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Medicina
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Heart Failure
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Heart Failure

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

Deadline for manuscript submissions: closed (30 June 2021) | Viewed by 32481

Special Issue Editors

Prof. Dr. Anton Sabashnikov

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Guest Editor
Department of Cardiac Surgery, Intensive Care Medicine and Thoracic Surgery, Heart Center, University Hospital Cologne, Kerpenerstr. 62, 50937 Cologne, Germany
Interests: cardiothoracic surgery; heart failure; mechanical circulatory support
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Aron-Frederik Popov

E-Mail Website
Guest Editor
Department of Cardiothoracic, Transplantation and Vascular Surgery, Medical High School Hannover, Hannover, Germany
Interests: heart failure surgery; heart and lung transplantation; ECLS; MCS (short and long term); minimally invasive cardiac surgery; reconstructive valve surgery; aortic surgery; bypass surgery; innovations in surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Acute and chronic heart failure is a global medical issue, being a leading disease causing death worldwide. Next to recommended life-style optimization, such as healthy dietary habits in combination with moderate aerobic exercise for preventing heart disease in general, conservative treatment options for patients with diagnosed heart failure are limited to medical treatments that may lead to recovery or maintenance efforts in response to heart failure. Some individual patients may also benefit from operative revascularization, valve surgery, or cardiac resynchronization therapy. In recent decades, various mechanical circulatory support (MCS) devices have been increasingly used in selected therapy refractory patients as an upgraded stage of treatment, when conservative and other options are either limited, insufficient, or exhausted in terms of their effectiveness. Therefore, depending on the onset and severity of symptoms in cases of advanced heart failure, several MCS devices are now frequently used to achieve partial or full support for the affected ventricles.

In addition to short-term MCS options, including extracorporeal membrane oxygenation (ECMO), intra-aortic balloon pump (IABP), and short-term ventricular assist device (VAD) systems, several long-term VAD devices have been developed and technically optimized over the last decades. Especially in the era of donor organ scarcity and permanently decreasing ideal donor heart numbers for patients with end-stage heart failure, the implantation of long-term MCS systems has become a mandatory part of therapeutic options.

Improvements in technical features, flow characteristics, and durability have led to significant benefits in terms of survival and device-related complications, as have the reduction in the sizes of these devices and, as a logical consequence, the improved surgical techniques that have reduced the invasiveness and trauma of surgery.

Rising numbers of interdisciplinary heart failure units with expertise in MCS are now capable of fully addressing therapeutic care of patients with acute or chronic heart failure. Moreover, a significant proportion of patients with severe heart or lung failure that are not primarily referred to specialized centers cannot be transported without mechanical support for further treatment in institutions with such opportunities; as a consequence, transportable short-term MCS systems are being increasingly used for transportation of such patients both from hospitals and from out-of-hospital locations.

In this context, this Special Issue addresses the current state of short- and long-term MCS systems and is intended to provide new insights into and aspects of clinical and experimental research from highly experienced centers all over the world. Along with permanent improvement in outcomes of patients with severe heart failure treated using MCS, further experience, scientific collaborations, as well as clinical and experimental investigations are paramount to further optimize survival and quality of life of this highly demanding patient population.

Dr. Anton Sabashnikov
Prof. Dr. Aron-Frederik Popov
Guest Editors

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Keywords

  • heart failure
  • inotropic support
  • intra-aortic balloon pump
  • extracorporeal membrane oxygenation
  • ventricular assist device
  • mechanical circulatory support
  • cardiac transplantation

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Published Papers (12 papers)

