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Facing the Heart Failure Pandemic: Recent Advances in Heart Failure...
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Facing the Heart Failure Pandemic: Recent Advances in Heart Failure Management

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

Deadline for manuscript submissions: 30 April 2025 | Viewed by 6368

Special Issue Editors

Dr. Tobias Schupp

E-Mail Website
Guest Editor
First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
Interests: sudden cardiac death; ICD; pharmacology; cardiogenic shock; sepsis; heart failure
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Michael Behnes

E-Mail Website
Guest Editor
First Department of Medicine, University Medical Centre Mannheim (UMM), Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany
Interests: cardiology; interventional cardiology; coronary chronic total occlusion; sudden cardiac death; heart failure; myocardial infarction
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

As a result of the ongoing demographic changes, the overall incidence of patients with heart failure (HF) is increasing worldwide. Despite the ongoing advances in the management of HF, including improved strategies for coronary revascularization, pharmacotherapies and invasive cardiac devices, HF is still characterized by 1-year mortality rates of 10-35%. Risk stratification in patients with HF is complex and the measurement of left ventricular ejection fraction (LVEF) remains the most commonly used tool for decision-making in HF. With the publication of the 2021 ESC guidelines for the management of HF, risk stratification for HF has even become more difficult with the introduction of HF with mildly reduced ejection fraction (HFmrEF), which represents a largely unexplored category of HF patients with very limited evidence. Furthermore, most randomized controlled trials in the field of HF were published more than one decade ago; however, now, clinical characteristics of HF patients have significantly changed, resulting in a larger proportion of older and multi-morbid patients. The scope of this Special Issue is to provide an overview of recent advances in the management of patients with HF. Therefore, researchers in the field of HF are encouraged to submit an original article or review to this Special Issue (case reports and short reviews are not accepted).

Dr. Tobias Schupp
Prof. Dr. Michael Behnes
Guest Editors

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Keywords

  • heart failure
  • heart failure with mildly reduced ejection fraction
  • cardiomyopathies
  • coronary artery disease
  • coronary revascularization
  • mortality

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Published Papers (5 papers)

