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Clinical Management of Patients with Heart Failure

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiovascular Medicine".

Deadline for manuscript submissions: 24 November 2024 | Viewed by 6798

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Dr. Cristina Tudoran

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Department VII, Internal Medicine II, Discipline of Cardiology, University of Medicine and Pharmacy “Victor Babes” Timisoara, E. Murgu Square, Nr. 2, Timisoara, Romania
Interests: pulmonary hypertension; heart failure; heart rate variability; miocarditis; pericarditis; COVID-19; post-acute COVID-19 syndrome
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Dr. Larisa Anghel

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1. Internal Medicine Department, University of Medicine and Pharmacy , "Grigore T. Popa”, Iasi, Romania
2. Cardiology Department, Cardiovascular Diseases Institute "Prof. Dr. George I. M. Georgescu", Iași, Romania
Interests: heart failure; systemic hypertension; acute and chronic coronary syndrome; arrhythmias; management of patients with cardiovascular diseases; cardiovascular risk factors
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Heart failure is among the leading causes for increased morbidity and mortality worldwide, also leading to increased costs for healthcare systems. It evolves with repeated episodes of decompensation, representing one of the most frequent reasons for hospitalization at cardiology or internal medicine units, but also aggravating the course of other pathologies. Even in its more stable form, chronic heart failure may affect patients' wellbeing and quality of life, impacting their level of activity and reducing their possibility of self-care, as well as generating socio-economic consequences for the diseased persons and their families. The onset of heart failure is frequently subtle and unexpected, and this pathology can progress slowly, remaining unnoticed for several years. When patients seek specialized medical advice, it is often too late to obtain optimal results because several complications and associated co-morbidities are already present, and the most appropriate recommended management must be adapted to their clinical conditions.

Over the last decade, along with the progress in fundamental sciences and pharmacotherapy, and the prodigious efforts of the cardiology societies and healthcare systems worldwide, new therapeutic methods have been developed and the availability of specialized medical care for the general population has increased, leading to a better management of patients with heart failure and an increased life-expectancy of these subjects. Although a variety of new treatment options are available, starting with innovative drugs and continuing with invasive procedures, along with lifestyle change measures, selecting the most appropriate management strategy for heart failure is difficult, raising challenges for medical personnel and healthcare systems, while often leading to suboptimal results for the patient.

This Special Issue focuses on original articles, reviews, meta-analysis referring to groundbreaking research regarding the clinical management of heart failure.

Dr. Cristina Tudoran
Dr. Larisa Anghel
Guest Editors

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Keywords

acute heart failure
chronic heart failure
treatment options
management of heart failure
lifestyle changes
diagnosis of heart failure

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Research

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15 pages, 600 KiB

Open AccessArticle

Impact of Newly Diagnosed Left Bundle Branch Block on Long-Term Outcomes in Patients with STEMI

by Larisa Anghel, Cristian Stătescu, Radu Andy Sascău, Bogdan-Sorin Tudurachi, Andreea Tudurachi, Laura-Cătălina Benchea, Cristina Prisacariu and Rodica Radu

J. Clin. Med. 2024, 13(18), 5479; https://doi.org/10.3390/jcm13185479 - 15 Sep 2024

Viewed by 259

Abstract

Background/Objectives: This study assessed the long-term prognostic implications of newly developed left bundle branch block (LBBB) in patients with ST-elevation myocardial infarction (STEMI) and a single coronary lesion, following primary percutaneous coronary intervention (PCI). Methods: Among 3526 patients admitted with acute myocardial infarction between January 2011 and December 2013, 42 were identified with STEMI, a single coronary lesion, and newly diagnosed LBBB. A control group of 42 randomly selected STEMI patients without LBBB was also included. All participants were prospectively evaluated with a median follow-up duration of 9.4 years. Demographic, clinical, and laboratory data were analyzed to assess the impact of LBBB on long-term outcomes. Results: The baseline characteristics were similar between the groups. The STEMI with new LBBB group had significantly higher rates of new myocardial infarction, revascularization, and mortality, highlighting the severe prognostic implications and elevated risk for adverse outcomes compared to STEMI without LBBB. The multivariate Cox regression analysis demonstrated that the presence of LBBB (HR: 2.15, 95% CI: 1.28–3.62, p = 0.003), lower LVEF (HR: 1.45, 95% CI: 1.22–1.72, p < 0.001), and longer pain-to-admission time (HR: 1.32, 95% CI: 1.09–1.61, p = 0.008) were significant independent predictors of adverse outcomes. Conclusions: Newly acquired LBBB in STEMI patients is associated with poorer long-term outcomes. Early identification and management of factors such as reduced LVEF and timely hospital admission, specifically in patients with new-onset LBBB, can improve prognosis. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)