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9 pages, 658 KiB  
Article
Prognostic Value of the PROFUND Index for 30-Day Mortality in Acute Heart Failure
by Manuel Méndez-Bailón, Rosario Iguarán-Bermúdez, Lidia López-García, Beatriz Sánchez-Sauce, Pablo Pérez-Mateos, Julia Barrado-Cuchillo, Miguel Villar-Martínez, Santiago Fernández-Castelao, Jose Luis García-Klepzig, Manuel Enrique Fuentes-Ferrer, Alejandra García-García, Isidre Vilacosta, José María de Miguel-Yanes, José Manuel Casas-Rojo, Elpidio Calvo-Manuel, Emmanuel Andres, Noel Lorenzo-Villalba and on behalf of the Heart Failure and Pluripathology Groups from the Spanish National Society of Internal Medicine
Medicina 2021, 57(11), 1150; https://doi.org/10.3390/medicina57111150 - 23 Oct 2021
Cited by 2 | Viewed by 2251
Abstract
Background and Objectives: The prevalence and incidence of heart failure (HF) have been increasing in recent years as the population ages. These patients show a distinct profile of comorbidity, which makes their care more complex. In recent years, the PROFUND index, a specific [...] Read more.
Background and Objectives: The prevalence and incidence of heart failure (HF) have been increasing in recent years as the population ages. These patients show a distinct profile of comorbidity, which makes their care more complex. In recent years, the PROFUND index, a specific tool for estimating the mortality rate at one year in pluripathology patients, has been developed. The aim of this study was to evaluate the prognostic value of the PROFUND index and of in-hospital and 30-day mortality after discharge of patients admitted for acute heart failure (AHF). Materials and Methods: A prospective multicenter longitudinal study was performed that included patients admitted with AHF and ≥2 comorbid conditions. Clinical, analytical, and prognostic variables were collected. The PROFUND index was collected in all patients and rates of in-hospital and 30-day mortality after discharge were analyzed. A bivariate analysis was performed with quantitative variables between patients who died and those who survived at the 30-day follow-up. A logistic regression analysis was performed with the variables that obtained statistical significance in the bivariate analysis between deceased and surviving subjects. Results: A total of 128 patients were included. Mean age was 80.5 +/− 9.98 years, and women represented 51.6%. The mean PROFUND index was 5.26 +/− 4.5. The mortality rate was 8.6% in-hospital and 20.3% at 30 days. Preserved left ventricular ejection fraction was found in 60.9%. In the sample studied, there were patients with a PROFUND score < 7 predominated (89 patients (70%) versus 39 patients (31%) with a PROFUND score ≥ 7). Thirteen patients (15%) with a PROFUND score < 7 died versus the 13 (33%) with a PROFUND score ≥ 7, p = 0.03. Twelve patients (15%) with a PROFUND score < 7 required readmission versus 12 patients (35%) with a PROFUND score ≥ 7, p = 0.02. The ROC curve of the PROFUND index for in-hospital mortality and 30-day follow-up in patients with AHF showed AUC 0.63, CI: 95% (0.508–0.764), p <0.033. Conclusions: The PROFUND index is a clinical tool that may be useful for predicting short-term mortality in elderly patients with AHF. Further studies with larger simple sizes are required to validate these results. Full article
(This article belongs to the Special Issue Heart Failure)
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12 pages, 5447 KiB  
Article
Development of a Rapid Diagnostic Kit for Congestive Heart Failure Using Recombinant NT-proBNP Antigen
by Young-Ki Lee, Dong-Ok Choi and Ga-Yeon Kim
Medicina 2021, 57(8), 751; https://doi.org/10.3390/medicina57080751 - 25 Jul 2021
Cited by 4 | Viewed by 2448
Abstract
Background and Objectives: In patients with congestive heart failure, brain natriuretic peptide (BNP) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) are released due to excessive heart muscle expansion; they can be used for the early detection, progress monitoring, and treatment of congestive [...] Read more.
