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Diagnostics
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Clinical Advances in Heart Failure
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Clinical Advances in Heart Failure

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Pathology and Molecular Diagnostics".

Deadline for manuscript submissions: 30 April 2024 | Viewed by 9070

Special Issue Editor

Dr. Noémi Nyolczas

E-Mail Website
Guest Editor
1. Gottsegen National Cardiovascular Center, Budapest, Hungary
2. Doctoral School of Clinical Medicine, University of Szeged, Szeged, Hungary
Interests: investigation of the parameters determining the prognosis of heart failure with reduced ejection fraction; assessment of left ventricular reverse remodelling in heart failure with reduced ejection fraction; evaluation of the effects of human autologous bone marrow-derived intracoronary and intramyocardial stem cell therapy after acute myocardial infarction and in chronic heart failure with ischemic etiology

Special Issue Information

Dear Colleagues,

The diagnosis of heart failure has undergone tremendous progress in recent decades.

The range of imaging techniques has expanded significantly. We have now the opportunity to apply three-dimensional echocardiography, tissue Doppler imaging, contrast echocardiography, and deformation imaging (strain and strain rate) techniques in addition to the basic echocardiographic methods. Beyond echocardiography MR, CT, SPECT, PET are also available to assess the structural and functional abnormalities of the heart. Nowadays, these different imaging techniques are important not only in making a diagnosis and distinguishing between different categories of heart failure (HFrEF, HFmrEF, HFpEF, HFimpEF) but also in defining the indication criteria for different drug and device treatment options, determining a prognosis, and monitoring the effectiveness of therapy.

In addition to the imaging techniques, the use of different cardiac biomarkers (natriuretic peptides, troponins, galectin-3, sST2, GDF-15, MMPs, etc.) is a cornerstone of heart failure diagnosis. Like the imaging techniques, biomarkers are the basis for proper diagnosis of heart failure and play an important role in determining the prognosis of the disease and assessing treatment efficacy.

Today, one of the major challenges of heart failure management is to determine its etiology in individual patients. This is particularly important for the group of HFpEF patients, for whom, despite not having any evidence-based therapy at present, we already have disease-specific and, for certain etiologies (eg. amyloidosis, HCM, Fabry disease), prognosis-modifying treatment options. However, accurate assessment of the etiology of HFpEF requires a broad spectrum of diagnostic tools, from advanced imaging techniques, through biomarkers, to myocardial biopsy and genetic testing.

Today, we also have more and more opportunities to analyze the huge amount of information that we can obtain, by taking advantage of artificial intelligence and machine learning.

In the current Special Issue of Diagnostics, we would like to present the progress in heart failure diagnostics with original research papers, communications, and review articles.

Dr. Noémi Nyolczas
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Diagnostics is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • heart failure
  • biomarkers
  • imaging modalities

Published Papers (5 papers)

