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Medicina
Special Issues
Diagnosis, Monitoring, and Treatment of Chronic Heart Failure
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Diagnosis, Monitoring, and Treatment of Chronic Heart Failure

A special issue of Medicina (ISSN 1648-9144). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: closed (30 November 2021) | Viewed by 10386

Special Issue Editor

Dr. Vasiliki Bistola

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Guest Editor
Heart Failure Unit, 2nd Cardiology Department, Attikon University Hospital, National Kapodistrian University of Athens, Athens, Greece
Interests: acute and chronic heart failure; diagnosis; pharmacotherapy; heart failure with preserved ejection fraction; cardiomyopathies; cardiometabolic diseases; advanced heart failure

Special Issue Information

Dear Colleagues,

Heart failure is a growing health problem with significant mortality and morbidity. Diagnostic evaluation of HF patients is critical but often challenging and aims to establish HF diagnosis but also to confirm the underlying etiology. Cardiac imaging including standard and novel echocardiographic techniques (such as speckle tracking and three-dimensional echo) and cardiac magnetic resonance with advanced mapping techniques have expanded our diagnostic and prognostic potential. In addition to standard-of-care natriuretic peptides and troponins, emerging biomarkers including pro-fibrotic peptides (such as ST2) and newer circulating noncoding RNA molecules are being tested as diagnostic and prognostic markers in HF.

Recently, noninvasive telemonitoring of HF outpatients has given some promising preliminary results in improving patient care. However, optimal monitoring tools remain to be defined among proposed interventions that include nurse home visits, structured telephone contacts, and use of electronic devices and telecommunications technologies.

Optimal HF management includes pharmacologic therapies and devices in selected patients. However, implementation of guideline-recommended maximal tolerated doses of neurohormonal inhibitors lags significantly in clinical practice. New pharmacologic therapies have recently emerged for patients with HF with reduced ejection fraction, including sodium-glucose co-transporter 2 inhibitors, omecamtiv mecarbil and vericiguat. Combination of standard with emerging pharmacotherapies may present new challenges for implementation to avoid tolerability issues related to blood pressure, renal function and serum potassium.

HF with preserved ejection fraction remains an unmet therapeutic need, although the identification of transthyretin amyloidosis as a specific cause in a subset of HFPEF patients along with the development of TTR-specific therapies could improve outcomes of affected individuals.

The purpose of this Special Issue is to address recent developments but also remaining gaps and challenges in the diagnostic and therapeutic management of chronic HF, focusing specifically on the role of emerging imaging modalities (newer echocardiographic techniques, CMR, etc.) and serum biomarkers; effectiveness of telemonitoring strategies; and implementation of pharmacotherapies and devices in clinical practice. It is my privilege to cordially invite researchers and practitioners to share their experience and submit new ideas and recent results to this unique Special Issue.

Dr. Vasiliki Bistola
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. Medicina is an international peer-reviewed open access monthly 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 1800 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

  • Chronic heart failure
  • Heart failure with reduced ejection fraction
  • Heart failure with preserved ejection fraction
  • Diagnosis
  • Cardiac imaging
  • Biomarkers
  • Cardiac magnetic resonance
  • Telemonitoring
  • Pharmacotherapy
  • Devices in heart failure

Published Papers (4 papers)