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13 pages, 3231 KiB

Open AccessArticle

The Interplay between Severe Cirrhosis and Heart: A Focus on Diastolic Dysfunction

by Dragoș Lupu, Laurențiu Nedelcu and Diana Țînț

J. Clin. Med. 2024, 13(18), 5442; https://doi.org/10.3390/jcm13185442 - 13 Sep 2024

Viewed by 381

Abstract

Background/Objectives: Cardiovascular involvement in severe cirrhosis presents diagnostic challenges and carries significant prognostic implications. This study aims to evaluate the relationship between liver disease severity and portal hypertension with the burden of diastolic dysfunction. Methods: We prospectively enrolled patients with hepatic cirrhosis, classified according to the Child–Pugh criteria. Of the 102 patients included, 65 were classified as Group A (non-severe cirrhosis: Child–Pugh Classes A and B) and 37 as Group B (severe cirrhosis: Child–Pugh Class C). Portal vein and spleen diameters were assessed using abdominal ultrasound. All patients underwent echocardiographic evaluation. LV systolic function was assessed by measuring ejection fraction, while diastolic function was evaluated using three parameters: E/Em ratio, E/Vp ratio, and indexed left atrial volume. Results: We observed a significantly greater burden of diastolic dysfunction in Group B compared to Group A. Specifically, the E/Vp ratio was 2.2 ± 0.4 in Group B versus 1.9 ± 0.3 in Group A (p < 0.001); the indexed LA volume was 34.5 ± 3.2 mL/m² in Group B versus 30.1 ± 2.9 mL/m² in Group A (p < 0.001); and the E/Em ratio was 17.0 ± 3.0 in Group B versus 11.5 ± 2.8 in Group A (p < 0.001). Additionally, the mean diameters of the portal vein and spleen were larger in Group B, with measurements of 14.3 ± 2.1 mm versus 11.5 ± 1.6 mm for the portal vein and 15.0 ± 1.2 mm versus 11.7 ± 1.5 mm for the spleen (p < 0.001), which correlated with the extent of diastolic dysfunction. Conclusions: Diastolic dysfunction was prevalent in 55% of patients with liver cirrhosis. The burden of diastolic dysfunction was higher in patients with severe hepatic cirrhosis compared to those with milder forms, and it correlated with the severity of portal hypertension, as assessed by measuring portal vein diameter and spleen diameter. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)

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14 pages, 7910 KiB

Open AccessArticle

Pulsatile Left Ventricular Assistance in High-Risk Percutaneous Coronary Interventions: Short-Term Outcomes

by Josko Bulum, Marcelo B. Bastos, Ota Hlinomaz, Oren Malkin, Tomasz Pawlowski, Milan Dragula and Robert Gil

J. Clin. Med. 2024, 13(18), 5357; https://doi.org/10.3390/jcm13185357 - 10 Sep 2024

Viewed by 385

Abstract

Objectives: To document the real-world experience with the use of pneumatic pulsatile mechanical circulatory support (MCS) with the PulseCath iVAC2L during high-risk percutaneous coronary interventions (HR-PCIs). Background: The use of MCS in HR-PCIs may reduce the rate of major adverse cardiovascular events (MACEs) at 90 days. The PulseCath iVAC2L is a short-term pulsatile transaortic left ventricular (LV) assist device that has been in use since 2014. The iVAC2L Registry tracks its safety and efficacy in a variety of hospitals worldwide. Methods: The iVAC2L Registry is a multicenter, observational registry that aggregates clinical data from patients treated with the iVAC2L worldwide. A total of 293 consecutive cases were retrospectively collected and analyzed. Estimated rates of in-hospital clinical endpoints were described. All-cause mortality was used as the primary endpoint and other outcomes of interest were used as secondary endpoints. The rates obtained were reported and contextualized. Results: The in-hospital rate of all-cause mortality was 1.0%, MACE was 3.1%. Severe hypotension occurred in 8.9% of patients. Major bleeding and major vascular complications occurred in 1.0% and 2.1%, respectively. Acute myocardial infarction occurred in 0.7% of patients. Cerebrovascular events occurred in 1.4% of patients. Cardiac arrest occurred in 1.7% of patients. A statistically significant improvement in blood pressure was observed with iVAC2L activation. Conclusions: The results of the present study suggest that the iVAC2L is capable of improving hemodynamics with a low rate of adverse events. However, confirmatory studies are needed to validate these findings. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)