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Research

16 pages, 2152 KiB  
Article
The Impact of Specialised Heart Failure Outpatient Care on the Long-Term Application of Guideline-Directed Medical Therapy and on Prognosis in Heart Failure with Reduced Ejection Fraction
by Balázs Muk, Fanni Bánfi-Bacsárdi, Máté Vámos, Dávid Pilecky, Zsuzsanna Majoros, Gábor Márton Török, Dénes Vágány, Balázs Polgár, Balázs Solymossi, Tünde Dóra Borsányi, Péter Andréka, Gábor Zoltán Duray, Róbert Gábor Kiss, Miklós Dékány and Noémi Nyolczas
Diagnostics 2024, 14(2), 131; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics14020131 - 06 Jan 2024
Viewed by 891
Abstract
(1) Background: Besides the use of guideline-directed medical therapy (GDMT), multidisciplinary heart failure (HF) outpatient care (HFOC) is of strategic importance in HFrEF. (2) Methods: Data from 257 hospitalised HFrEF patients between 2019 and 2021 were retrospectively analysed. Application and target doses of [...] Read more.
(1) Background: Besides the use of guideline-directed medical therapy (GDMT), multidisciplinary heart failure (HF) outpatient care (HFOC) is of strategic importance in HFrEF. (2) Methods: Data from 257 hospitalised HFrEF patients between 2019 and 2021 were retrospectively analysed. Application and target doses of GDMT were compared between HFOC and non-HFOC patients at discharge and at 1 year. 1-year all-cause mortality (ACM) and rehospitalisation (ACH) rates were compared using the Cox proportional hazard model. The effect of HFOC on GDMT and on prognosis after propensity score matching (PSM) of 168 patients and the independent predictors of 1-year ACM and ACH were also evaluated. (3) Results: At 1 year, the application of RASi, MRA and triple therapy (TT: RASi + βB + MRA) was higher (p < 0.05) in the HFOC group, as was the proportion of target doses of ARNI, βB, MRA and TT. After PSM, the composite of 1-year ACM or ACH was more favourable with HFOC (propensity-adjusted HR = 0.625, 95% CI = 0.401–0.974, p = 0.038). Independent predictors of 1-year ACM were age, systolic blood pressure, application of TT and HFOC, while 1-year ACH was influenced by the application of TT. (4) Conclusions: HFOC may positively impact GDMT use and prognosis in HFrEF even within the first year of its initiation. Full article
(This article belongs to the Special Issue Clinical Advances in Heart Failure)
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13 pages, 1429 KiB  
Article
Screening for Myocardial Injury after Mild SARS-CoV-2 Infection with Advanced Transthoracic Echocardiography Modalities
by Gergely Rácz, Hedvig Takács, Árpád Kormányos, Bianka Polestyuk, János Borbás, Nándor Gyenes, Noémi Schvartz, Gergely Németh, Zsigmond Tamás Kincses, Róbert Sepp and Viktória Nagy
Diagnostics 2022, 12(8), 1941; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12081941 - 11 Aug 2022
Cited by 4 | Viewed by 1241
Abstract
Although the clinical manifestations of SARS-CoV-2 viral infection affect mainly the respiratory system, cardiac complications are common and are associated with increased morbidity and mortality. While echocardiographic alterations indicating myocardial involvement are widely reported in patients hospitalized for acute COVID-19 infection, much fewer [...] Read more.
Although the clinical manifestations of SARS-CoV-2 viral infection affect mainly the respiratory system, cardiac complications are common and are associated with increased morbidity and mortality. While echocardiographic alterations indicating myocardial involvement are widely reported in patients hospitalized for acute COVID-19 infection, much fewer data available in non-hospitalized, mildly symptomatic COVID-19 patients. In our work, we aimed to investigate subclinical cardiac alterations characterized by parameters provided by advanced echocardiographic techniques following mild SARS-CoV-2 viral infection. A total of 86 patients (30 males, age: 39.5 ± 13.0 yrs) were assessed 59 ± 33 days after mild SARS-CoV-2 viral infection (requiring no hospital or <5 days in-hospital treatment) by advanced echocardiographic examination including 2-dimensional (2D) speckle tracking echocardiography and non-invasive myocardial work analysis, and were compared to an age-and sex-matched control group. Altogether, variables from eleven echocardiographic categories representing morphological or functional echocardiographic parameters showed statistical difference between the post-COVID patient