Therapeutic Strategies for Heart Failure

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425).

Deadline for manuscript submissions: closed (31 December 2022) | Viewed by 24069

Special Issue Editors


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Guest Editor
1st Chair and Department of Cardiology, Medical University of Warsaw, Banacha 1a, 02-097 Warsaw, Poland
Interests: heart failure; atrial fibrillation; echocardiography; valvular heart disease
1. Department of Cardiology, Maastricht University Medical Centre and Cardiovascular Research Institute Maastricht, Universiteitssingel 50, 6229 ER Maastricht, The Netherlands
2. Institute of Pharmacology, West German Heart and Vascular Centre, University Duisburg-Essen, Hufelandstraße 55, 45147 Essen, Germany
3. 1st Department of Cardiology, Medical University of Warsaw, Banacha 1A, 02-197 Warsaw, Poland
Interests: atrial fibrillation; diet; lifestyle; mHealth; telemedicine

Special Issue Information

Dear Colleagues,

With high mortality, morbidity, and socioeconomic burden, heart failure (HF) remains a major challenge but at the same time one of the most rapidly developing areas in modern cardiology. Recent years, and in fact weeks, have brought crucial advances in the treatment of both HF with reduced (HFrEF) and, for the first time, HF with preserved ejection fraction (HFpEF). In this Special Issue, we aim to focus on a broad range of therapeutic strategies in HF and would like to invite the submission of research articles, review papers, and case reports on the following topics:

  • SGLT2 inhibitors across the spectrum of ejection fraction in HF—a wonder drug that has it all?
  • In-hospital initiation of disease-modifying, chronic HFrEF pharmacotherapy after acute HF decompensation—timing, sequence and drug choice based on clinical profiles;
  • Decongestion strategies in acute and chronic HF (including diuretic resistance, electrolyte disturbances, and novel therapies);
  • Targeted treatment of specific HFpEF etiologies;
  • Transcatheter structural interventions in HF: valvular interventions, interatrial shunt devices, left ventricular restoration devices, etc.;
  • Treatment of right-ventricular heart failure—are diuretics our only option?
  • How to guide and optimize HF therapy (clinical assessment vs. biomarkers vs. hemodynamic monitoring; telemonitoring; eHealth and mHealth);
  • Treatment of acute decompensated HF—looking for EBM;
  • Exercise rehabilitation in HF—prevention and treatment of sarcopenia in HF;
  • Novel drugs for HF—do we need more?
  • New biomarkers (including microRNA) and their potential role in HF treatment optimization;
  • Treatment of cardiac and extra-cardiac comorbidities;
  • Electrotherapy in HF—beyond ICDs and cardiac resynchronization;
  • Mechanical circulatory support—the what, the when, and the how.

Articles on other topics in the field of HF therapy are also welcome.

Dr. Agnieszka Kapłon-Cieślicka
Dr. Monika Gawałko
Guest Editors

Manuscript Submission Information

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Keywords

  • heart failure with reduced ejection fraction
  • heart failure with mildly reduced ejection fraction
  • heart failure with preserved ejection fraction
  • SGLT2 inhibitors
  • diuretics
  • functional mitral regurgitation
  • functional tricuspid regurgitation
  • mechanical circulatory support

Published Papers (8 papers)