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13 pages, 2976 KiB  
Article
Usefulness of Serial Multiorgan Point-of-Care Ultrasound in Acute Heart Failure: Results from a Prospective Observational Cohort
by Marta Torres-Arrese, Gonzalo García de Casasola-Sánchez, Manuel Méndez-Bailón, Esther Montero-Hernández, Marta Cobo-Marcos, Mercedes Rivas-Lasarte, Luis Caurcel-Díaz, Pablo Rodríguez-Fuertes, Tomas Villén-Villegas and Yale Tung-Chen
Medicina 2022, 58(1), 124; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58010124 - 14 Jan 2022
Cited by 4 | Viewed by 3105
Abstract
Background and Objectives: Acute heart failure (AHF) is a common disease and a cause of high morbidity and mortality, constituting a major health problem. The main purpose of this study was to determine the impact of multiorgan ultrasound in identifying pulmonary hypertension [...] Read more.
Background and Objectives: Acute heart failure (AHF) is a common disease and a cause of high morbidity and mortality, constituting a major health problem. The main purpose of this study was to determine the impact of multiorgan ultrasound in identifying pulmonary hypertension (PH), a major prognostic factor in patients admitted due to AHF, and assess whether there are significant changes in the venous excess ultrasonography (VE × US) score or femoral vein Doppler at discharge. Materials and Methods: Patients were evaluated with a standard protocol of lung ultrasound, echocardiography, inferior vena cava (IVC) and hepatic, portal, intra-renal and femoral vein Doppler flow patterns at admission and on the day of discharge. Results: Thirty patients were enrolled during November 2021. The mean age was seventy-nine years (Standard Deviation–SD 13.4). Seven patients (23.3%) had a worsening renal function during hospitalization. Regarding ultrasound findings, VE × US score was calculated at admission and at discharge, unexpectedly remaining unchanged or even worsened (21 patients, 70.0%). The area under the curve for the lung score was 83.9% (p = 0.008), obtaining a cutoff value of 10 that showed a sensitivity of 82.6% and a specificity of 71.4% in the identification of intermediate and high PH. It was possible to monitor significant changes between both exams on the lung score (16.5 vs. 9.3; p < 0.001), improvement in the hepatic vein Doppler pattern (2.4 vs. 2.1; p = 0.002), improvement in portal vein Doppler pattern (1.7 vs. 1.4; p = 0.023), without significant changes in the intra-renal vein Doppler pattern (1.70 vs. 1.57; p = 0.293), VE × US score (1.3 vs. 1.1; p = 0.501), femoral vein Doppler pattern (2.4 vs. 2.1; p = 0.161) and IVC collapsibility (2.0 vs. 2.1; p = 0.420). Conclusions: Our study results suggest that performing serial multiorgan Point-of-Care ultrasound can help us to better identify high and intermediate probability of PH patients with AHF. Currently proposed multi-organ, venous Doppler scanning protocols, such as the VE × US score, should be further studied before expanding its use in AHF patients. Full article
(This article belongs to the Special Issue Diagnosis, Monitoring, and Treatment of Chronic Heart Failure)
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12 pages, 2444 KiB  
Article
A Simple Predictive Marker in Cardiac Resynchronization Therapy Recipients: Prominent S-Wave in Right Precordial Leads
by Naoya Kataoka, Teruhiko Imamura, Takahisa Koi, Keisuke Uchida and Koichiro Kinugawa
Medicina 2021, 57(8), 815; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57080815 - 10 Aug 2021
Cited by 1 | Viewed by 1769
Abstract
Background and objectives: Current guidelines criteria do not satisfactorily discriminate responders to cardiac resynchronization therapy (CRT). QRS amplitude is an established index to recognize the severity of myocardial disturbance and might be a key to optimal patient selection for CRT. Materials and Methods: [...] Read more.
Background and objectives: Current guidelines criteria do not satisfactorily discriminate responders to cardiac resynchronization therapy (CRT). QRS amplitude is an established index to recognize the severity of myocardial disturbance and might be a key to optimal patient selection for CRT. Materials and Methods: (1) Initial R-wave amplitude, (2) S-wave amplitude, and (3) a summation of maximal R- or R′-wave amplitude and S-wave amplitude were measured at baseline. These parameters were averaged according to right (V1 to V3) or left (V4 to V6) precordial leads. The impact of these parameters on response to CRT, which was defined as a decrease in left ventricular end-systolic volume ≥15% at six-month follow-up, was investigated. Results: Among 47 patients (71 years old, 28 men) who received guideline-indicated CRT implantation, 25 (53%) achieved the definition of CRT responder. Among baseline electrocardiogram parameters, only the higher S-wave amplitude in right precordial leads was an independent predictor of CRT responders (odds ratio: 2.181, 95% confidence interval: 1.078–4.414, p = 0.030) at a cutoff of 1.44 mV. The cutoff was independently associated with cumulative incidence of heart failure readmission and appropriate electrical defibrillation following CRT implantation (p < 0.05, respectively). Conclusions: Prominent S-wave in right precordial leads might be a promising index to predict left ventricular reverse remodeling and greater clinical outcomes following CRT implantation. Full article
