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Heart Failure: Prevention, Targets, and Treatment
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Heart Failure: Prevention, Targets, and Treatment

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

Deadline for manuscript submissions: closed (30 June 2022) | Viewed by 16193

Special Issue Editor

Prof. Dr. Francesco Clemenza

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Guest Editor
Cardiologist Consultant for Cardiothoracic Department, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Palermo, Italy
Interests: advanced heart failure; congestion; L-VADs; heart transplantation; myocarditis; ventricular reverse remodelling; HFpEF

Special Issue Information

Dear Colleagues,

In recent years there have been major advances in the field of heart failure, both in terms of pathophysiological understanding and treatment. However, we still need to improve our approach to some aspects, which are not fully developed in scientific terms and—consequently—in clinical practice. Among these, we intend to address three main topics in this JCM Special Issue:

1) Identification and treatment of congestion: physical examination has limitations in identifying the hydration status of the heart failure patient; performance in this field can be improved with the use of various methods and tools (natriuretic peptides, BIVA, pulmonary “comets”, inferior vena cava diameter, etc.); however, it is not clear which of these or which combination of them guarantees the best result. The most appropriate treatment in cases of diuretic “resistance” is also a matter of debate, e.g., the use of combination diuretics or indications for peritoneal ultrafiltration.

2) Ventricular reverse remodeling: although it is clear that this is a clinical event that is not uncommon, especially in the context of non-ischemic dilated cardiomyopathies, the mechanisms by which it occurs in some patients and not in others are not as clear. Furthermore, it is not clear which of the drugs recommended for heart failure with reduced EF act most effectively to bring about a significant increase in EF.

3) Heart failure with preserved EF: this condition is strongly represented epidemiologically but still lacks proven effective treatments with RCTs. However, in recent years, there has been considerable progress in terms of pathophysiological understanding, and some trials (with MRA and ARNI) have shown positive results, at least for some subgroups. Research in this field has moved toward the identification of different phenotypes for which specific therapies should be reserved.

Prof. Dr. Francesco Clemenza
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. Journal of Clinical Medicine 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

  • Physical examination and congestion
  • Natriuretic peptides
  • BIVA
  • Pulmonary comets
  • Diuretic resistance
  • Peritoneal ultrafiltration
  • Ventricular reverse remodeling
  • MRA
  • ARNI
  • HFpEF

Published Papers (8 papers)

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Editorial

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3 pages, 186 KiB  
Editorial
Obesity and HFpEF
by Francesco Clemenza, Roberto Citarrella, Angelo Patti and Manfredi Rizzo
J. Clin. Med. 2022, 11(13), 3858; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11133858 - 03 Jul 2022
Cited by 3 | Viewed by 2053
Abstract
Heart failure with preserved ejection fraction (HFpEF) has represented a therapeutic challenge in recent decades [...] Full article
(This article belongs to the Special Issue Heart Failure: Prevention, Targets, and Treatment)