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12 pages, 407 KiB

Open AccessArticle

Use and Benefit of Sacubitril/Valsartan in Elderly Patients with Heart Failure with Reduced Ejection Fraction

by Luis Nieto Roca, Marcelino Cortés García, Jorge Balaguer Germán, Antonio José Bollas Becerra, José María Romero Otero, José Antonio Esteban Chapel, Carlos Rodríguez López, Ana María Pello Lázaro, Mikel Taibo Urquía and José Tuñón

J. Clin. Med. 2024, 13(16), 4772; https://doi.org/10.3390/jcm13164772 - 14 Aug 2024

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Abstract

Background: Heart failure (HF) is a highly prevalent syndrome in elderly subjects. Currently, multiple drugs have shown clinical benefits in patients with HF and reduced ejection fraction (HFrEF). However, evidence is scarce in elderly patients (beyond 75 years old), even more so for the latest drugs, such as angiotensin receptor-neprilysin inhibitors (ARNIs). This study aims to evaluate the use and benefits of ARNIs in elderly patients with HFrEF. Methods: A prospective observational cohort study was designed. Patients with left ventricular systolic dysfunction (defined by left ventricular ejection fraction [LVEF] < 40%) and age ≥ 75 years from January 2016 to December 2020 were prospectively included. Patients with an indication for ARNIs at inclusion or throughout follow-up were selected. Clinical, electrocardiographic and echocardiographic variables were collected. Results: A total of 616 patients were included, 34.4% of them female, with a mean age of 83.3 years, mean LVEF of 28.5% and ischemic etiology in 53.9% of patients. Only 14.3% of patients were taking ARNIs. After a mean follow-up of 34 months, 50.2% of patients died, and 62.2% had a cardiac event (total mortality or hospital admission due to HF). Multivariate Cox regression analysis showed that the use of ARNIs was independently and significantly associated with lower rates of mortality [HR 0.36 (95% CI 0.21–0.61)], with similar results in relation to all-cause mortality in a propensity-score-matched analysis [HR 0.33 (95% CI 0.19–0.57)]. Conclusions: We observed an important underuse of ARNIs in a cohort of elderly HFrEF patients, in which treatment with ARNIs was associated with a significant reduction in mortality. Greater implementation of clinical practice guidelines in this group of patients could improve their prognosis. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)

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18 pages, 2714 KiB

Open AccessArticle

Unexpected Genetic Twists in Patients with Cardiac Devices

by Emilia-Violeta Goanta, Cristina Vacarescu, Georgica Tartea, Adrian Ungureanu, Sebastian Militaru, Alexandra Muraretu, Adelina-Andreea Faur-Grigori, Lucian Petrescu, Radu Vătăsescu and Dragos Cozma

J. Clin. Med. 2024, 13(13), 3801; https://doi.org/10.3390/jcm13133801 - 28 Jun 2024

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Abstract

Objective: To assess the frequency and types of genetic mutations in patients with arrhythmias who underwent cardiac device implantation. Methods: Retrospective observational study, including 38 patients with different arrhythmias and cardiac arrest as a first cardiac event. Treatment modalities encompass pacemakers, transvenous defibrillators, loop recorders, subcutaneous defibrillators, and cardiac resynchronization therapy. All patients underwent genetic testing, using commercially available panels (106–174 genes). Outcome measures include mortality, arrhythmia recurrence, and device-related complications. Results: Clinical parameters revealed a family history of sudden cardiac death in 19 patients (50%), who were predominantly male (58%) and had a mean age of 44.5 years and a mean left ventricle ejection fraction of 40.3%. Genetic testing identified mutations in various genes, predominantly TMEM43 (11%). In two patients (3%) with arrhythmogenic cardiomyopathy, complete subcutaneous defibrillator extraction with de novo transvenous implantable cardioverter-defibrillator implantation was needed. The absence of multiple associations among severe gene mutations was crucial for cardiac resynchronization therapy response. Mortality in this group was around 3% in titin dilated cardiomyopathy patients. Conclusions: Integration of genetic testing into the decision-making process for patients with electronic devices represents a paradigm shift in personalized medicine. By identifying genetic markers associated with arrhythmia susceptibility, heart failure etiology, and cardiac resynchronization therapy response, clinicians can tailor device choices to optimize patient outcomes. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)

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15 pages, 1027 KiB

Open AccessArticle

The Role of High-Sensitivity Troponin T Regarding Prognosis and Cardiovascular Outcome across Heart Failure Spectrum

by Andrea D’Amato, Paolo Severino, Silvia Prosperi, Marco Valerio Mariani, Rosanna Germanò, Andrea De Prisco, Vincenzo Myftari, Claudia Cestiè, Aurora Labbro Francia, Stefanie Marek-Iannucci, Leonardo Tabacco, Leonardo Vari, Silvia Luisa Marano, Gianluca Di Pietro, Carlo Lavalle, Gennaro Sardella, Massimo Mancone, Roberto Badagliacca, Francesco Fedele and Carmine Dario Vizza