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Research

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17 pages, 1976 KiB  
Article
Effects of Home-Based Electrical Stimulation on Plasma Cytokines Profile, Redox Biomarkers, and Metalloproteinases in the Heart Failure with Reduced Ejection Fraction: A Randomized Trial
by Marianne Lucena da Silva, Ivo Vieira de Sousa Neto, Alexandra C. G. B. de Lima, Fabrício Barin, Otávio de Toledo Nóbrega, Rita de Cássia Marqueti, Graziella F. B. Cipriano, João Luiz Quagliotti Durigan, Eduardo Antônio Ferreira, Martim Bottaro, Ross Arena, Larry P. Cahalin, José Alberto Neder and Gerson Cipriano Junior
J. Cardiovasc. Dev. Dis. 2022, 9(12), 463; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9120463 - 15 Dec 2022
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Abstract
Background: Low-frequency electrical stimulation (LFES) is an adjuvant method for heart failure (HF) patients with restrictions to start an exercise. However, the impact on molecular changes in circulating is unknown. We investigated the effects of 10 weeks of home-based LFES on plasma cytokines [...] Read more.
Background: Low-frequency electrical stimulation (LFES) is an adjuvant method for heart failure (HF) patients with restrictions to start an exercise. However, the impact on molecular changes in circulating is unknown. We investigated the effects of 10 weeks of home-based LFES on plasma cytokines profile, redox biomarkers, metalloproteinases (MMPs) activity, and exercise performance in HF patients. Methods: Twenty-four HF patients (52.45 ± 9.15 years) with reduced ejection fraction (HFrEF) (EF < 40%), were randomly assigned to a home-based LFES or sham protocol. Plasma cytokines profile was assessed through interleukins, interferon-gamma, and tumor necrosis factor levels. Oxidative stress was evaluated through ferric reducing antioxidant power, thiobarbituric acid-reactive substances, and inducible nitric oxide synthase. The MMPs activity were analyzed by zymography. Cardiorespiratory capacity and muscle strength were evaluated by cardiopulmonary test and isokinetic. Results: LFES was able to increase the active-MMP2 activity post compared to pre-training (0.057 to 0.163, p = 0.0001), while it decreased the active-MMP9 (0.135 to 0.093, p = 0.02). However, it did not elicit changes in cytokines, redox biomarkers, or exercise performance (p > 0.05). Conclusion: LFES protocol is a promising intervention to modulate MMPs activity in HFrEF patients, although with limited functional effects. These preliminary responses may help the muscle to adapt to future mechanical demands dynamically. Full article
(This article belongs to the Special Issue Therapeutic Strategies for Heart Failure)
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15 pages, 1729 KiB  
Article
Obesity and Body Mass Components Influence Exercise Tolerance and the Course of Hypertension in Perimenopausal Women
by Agata Bielecka-Dabrowa, Katarzyna Gryglewska, Agata Sakowicz, Marek Rybak, Kamil Janikowski and Maciej Banach
J. Cardiovasc. Dev. Dis. 2022, 9(8), 238; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9080238 - 27 Jul 2022
Cited by 1 | Viewed by 1724
Abstract
The aim of this study was to identify the potential influence of obesity and body mass components on exercise tolerance assessed in cardiopulmonary exercise testing (CPET), biochemical and echocardiographic parameters and factors correlated with oxygen absorption at the anaerobic threshold in hypertensive women [...] Read more.
The aim of this study was to identify the potential influence of obesity and body mass components on exercise tolerance assessed in cardiopulmonary exercise testing (CPET), biochemical and echocardiographic parameters and factors correlated with oxygen absorption at the anaerobic threshold in hypertensive women with low levels of physical activity in the perimenopausal period. The study comprised 188 hypertensive women divided, based on body mass index (BMI), into an obesity group and a non-obesity group. Women with BMI ≥ 30 kg/m2 had significantly higher parameters of left ventricular diastolic dysfunction in echocardiography, lower total body water (TBC) in percentage assessed by bioimpedance and significantly worse exercise capacity assessed by CPET. In the study group, VO2 AT (mL/kg/min) correlated positively with TBW (r = 0.4, p < 0.0001) and with the ratio of extracellular water to total body water (ECW/TBW) (r = 0.4, p < 0.00001) and negatively with fat (% and kg) (r = −0.4, p < 0.0001 for both). Obesity negatively affects parameters of diastolic left ventricular function, as well as exercise tolerance in CPET in hypertensive females during the perimenopausal period. The oxygen uptake at anaerobic threshold correlates positively with total body water and ECW/TBW and negatively with body fat; this connection is more pronounced in women without obesity. ClinicalTrials.gov Identifier: NCT04802369. Full article
(This article belongs to the Special Issue Therapeutic Strategies for Heart Failure)
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8 pages, 2602 KiB  
Article
The Use of Machine Learning Algorithms in the Evaluation of the Effectiveness of Resynchronization Therapy
by Bartosz Krzowski, Jakub Rokicki, Renata Główczyńska, Nikola Fajkis-Zajączkowska, Katarzyna Barczewska, Mariusz Mąsior, Marcin Grabowski and Paweł Balsam
J. Cardiovasc. Dev. Dis. 2022, 9(1), 17; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9010017 - 10 Jan 2022
Cited by 3 | Viewed by 2729
Abstract
Background: Cardiovascular disease remains the leading cause of death in the European Union and worldwide. Constant improvement in cardiac care is leading to an increased number of patients with heart failure, which is a challenging condition in terms of clinical management. Cardiac resynchronization [...] Read more.
Background: Cardiovascular disease remains the leading cause of death in the European Union and worldwide. Constant improvement in cardiac care is leading to an increased number of patients with heart failure, which is a challenging condition in terms of clinical management. Cardiac resynchronization therapy is becoming more popular because of its grounded position in guidelines and clinical practice. However, some patients do not respond to treatment as expected. One way of assessing cardiac resynchronization therapy is with ECG analysis. Artificial intelligence is increasing in terms of everyday usability due to the possibility of everyday workflow improvement and, as a result, shortens the time required for diagnosis. A special area of artificial intelligence is machine learning. AI algorithms learn on their own based on implemented data. The aim of this study was to evaluate using artificial intelligence algorithms for detecting inadequate resynchronization therapy. Methods: A total of 1241 ECG tracings were collected from 547 cardiac department patients. All ECG signals were analyzed by three independent cardiologists. Every signal event (QRS-complex) and rhythm was manually classified by the medical team and fully reviewed by additional cardiologists. The results were divided into two parts: 80% of the results were used to train the algorithm, and 20% were used for the test (Cardiomatics, Cracow, Poland). Results: The required level of detection sensitivity of effective cardiac resynchronization therapy stimulation was achieved: 99.2% with a precision of 92.4%. Conclusions: Artificial intelligence algorithms can be a useful tool in assessing the effectiveness of resynchronization therapy. Full article
(This article belongs to the Special Issue Therapeutic Strategies for Heart Failure)
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Review

