

Abstract

Background: The impact of sodium-glucose cotransporter-2 inhibitors (SGLT2is) in addition to optimal medical therapy (OMT) on the right ventricular (RV) systolic function using advanced echocardiographic analysis among outpatients with heart failure and a reduced ejection fraction (HFrEF) has thus far been poorly investigated. Methods: This was a single-center, prospective, single-blinded study in which an echocardiographic expert was blinded to the allocation of the treatment. A total of 36 outpatients with HFrEF were randomized to either OMT or OMT+SGLT2i. Both groups underwent an echocardiographic examination of the RV systolic function at the baseline and at the 3-month follow-up (3mFU). Results: The patients in both groups did not significantly differ with respect to the relevant baseline comorbidities, therapy, and clinical characteristics. The patients receiving OMT+SGLT2i showed a significant improvement from the baseline to the 3mFU in all the measured RV echocardiographic parameters, while for the OMT group, a significant improvement after the 3mFU was observed for TAPSE and s’. The mean percent change from the baseline to the 3mFU was significant when comparing OMT+SGLT2i to the OMT group concerning RV FWS (+91% vs. +28%, p = 0.039), TR maxPG (−27% vs. +19%, p = 0.005), and TR Vmax (−17% vs. +13%, p = 0.008), respectively. Conclusions: Adding SGLT2i to OMT in patients with HFrEF resulted in a greater improvement in the RV systolic function from the baseline to the 3mFU compared to the OMT alone. Full article

(This article belongs to the Special Issue Clinical Frontiers in Heart Failure)

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14 pages, 708 KiB

Open AccessArticle

Challenges for Management of Dilated Cardiomyopathy during COVID-19 Pandemic—A Telemedicine Application

by Luminita Iliuta, Andreea Gabriella Andronesi, Eugenia Panaitescu, Madalina Elena Rac-Albu, Alexandru Scafa-Udriște and Horațiu Moldovan

J. Clin. Med. 2022, 11(24), 7411; https://doi.org/10.3390/jcm11247411 - 14 Dec 2022

Cited by 3 | Viewed by 1497

Abstract

Background and Objectives: The 2019 coronavirus pandemic (COVID-19) represented a significant challenge for the medical community. The first aim of this study was to examine the COVID-19 impact on the follow-up of patients with dilated cardiomyopathy (DCM) and to establish the advantages of multiparametric home monitoring. Also, we tried to establish the main prognostic predictors at 2-years follow-up and the value of LV diastolic filling pattern (LVDFP) in increasing mortality and morbidity. Materials and Methods: We conducted a prospective study of 142 patients with DCM assessed by in-patient visit in the pre-pandemic period and hybrid (face-to-face, online consultation and telemedicine home monitoring with a dedicated application) during the pandemic period. The statistical analysis compared the strategy used in the pre-pandemic with management during the pandemic, in terms of clinical assessment, hospitalizations/emergency room visits due to HF exacerbation and total mortality. Results: We did not observe significant changes in blood pressure (BP), heart rate (FC), weight and symptoms or an increased rate of adverse drug events between the two periods. We successfully titrated HF medications with close monitoring of HF decompensations, which were similar in number, but were mostly managed at home during the pandemic. There was also no statistically significant difference in emergency room visits due to severe decompensated HF. Mortality in the first and second year of follow-up was between 12.0 and 13%, similar in the pre-pandemic and pandemic periods, but significantly higher in patients with restrictive LVDFP. Clinical improvement or stability after 2 years was more frequent in patients with nonrestrictive LVDFP. The main prognostic predictors at 1 and 2-years follow-up were: the restrictive LVDFP, significantly dilated LV, comorbidities (DM, COPD), older age, associated severe mitral regurgitation and pulmonary hypertension. Conclusions: The pandemic restrictions determined a marked decrease of the healthcare use, but no significant change in the clinical status of DCM patients under multiparametric home monitoring. At 2-years follow-up, the presence of the restrictive LVDFP was associated with an increased risk of death and with a worse clinical status in DCM patients. Full article

(This article belongs to the Special Issue Clinical Frontiers in Heart Failure)

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11 pages, 2419 KiB

Open AccessArticle

The Prognostic Role of Polysomnography Parameters in Heart Failure Patients with Previous Decompensation

by Elena Medvedeva, Lyudmila Korostovtseva, Mihail Bochkarev, Anastasiya Shumeiko, Aelita Berezina, Maria Simonenko, Yulia Sazonova, Andrey Kozlenok and Yurii Sviryaev