Research

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14 pages, 1596 KiB  
Article
Prognosis of Advanced Heart Failure Patients according to Their Hemodynamic Profile Based on the Modified Forrester Classification
by Guillaume Baudry, Juliette Bourdin, Raluca Mocan, Elisabeth Hugon-Vallet, Matteo Pozzi, Antoine Jobbé-Duval, Nicolas Paulo, Patrick Rossignol, Laurent Sebbag and Nicolas Girerd
J. Clin. Med. 2022, 11(13), 3663; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11133663 - 24 Jun 2022
Cited by 2 | Viewed by 1614
Abstract
Introduction: Heart transplantation (HT) remains the gold-standard treatment but is conditioned by organ shortage. This study aimed to evaluate the value of Forrester classification and determine which congestion criteria had the best prognostic value to predict cardiorenal events on heart transplant waiting list. [...] Read more.
Introduction: Heart transplantation (HT) remains the gold-standard treatment but is conditioned by organ shortage. This study aimed to evaluate the value of Forrester classification and determine which congestion criteria had the best prognostic value to predict cardiorenal events on heart transplant waiting list. Methods and results: One hundred consecutive patients (54 years old, 72% men) with available right heart catheterization (RHC) listed in our center for HT between 2014 and 2019 were included. Cardiac catheterization measurements were obtained at the time of HT listing evaluation. Patients were classified according to perfusion and congestion status in four groups: “warm and dry”, “warm and wet”, “cold and dry”, and “cold and wet”. pWet was used to classify patients with pulmonary congestion and sWet for systemic congestion. The primary endpoint was the rate of a composite criteria of cardiogenic shock, acute kidney injury, and acute heart failure. Secondary endpoint was the incidence of waitlist death, emergency HT, or left ventricular assist device (LVAD) implantation at 12 months evaluated by Kaplan–Meier curves and log-rank test. Only Forrester classification according to systemic congestion was associated with the primary composite endpoint (p = 0.011), while patients’ profile according to pulmonary congestion was not (p = 0.331). Similarly, only the Forrester classification according to systemic congestion predicted waitlist death, emergency HT, or LVAD implantation at 12 months, with p = 0.010 and p = 0.189 for systemic and pulmonary congestion, respectively. Moreover, systemic congestion was the main driver of cardiorenal events on waitlist. Conclusions: Forrester classification according to systemic congestion is associated with cardiorenal outcomes in patients listed for heart transplant and the risk of waitlist death, emergency HT, or LVAD implantation at 12 months. Full article
(This article belongs to the Special Issue Heart Failure: Prevention, Targets, and Treatment)
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15 pages, 1942 KiB  
Article
Dapagliflozin Impact on the Exercise Capacity of Non-Diabetic Heart Failure with Reduced Ejection Fraction Patients
by João Reis, Ana Rita Teixeira, António Valentim Gonçalves, Rita Ilhão Moreira, Tiago Pereira Silva, Ana Teresa Timóteo and Rui Cruz Ferreira
J. Clin. Med. 2022, 11(10), 2935; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11102935 - 23 May 2022
Cited by 6 | Viewed by 2877
Abstract
Background: Dapagliflozin has been shown to reduce morbidity and mortality in Heart Failure with reduced Ejection Fraction (HFrEF), but its impact on exercise capacity of non-diabetic HF outpatients is unknown. Methods: Adult non-diabetic HF patients with a left ventricular ejection fraction (LVEF) <50% [...] Read more.
Background: Dapagliflozin has been shown to reduce morbidity and mortality in Heart Failure with reduced Ejection Fraction (HFrEF), but its impact on exercise capacity of non-diabetic HF outpatients is unknown. Methods: Adult non-diabetic HF patients with a left ventricular ejection fraction (LVEF) <50% were randomized 1:1 to receive dapagliflozin 10 mg or to continue with HF medication. Patients underwent an initial evaluation which was repeated after 6 months. The variation of several clinical parameters was compared, with the primary endpoint being the 6 month peak oxygen uptake (pVO2) variation. Results: A total of 40 patients were included (mean age 61 ± 13 years, 82.5% male, mean LVEF 34 ± 5%), half being randomized to dapagliflozin, with no significant baseline differences between groups. The reported drug compliance was 100%, with no major safety events. No statistically significant difference in HF events was found (p = 0.609). There was a 24% reduction in the number of patients in New York Heart Association (NYHA) class III in the treatment group as opposed to a 15.8% increase in the control group (p = 0.004). Patients under dapagliflozin had a greater improvement in pVO2 (3.1 vs. 0.1 mL/kg/min, p = 0.030) and a greater reduction in NT-proBNP levels (−217.6 vs. 650.3 pg/mL, p = 0.007). Conclusion: Dapagliflozin was associated with a significant improvement in cardiopulmonary fitness at 6 months follow-up in non-diabetic HFrEF patients. Full article