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Research

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14 pages, 772 KiB  
Article
Neurohormonal Effects of Intravenous Dopamine in Patients with Acute Heart Failure
by Christos Kourek, Andrew Xanthopoulos, Grigorios Giamouzis, Charalambos Parisis, Alexandros Briasoulis, Dimitrios E. Magouliotis, Filippos Triposkiadis and John Skoularigis
J. Clin. Med. 2024, 13(19), 5667; https://doi.org/10.3390/jcm13195667 - 24 Sep 2024
Viewed by 1323
Abstract
Background/Objectives: Many clinical trials have shown beneficial effects of low-dose dopamine on renal function, diuresis and symptom relief, or cardiac function in hospitalized patients with acute decompensated heart failure (HF). The aim is to assess the neurohormonal effects and the effects on [...] Read more.
Background/Objectives: Many clinical trials have shown beneficial effects of low-dose dopamine on renal function, diuresis and symptom relief, or cardiac function in hospitalized patients with acute decompensated heart failure (HF). The aim is to assess the neurohormonal effects and the effects on clinical outcomes of the addition of low-dose dopamine in furosemide treatment in patients hospitalized for acute decompensated HF. Methods: A total of 62 patients hospitalized for acute decompensation of HF, were randomly allocated to one of the following three groups: i. LDF (low-dose furosemide), ii. HDF (high-dose furosemide) and, iii. LDFD (low-dose furosemide and dopamine). Primary outcomes of the present analysis were biochemical and neurohormonal indices (i.e., urea, creatinine, hemoglobin, electrolytes, natriuretic peptides, troponin, renin, angiotensin, aldosterone, adrenaline, noradrenaline). Secondary endpoints included clinical outcomes (i.e., length of stay, in-hospital mortality, 2-month mortality and rehospitalization, and 1-year mortality and rehospitalization). Results: Urea and creatinine levels were similar for each day among the three groups (p > 0.05). The amount of urine was similar among the three groups per measurement at 2, 4, 6 and at 8 h (p > 0.05). Biochemical and neurohormonal indices as well as clinical outcomes did not differ among patients receiving different doses of furosemide, nor in patients receiving furosemide in combination with dopamine (p > 0.05). Conclusions: Although the addition of low-dose dopamine to intravenous furosemide was considered to have some theoretical advantages in maintaining renal function, no significant differences in neurohormonal effects and clinical outcomes were observed in patients hospitalized for acute decompensation of HF. Full article
(This article belongs to the Special Issue Facing the Heart Failure Pandemic: Recent Advances in Heart Failure Management)
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13 pages, 940 KiB  
Article
The Clinical Outcome of Cardiac Rehabilitation in Coronary Artery Disease Patients with Regard to the Presence of Left Ventricular Systolic Dysfunction
by Iwona Szadkowska and Katarzyna Szmigielska
J. Clin. Med. 2024, 13(10), 2969; https://doi.org/10.3390/jcm13102969 - 17 May 2024
Viewed by 1609
Abstract
Background: Despite the use of advanced treatment techniques, coronary artery disease (CAD) still remains the main cause of left ventricular (LV) dysfunction and heart failure. Participation in cardiac rehabilitation (CR) programs can lead to a number of beneficial effects, but some patients [...] Read more.
Background: Despite the use of advanced treatment techniques, coronary artery disease (CAD) still remains the main cause of left ventricular (LV) dysfunction and heart failure. Participation in cardiac rehabilitation (CR) programs can lead to a number of beneficial effects, but some patients do not demonstrate the expected improvement. The aim of this study is to evaluate the impact of CR on changes in exercise capacity with regard to the presence of LV dysfunction. Methods: A group of 428 patients with CAD were consecutively admitted to an outpatient comprehensive cardiac rehabilitation program comprising 24 exercise sessions of interval training on cycle ergometers, three times a week for 45 min, and a health education. The patients were compared in two subgroups, i.e., with LV systolic dysfunction (LVEF < 50%, n = 175) and LVEF ≥ 50% (n = 253). Results: In the LVEF < 50% group, the exercise capacity improved by 1 ± 0.78 MET (median 1.15 MET), and 0.86 ± 0.77 MET (median 1.08 MET) in the LVEF ≥ 50% group. Women with LVEF < 50% demonstrated a significant increase in exercise capacity by 1.2 MET, while those with LVEF ≥ 50% did not display any such increase. All men, regardless of LVEF, exhibited a similar improvement in exercise capacity greater than 1 MET. Conclusions: An outpatient eight-week cardiac rehabilitation program based on 45 min aerobic interval training sessions three times a week appears less effective for women with CAD and EF ≥ 50%. In this group, the proposed training intervention is insufficient in improving exercise capacity to an extent that could indicate a reduction in mortality risk. Full article
(This article belongs to the Special Issue Facing the Heart Failure Pandemic: Recent Advances in Heart Failure Management)
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11 pages, 1518 KiB  
Article
Effect of Cardiovascular Risk Factors on 30-Day All-Cause Mortality in Cardiogenic Shock
by Jan Forner, Tobias Schupp, Kathrin Weidner, Marinela Ruka, Sascha Egner-Walter, Michael Behnes, Muharrem Akin, Mohamed Ayoub, Kambis Mashayekhi, Ibrahim Akin and Jonas Rusnak
J. Clin. Med. 2023, 12(14), 4870; https://doi.org/10.3390/jcm12144870 - 24 Jul 2023
Cited by 1 | Viewed by 1409
Abstract
Although previous studies investigated the influence of cardiovascular risk (CVR) factors in patients with acute coronary syndrome, data concerning the effect of CVR factors on the prognosis of patients with cardiogenic shock (CS) is scarce. Consecutive patients with CS were prospectively included from [...] Read more.
Although previous studies investigated the influence of cardiovascular risk (CVR) factors in patients with acute coronary syndrome, data concerning the effect of CVR factors on the prognosis of patients with cardiogenic shock (CS) is scarce. Consecutive patients with CS were prospectively included from 2019 to 2021. The prognosis of patients with “low CVR” (i.e., 0–1 CVR factors) was compared to patients with “high CVR” (i.e., 2–4 CVR factors) according to presence or absence of arterial hypertension, diabetes mellitus, hyperlipidaemia or smoking. The primary endpoint was 30-day all-cause mortality. Statistical analyses included Kaplan-Meier and Cox proportional regression analyses. 273 consecutive patients with CS were included. 28% presented with low CVR and 72% with high CVR. Within the entire study cohort, the risk of 30-day all-cause mortality did not differ between patients with high and low CVR (55% vs. 57%; log rank p = 0.727; HR = 0.942; 95% CI 0.663–1.338; p = 0.738). Even after multivariable adjustment, high CVR was not associated with an elevated risk of 30-day all-cause mortality (HR = 1.039; 95% CI 0.648–1.667; p = 0.873). The presence of arterial hypertension (55% vs. 58%; log rank p = 0.564; HR = 0.906; 95% CI 0.638–1.287; p = 0.582), diabetes mellitus (60% vs. 52%; log rank p = 0.215; HR = 1.213; 95% CI 0.881–1.671; p = 0.237) and a history of smoking (56% vs. 56%; log rank p = 0.725; HR = 0.945; 95% CI 0.679–1.315; p = 0.737) did not significantly influence short-term prognosis.. Only the absence of hyperlipidaemia significantly decreased the risk of all-cause mortality (65% vs. 51%; log rank p = 0.038; HR = 0.718; 95% CI 0.516–0.998; p = 0.049), which was no longer observed after multivariable adjustment (HR = 0.801; 95% CI 0.536–1.195; p = 0.277). In conclusion, neither the overall CVR nor individual CVR factors were associated with the risk of 30-day all-cause mortality in patients with CS. Full article
(This article belongs to the Special Issue Facing the Heart Failure Pandemic: Recent Advances in Heart Failure Management)
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Review