group and the control group. The magnitude of change was subtle or mild in the case of these parameters, ranging from 1–11.7% of relative change. Among the parameters, global longitudinal strain [−20.3 (−21.1–−19.0) vs. −19.1 (−20.4–−17.6) %; p = 0.0007], global myocardial work index [1975 (1789–2105) vs. 1829 (1656–2057) Hgmm%; p = 0.007] and right ventricular free wall strain values (−26.6 ± 3.80 vs. −23.8 ± 4.0%; p = 0.0003) showed the most significant differences between the two groups. Subclinical cardiac alterations are present following even mild SARS-CoV-2 viral infection. These more subtle alterations are difficult to detect by routine echocardiography. Extended protocols, involving speckle-tracking echocardiography, non-invasive measurement of cardiac hemodynamics, and possibly myocardial work are necessary for detection and adequate follow-up. Full article
(This article belongs to the Special Issue Clinical Advances in Heart Failure)
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12 pages, 586 KiB  
Article
The Genetic Architecture of Hypertrophic Cardiomyopathy in Hungary: Analysis of 242 Patients with a Panel of 98 Genes
by Róbert Sepp, Lidia Hategan, Beáta Csányi, János Borbás, Annamária Tringer, Eszter Dalma Pálinkás, Viktória Nagy, Hedvig Takács, Dóra Latinovics, Noémi Nyolczas, Attila Pálinkás, Réka Faludi, Miklós Rábai, Gábor Tamás Szabó, Dániel Czuriga, László Balogh, Róbert Halmosi, Attila Borbély, Tamás Habon, Zoltán Hegedűs and István Nagyadd Show full author list remove Hide full author list
Diagnostics 2022, 12(5), 1132; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12051132 - 03 May 2022
Cited by 5 | Viewed by 2201
Abstract
Hypertrophic cardiomyopathy (HCM) is a primary disease of the myocardium most commonly caused by mutations in sarcomeric genes. We aimed to perform a nationwide large-scale genetic analysis of a previously unreported, representative HCM cohort in Hungary. A total of 242 consecutive HCM index [...] Read more.
Hypertrophic cardiomyopathy (HCM) is a primary disease of the myocardium most commonly caused by mutations in sarcomeric genes. We aimed to perform a nationwide large-scale genetic analysis of a previously unreported, representative HCM cohort in Hungary. A total of 242 consecutive HCM index patients (127 men, 44 ± 11 years) were studied with next generation sequencing using a custom-designed gene-panel comprising 98 cardiomyopathy-related genes. A total of 90 patients (37%) carried pathogenic/likely pathogenic (P/LP) variants. The percentage of patients with P/LP variants in genes with definitive evidence for HCM association was 93%. Most of the patients with P/LP variants had mutations in MYBPC3 (55 pts, 61%) and in MYH7 (21 pts, 23%). Double P/LP variants were present in four patients (1.7%). P/LP variants in other genes could be detected in ≤3% of patients. Of the patients without P/LP variants, 46 patients (19%) carried a variant of unknown significance. Non-HCM P/LP variants were identified in six patients (2.5%), with two in RAF1 (p.Leu633Val, p.Ser257Leu) and one in DES (p.Arg406Trp), FHL1 (p.Glu96Ter), TTN (p.Lys23480fs), and in the mitochondrial genome (m.3243A>G). Frameshift, nonsense, and splice-variants made up 82% of all P/LP MYBPC3 variants. In all the other genes, missense mutations were the dominant form of variants. The MYBPC3 p.Gln1233Ter, the MYBPC3 p.Pro955ArgfsTer95, and the MYBPC3 p.Ser593ProfsTer11 variants were identified in 12, 7, and 13 patients, respectively. These three variants made up 36% of all patients with identified P/LP variants, raising the possibility of a possible founder effect for these mutations. Similar to other HCM populations, the MYBPC3 and the MYH7 genes seemed to be the most frequently affected genes in Hungarian HCM patients. The high prevalence of three MYBPC3 mutations raises the possibility of a founder effect in our HCM cohort. Full article
(This article belongs to the Special Issue Clinical Advances in Heart Failure)
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14 pages, 1036 KiB  
Article
The Prognostic Value of Anemia in Patients with Preserved, Mildly Reduced and Recovered Ejection Fraction
by Anita Pintér, Anett Behon, Boglárka Veres, Eperke Dóra Merkel, Walter Richard Schwertner, Luca Katalin Kuthi, Richard Masszi, Bálint Károly Lakatos, Attila Kovács, Dávid Becker, Béla Merkely and Annamária Kosztin
Diagnostics 2022, 12(2), 517; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12020517 - 17 Feb 2022