J. Clin. Med. 2024, 13(12), 3533; https://doi.org/10.3390/jcm13123533 - 17 Jun 2024

Viewed by 714

Abstract

Background: Cardiac troponin release is related to the cardiomyocyte loss occurring in heart failure (HF). The prognostic role of high-sensitivity cardiac troponin T (hs-cTnT) in several settings of HF is under investigation. The aim of the study is to assess the prognostic role of intrahospital hs-cTnT in patients admitted due to HF. Methods: In this observational, single center, prospective study, patients hospitalized due to HF have been enrolled. Admission, in-hospital peak, and discharge hs-cTnT have been assessed. Patients were followed up for 6 months. Cardiovascular (CV) death, HF hospitalization (HFH), and worsening HF (WHF) (i.e., urgent ambulatory visit/loop diuretics escalation) events have been assessed at 6-month follow up. Results: 253 consecutive patients have been enrolled in the study. The hs-cTnT median values at admission and discharge were 0.031 ng/mL (IQR 0.02–0.078) and 0.031 ng/mL (IQR 0.02–0.077), respectively. The risk of CV death/HFH was higher in patients with admission hs-cTnT values above the median (p = 0.02) and in patients who had an increase in hs-cTnT during hospitalization (p = 0.03). Multivariate Cox regression analysis confirmed that hs-cTnT above the median (OR: 2.06; 95% CI: 1.02–4.1; p = 0.04) and increase in hs-cTnT during hospitalization (OR:1.95; 95%CI: 1.006–3.769; p = 0.04) were predictors of CV death/HFH. In a subgroup analysis of patients with chronic HF, hs-cTnT above the median was associated with increased risk of CV death/HFH (p = 0.03), while in the subgroup of patients with HFmrEF/HFpEF, hs-cTnT above the median was associated with outpatient WHF events (p = 0.03). Conclusions: Inpatient hs-cTnT levels predict CV death/HFH in patients with HF. In particular, in the subgroup of chronic HF patients, hs-cTnT is predictive of CV death/HFH; while in patients with HFmrEF/HFpEF, hs-cTnT predicts WHF events. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)

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Review

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11 pages, 4030 KiB

Open AccessReview

Mitral Annular Plane Systolic Excursion (MAPSE): A Review of a Simple and Forgotten Parameter for Assessing Left Ventricle Function

by Liviu Cirin, Simina Crișan, Constantin-Tudor Luca, Roxana Buzaș, Daniel Florin Lighezan, Cristina Văcărescu, Andreea Cozgarea, Cristina Tudoran and Dragoș Cozma

J. Clin. Med. 2024, 13(17), 5265; https://doi.org/10.3390/jcm13175265 - 5 Sep 2024

Viewed by 482

Abstract

Mitral annular plane systolic excursion (MAPSE) was a widely used and simple M-mode echocardiographic parameter for determining the left ventricle (LV) longitudinal systolic function. The purpose of this review is to analyze the use of MAPSE as a simple LV systolic function marker in different clinical scenarios, especially given the recent paradox of choices in ultrasound markers assessing cardiac performance. Recent data on the use of MAPSE in the assessment of LV function in different settings seem to be relatively scarce, given the wide variety of possible causes of cardiovascular pathology. There remain significant possible clinical applications of MAPSE utilization. This review included all major articles on the topic of mitral annular plane systolic excursion published and indexed in the PubMed, Google Scholar, and Scopus databases. We analyzed the potential implications of using simpler ultrasonographical tools in heart failure diagnosis, prediction, and treatment. MAPSE is a dependable, robust, and easy-to-use parameter compared to ejection fraction (EF) or global longitudinal strain (GLS) for the quick assessment of LV systolic function in various clinical settings. However, there may be a gap of evidence in certain scenarios such as conventional cardiac pacing. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)

