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Acute and Chronic Heart Failure: Pathophysiology and New Therapeutic Developments

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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: 31 August 2024 | Viewed by 5365

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Special Issue Editors

Dr. Serafino Fazio

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Guest Editor

Retired Professor of Internal Medicine, Federico II University School of Medicine, Naples, Italy
Interests: hormones and heart; cardiac failure; insulin resistance; hyperinsulinism; metabolic syndrome; nutraceuticals; pulmonary arterial hypertension; COVID-19

Dr. Valentina Mercurio

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Guest Editor

Department of Translational Medical Sciences, Federico II University, Naples, Italy
Interests: heart failure; echocardiography; right ventricular function; pulmonary vascular disease; pulmonary arterial hypertension; cardio-oncology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Despite the considerable progress in the prevention and treatment of heart disease, heart failure is still a very important cause of recurring hospitalizations, with relevant social and health care costs, and it is burdened with a significant mortality. Notably, while advances in the treatment of acute coronary syndromes with myocardial revascularization and the increased awareness in the management of cardiovascular risk factors have improved the survival of patients with ischemic heart disease, there has been a progressive increase in the number of patients with chronic heart failure.

Heart failure can result from alterations in both the left and right ventricles, which can be not only due to ischemic heart disease but also to other causes, such as valvular abnormalities, systemic hypertension, pulmonary vascular disease, etc. It is also noteworthy, not only for treatment purposes, to highlight the recent increase in the incidence of heart failure with reduced ejection fraction and that with preserved ejection fraction. Lately, there has also been an effort to improve the follow up of patients with heart failure with telemedicine, in order to reduce the number of hospital admissions and. thus, possibly, social and health care costs.

Therefore, we consider “Heart Failure” an extremely up-to-date and broad topic for which a Special Issue is certainly relevant.

Dr. Serafino Fazio
Dr. Valentina Mercurio
Guest Editors

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Keywords

heart failure with reduced ejection fraction
heart failure with preserved ejection fraction
pathophysiological novelties
treatment advances
pulmonary arterial hypertension
at-home follow up of patients with heart failure

Published Papers (4 papers)

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Research

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13 pages, 1628 KiB

Open AccessArticle

Three-Dimensional Combined Atrioventricular Coupling Index—A Novel Prognostic Marker in Dilated Cardiomyopathy

by Aura Vîjîiac, Alina Ioana Scărlătescu, Ioana Gabriela Petre, Cristian Vîjîiac and Radu Gabriel Vătășescu

Biomedicines 2024, 12(2), 302; https://doi.org/10.3390/biomedicines12020302 - 28 Jan 2024

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Abstract

Atrioventricular coupling has recently emerged as an outcome predictor. Our aim was to assess, through three-dimensional (3D) echocardiography, the role of the left atrioventricular coupling index (LACI), right atrioventricular coupling index (RACI) and a novel combined atrioventricular coupling index (CACI) in a cohort of patients with dilated cardiomyopathy (DCM). One hundred twenty-one consecutive patients with DCM underwent comprehensive 3D echocardiographic acquisitions. LACI was defined as the ratio between left atrial and left ventricular 3D end-diastolic volumes. RACI was defined as the ratio between right atrial and right ventricular 3D end-diastolic volumes. CACI was defined as the sum of LACI and RACI. Patients were prospectively followed for death, heart transplant, nonfatal cardiac arrest and hospitalization for heart failure. Fifty-five patients reached the endpoint. All three coupling indices were significantly more impaired in patients with events, with CACI showing the highest area under the curve (AUC = 0.66, p = 0.003). All three indices were independent outcome predictors when tested in multivariable Cox regression (HR = 2.62, p = 0.01 for LACI; HR = 2.58, p = 0.004 for RACI; HR = 2.37, p = 0.01 for CACI), but only CACI showed an incremental prognostic power over traditional risk factors such as age, left ventricular strain, right ventricular strain and mitral regurgitation severity (likelihood ratio χ² test = 28.2, p = 0.03). CACI assessed through 3D echocardiography, reflecting both left and right atrioventricular coupling, is an independent predictor of adverse events in DCM, yielding an incremental prognostic power over traditional risk factors. Full article

(This article belongs to the Special Issue Acute and Chronic Heart Failure: Pathophysiology and New Therapeutic Developments)

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12 pages, 1317 KiB

Open AccessArticle

Association between Serum Free Fatty Acids and Clinical and Laboratory Parameters in Acute Heart Failure Patients

by Iva Klobučar, Helga Hinteregger, Margarete Lechleitner, Matias Trbušić, Gudrun Pregartner, Andrea Berghold, Wolfgang Sattler, Saša Frank and Vesna Degoricija

Biomedicines 2023, 11(12), 3197; https://doi.org/10.3390/biomedicines11123197 - 1 Dec 2023