Cited by 8 | Viewed by 1919
Abstract
Data on the relevance of anemia in heart failure (HF) patients with an ejection fraction (EF) > 40% by subgroup—preserved (HFpEF), mildly reduced (HFmrEF) and the newly defined recovered EF (HFrecEF)—are scarce. Patients with HF symptoms, elevated NT-proBNP, EF ≥ 40% and structural [...] Read more.
Data on the relevance of anemia in heart failure (HF) patients with an ejection fraction (EF) > 40% by subgroup—preserved (HFpEF), mildly reduced (HFmrEF) and the newly defined recovered EF (HFrecEF)—are scarce. Patients with HF symptoms, elevated NT-proBNP, EF ≥ 40% and structural abnormalities were registered in the HFpEF-HFmrEF database. We described the outcome of our HFpEF-HFmrEF cohort by the presence of anemia. Additionally, HFrecEF patients were also selected from HFrEF patients who underwent resynchronization and, as responders, reached 40% EF. Using propensity score matching (PSM), 75 pairs from the HFpEF-HFmrEF and HFrecEF groups were matched by their clinical features. After PMS, we compared the survival of the HFpEF-HFmrEF and HFrecEF groups. Log-rank, uni-and multivariate regression analyses were performed. From 375 HFpEF-HFmrEF patients, 42 (11%) died during the median follow-up time of 1.4 years. Anemia (HR 2.77; 95%CI 1.47–5.23; p < 0.01) was one of the strongest mortality predictors, which was also confirmed by the multivariate analysis (aHR 2.33; 95%CI 1.21–4.52; p = 0.01). Through PSM, the outcomes for HFpEF-HFmrEF and HFrecEF patients with anemia were poor, exhibiting no significant difference. In HFpEF-HFmrEF, anemia was an independent mortality predictor. Its presence multiplied the mortality risk in those with EF ≥ 40%, regardless of HF etiology. Full article
(This article belongs to the Special Issue Clinical Advances in Heart Failure)
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10 pages, 1566 KiB  
Article
Neutrophil Activation/Maturation Markers in Chronic Heart Failure with Reduced Ejection Fraction
by Suriya Prausmüller, Georg Spinka, Stefanie Stasek, Henrike Arfsten, Philipp Emanuel Bartko, Georg Goliasch, Martin Hülsmann and Noemi Pavo
Diagnostics 2022, 12(2), 444; https://0-doi-org.brum.beds.ac.uk/10.3390/diagnostics12020444 - 09 Feb 2022
Cited by 8 | Viewed by 1822
Abstract
Background: Neutrophils are critically involved in the immune response. Inflammatory stimuli alter the expression status of their surface molecule toolset, while inflammation-stimulated granulopoiesis might also influence their maturation status. Data on neutrophil status in heart failure with reduced ejection fraction (HFrEF) are scarce. [...] Read more.
Background: Neutrophils are critically involved in the immune response. Inflammatory stimuli alter the expression status of their surface molecule toolset, while inflammation-stimulated granulopoiesis might also influence their maturation status. Data on neutrophil status in heart failure with reduced ejection fraction (HFrEF) are scarce. The present study aims to evaluate the role of neutrophil CD11b, CD66b and CD64 expression in HFrEF. Methods: A total of 135 HFrEF patients and 43 controls were recruited. Mean fluorescence intensity of the activation/maturation markers CD11b, CD66b and CD64 was measured on neutrophils by flow cytometry. CD10 (neprilysin) expression was simultaneously determined. Results: Neutrophil CD64 expression was higher in HFrEF compared with controls, while CD11b/CD66b levels were similar. Neutrophil CD11b and CD66b showed a significant direct correlation to neutrophil CD10 expression (rs = 0.573, p < 0.001 and rs = 0.184, p = 0.033). Neutrophil CD11b and CD66b correlated inversely with heart failure severity reflected by NT-proBNP and NYHA class (NT-proBNP: rs = −0.243, p = 0.005 and rs = −0.250, p = 0.004; NYHA class: p = 0.032 and p = 0.055), whereas no association for CD64 could be found. Outcome analysis did not reveal a significant association between the expression of CD11b, CD66b and CD64 and all-cause mortality (p = ns). Conclusions: The results underline the potential role of neutrophils in HFrEF disease pathophysiology and risk stratification and should stimulate further research, characterizing subpopulations of neutrophils and searching for key molecules involved in the downward spiral of inflammation and heart failure. Full article
(This article belongs to the Special Issue Clinical Advances in Heart Failure)
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