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The Management of Chronic Heart Failure and Hypertension

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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 (15 December 2020) | Viewed by 18823

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Special Issue Editor

Prof. Dr. Guido Iaccarino

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Guest Editor

Department of Advanced Biomedical Sciences, ‘Federico II’ University, Naples, Italy
Interests: cardiac function; cardiology; heart failure; hypertension; medicinal and pharmaceutical chemistry; cardiovascular; phosphorylation; apoptosis; clinical trials; metabolic syndrome

Special Issue Information

Dear Colleagues,

The ever-increasing life span of the global human population is leading to a new epidemiology of chronic conditions and, in particular, cardiovascular conditions. Indeed, the number of patients with hypertension and chronic heart failure are increasing, and healthcare systems are starting to fail in providing the traditional paradigms of care. New horizons are therefore being created—where innovation is the keyword—in an attempt to find new targets of disease, new therapies, new models of treatment, and new partners in treatment. Innovation remains the only hope for the future of our patients, of ourselves, and of our children, before the collapse of our model healthcare systems.

With this Special Issue, we wish to provide a glimpse of the future. We expect you to provide your point of view or best results in terms of personalization of diagnosis and risk stratification and as based on “omics” and artificial intelligence. We want to hear about your proposed mechanisms for diseases that have lead to the progression of these conditions towards cardiovascular events; we want to learn how to prevent the progression of hypertension and heart failure, the impact of modern strategies of prevention and treatment based on lifestyles and integrated care; we want to look at the picture of those new technologies, including ICT, mHealth, and eHealth, and what they can capture from the future. In short, we challenge you to provide your best, boldest, visionary science to this issue to help us to understand the new horizons into which we are sailing.

Prof. Dr. Guido Iaccarino
Guest Editor

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Keywords

hypertension
chronic heart failure
polytherapy
frailty
ICT
molecular targets
omics
mHealth
eHealth
physical activity
mediterranean diet

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Published Papers (5 papers)

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Research

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13 pages, 1129 KiB

Open AccessArticle

Athlete’s Passport: Prevention of Infections, Inflammations, Injuries and Cardiovascular Diseases

by Cristina Mennitti, Mariarita Brancaccio, Luca Gentile, Annaluisa Ranieri, Daniela Terracciano, Michele Cennamo, Evelina La Civita, Antonietta Liotti, Giovanni D’Alicandro, Cristina Mazzaccara, Giulia Frisso, Raffaela Pero, Barbara Lombardo and Olga Scudiero

J. Clin. Med. 2020, 9(8), 2540; https://doi.org/10.3390/jcm9082540 - 6 Aug 2020

Cited by 13 | Viewed by 3117

Abstract

Laboratory medicine in sports medicine is taking on an ever-greater role in the assessment and monitoring of an athlete’s health condition. The acute or intense exercise practiced by elite athletes can lead to the appearance of infections, inflammations, muscle injuries or cardiovascular disorders, whose diagnosis is not always rapid and efficient, as there is no continuous monitoring of the athlete. The absence of such monitoring can have serious consequences in terms of recovery of the professional athlete. These imbalances can induce metabolic adaptations which translate into alterations of specific parameters in terms of concentration and activity. The aim of this study was to follow the variation of specific biochemical biomarkers in a basketball team participating to the maximum championship during different phases of the agonistic season. The evaluation of serum biomarkers can help doctors to safeguard the athlete’s health and sports trainers to adapt workouts, thus avoiding the appearance of diseases and injuries that in some cases can be underestimated by becoming irreversible ailments that do not allow the athlete to return to a healthy state. This information can be useful to create athlete biologic passports. Full article

(This article belongs to the Special Issue The Management of Chronic Heart Failure and Hypertension)

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12 pages, 2597 KiB

Open AccessArticle

Role of Cardiac Computed Tomography for Etiology Evaluation of Newly Diagnosed Heart Failure with Reduced Ejection Fraction

by Dong Jin Im, Jong-Chan Youn, Hye-Jeong Lee, Kyungsun Nam, Young Joo Suh, Yoo Jin Hong, Jin Hur, Young Jin Kim, Byoung Wook Choi and Seok-Min Kang