(This article belongs to the Special Issue Diagnosis, Monitoring, and Treatment of Chronic Heart Failure)
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5 pages, 703 KiB  
Case Report
Doppler Echocardiography-Guided Heart Rate Modulation Therapy Using Ivabradine in a Patient with Systolic Heart Failure
by Teruhiko Imamura and Koichiro Kinugawa
Medicina 2022, 58(2), 164; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina58020164 - 21 Jan 2022
Cited by 1 | Viewed by 2052
Abstract
Heart rate reduction using ivabradine, a selective If channel blocker that purely decreases heart rate without affecting hemodynamics, improves clinical outcomes in patients with systolic heart failure. However, the ideal heart rate that should be a target remains unknown. Our team recently [...] Read more.
Heart rate reduction using ivabradine, a selective If channel blocker that purely decreases heart rate without affecting hemodynamics, improves clinical outcomes in patients with systolic heart failure. However, the ideal heart rate that should be a target remains unknown. Our team recently proposed a methodology using Doppler echocardiography to estimate ideal heart rate, at which E-wave and A-wave stand adjacent without overlap. However, the implication of Doppler echocardiography-guided heart rate modulation therapy using ivabradine remains uncertain. We had a 72-year-old man with systolic heart failure and sinus tachycardia who initiated ivabradine therapy. Ivabradine dose was adjusted between 5.0 mg/day and 10.0 mg/day and continued for 12 weeks to minimize the overlap between the two echocardiography waves, accompanying improvement in cardiac output, left ventricular ejection fraction, plasma B-type natriuretic peptide, and six-minute walk distance. Doppler echocardiography-guided heart rate regulation therapy using ivabradine may be a promising strategy to improve cardiac function and clinical outcomes in patients with systolic heart failure, although further studies are required to validate this hypothesis. Full article
(This article belongs to the Special Issue Diagnosis, Monitoring, and Treatment of Chronic Heart Failure)
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5 pages, 1355 KiB  
Case Report
Impact of Hypoxia-Inducible Factor Prolyl Hydroxylase Inhibitor on Heart Failure with Preserved Ejection Fraction
by Teruhiko Imamura, Masakazu Hori, Shuhei Tanaka and Koichiro Kinugawa
Medicina 2021, 57(12), 1319; https://0-doi-org.brum.beds.ac.uk/10.3390/medicina57121319 - 01 Dec 2021
Cited by 4 | Viewed by 2901
Abstract
Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitor is a recently introduced oral medication to treat renal anemia, but its clinical implication in patients with heart failure, particularly heart failure with preserved ejection fraction (HFpEF), remains unknown. We had a 91-year-old woman with HFpEF who [...] Read more.
Hypoxia-inducible factor prolyl hydroxylase (HIF-PH) inhibitor is a recently introduced oral medication to treat renal anemia, but its clinical implication in patients with heart failure, particularly heart failure with preserved ejection fraction (HFpEF), remains unknown. We had a 91-year-old woman with HFpEF who was admitted to our institute to treat her worsening heart failure. She initiated HIF-PH inhibitor daprodustat to treat her renal anemia (hemoglobin 8.8 g/dL and estimated glomerular filtration ratio 15.6 mL/min/1.73 m2). Following a 6-month treatment with daprodustat, hemoglobin increased up to 10.4 g/dL, left ventricular mass index decreased from 107 g/m2 to 88 g/m2, and plasma B-type natriuretic peptide decreased from 276 pg/mL to 122 pg/mL, despite doses of other medications remaining unchanged. HIF-PH inhibitors might be a promising tool to ameliorate renal anemia and facilitate cardiac reverse remodeling in patients with HFpEF. Full article
(This article belongs to the Special Issue Diagnosis, Monitoring, and Treatment of Chronic Heart Failure)
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