(This article belongs to the Special Issue Heart Failure: Prevention, Targets, and Treatment)
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13 pages, 762 KiB  
Communication
The Role of Vitamin D3 as an Independent Predicting Marker for One-Year Mortality in Patients with Acute Heart Failure
by Kirsten Thiele, Anne Cornelissen, Roberta Florescu, Kinan Kneizeh, Vincent Matthias Brandenburg, Klaus Witte, Nikolaus Marx, Alexander Schuh and Robert Stöhr
J. Clin. Med. 2022, 11(10), 2733; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11102733 - 12 May 2022
Cited by 3 | Viewed by 1348
Abstract
Background: Deficiency in vitamin D3 and its metabolites has been linked to dismal outcomes in patients with chronic diseases, including cardiovascular disease and heart failure (HF). It remains unclear if a vitamin D3 status is a prognostic feature in patients with [...] Read more.
Background: Deficiency in vitamin D3 and its metabolites has been linked to dismal outcomes in patients with chronic diseases, including cardiovascular disease and heart failure (HF). It remains unclear if a vitamin D3 status is a prognostic feature in patients with acute decompensated HF. Methods: We assessed serum levels of 25-OH-vitamin D3 and 1,25-(OH)2-vitamin D3 in 139 patients with acute HF who had been admitted to the intermediate care unit of a maximum care hospital. The follow-up period was one year. After exclusion of patients with sampling errors and those who were lost to follow-up, 118 patients remained in the final study cohort. Outcome estimates by 25-OH-vitamin D3 and 1,25-(OH)2-vitamin D3 levels were compared to the Seattle Heart Failure (SHF) Model. Results: More than two-thirds (79.7%) of the patients showed inadequate 25-OH-vitamin D3 levels (i.e., <30 ng/mL) upon admission. Low levels of 1,25-(OH)2-vitamin D3 (i.e., <19.9 pg/mL) were observed in 16.1% of patients. Of the 118 HF patients, 22 (19%) died during the following 12 months. There were no differences in vitamin D3 levels between patients who died and those who survived, neither in 25-OH-vitamin D3 (23.37 ± 19.14 ng/mL vs. 19.11 ± 12.25 ng/mL; p = 0.19) nor in 1,25-(OH)2-vitamin D3 levels (31.10 ± 19.75 ng/mL vs. 38.25 ± 15.73 ng/mL; p = 0.02); therefore, vitamin D3 levels alone did not predict one-year survival (AUC [25-OH-vitamin D3] 0.50; 95% CI 0.34–0.65; AUC [1,25-(OH)2-vitamin D3] 0.62; 95% CI 0.48–0.76). Moreover, whilst the SHF model exhibited acceptable discriminatory ability for predicting one-year mortality (AUC 0.79; 95% CI 0.66–0.91), adding vitamin D levels on admission to the SHF score did not improve its discriminatory value. Conclusion: Our data do not support the use of vitamin D3 screening in patients admitted with acute decompensated HF to aid prognostication. Full article
(This article belongs to the Special Issue Heart Failure: Prevention, Targets, and Treatment)
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13 pages, 1291 KiB  
Article
Vascular Dysfunction Predicts Future Deterioration of Left Ventricular Ejection Fraction in Patients with Heart Failure with Mildly Reduced Ejection Fraction
by Shinji Kishimoto, Tatsuya Maruhashi, Masato Kajikawa, Takahiro Harada, Takayuki Yamaji, Yiming Han, Aya Mizobuchi, Yu Hashimoto, Kenichi Yoshimura, Yukiko Nakano, Kazuaki Chayama, Chikara Goto, Farina Mohamad Yusoff, Ayumu Nakashima and Yukihito Higashi
J. Clin. Med. 2021, 10(24), 5980; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10245980 - 20 Dec 2021
Cited by 4 | Viewed by 1482
Abstract
The purpose of this study was to evaluate whether heart failure with mildly reduced ejection fraction (HFmrEF) is associated with vascular dysfunction and whether vascular function predicts future deterioration of LVEF in patients with HFmrEF. We evaluated endothelial function assessed by flow-mediated vasodilation [...] Read more.
