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Advancements in Heart Failure Management: From Precision Medicine to Therapeutic...
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Advancements in Heart Failure Management: From Precision Medicine to Therapeutic Innovations

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

Deadline for manuscript submissions: 25 February 2025 | Viewed by 6062

Special Issue Editor

Dr. Akito Nakagawa

E-Mail Website
Guest Editor
1. Nakagawa Clinic, Shoushoukai Healthcare Corporation, Suita, Osaka 564-0082, Japan
2. Department of Cardiovascular Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
3. Department of Medical Informatics, Graduate School of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
Interests: heart failure; imaging; echocardiography; observational studies; medical informatics
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Pharmacological innovations as well as multifactorial approaches are helping to expand the potential of managing the heterogeneous nature of heart failure. Promising gene-editing technologies offer potential routes to correct genetic mutations that cause heart failure. Regenerative medicine approaches, including stem cell therapy and tissue engineering, hold great potential for repairing damaged cardiac tissue and restoring function. Precision medicine approaches that take into account genetics, biomarkers, and comorbidities to tailor heart failure treatment to individual patient profiles are gaining attention. The integration of artificial intelligence and machine learning into heart failure management has also enabled the development of predictive models for early intervention, risk stratification, and personalized treatment recommendations.

Despite the availability of current therapies, it should be recognized that not all patients will have an ideal response and often show persistent progression. The prevalence of heart failure continues to increase, and the limitations of existing therapies make the development of new treatment strategies an urgent necessity.

We welcome submissions of original research as well as systematic reviews on the topic of advancements in heart failure management and treatment. State-of-the-art narrative reviews are also eligible for publication.

Dr. Akito Nakagawa
Guest Editor

Manuscript Submission Information

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Keywords

  • heart failure
  • developments in diagnostics
  • pharmacological innovations
  • device-based interventions
  • multi-omics approaches
  • lifestyle modifications

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Published Papers (5 papers)