J. Clin. Med. 2020, 9(7), 2270; https://doi.org/10.3390/jcm9072270 - 17 Jul 2020

Cited by 8 | Viewed by 3097

Abstract

Delayed-enhanced dual-energy computed tomography (DECT) can evaluate the extent and degree of myocardial fibrosis while coronary CT angiography (CCTA) is a widely accepted coronary artery evaluation method. We sought to describe the role of combined cardiac CT for the evaluation of underlying etiology in patients with newly diagnosed heart failure with reduced ejection fraction (HFrEF). Sixty-three consecutive patients (31 men, 63 ± 16 years) with newly diagnosed HFrEF were enrolled in this prospective study. Coronary artery disease and myocardial fibrosis were evaluated on CCTA and DECT, respectively, and the tentative underlying etiologies of heart failure (HF) were determined with combinations of findings from both CTs. Concordance between tentative etiologies from cardiac CT and final etiologies from clinical decisions within a 2-year follow-up was assessed. Eighteen patients were diagnosed with ischemic HF on initial cardiac CT, and the final diagnosis was not changed. Another 45 patients with nonischemic HF included tentative etiologies of dilated cardiomyopathy (n = 32, 71.1%), sarcoidosis or myocarditis (n = 8, 17.8%), amyloidosis (n = 2, 4.4%), noncompaction (n = 2, 4.4%) and arrhythmogenic right ventricular cardiomyopathy (n = 1, 2.2%). Five nonischemic HF patients showed different etiologies between initial cardiac CT and clinical decisions. The concordance between cardiac CT and clinical decisions was 92.1%. A high degree of concordance was achieved between tentative etiologies from cardiac CT and final diagnoses from clinical decisions. Combined cardiac CT is a feasible, safe and effective imaging tool for the initial evaluation of newly diagnosed HFrEF patients. Full article

(This article belongs to the Special Issue The Management of Chronic Heart Failure and Hypertension)

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11 pages, 1744 KiB

Open AccessArticle

Short-Period Temporal Dispersion Repolarization Markers Predict 30-Days Mortality in Decompensated Heart Failure

by Gianfranco Piccirillo, Federica Moscucci, Gaetano Bertani, Ilaria Lospinuso, Fabiola Mastropietri, Marcella Fabietti, Teresa Sabatino, Giulia Zaccagnini, Davide Crapanzano, Ilaria Di Diego, Andrea Corrao, Pietro Rossi and Damiano Magrì

J. Clin. Med. 2020, 9(6), 1879; https://doi.org/10.3390/jcm9061879 - 16 Jun 2020

Cited by 10 | Viewed by 2371

Abstract

Background and Objectives: Electrocardiographic (ECG) markers of the temporal dispersion of the myocardial repolarization phase have been shown able to identify chronic heart failure (CHF) patients at high mortality risk. The present prospective single-center study sought to investigate in a well-characterized cohort of decompensated heart failure (HF) patients the ability of short-term myocardial temporal dispersion ECG variables in predicting the 30-day mortality, as well as their relationship with N-terminal Pro Brain Natriuretic Peptide (NT-proBNP) plasmatic values. Method: One hundred and thirteen subjects (male: 59, 67.8%) with decompensated CHF underwent 5 min of ECG recording, via a mobile phone. We obtained QT end (QTe), QT peak (QTp) and T peak to T end (Te) and calculated the mean, standard deviation (SD), and normalized index (VN). Results: Death occurred for 27 subjects (24%) within 30 days after admission. Most of the repolarization indexes (QTe mean (p < 0.05), QTe_SD (p < 0.01), QTp_SD (p < 0.05), mean Te (p < 0.05), Te_SD (p < 0.001) QTeVN (p < 0.05) and TeVN (p < 0.01)) were significantly higher in those CHF patients with the highest NT-proBNP (>75th percentile). In all the ECG data, only Te_SD was significantly and positively related to the NT-proBNP levels (r: 0.471; p < 0.001). In the receiver operating characteristic (ROC) analysis, the highest accuracy for 30-day mortality was found for QTe_SD (area under curve, AUC: 0.705, p < 0.01) and mean Te (AUC: 0.680, p < 0.01), whereas for the NT-proBNP values higher than the 75th percentile, the highest accuracy was found for Te_SD (AUC: 0.736, p < 0.001) and QTe_SD (AUC: 0.696, p < 0.01). Conclusion: Both mean Te and Te_SD could be considered as reliable markers of worsening HF and of 30-day mortality. Although larger and possibly interventional studies are needed to confirm our preliminary finding, these non-invasive and transmissible ECG parameters could be helpful in the remote monitoring of advanced HF patients and, possibly, in their clinical management. (ClinicalTrials.gov number, NCT04127162). Full article