The purpose of this study was to evaluate whether heart failure with mildly reduced ejection fraction (HFmrEF) is associated with vascular dysfunction and whether vascular function predicts future deterioration of LVEF in patients with HFmrEF. We evaluated endothelial function assessed by flow-mediated vasodilation (FMD) and vascular smooth muscle function assessed by nitroglycerine-induced vasodilation (NID) in 69 patients with HFmrEF and 426 patients without HF and evaluated the future deterioration of LVEF, defined as a decrease in LVEF to <40%, in 39 patients with HFmrEF for up to 3 years. Both FMD and NID were significantly lower in patients with HFmrEF than in patients without HF. We categorized patients into two groups based on low tertiles of NID: a low group (NID of <7.0%) and an intermediate and high group (NID of ≥7.0%). There were significant differences between the Kaplan–Meier curves for the deterioration of LVEF in the two groups (p < 0.01). Multivariate Cox proportional hazard analysis revealed that NID of <7.0% was an independent predictor of future deterioration of LVEF in patients with HFmrEF. Both endothelial function and vascular smooth muscle function are impaired in patients with HFmrEF compared with those in patients without HF. In addition, low NID of <7.0% predicts future deterioration of LVEF. Full article
(This article belongs to the Special Issue Heart Failure: Prevention, Targets, and Treatment)
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9 pages, 779 KiB  
Article
Obesity and Uncontrolled Diabetes Predict Depression in HF Patients
by Albenita Fetahu, Kaltrinë Rrustemi, Michael Y. Henein, Besim Bytyçi, Flamure Mehmeti, Ibadete Bytyçi and Lulzim Kamberi
J. Clin. Med. 2021, 10(23), 5663; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10235663 - 30 Nov 2021
Cited by 3 | Viewed by 1691
Abstract
Background and aim: Heart failure (HF) is a clinical syndrome associated with poor quality of life and prognosis, and premature mortality. The aim of this study was to assess the prevalence of depression and its risk factors in HF patients. Methods: The study [...] Read more.
Background and aim: Heart failure (HF) is a clinical syndrome associated with poor quality of life and prognosis, and premature mortality. The aim of this study was to assess the prevalence of depression and its risk factors in HF patients. Methods: The study included 151 HF patients (mean age of 66.6 ± 11 years, 52.3% female). Based on ejection fraction (EF), the study cohort was divided into the following two groups: group-I: HFpEF patients (EF ≥ 50%, n = 47) and group-II: HFrEF patients (EF < 40%, n = 104). For the enrolled patients, demographic, clinic and echocardiographic indices, and depression scale results were collected. Results: The patients with HF and depression were older, mostly females, more obese, and had a higher glycemic level and higher NYHA functional class compared with the patients without depression (p < 0.05 for all). The left ventricle (LV) and left atrial (LA) dimensions were larger, and EF was lower, in patients with depression compared to those without depression (p < 0.05 for all), while the right ventricle (RV) measurements did not differ (p > 0.05). The same parameters remained significantly different when the patients were divided into HFpEF and HFrEF. The depression scale correlated with glycemic level (r = 0.51, p = 0.01), obesity (rpb = 0.53, p = 0.001), age (r = 0.47, p = 0.02), and severity of NYHA class (rpb = 0.54, p = 0.001). On a multivariate model, BMI ≥ 30 kg/m2, OR 1.890 (1.199 to 3.551; 0.02) glycemic level ≥ 8.5 mmol/L, OR 2.802 (1.709 to 5.077; p = 0.01), and NYHA class > 2, OR 2.103 (1.389 to 4.700; p = 0.01), proved to be the most powerful independent predictors of depression, in the group as a whole. Obesity and uncontrolled diabetes predicted depression, irrespective of EF. Conclusions: In this modest cohort of HF patients, obesity and uncontrolled diabetes were independent predictors of depression, irrespective of LV systolic function. This emphasizes the important role of medical education for better control of such risk factors. Full article
(This article belongs to the Special Issue Heart Failure: Prevention, Targets, and Treatment)
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12 pages, 896 KiB  
Article
Poorer Exercise Accommodation of Regional Systolic Myocardial Motion after Spironolactone Treatment in Heart Failure Patients with Preserved Ejection Fraction and Ventricular Dyssynchrony
by Chih-Chieh Yu, Fu-Chun Chiu, Chia-Ti Tsai, Yi-Chih Wang, Ling-Ping Lai, Juey-Jen Hwang and Jiunn-Lee Lin
