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Medicina
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Heart Failure: Pathophysiology, Symptoms, Diagnosis and Treatment
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Heart Failure: Pathophysiology, Symptoms, Diagnosis and Treatment

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 20 June 2024 | Viewed by 5816

Special Issue Editors

Prof. Dr. Ioannis Ventoulis

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Guest Editor
Department of Occupational Therapy, Faculty of Health Sciences, University of Western Macedonia, Ptolemaida, Greece
Interests: heart failure; hypertrophic cardiomyopathy; cardiovascular; intensive care medicine; coronary care unit; emergency medicine
Dr. Vasileios Kamperidis

E-Mail Website
Guest Editor
1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
Interests: echocardiography; speckle tracking; myocardial function; stress echo; 3D echo; valvular heart disease; heart failure; thalassaemia; cardio-oncology; diabetes
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Heart failure is a complex clinical syndrome characterized by a constellation of symptoms and signs due to elevated intracardiac pressures and inadequate cardiac output as a result of a structural or functional abnormality of the heart. It is a heterogeneous clinical entity that arises from several different causes, encompasses many distinct phenotypes, and manifests with many clinical faces. Indeed, the clinical spectrum of heart failure is variable. Heart failure is often divided into either chronic or acute heart failure, which in turn can be further subdivided into new onset (de novo) heart failure, acute decompensated heart failure, acute pulmonary oedema, isolated right ventricular failure, and cardiogenic shock. According to echocardiographic criteria based on the measurement of left ventricular ejection fraction, heart failure can be classified into heart failure with preserved, mildly reduced, and reduced ejection fraction. Meanwhile, heart failure with improved left ventricular ejection fraction has recently emerged as a new separate clinical entity. There is also the New York Heart Association (NYHA) functional classification of heart failure, which is solely based on the severity of symptoms and the degree of limitation in physical activity. Based on the progressive natural course of heart failure, a classification scheme spanning from stage A to stage D has also been utilized. In this context, patients with advanced heart failure can be further stratified into seven profiles according to the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS).

Heart failure constitutes a growing public health problem with increasing overall incidence and prevalence, especially in Western societies, owing to the increased survival after myocardial infarction along with the ageing of the population and the rising burden of comorbidities. Considering the fact that it is one of the most common causes of hospital admission with high readmission rates, heart failure undoubtedly poses a major economic burden on healthcare systems. The untoward ramifications of heart failure cannot be overstated, bearing in mind that it accounts for considerable morbidity and mortality rates. Despite the progress in the field of diagnosis and Treatment of heart failure that has been achieved in recent decades, its prognosis still remains grim. It is associated with impaired functional capacity and reduced quality of life and survival. Nonetheless, in recent years, there have been landmark trials that seem to have changed the medical landscape by substantially altering the hitherto clinical practice and management.

Heart failure unequivocally represents an evolving scientific field that poses major challenges to clinicians and continues to draw increasing attention by researchers, since there are still evidence gaps in many aspects of this complex syndrome that await to be elucidated by active ongoing research.

In this regard, Medicina is launching a Special Issue entitled ‘‘Heart Failure: Pathophysiology, Symptoms, Diagnosis and Treatment’’. The title has been deliberately chosen to be general in nature in order to accommodate a wide range of topics, perspectives, current limitations and potential controversies that lie within the scope of heart failure.

The aim of this Special Issue is to enhance our current understanding and shed light on the evolving pathophysiological concepts of heart failure, discuss existing evidence, outline contemporary diagnostic and management approaches, address recent developments, and provide new insights in the field of heart failure. Accordingly, we are inviting colleagues from all over the world to submit their latest research, original studies, opinion articles, reviews, meta-analyses, case series, or interesting case reports.

We cordially believe that this Special Issue will allow the dissemination of the most recent knowledge about heart failure, inform daily clinical practice, provide a state-of-the-art overview of this ever-growing subject, highlight recent advances, address unresolved issues, and propose future directions for research on this crucial topic.