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Abstract

Very little is known about the association between individual serum free fatty acids (FFAs) and clinical and laboratory parameters (indicators of heart failure severity) in acute heart failure (AHF) patients. Here, the baseline serum levels of FFAs, 16:0 (palmitic acid), 16:1 (palmitoleic acid), 18:0 (stearic acid), 18:1 (oleic acid), 18:2 (linoleic acid), 18:3 (alpha-linolenic acid or gamma-linolenic acid), 20:4 (arachidonic acid), 20:5 (eicosapentaenoic acid), and 22:6 (docosahexaenoic acid), were determined in 304 AHF patients (94.7% belonged to New York Heart Association functional class IV) using gas chromatography. Spearman correlation coefficients were used to examine the associations between the individual and total (the sum of all FFAs) FFAs and clinical and laboratory parameters. After applying a Bonferroni correction to correct for multiple testing, the total FFAs, as well as the individual FFAs (except FFAs 18:0, 20:5, and 22:6), were found to be significantly positively correlated with serum albumin. Only a few additional associations were found: FFA 16:0 was significantly negatively correlated with systolic pulmonary artery pressure, FFA 18:3 was significantly negatively correlated with C-reactive protein and body mass index, and FFA 20:4 was significantly negatively correlated with blood urea nitrogen. Based on our results, we conclude that in patients with severe AHF, individual and total serum FFAs are slightly associated with established laboratory and clinical parameters, which are indicators of heart failure severity. Full article

(This article belongs to the Special Issue Acute and Chronic Heart Failure: Pathophysiology and New Therapeutic Developments)

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14 pages, 3822 KiB

Open AccessArticle

Role of Pericytes in Cardiomyopathy-Associated Myocardial Infarction Revealed by Multiple Single-Cell Sequencing Analysis

by Yanqiao Lu, Huanhuan Huo, Feng Liang, Jieyuan Xue, Liang Fang, Yutong Miao, Lan Shen and Ben He

Biomedicines 2023, 11(11), 2896; https://doi.org/10.3390/biomedicines11112896 - 26 Oct 2023

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Abstract

Acute myocardial infarction (AMI) is one of the leading causes of cardiovascular death worldwide. AMI with cardiomyopathy is accompanied by a poor long-term prognosis. However, limited studies have focused on the mechanism of cardiomyopathy associated with AMI. Pericytes are important to the microvascular function in the heart, yet little attention has been paid to their function in myocardial infarction until now. In this study, we integrated single-cell data from individuals with cardiomyopathy and myocardial infarction (MI) GWAS data to reveal the potential function of pericytes in cardiomyopathy-associated MI. We found that pericytes were concentrated in the left atrium and left ventricle tissues. DLC1/GUCY1A2/EGFLAM were the top three uniquely expressed genes in pericytes (p < 0.05). The marker genes of pericytes were enriched in renin secretion, vascular smooth muscle contraction, gap junction, purine metabolism, and diabetic cardiomyopathy pathways (p < 0.05). Among these pathways, the renin secretion and purine metabolism pathways were also found in the process of MI. In cardiomyopathy patients, the biosynthesis of collagen, modulating enzymes, and collagen formation were uniquely negatively regulated in pericytes compared to other cell types (p < 0.05). COL4A2/COL4A1/SMAD3 were the hub genes in pericyte function involved in cardiomyopathy and AMI. In conclusion, this study provides new evidence about the importance of pericytes in the pathogenesis of cardiomyopathy-associated MI. DLC1/GUCY1A2/EGFLAM were highly expressed in pericytes. The hub genes COL4A2/COL4A1/SMAD3 may be potential research targets for cardiomyopathy-associated MI. Full article

(This article belongs to the Special Issue Acute and Chronic Heart Failure: Pathophysiology and New Therapeutic Developments)

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13 pages, 643 KiB

Open AccessOpinion

The Negative Impact of Insulin Resistance/Hyperinsulinemia on Chronic Heart Failure and the Potential Benefits of Its Screening and Treatment

by Serafino Fazio, Valentina Mercurio, Flora Affuso and Paolo Bellavite

Biomedicines 2023, 11(11), 2928; https://doi.org/10.3390/biomedicines11112928 - 30 Oct 2023

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Abstract

This opinion article highlights the potential alterations caused by insulin resistance and hyperinsulinemia on the cardiovascular system and their negative impact on heart failure (HF), and describes the potential benefits of an early screening with consequent prompt treatment. HF is the final event of several different cardiovascular diseases. Its incidence has been increasing over the last decades because of increased survival from ischemic heart disease thanks to improvements in its treatment (including myocardial revascularization interventions) and the increase in life span. In particular, incidence of HF with preserved ejection fraction (HFpEF) is significantly increasing, and patients with HFpEF often are also affected by diabetes mellitus and insulin resistance (IR), with a prevalence > 45%. Concentric left ventricular (LV) remodeling and diastolic dysfunction are the main structural abnormalities that characterize HFpEF. It is well documented in the literature that IR with chronic hyperinsulinemia, besides causing type 2 diabetes mellitus, can cause numerous cardiovascular alterations, including endothelial dysfunction and increased wall thicknesses of the left ventricle with concentric remodeling and diastolic dysfunction. Therefore, it is conceivable that IR might play a major role in the pathophysiology and the progressive worsening of HF. To date, several substances have been shown to reduce IR/hyperinsulinemia and have beneficial clinical effects in patients with HF, including SGLT2 inhibitors, metformin, and berberine. For this reason, an early screening of IR could be advisable in subjects at risk and in patients with heart failure, to promptly intervene with appropriate therapy. Future studies aimed at comparing the efficacy of the substances used both alone and in association are needed. Full article

(This article belongs to the Special Issue Acute and Chronic Heart Failure: Pathophysiology and New Therapeutic Developments)

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