J. Clin. Med. 2021, 10(17), 3827; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm10173827 - 26 Aug 2021
Cited by 1 | Viewed by 1799
Abstract
Patients with heart failure and preserved ejection fraction (HFpEF) are known to have reduced systolic myocardial velocity (Sm) with impaired accommodation to exercise. We tested the impact of an aldosterone antagonist on Sm at rest and post-exercise. Forty-nine HFpEF patients (65 ± 11 [...] Read more.
Patients with heart failure and preserved ejection fraction (HFpEF) are known to have reduced systolic myocardial velocity (Sm) with impaired accommodation to exercise. We tested the impact of an aldosterone antagonist on Sm at rest and post-exercise. Forty-nine HFpEF patients (65 ± 11 years, 24 male) with HF signs/symptoms, mitral E/Ea (annular early diastolic velocity) > 8, and left ventricular (LV) EF > 50% were randomized to spironolactone (25 mg/day, 25 patients) or the Control. At baseline and 6 months, we analyzed Sm of basal LV segments at rest and after a 6 min treadmill exercise. At 6 months, post-exercise mean Sm in the spironolactone group became greater than that in the Control (9.2 ± 1.6 vs. 8.3 ± 1.0 cm/s, p = 0.021), mainly due to the increment of post-exercise % increase of lateral Sm (44 ± 30 vs. 30 ± 19% at baseline, p = 0.045). Further analyses showed the presence of systolic dyssynchrony (standard deviation of electromechanical delay of 6-basal LV segments > 35 ms) was independently associated with a poorer response to spironolactone, defined as a post-exercise % increase of lateral Sm < 50% (OR = 2.7, 95% CI = 1.8–4.2) and the increment of Ea < 1.5 cm/s (OR = 1.5, 95% CI = 1.1–2.3). Spironolactone could improve exercise accommodation of regional systolic myocardial velocity for HFpEF patients. However, its benefits could be decreased in those with ventricular dyssynchrony. This suggested possible therapeutic impacts from underlying heterogeneity within HFpEF patients. Full article
(This article belongs to the Special Issue Heart Failure: Prevention, Targets, and Treatment)
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6 pages, 228 KiB  
Perspective
Hemodynamic Evaluation of the Right Heart-Pulmonary Circulation Unit in Patients Candidate to Transjugular Intrahepatic Portosystemic Shunt
by Giulia Manguso, Anthony Vignone, Manuela Merli, Cristiano Miotti, Annalisa Caputo, Carmine Dario Vizza and Roberto Badagliacca
J. Clin. Med. 2022, 11(2), 461; https://0-doi-org.brum.beds.ac.uk/10.3390/jcm11020461 - 17 Jan 2022
Cited by 4 | Viewed by 2467
Abstract
In Europe, liver cirrhosis represents the fourth-most common cause of death, being responsible for 170,000 deaths and 5500 liver transplantations per year. The main driver of its decompensation is portal hypertension, whose progression radically changes the prognosis of affected patients. Transjugular intrahepatic portosystemic [...] Read more.
In Europe, liver cirrhosis represents the fourth-most common cause of death, being responsible for 170,000 deaths and 5500 liver transplantations per year. The main driver of its decompensation is portal hypertension, whose progression radically changes the prognosis of affected patients. Transjugular intrahepatic portosystemic shunt (TIPS) is one of the main therapeutic strategies for these patients as it reverts portal hypertension, thus improving survival. However, the coexistence of portal hypertension and pulmonary hypertension or heart failure is considered a contraindication to TIPS. Nevertheless, in the latest guidelines, the definition of heart failure has not been specified. It is unclear whether the contraindication concerns the presence of clinical signs and symptoms of heart failure or hemodynamic changes in the right heart-pulmonary circulation. Moreover, data about induced right heart volume overload after TIPS and the potential development of heart failure and pulmonary hypertension is currently scanty and controversial. In this article we revise this issue in finding predictors of cardiac performance after TIPS procedure. Performing a fluid challenge during right heart catheterization might be a promising expedient to test the adaptation of the right ventricle to a sudden increase in preload in the first few months after TIPS. This test may unmask a potential cardiac inability to sustain the hemodynamic load after TIPS, allowing for a clearer definition of heart failure and, consequently, a more robust indication to TIPS. Full article
(This article belongs to the Special Issue Heart Failure: Prevention, Targets, and Treatment)
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