(This article belongs to the Special Issue The Management of Chronic Heart Failure and Hypertension)

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9 pages, 742 KiB

Open AccessArticle

Impact of Acute Hemoglobin Falls in Heart Failure Patients: A Population Study

by Cristina Lopez, Jose Luis Holgado, Antonio Fernandez, Inmaculada Sauri, Ruth Uso, Jose Luis Trillo, Sara Vela, Carlos Bea, Julio Nuñez, Ana Ferrer, Javier Gamez, Adrian Ruiz and Josep Redon

J. Clin. Med. 2020, 9(6), 1869; https://doi.org/10.3390/jcm9061869 - 15 Jun 2020

Cited by 1 | Viewed by 3160

Abstract

Aims: This study assessed the impact of acute hemoglobin (Hb) falls in heart failure (HF) patients. Methods: HF patients with repeated Hb values over time were included. Falls in Hb greater than 30% were considered to represent an acute episode of anemia and the risk of hospitalization and all-cause mortality after the first episode was assessed. Results: In total, 45,437 HF patients (54.9% female, mean age 74.3 years) during a follow-up average of 2.9 years were analyzed. A total of 2892 (6.4%) patients had one episode of Hb falls, 139 (0.3%) had more than one episode, and 342 (0.8%) had concomitant acute kidney injury (AKI). Acute heart failure occurred in 4673 (10.3%) patients, representing 3.6/100 HF patients/year. The risk of hospitalization increased with one episode (Hazard Ratio = 1.30, 95% confidence interval (CI) 1.19–1.43), two or more episodes (HR = 1.59, 95% CI 1.14–2.23, and concurrent AKI (HR = 1.61, 95% CI 1.27–2.03). A total of 10,490 patients have died, representing 8.1/100 HF patients/year. The risk of mortality was HR = 2.20 (95% CI 2.06–2.35) for one episode, HR = 3.14 (95% CI 2.48–3.97) for two or more episodes, and HR = 3.20 (95% CI 2.73–3.75) with AKI. In the two or more episodes and AKI groups, Hb levels at the baseline were significantly lower (10.2–11.4 g/dL) than in the no episodes group (12.8 g/dL), and a higher and significant mortality in these subgroups was observed. Conclusions: Hb falls in heart failure patients identified those with a worse prognosis requiring a more careful evaluation and follow-up. Full article

(This article belongs to the Special Issue The Management of Chronic Heart Failure and Hypertension)

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Review

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36 pages, 541 KiB

Open AccessReview

Inspiratory Muscle Training in Patients with Heart Failure

by Hugo Fernandez-Rubio, Ricardo Becerro-de-Bengoa-Vallejo, David Rodríguez-Sanz, César Calvo-Lobo, Davinia Vicente-Campos and J. L. Chicharro

J. Clin. Med. 2020, 9(6), 1710; https://doi.org/10.3390/jcm9061710 - 2 Jun 2020

Cited by 23 | Viewed by 6395

Abstract

Background: Prior systematic reviews and meta-analysis addressed that inspiratory muscle training (IMT) improved inspiratory muscle weakness, cardiorespiratory fitness and quality of life similar to conventional exercise training as a first alternative in deconditioned patients with heart failure (HF) lead to a better adaptation to posterior exercise training. The heterogeneity and variability in a wide range of new studies about this topic led to the necessity of an updated and comprehensive narrative review. The present review aimed to analyze and update the most relevant studies about IMT in patients who suffer from HF. Methods: A narrative review was carried out about IMT in HF patients including 26 experimental studies divided into 21 clinical trials and 5 quasi-experimental studies identified through database searching in PubMed, Cochrane and PEDro. Results: There is enough evidence to state that IMT produces improvements in functional capacity of patients with HF. Nevertheless, there is not enough evidence to support that IMT could improve cardiovascular parameters, blood biomarkers or quality of life in these patients. Conclusions: Thus, IMT may be recommended to improve functional capacity in patients who suffer from HF; nevertheless, more evidence is needed regarding cardiovascular parameters, biomarkers and quality of life. Furthermore, mortality or HF hospitalization was not evaluated and most studies were not longer than 3 months. According to IMT protocols and study designs heterogeneity and mid-term follow-up, further investigations through high-quality long-term randomized clinical trials should be performed to achieve systematic reviews and meta-analysis to support strong evidence for IMT in HF patients. Full article

(This article belongs to the Special Issue The Management of Chronic Heart Failure and Hypertension)

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