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15 pages, 2995 KiB  
Review
Cardiovascular Implantable Electronic Devices Enabled Remote Heart Failure Monitoring; What We Have Learned and Where to Go Next
by Solmaz Assa, Kevin Vernooy and Antonius M. W. van Stipdonk
J. Cardiovasc. Dev. Dis. 2023, 10(4), 152; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10040152 - 31 Mar 2023
Cited by 2 | Viewed by 1879
Abstract
Despite recent developments, heart failure (HF) remains to be a great burden to the individual patient, entailing major morbidity and mortality. Moreover, HF is a great burden to overall healthcare, mainly because of frequent hospitalizations. Timely diagnosis of HF deterioration and implementation of [...] Read more.
Despite recent developments, heart failure (HF) remains to be a great burden to the individual patient, entailing major morbidity and mortality. Moreover, HF is a great burden to overall healthcare, mainly because of frequent hospitalizations. Timely diagnosis of HF deterioration and implementation of appropriate therapy may prevent hospitalization and eventually improve a patient’s prognosis; however, depending on the patient’s presentation, the signs and symptoms of HF often offer too little therapeutic window to prevent hospitalizations. Cardiovascular implantable electronic devices (CIEDs) can provide real-time physiologic parameters and remote monitoring of these parameters can potentially help to identify patients at high risk. However, routine implementation of remote monitoring of CIEDs has still not been widely used in daily patient care. This review gives a detailed description of available metrics for remote HF monitoring, the studies that provide evidence of their efficacy, ways to implement them in clinical HF practice, as well as lessons learned on where to go on from where we currently are. Full article
(This article belongs to the Special Issue Therapeutic Strategies for Heart Failure)
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18 pages, 904 KiB  
Review
New Biomarkers and Their Potential Role in Heart Failure Treatment Optimisation—An African Perspective
by Marheb Badianyama, Dineo Mpanya, Umar Adamu, Farai Sigauke, Samantha Nel and Nqoba Tsabedze
J. Cardiovasc. Dev. Dis. 2022, 9(10), 335; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9100335 - 02 Oct 2022
Cited by 6 | Viewed by 2231
Abstract
Heart failure is a clinical syndrome resulting from various cardiovascular diseases of different aetiologies and pathophysiology. These varying pathologies involve several complex mechanisms that lead to the activation of the neurohumoral system, inflammation, angiogenesis, apoptosis, fibrosis, and eventually adverse cardiac remodelling associated with [...] Read more.
Heart failure is a clinical syndrome resulting from various cardiovascular diseases of different aetiologies and pathophysiology. These varying pathologies involve several complex mechanisms that lead to the activation of the neurohumoral system, inflammation, angiogenesis, apoptosis, fibrosis, and eventually adverse cardiac remodelling associated with a progressive decline in cardiac function. Once a diagnosis is made, the cardiac function has a gradual decline characterised by multiple hospital admissions. It is therefore imperative to identify patients at different stages of the heart failure continuum to better risk stratify and initiate optimal management strategies. Biomarkers may play a role in the diagnosis, prognostication, and monitoring response to treatment. This review discusses the epidemiology of heart failure and biomarkers commonly used in clinical practice such as natriuretic peptides and cardiac troponins. In addition, we provide a brief overview of novel biomarkers and genetic coding and non-coding biomarkers used in the management of patients with heart failure. We also discuss barriers that hinder the clinical application of novel biomarkers. Finally, we appraise the value of polygenic risk scoring, focusing on sub-Saharan Africa. Full article
(This article belongs to the Special Issue Therapeutic Strategies for Heart Failure)
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16 pages, 579 KiB  
Review
Sodium-Glucose Cotransporter-2 Inhibitors-from the Treatment of Diabetes to Therapy of Chronic Heart Failure
by Dominik Kurczyński, Bartosz Hudzik, Marta Jagosz, Jan Zabierowski, Jolanta Nowak, Andrzej Tomasik, Arkadiusz Badziński, Piotr Rozentryt and Mariusz Gąsior
J. Cardiovasc. Dev. Dis. 2022, 9(7), 225; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9070225 - 14 Jul 2022
Cited by 3 | Viewed by 6159
Abstract
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are currently the second-line pharmacotherapy in type 2 diabetes, particularly through their effectiveness in reducing glycemia, but also due to their cardioprotective and nephroprotective effects. In light of surprisingly satisfactory results from large, randomized trials on gliflozins, SGLT2 received [...] Read more.
Sodium-glucose cotransporter-2 (SGLT2) inhibitors are currently the second-line pharmacotherapy in type 2 diabetes, particularly through their effectiveness in reducing glycemia, but also due to their cardioprotective and nephroprotective effects. In light of surprisingly satisfactory results from large, randomized trials on gliflozins, SGLT2 received the highest recommendation (Class IA) with the highest level of evidence (A) in the treatment algorithm for HF with reduced LVEF in recent ESC HF guidelines. This great breakthrough in the treatment of HF is due to different mechanisms of action of gliflozins that are reported to be able to change the natural course of HF by reducing the risk of both hospitalization and death. They are recommended regardless of the patient’s diabetes status. This review summarizes the up-to-date literature on their beneficial and pleiotropic impact on the cardiovascular system. Full article
(This article belongs to the Special Issue Therapeutic Strategies for Heart Failure)
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17 pages, 3775 KiB  
Review
Heart Failure—Do We Need New Drugs or Have Them Already? A Case of Coenzyme Q10
by Krzysztof J. Filipiak, Stanisław Surma, Monika Romańczyk and Bogusław Okopień
J. Cardiovasc. Dev. Dis. 2022, 9(5), 161; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd9050161 - 16 May 2022
Cited by 6 | Viewed by 4855
Abstract
Heart failure (HF) is a global epidemic that contributes to the deterioration of quality of life and its shortening in 1–3% of adult people in the world. Pharmacotherapy of HF should rely on highly effective drugs that improve prognosis and prolong life. Currently, [...] Read more.
Heart failure (HF) is a global epidemic that contributes to the deterioration of quality of life and its shortening in 1–3% of adult people in the world. Pharmacotherapy of HF should rely on highly effective drugs that improve prognosis and prolong life. Currently, the ESC guidelines from 2021 indicate that ACEI, ARNI, BB, and SGLT2 inhibitors are the first-line drugs in HF. It is also worth remembering that the use of coenzyme Q10 brought many benefits in patients with HF. Coenzyme Q10 is a very important compound that performs many functions in the human body. The most important function of coenzyme Q10 is participation in the production of energy in the mitochondria, which determines the proper functioning of all cells, tissues, and organs. The highest concentration of coenzyme Q10 is found in the tissue of the heart muscle. As the body ages, the concentration of coenzyme Q10 in the tissue of the heart muscle decreases, which makes it more susceptible to damage by free radicals. It has been shown that in patients with HF, the aggravation of disease symptoms is inversely related to the concentration of coenzyme Q10. Importantly, the concentration of coenzyme Q10 in patients with HF was an important predictor of the risk of death. Long-term coenzyme Q10 supplementation at a dose of 300 mg/day (Q-SYMBIO study) has been shown to significantly improve heart function and prognosis in patients with HF. This article summarizes the latest and most important data on CoQ10 in pathogenesis. Full article
(This article belongs to the Special Issue Therapeutic Strategies for Heart Failure)
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Other