Prof. Dr. Ioannis Ventoulis
Dr. Vasileios Kamperidis
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Medicina is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • heart failure
  • chronic heart failure
  • acute heart failure
  • advanced heart failure
  • pathophysiology
  • biomarkers
  • guideline-directed medical therapy
  • multidisciplinary team management
  • mechanical circulatory support
  • palliative and supportive care

Published Papers (3 papers)

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13 pages, 684 KiB  
Article
Predictors of Higher Frequency of Atrial Fibrillation in Patients with Cardiac Resynchronization Therapy
by Aleksandra Grbović, Siniša Pavlović and Vasko Žugić
Medicina 2023, 59(12), 2178; https://doi.org/10.3390/medicina59122178 - 15 Dec 2023
Viewed by 793
Abstract
Background and Objectives: Cardiac resynchronization therapy (CRT) is one of the effective therapeutic options in the treatment of systolic heart failure (HF) with persistent symptoms. This prospective study was designed to determine whether CRT with biventricular pacing would reduce the risk of [...] Read more.
Background and Objectives: Cardiac resynchronization therapy (CRT) is one of the effective therapeutic options in the treatment of systolic heart failure (HF) with persistent symptoms. This prospective study was designed to determine whether CRT with biventricular pacing would reduce the risk of development of atrial fibrillation (AF) and to identify predictors for AF occurrence. Materials and Methods: The study population consisted of 126 patients, with a mean age of 63.8 ± 9.1 years, who were eligible for CRT with biventricular pacing. Inclusion criteria were left ventricular ejection fraction (LVEF) ≤ 35%, QRS duration ≥ 130 msec, and persistent HF symptoms of New York Heart Association (NYHA) II or III, despite optimal drug therapy. Patients were followed for a period of 24 months and were evaluated through clinical, electrocardiographic, and echocardiographic examination at baseline (prior to CRT implantation), as well as at 6 and 24 months post-implantation. At the end of follow-up, patients were divided into clinical responders and non-responders based on the following criteria: decrease in NYHA class ≥ I, increase in LVEF ≥ 10%, and reduction in QRS duration ≥ 20 msec. Results: At follow-up, CRT was associated with a significant increase in LVEF (20.6 ± 6.9% pre-implantation, 32.9 ± 9.3% 24 months after implantation; p < 0.001), reduction in left ventricular end-diastolic and end-systolic diameters, and decrease in QRS duration (167.6 ± 14.3 msec pre-implantation, 131.7 ± 11.7 msec 24 months after implantation; p < 0.001), while left atrial (LA) diameter was slightly increased (p = 0.070). The frequency of AF occurrence increased after two years of follow-up (52.4% to 56.9%, p < 0.001). Significant predictors of AF occurrence in our study population were response to CRT—AF more frequent in non-responders (B = 8.134; p < 0.001), LA diameter—AF more frequent with larger LA diameter (B = 0.813; p < 0.001), and coronary sinus (CS) lead position—AF more frequent with posterolateral in comparison with lateral CS lead position (B = 5.159; p = 0.005). Conclusions: The results of our study provide new data on AF predictors in patients with HF subjected to CRT. There remains a permanent need for new predictors, which might help in patient selection and improvement in response rate. Full article
(This article belongs to the Special Issue Heart Failure: Pathophysiology, Symptoms, Diagnosis and Treatment)
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Review