J. Clin. Med. 2022, 11(13), 3656; https://doi.org/10.3390/jcm11133656 - 24 Jun 2022

Cited by 1 | Viewed by 1197

Abstract

Background: Sleep-disordered breathing (SDB) is a widespread comorbidity in patients with chronic heart failure (HF) and may have a deleterious effect on the pathogenesis of HF. We aimed to evaluate the prognostic role of polysomnography parameters in HF patients with previous decompensation. Methods: 123 patients were included in the prospective cohort study. In addition to the standard examination, all patients underwent polysomnography (PSG). Results: The Kaplan–Meier analysis showed the incidence of the combined endpoint differs between LVEF categories ≤25.5% vs. >25.5% (χ² = 9.6, log rank p = 0.002), NTpro-BNP > 680 vs. ≤680 pg/mL (χ² = 12.7, log rank p = 0.001), VO₂peak categories <16 vs. ≥16 mL/min/kg (χ² = 14.2, log rank p = 0.001), VE/VCO₂ slope ≥38.5 vs. <38.5 (χ² = 14.5, log rank p = 0.001), wake after sleep onset >40 min vs. ≤40 min (χ² = 9.7, log rank p = 0.03), and sleep stage 2 (S₂) <44% vs. ≥44% (χ² = 12.4, log rank p = 0.001). Conclusion: Among the PSG parameters, WASO > 40 min and S₂ < 44% were associated with a combined endpoint in patients with previous decompensation of HF. Moreover, higher NT-proBNP and VE/VCO₂ slope, lower LVEF, and VO_2peak were also independent factors of a poor prognosis. Full article

(This article belongs to the Special Issue Clinical Frontiers in Heart Failure)

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Review

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15 pages, 2386 KiB

Open AccessReview

The Role of Novel Cardiac Imaging for Contemporary Management of Heart Failure

by Frank A. Flachskampf and Tomasz Baron

J. Clin. Med. 2022, 11(20), 6201; https://doi.org/10.3390/jcm11206201 - 20 Oct 2022

Viewed by 2257

Abstract

Heart failure is becoming the central problem in cardiology. Its recognition, differential diagnosis, and the monitoring of therapy are intimately coupled with cardiac imaging. Cardiac imaging has witnessed an explosive growth and differentiation, with echocardiography continuing as the first diagnostic step; the echocardiographic exam itself has become considerably more complex than in the last century, with the assessment of diastolic left ventricular function and strain imaging contributing important information, especially in heart failure. Very often, however, echocardiography can only describe the fact of functional impairment and morphologic remodeling, whereas further clarification of the underlying disease, such as cardiomyopathy, myocarditis, storage diseases, sarcoidosis, and others, remains elusive. Here, cardiovascular magnetic resonance and perfusion imaging should be used judiciously to arrive as often as possible at a clear diagnosis which ideally enables specific therapy. Full article

(This article belongs to the Special Issue Clinical Frontiers in Heart Failure)

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Other

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13 pages, 2688 KiB

Open AccessSystematic Review

Cardiomyopathy Associated with Right Ventricular Apical Pacing-Systematic Review and Meta-Analysis

by Andrzej Osiecki, Wacław Kochman, Klaus K. Witte, Małgorzata Mańczak, Robert Olszewski and Dariusz Michałkiewicz

J. Clin. Med. 2022, 11(23), 6889; https://doi.org/10.3390/jcm11236889 - 22 Nov 2022

Cited by 2 | Viewed by 1061

Abstract

AIMS: Bradyarrhythmias are potentially life-threatening medical conditions. The most widespread treatment for slow rhythms is artificial ventricular pacing. From the inception of the idea of artificial pacing, ventricular leads were located in the apex of the right ventricle. Right ventricular apical pacing (RVAP) was thought to have a deteriorating effect on left ventricular systolic function. The aim of this study was to systematically assess results of randomized controlled trials to determine the effects of right ventricular apical pacing on left ventricular ejection fraction (LVEF). Methods: we systematically searched the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases for studies evaluating the influence of RVAP on LVEF. Pooled mean difference (MD) with a 95% confidence interval (CI) was estimated using a random effect model. Results: 14 randomized controlled trials (RCTs) comprising 885 patients were included. In our meta-analysis, RVAP was associated with statistically significant left ventricular systolic function impairment as measured by LVEF. The mean difference between LVEF at baseline and after intervention amounted to 3.35% (95% CI: 1.80–4.91). Conclusion: our meta-analysis confirms that right ventricular apical pacing is associated with progressive deterioration of left ventricular systolic function. Full article

(This article belongs to the Special Issue Clinical Frontiers in Heart Failure)

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