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10 pages, 2235 KiB  
Case Report
Early Smartphone App-Based Remote Diagnosis of Silent Atrial Fibrillation and Ventricular Fibrillation in a Patient with Cardiac Resynchronization Therapy Defibrillator
by Dagmar Kowal, Agnieszka Katarzyńska-Szymańska, Marek Prech, Błażej Rubiś and Przemysław Mitkowski
J. Cardiovasc. Dev. Dis. 2023, 10(1), 30; https://0-doi-org.brum.beds.ac.uk/10.3390/jcdd10010030 - 14 Jan 2023
Cited by 1 | Viewed by 1579
Abstract
Due to distressing statistics concerning cardiovascular diseases, remote monitoring of cardiac implantable electronic devices (CIED) has received a priority recommendation in daily patient care. However, most bedside systems available so far are not optimal due to limited patient adherence. We report that smartphone [...] Read more.
Due to distressing statistics concerning cardiovascular diseases, remote monitoring of cardiac implantable electronic devices (CIED) has received a priority recommendation in daily patient care. However, most bedside systems available so far are not optimal due to limited patient adherence. We report that smartphone app technology communicating with CIED improved the patient’s engagement and adherence, as well as the accuracy of atrial and ventricular arrhythmias diagnosis, thus offering more efficient treatment and, consequently, better patient clinical outcomes. Our findings are in concordance with previously published results for implantable loop recorders and pacemakers, and provide new insight for heart failure patients with an implanted cardiac resynchronization therapy defibrillator. Full article
(This article belongs to the Special Issue Therapeutic Strategies for Heart Failure)
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