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26 pages, 766 KiB

Open AccessReview

Biomarkers in Heart Failure with Preserved Ejection Fraction: A Perpetually Evolving Frontier

by Ana-Maria Vrabie, Stefan Totolici, Caterina Delcea and Elisabeta Badila

J. Clin. Med. 2024, 13(16), 4627; https://doi.org/10.3390/jcm13164627 - 7 Aug 2024

Viewed by 694

Abstract

Heart failure with preserved ejection fraction (HFpEF) represents a complex clinical syndrome, often very difficult to diagnose using the available tools. As the global burden of this disease is constantly growing, surpassing the prevalence of heart failure with reduced ejection fraction, during the last few years, efforts have focused on optimizing the diagnostic and prognostic pathways using an immense panel of circulating biomarkers. After the paradigm of HFpEF development emerged more than 10 years ago, suggesting the impact of multiple comorbidities on myocardial structure and function, several phenotypes of HFpEF have been characterized, with an attempt to find an ideal biomarker for each distinct pathophysiological pathway. Acknowledging the limitations of natriuretic peptides, hundreds of potential biomarkers have been evaluated, some of them demonstrating encouraging results. Among these, soluble suppression of tumorigenesis-2 reflecting myocardial remodeling, growth differentiation factor 15 as a marker of inflammation and albuminuria as a result of kidney dysfunction or, more recently, several circulating microRNAs have proved their incremental value. As the number of emerging biomarkers in HFpEF is rapidly expanding, in this review, we aim to explore the most promising available biomarkers linked to key pathophysiological mechanisms in HFpEF, outlining their utility for diagnosis, risk stratification and population screening, as well as their limitations. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)

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15 pages, 551 KiB

Open AccessReview

Heart Rate Recovery: Up to Date in Heart Failure—A Literature Review

by Andreea Cozgarea, Dragoș Cozma, Minodora Teodoru, Alexandra-Iulia Lazăr-Höcher, Liviu Cirin, Adelina-Andreea Faur-Grigori, Mihai-Andrei Lazăr, Simina Crișan, Dan Gaiță, Constantin-Tudor Luca and Cristina Văcărescu

J. Clin. Med. 2024, 13(11), 3328; https://doi.org/10.3390/jcm13113328 - 5 Jun 2024

Viewed by 1220

Abstract

The rising prevalence of cardiovascular disease underscores the growing significance of heart failure (HF). Pathophysiological insights into HF highlight the dysregulation of the autonomic nervous system (ANS), characterized by sympathetic overactivity and diminished vagal tone, impacting cardiovascular function. Heart rate recovery (HRR), a metric measuring the heart’s ability to return to its baseline rate post-exertion, plays a crucial role in assessing cardiovascular health. Widely applied across various cardiovascular conditions including HF, coronary artery disease (CAD), and arterial hypertension (HTN), HRR quantifies the difference between peak and recovery heart rates. Given its association with elevated sympathetic tone and exercise, HRR provides valuable insights into the perspective of HF, beyond effort tolerance, reaching toward prognostic and mortality indicators. Incorporating HRR into cardiovascular evaluations enhances our understanding of autonomic regulation in HF, offering potential implications for prognostication and patient management. This review addresses the significance of HRR in HF assessment, analyzing recently conducted studies, and providing a foundation for further research and clinical application. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)

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19 pages, 1465 KiB

Open AccessReview

A Comparative Analysis of Apical Rocking and Septal Flash: Two Views of the Same Systole?

by Alexandra-Iulia Lazăr-Höcher, Dragoș Cozma, Liviu Cirin, Andreea Cozgarea, Adelina-Andreea Faur-Grigori, Rafael Catană, Dănuț George Tudose, Georgică Târtea, Simina Crișan, Dan Gaiță, Constantin-Tudor Luca and Cristina Văcărescu

J. Clin. Med. 2024, 13(11), 3109; https://doi.org/10.3390/jcm13113109 - 25 May 2024

Viewed by 733

Abstract

Heart failure (HF) is a complex medical condition characterized by both electrical and mechanical dyssynchrony. Both dyssynchrony mechanisms are intricately linked together, but the current guidelines for cardiac resynchronization therapy (CRT) rely only on the electrical dyssynchrony criteria, such as the QRS complex duration. This possible inconsistency may result in undertreating eligible individuals who could benefit from CRT due to their mechanical dyssynchrony, even if they fail to fulfill the electrical criteria. The main objective of this literature review is to provide a comprehensive analysis of the practical value of echocardiography for the assessment of left ventricular (LV) dyssynchrony using parameters such as septal flash and apical rocking, which have proven their relevance in patient selection for CRT. The secondary objectives aim to offer an overview of the relationship between septal flash and apical rocking, to emphasize the primary drawbacks and benefits of using echocardiography for evaluation of septal flash and apical rocking, and to offer insights into potential clinical applications and future research directions in this area. Conclusion: there is an opportunity to render resynchronization therapy more effective for every individual; septal flash and apical rocking could be a very useful and straightforward echocardiography resource. Full article

(This article belongs to the Special Issue Clinical Management of Patients with Heart Failure)

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