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25 pages, 738 KiB  
Review
Differences in Health-Related Quality of Life among Patients with Heart Failure
by Ioannis Ventoulis, Vasileios Kamperidis, Maria Roselle Abraham, Theodore Abraham, Antonios Boultadakis, Efthymios Tsioukras, Aikaterini Katsiana, Konstantinos Georgiou, John Parissis and Effie Polyzogopoulou
Medicina 2024, 60(1), 109; https://doi.org/10.3390/medicina60010109 - 06 Jan 2024
Viewed by 1303
Abstract
Heart failure (HF) is characterized by a progressive clinical course marked by frequent exacerbations and repeated hospitalizations, leading to considerably high morbidity and mortality rates. Patients with HF present with a constellation of bothersome symptoms, which range from physical to psychological and mental [...] Read more.
Heart failure (HF) is characterized by a progressive clinical course marked by frequent exacerbations and repeated hospitalizations, leading to considerably high morbidity and mortality rates. Patients with HF present with a constellation of bothersome symptoms, which range from physical to psychological and mental manifestations. With the transition to more advanced HF stages, symptoms become increasingly more debilitating, interfere with activities of daily living and disrupt multiple domains of life, including physical functioning, psychological status, emotional state, cognitive function, intimate relationships, lifestyle status, usual role activities, social contact and support. By inflicting profuse limitations in numerous aspects of life, HF exerts a profoundly negative impact on health-related quality of life (HRQOL). It is therefore not surprising that patients with HF display lower levels of HRQOL compared not only to the general healthy population but also to patients suffering from other chronic diseases. On top of this, poor HRQOL in patients with HF becomes an even greater concern considering that it has been associated with unfavorable long-term outcomes and poor prognosis. Nevertheless, HRQOL may differ significantly among patients with HF. Indeed, it has consistently been reported that women with HF display poorer HRQOL compared to men, while younger patients with HF tend to exhibit lower levels of HRQOL than their older counterparts. Moreover, patients presenting with higher New York Heart Association (NYHA) functional class (III–IV) have significantly more impaired HRQOL than those in a better NYHA class (I–II). Furthermore, most studies report worse levels of HRQOL in patients suffering from HF with preserved ejection fraction (HFpEF) compared to patients with HF with reduced ejection fraction (HFrEF) or HF with mildly reduced ejection fraction (HFmrEF). Last, but not least, differences in HRQOL have been noted depending on geographic location, with lower HRQOL levels having been recorded in Africa and Eastern Europe and higher in Western Europe in a recent large global study. Based on the observed disparities that have been invariably reported in the literature, this review article aims to provide insight into the underlying differences in HRQOL among patients with HF. Through an overview of currently existing evidence, fundamental differences in HRQOL among patients with HF are analyzed based on sex, age, NYHA functional class, ejection fraction and geographic location or ethnicity. Full article
(This article belongs to the Special Issue Heart Failure: Pathophysiology, Symptoms, Diagnosis and Treatment)
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14 pages, 921 KiB  
Review
The Optimal Management of Patients with Atrial Fibrillation and Acute Heart Failure in the Emergency Department
by Maria Velliou, Elias Sanidas, Antonis Diakantonis, Ioannis Ventoulis, John Parissis and Effie Polyzogopoulou
Medicina 2023, 59(12), 2113; https://doi.org/10.3390/medicina59122113 - 02 Dec 2023
Cited by 1 | Viewed by 3238
Abstract
Atrial fibrillation (AF) and acute heart failure (AHF) are two closely interrelated conditions that frequently coexist in a manifold manner, with AF serving either as the causative factor or as the consequence or even as an innocent bystander. The interplay between these two [...] Read more.
Atrial fibrillation (AF) and acute heart failure (AHF) are two closely interrelated conditions that frequently coexist in a manifold manner, with AF serving either as the causative factor or as the consequence or even as an innocent bystander. The interplay between these two clinical conditions is complex, given that they share common pathophysiological pathways and they can reciprocally exacerbate each other, thus triggering a vicious cycle that worsens the prognosis and increases the thromboembolic risk. The optimal management of AF in the context of AHF in the emergency department remains a challenge depending on the time onset, as well as the nature and the severity of the associated symptoms. Acute rate control, along with early rhythm control, when indicated, and anticoagulation represent the main pillars of the therapeutic intervention. The purpose of this review is to elucidate the pathophysiological link between AF and AHF and accordingly present a stepwise algorithmic approach for the management of AF in AHF patients in the emergency setting. Full article
(This article belongs to the Special Issue Heart Failure: Pathophysiology, Symptoms, Diagnosis and Treatment)
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