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20 pages, 2788 KiB  
Review
Diagnosing Heart Failure with Preserved Ejection Fraction in Obese Patients
by Marino Basha, Evdoxia Stavropoulou, Anastasia Nikolaidou, Georgios Dividis, Emmanouela Peteinidou, Panagiotis Tsioufis, Nikolaos Kamperidis, Kyriakos Dimitriadis, Theodoros Karamitsos, George Giannakoulas, Konstantinos Tsioufis, Antonios Ziakas and Vasileios Kamperidis
J. Clin. Med. 2025, 14(6), 1980; https://doi.org/10.3390/jcm14061980 - 14 Mar 2025
Viewed by 539
Abstract
Obesity is a current pandemic that sets all affected individuals at risk of heart failure (HF), and the majority of them will develop the clinical syndrome of HF with preserved ejection fraction (HFpEF). The diagnosis of HFpEF is challenging as it is based [...] Read more.
Obesity is a current pandemic that sets all affected individuals at risk of heart failure (HF), and the majority of them will develop the clinical syndrome of HF with preserved ejection fraction (HFpEF). The diagnosis of HFpEF is challenging as it is based on the detection of subtle functional and structural remodeling of the heart that leads to diastolic dysfunction with increased left ventricular (LV) filling pressures and raised natriuretic peptides (NPs). The accurate diagnosis of HFpEF is even more challenging in patients who are obese, since the echocardiographic imaging quality may be suboptimal, the parameters for the evaluation of cardiac structure are indexed to the body surface area (BSA) and thus may underestimate the severity of the remodeling, and the NPs in patients who are obese have a lower normal threshold. Moreover, patients who are obese are prone to atrial fibrillation (AF) and pulmonary hypertension (PH), making the evaluation of diastolic dysfunction more strenuous. The current review aims to offer insights on the accurate diagnosis of HFpEF in patients who are obese in different clinical scenarios—patients who are obese in different clinical scenarios—such as in sinus rhythm, in atrial fibrillation, and in the case of pulmonary hypertension—by applying multimodality imaging and clinical diagnostic algorithms. Full article
(This article belongs to the Special Issue Facing the Heart Failure Pandemic: Recent Advances in Heart Failure Management)
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Graphical abstract

Other

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11 pages, 2265 KiB  
Systematic Review
Late Gadolinium Enhancement Magnetic Resonance Imaging (MRI) for Predicting Left Ventricular Reverse Remodeling in Non-Ischemic Cardiomyopathy: A Systematic Review and Meta-Analysis
by Yuri Teraoka, Shingo Kato, Naofumi Yasuda, Shungo Sawamura, Nobuyuki Horita and Daisuke Utsunomiya
J. Clin. Med. 2025, 14(3), 895; https://doi.org/10.3390/jcm14030895 - 29 Jan 2025
Viewed by 711
Abstract
Background/Objectives: Late gadolinium enhancement (LGE)-MRI has proven utility in prognosticating outcomes in patients with non-ischemic cardiomyopathy (NICM). However, evidence regarding its ability to predict responsiveness to optimal medical therapy remains insufficient. This study conducted a meta-analysis to evaluate the predictive utility of [...] Read more.
Background/Objectives: Late gadolinium enhancement (LGE)-MRI has proven utility in prognosticating outcomes in patients with non-ischemic cardiomyopathy (NICM). However, evidence regarding its ability to predict responsiveness to optimal medical therapy remains insufficient. This study conducted a meta-analysis to evaluate the predictive utility of LGE-MRI for left ventricular reverse remodeling (LVRR) in response to pharmacological therapy. Methods: Data from 1092 NICM patients across 13 studies were included in the analysis. To assess the predictive ability of LGE-MRI for LVRR following optimal medical therapy, a pooled odds ratio was calculated using an inverse variance random-effects meta-analysis. Subgroup analyses were performed by stratifying patients based on the presence or absence of left ventricular dilation and by LVEF (<30% vs. ≥30%). Results: The pooled odds ratio of the absence of LGE for predicting LVRR in NICM was 3.72 (95% CI: 2.83–4.90, I2 = 0, P for heterogeneity = 0.54). A comparison of pooled odds ratios between dilated cardiomyopathy (DCM) and NICM showed no significant difference (p = 0.16). A subgroup analysis in NICM based on the left ventricular ejection fraction (LVEF) demonstrated no significant difference in odds ratios between patients with LVEF <30% (OR: 2.96, 95% CI: 1.80–4.87) and those with LVEF ≥30% (OR: 3.97, 95% CI: 2.97–5.31), (p = 0.13). Conclusions: This meta-analysis suggested that LGE-MRI serves as a reliable predictor of LVRR in patients with NICM, regardless of left ventricular dilation or baseline LVEF classification. Full article
(This article belongs to the Special Issue Facing the Heart Failure Pandemic: Recent Advances in Heart Failure Management)
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