Chronic Heart Failure: From Molecular Mechanisms to Therapies Strategies

A special issue of Biomolecules (ISSN 2218-273X). This special issue belongs to the section "Molecular Medicine".

Deadline for manuscript submissions: 31 July 2025 | Viewed by 462

Special Issue Editors


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Guest Editor
1. Cardiology Department, Heart Institute, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
2. Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
3. Community Heart Failure Program, Cardiology Department, Bellvitge University Hospital, L’Hospitalet de Llobregat, Barcelona, Spain
4. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Salud Carlos III, 28029 Madrid, Spain
5. Department of Clinical Sciences, School of Medicine, University of Barcelona, Barcelona, Spain
Interests: chronic heart failure; eHealth; telemedicine; transitional care; chronic care model
Special Issues, Collections and Topics in MDPI journals

E-Mail Website
Guest Editor
1. Bio-Heart Cardiovascular Diseases Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
2. Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Instituto Salud Carlos III, 28029 Madrid, Spain
Interests: heart failure; iron metabolism; biomarkers; molecular pathways

Special Issue Information

Dear Colleagues,

Chronic heart failure (CHF) is a devastating syndrome with a very negative impact on mortality, morbidity, and the health-related quality of life of patients with this diagnosis. CHF also represents a challenge to healthcare systems due to its growing prevalence and to the rising medical resource use and expenditure associated with this syndrome.

The current understanding of its pathophysiology is based on the “neurohormonal hypothesis”, which states that CHF progression is promoted by the long-term maladaptive and deleterious effects of sustained neurohormonal activation in the heart and in the rest of the cardiovascular system. The inhibition of these neurohormonal systems has demonstrated a consistent reduction in morbidity and mortality in patients with systolic HF and is the basis of modern pharmacological treatment. However, these effective therapies have failed to promote a complete remission of symptoms and restore life expectancy in many patients.

This Special Issue will provide novel findings and innovations in the field of CHF pathophysiology, potential new biomarkers, and therapies. This understanding is essential for the development of early diagnostic tools, improved risk management strategies, and innovative prevention methods. A multidisciplinary and integrated management approach is essential to achieve such an ambitious challenge.

Dr. Josep Comín-Colet
Dr. Marta Tajes
Guest Editors

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Keywords

  • chronic heart failure
  • pathophysiology
  • comorbidities
  • new therapies
  • molecular pathways

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Published Papers (1 paper)

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Review

18 pages, 2505 KiB  
Review
The Functional and Imaging Implications of Left Bundle Branch Pacing in Ischemic Cardiomyopathy
by Fulvio Cacciapuoti, Ciro Mauro, Ilaria Caso, Salvatore Crispo, Rossella Gottilla, Valentina Capone, Saverio Ambrosino, Ciro Pirozzi, Orlando Munciguerra and Mario Volpicelli
Biomolecules 2025, 15(4), 489; https://doi.org/10.3390/biom15040489 - 26 Mar 2025
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Abstract
Heart failure with reduced ejection fraction due to ischemic cardiomyopathy remains a significant clinical challenge. Electrical conduction delays exacerbate symptoms by causing uncoordinated contractions, reducing pumping efficiency, and increasing mortality. Right ventricular pacing further worsens dyssynchrony, while resynchronization therapy improves outcomes but has [...] Read more.
Heart failure with reduced ejection fraction due to ischemic cardiomyopathy remains a significant clinical challenge. Electrical conduction delays exacerbate symptoms by causing uncoordinated contractions, reducing pumping efficiency, and increasing mortality. Right ventricular pacing further worsens dyssynchrony, while resynchronization therapy improves outcomes but has a high non-responder rate. Given these limitations, bundle branch pacing engages the heart’s conduction system, restoring synchronized contraction and enhancing cardiac function. This review examines the impact of left-bundle-branch-block-induced dyssynchrony, the role of advanced imaging in assessing ventricular function, and the clinical outcomes of bundle branch pacing in heart failure patients. Specifically, we explore the mechanical and hemodynamic effects of left bundle branch block, imaging techniques for dyssynchrony evaluation, and the comparative benefits of bundle branch pacing versus resynchronization therapy. Conduction delays impair function, increase myocardial stress, and worsen clinical outcomes. Advanced imaging plays a critical role in patient selection, identifying those most likely to benefit from conduction system pacing. By restoring electrical coordination, bundle branch pacing enhances ventricular function, reduces hospitalizations, and promotes reverse remodeling. It offers similar or superior benefits to conventional resynchronization therapy, regulates stress hormones, reduces oxidative damage, and improves calcium handling. Bundle branch pacing represents a significant advancement in heart failure management, but careful patient selection remains crucial. Future research should focus on optimizing implantation techniques and validating long-term benefits through large-scale clinical trials. Full article
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