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Research

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11 pages, 8366 KiB  
Article
The Prognostic Role of Pulmonary Arterial Elastance in Patients Undergoing Left Ventricular Assist Device Implantation: A Pilot Study
by Marco Di Mauro, Michelle Kittleson, Giulio Cacioli, Vito Piazza, Rita Lucia Putini, Rita Gravino, Vincenzo Polizzi, Andrea Montalto, Marina Comisso, Fabio Sbaraglia, Emanuele Monda, Andrea Petraio, Marisa De Feo, Cristiano Amarelli, Claudio Marra, Francesco Musumeci, Emilio Di Lorenzo and Daniele Masarone
J. Clin. Med. 2024, 13(23), 7102; https://doi.org/10.3390/jcm13237102 - 24 Nov 2024
Viewed by 642
Abstract
Background: Pulmonary arterial elastance (Ea) is a helpful parameter to predict the risk of acute postoperative right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation. A new method for calculating Ea, obtained by the ratio between transpulmonary gradient and stroke [...] Read more.
Background: Pulmonary arterial elastance (Ea) is a helpful parameter to predict the risk of acute postoperative right ventricular failure (RVF) after left ventricular assist device (LVAD) implantation. A new method for calculating Ea, obtained by the ratio between transpulmonary gradient and stroke volume (EaB), has been proposed as a more accurate measure than the Ea obtained as the ratio between pulmonary artery systolic pressure and stroke volume (EaC). However, the role of EaB in predicting acute RVF post-LVAD implantation remains unclear. Methods and Results: A total of 35 patients who underwent LVAD implantation from 2018 to 2021 were reviewed in this retrospective analysis. Acute RVF after LVAD implantation occurred in 12 patients (34%): 5 patients with moderate RVF (14% of total) and 7 patients with severe RVF. The EaB was not significantly different between the “severe RVF” vs. “not-severe RVF” groups (0.27 ± 0.04 vs 0.23 ± 0.1, p < 0.403). However, the combination of arterial elastance and central venous pressure was significantly different between the “not-severe RVF” group (central venous pressure < 14 mmHg and EaC < 0.88 mmHg/mL or EaB < 0.24 mmHg/mL; p < 0.005) and the “severe RVF” group (central venous pressure > 14 mmHg and EaC > 0.88 mmHg/mL or EaB > 0.24 mmHg/mL; p < 0.005). Conclusions: Ea is a reliable parameter of right ventricular afterload and helps discriminate the risk of acute RVF after LVAD implantation. The combined analysis of Ea and central venous pressure can also risk stratify patients undergoing LVAD implantation for the development of RVF. Full article
(This article belongs to the Special Issue Advancements in Heart Failure Management: From Precision Medicine to Therapeutic Innovations)
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11 pages, 582 KiB  
Article
Thoracic Fluid Content as an Indicator of High Intravenous Diuretic Requirements in Hospitalized Patients with Decompensated Heart Failure
by Agata Galas, Paweł Krzesiński, Małgorzata Banak and Grzegorz Gielerak
J. Clin. Med. 2024, 13(18), 5625; https://doi.org/10.3390/jcm13185625 - 22 Sep 2024
Viewed by 1376
Abstract
Background: The main cause of hospitalization in patients with heart failure is hypervolemia. Therefore, the primary treatment strategy involves diuretic therapy using intravenous loop diuretics to achieve decongestion and euvolemia. Some patients with acutely decompensated heart failure (ADHF) do not respond well to [...] Read more.
Background: The main cause of hospitalization in patients with heart failure is hypervolemia. Therefore, the primary treatment strategy involves diuretic therapy using intravenous loop diuretics to achieve decongestion and euvolemia. Some patients with acutely decompensated heart failure (ADHF) do not respond well to diuretic treatment, which may be due to diuretic resistance (DR). Such cases require high doses of diuretic medications and combination therapy with diuretics of different mechanisms of action. Although certain predisposing factors for diuretic resistance have been identified (such as hypotension, type 2 diabetes, impaired renal function, and hyponatremia), further research is needed to identify other pathophysiological markers of DR. Objective: This study aims to identify admission markers that can predict a high requirement for intravenous diuretics in hospitalized patients with decompensated heart failure. Methods: This study included 102 adult patients hospitalized for ADHF. At admission, patients underwent clinical assessment, laboratory parameter evaluation (including the N-terminal prohormone of brain natriuretic peptide [NT-proBNP] levels), and hemodynamic assessment using impedance cardiography (ICG). Hemodynamic profiles were based on the use of parameters such as heart rate (HR), blood pressure (BP), and thoracic fluid content (TFC) as markers of volume status. The analysis included 97 patients with documented doses of intravenous diuretic use. Patients were stratified into two groups based on median diuretic consumption (equivalent to 540 mg of intravenous furosemide): the high-loop diuretic utilization (LDU) group (n = 49) and the low-LDU group (n = 48). Results: Compared to low-LDU patients, high-LDU patients had greater thoracic fluid content at admission, both quantitatively (37.4 ± 8.1 vs. 34.1 ± 6.9 kOhm-1; p = 0.024) and qualitatively (TFC ≥ 35 kOhm-1: 59.2% vs. 33.3%; p = 0.011). Anemia was more common in the high-LDU group (67.4% vs. 43.8%; p = 0.019), as was elevated NT-proBNP (≥median of 3952 pg/mL: 60.4% vs. 37.5%; p = 0.024). High LDU was associated with a significantly longer hospitalization duration (12.9 ± 6.4 vs. 7.0 ± 2.6 days; p < 0.001). Logistic regression analysis identified anemia, elevated NT-proBNP, and high TFC as predictors of high LDU (HR: 2.65, 2.54, and 2.90, respectively). In a multifactorial model, only high TFC remained an independent predictor (HR: 2.60, 95% CI 1.04–6.49; p = 0.038). Conclusions: TFC was the sole independent admission marker of a high requirement for intravenous diuretics in patients hospitalized for decompensated heart failure. An objective assessment of volume status by impedance cardiography may support intensive personalized decongestion therapy. Full article
(This article belongs to the Special Issue Advancements in Heart Failure Management: From Precision Medicine to Therapeutic Innovations)
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20 pages, 1713 KiB  
Article
Exploring the Influence of Contextual Factors and the Caregiving Process on Caregiver Burden and Quality of Life Outcomes of Heart Failure (HF) Dyads after a Hospital Discharge: A Mixed-Methods Study
by Tamara L. Oliver, Breanna Hetland, Myra Schmaderer, Ronald Zolty, Christopher Wichman and Bunny Pozehl
J. Clin. Med. 2024, 13(16), 4797; https://doi.org/10.3390/jcm13164797 - 15 Aug 2024
Viewed by 1466
Abstract
Background: This study explores heart failure (HF) dyadic contextual factors and caregiver burden during acute exacerbation hospitalization and discharge. Methods: It employed a mixed-methods approach, with HF dyads completing questionnaires and semi-structured interviews at a one-week post-discharge outpatient visit. Quantitative tools [...] Read more.
Background: This study explores heart failure (HF) dyadic contextual factors and caregiver burden during acute exacerbation hospitalization and discharge. Methods: It employed a mixed-methods approach, with HF dyads completing questionnaires and semi-structured interviews at a one-week post-discharge outpatient visit. Quantitative tools included the SF-12 Quality of Life, Zarit Burden Interview (ZBI), Bakas Caregiving Outcomes Scale (BCOS), and Self-Care of Heart Failure Index v. 6 (SCHFI). Thematic analysis was conducted on interview data to assess caregiver burden, disease trajectory, comorbidities, caregiving time, and employment status. Results: Twelve HF dyads participated, with caregivers (six female, six male) averaging 65.76 years. The ZBI indicated a low caregiver burden (median score of 15), but qualitative data revealed a higher perceived burden related to social isolation, future fears, and caregiver dependence. Male caregivers reported a lower burden than females. Positive goal congruence was noted in caregiving hours and HF management compliance. HF patients had a 10-year survival prediction of 22.75% per the Charlson Comorbidity Index, with 69% in NYHA class III and an average ejection fraction of 37.7%. Caregivers working full-time and caring for higher NYHA-class patients showed higher ZBI and BCOS scores. Conclusions: The study highlights the need for mixed methods and longitudinal research to understand HF disease trajectory and caregiver burden, emphasizing the importance of including caregivers in HF education and screening for perceived burden to improve outcomes and reduce re-hospitalizations. Full article
(This article belongs to the Special Issue Advancements in Heart Failure Management: From Precision Medicine to Therapeutic Innovations)
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13 pages, 1417 KiB  
Article
Clinical Implications of Remote Dielectric Sensing-Guided Management
by Yu Nomoto, Teruhiko Imamura, Toshihide Izumida, Nikhil Narang and Koichiro Kinugawa
J. Clin. Med. 2024, 13(10), 2906; https://doi.org/10.3390/jcm13102906 - 14 May 2024
Viewed by 1249
Abstract
Background: Remote dielectric sensing (ReDS) systems can quantify the degree of pulmonary congestion rapidly and non-invasively. However, the clinical implications of ReDS-guided medication adjustment remain uncertain. Methods: Patients hospitalized to treat cardiovascular diseases, including heart failure, valvular disease, and coronary artery disease, and [...] Read more.
Background: Remote dielectric sensing (ReDS) systems can quantify the degree of pulmonary congestion rapidly and non-invasively. However, the clinical implications of ReDS-guided medication adjustment remain uncertain. Methods: Patients hospitalized to treat cardiovascular diseases, including heart failure, valvular disease, and coronary artery disease, and underwent ReDS measurement before index discharge between 2021 and 2022 were included. According to our institutional protocol, ReDS values were blinded to the attending clinicians until February 2022 (blind period). After the period, ReDS values were timely opened to the attending clinicians, and medications such as diuretics were adjusted according to the ReDS values (target value between 20% and 35%) before index discharge (open period). A composite primary outcome of all-cause death and heart failure readmissions was compared between the two groups. Results: A total of 183 patients were included (median 79 years old, 101 men), consisting of 138 patients in the blind period and 45 patients in the open period. During a median of 646 (401, 818) days after the index discharge, 33 patients experienced the primary outcome of interest. Management during the open period, where medications were adjusted according to ReDS values, was independently associated with a lower incidence of the primary outcome with an adjusted hazard ratio of 0.22 (95% confidence interval 0.05–0.94, p = 0.041), as compared with those of the blind period. Conclusions: According to the findings of the present retrospective study, ReDS-guided management may have the potential to reduce the risk of mortality and heart failure admission in individuals hospitalized for cardiovascular diagnoses. Further prospective randomized control trials involving those with a variety of background etiologies and clinical scenarios are warranted to validate our findings and establish optimal ReDS-guided management. Full article
(This article belongs to the Special Issue Advancements in Heart Failure Management: From Precision Medicine to Therapeutic Innovations)
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Review

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18 pages, 1813 KiB  
Review
Exercise Training in Heart Failure: Current Evidence and Future Directions
by Loay Eleyan, Ahmed R. Gonnah, Imran Farhad, Aser Labib, Alisha Varia, Alaa Eleyan, Abdullah Almehandi, Abdulrahman O. Al-Naseem and David H. Roberts
J. Clin. Med. 2025, 14(2), 359; https://doi.org/10.3390/jcm14020359 - 9 Jan 2025
Viewed by 627
Abstract
Heart Failure (HF) is a prevalent condition which places a substantial burden on healthcare systems worldwide. Medical management implemented with exercise training (ET) plays a role in prognostic and functional capacity improvement. The aim of this review is to determine the effect of [...] Read more.
Heart Failure (HF) is a prevalent condition which places a substantial burden on healthcare systems worldwide. Medical management implemented with exercise training (ET) plays a role in prognostic and functional capacity improvement. The aim of this review is to determine the effect of exercise training (ET) on HFpEF and HFrEF patients as well as exercise modality recommendations in frail and sarcopenic subpopulations. Pharmacological therapy structures the cornerstone of management in HF reduced ejection fraction (HFrEF) and aids improved survival rates. Mortality reduction with pharmacological treatments in HF preserved ejection fraction (HFpEF) are yet to be established. Cardiac rehabilitation (CR) and ET can play an important role in both HFrEF and HFpEF. Preliminary findings suggest that CR significantly improves functional capacity, exercise duration, and quality of life. ET has shown beneficial effects on peak oxygen consumption (pVO2) and 6 min walk test distance in HFrEF and HFpEF patients, as well as a reduction in hospitalisation and mortality rates; however, the limited scope of larger trials reporting on this underscores the need for further research. ET also has been shown to have beneficial effects on depression and anxiety levels. High-intensity training (HIT) and moderate continuous training (MCT) have both shown benefits, while resistance exercise training and ventilatory assistance may also be beneficial. ET adherence rates are higher when enrolled to a supervised programme, but prescription rates remain low worldwide. Larger robust trials are required to determine ET’s effects on HF, as well as the most efficacious and personalised exercise prescriptions in HF subtypes. Full article
(This article belongs to the Special Issue Advancements in Heart Failure Management: From Precision Medicine to Therapeutic Innovations)
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