Background and Objectives: In patients with congestive heart failure, brain natriuretic peptide (BNP) and N-terminal prohormone of brain natriuretic peptide (NT-proBNP) are released due to excessive heart muscle expansion; they can be used for the early detection, progress monitoring, and treatment of congestive heart failure. Recently, considerable efforts have been made to develop an NT-proBNP-based biomarker for detecting heart failure. This study attempts to develop a rapid and accurate congestive heart failure diagnostic kit using NT-proBNP. Materials and Methods: A new gene based on NT-proBNP was selected, recombined, and expressed in Escherichia coli strains, and then monoclonal antibodies were produced using the hybridoma technique. Additionally, antigen-antibody reactivity was confirmed using indirect enzyme-linked immunosorbent assay (ELISA). Furthermore, the first pair and full-strip pair tests were conducted to select candidate clones; these were applied to a rapid diagnosis kit based on gold conjugates and compared with other currently available antigens. Results: NT-proBNP-based antigens with high specificity and monoclonal antibodies were produced, and the optimal antigen-antibody reactivity was confirmed using indirect ELISA. The first pair and full-strip pair tests were performed to select the optimal candidate clones, and a rapid diagnosis kit with excellent reactivity was developed by applying these to a rapid diagnosis kit based on gold conjugates. Conclusions: The development of this rapid diagnosis kit with excellent performance in congestive heart failure is expected to improve disease management by providing an early assessment of the risk of heart failure. Full article
(This article belongs to the Special Issue Heart Failure)
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8 pages, 1056 KiB  
Article
Quality of Life Following Urgent LVAD Implantation for ECMO Therapy in Cardiogenic Shock: A Long-Term Follow-Up
by Rafal Berger, Hasan Hamdoun, Rodrigo Sandoval Boburg, Medhat Radwan, Metesh Acharya, Reiner Markus Waeschle, Christian Schlensak, Aron-Frederik Popov and Petar Risteski
Medicina 2021, 57(8), 747; https://doi.org/10.3390/medicina57080747 - 24 Jul 2021
Cited by 2 | Viewed by 2333
Abstract
Background and Objectives: Over the past decade, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has developed into a mainstream treatment for refractory cardiogenic shock (CS) to maximal conservative management. Successful weaning of VA-ECMO may not be possible, and bridging with further mechanical circulatory support [...] Read more.
Background and Objectives: Over the past decade, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has developed into a mainstream treatment for refractory cardiogenic shock (CS) to maximal conservative management. Successful weaning of VA-ECMO may not be possible, and bridging with further mechanical circulatory support (MCS), such as urgent implantation of a left ventricular assist device (LVAD), may represent the only means to sustain the patient haemodynamically. In the recovery phase, many survivors are not suitably prepared physically or psychologically for the novel issues encountered during daily life with an LVAD. Materials and Methods: A retrospective analysis of our institutional database between 2012 and 2019 was performed to identify patients treated with VA-ECMO for CS who underwent urgent LVAD implantation whilst on MCS. Post-cardiotomy cases were excluded. QoL was assessed prospectively during a routine follow-up visit using the EuroQol-5 dimensions-5 level (EQ-5D-5L) and the Patient Health Questionnaire (PHQ-9) surveys. Results: Among 126 in-hospital survivors of VA-ECMO therapy due to cardiogenic shock without prior cardiac surgery, 31 (24.6%) urgent LVAD recipients were identified. In 11 (36.7%) cases, cardiopulmonary resuscitation (CPR) was performed (median 10, range 1–60 min) before initiation of VA-ECMO, and in 5 (16.7%) cases, MCS was established under CPR. Mean age at LVAD implantation was 51.7 (+/−14) years and surgery was performed after a mean 12.1 (+/−8) days of VA-ECMO support. During follow-up of 46.9 (+/−25.5) months, there were 10 deaths after 20.4 (+/−12.1) months of LVAD support. Analysis of QoL questionnaires returned a mean EQ-5D-5L score of 66% (+/−21) of societal valuation for Germany and a mean PHQ-9 score of 5.7 (+/−5) corresponding to mild depression severity. When compared with 49 elective LVAD recipients without prior VA-ECMO therapy, there was no significant difference in QoL results. Conclusions: Patients requiring urgent LVAD implantation under VA-ECMO support due to CS are associated with comparable quality of life without a significant difference from elective LVAD recipients. Close follow-up is required to oversee patient rehabilitation after successful initial treatment. Full article
(This article belongs to the Special Issue Heart Failure)
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9 pages, 299 KiB  
Article
The Difference of Cholesterol, Platelet and Cortisol Levels in Patients Diagnosed with Chronic Heart Failure with Reduced Ejection Fraction Groups According to Neutrophil Count
by Aušra Mongirdienė, Jolanta Laukaitienė, Vilius Skipskis, Lolita Kuršvietienė and Julius Liobikas
Medicina 2021, 57(6), 557; https://doi.org/10.3390/medicina57060557 - 1 Jun 2021
Cited by 5 | Viewed by 2816
Abstract
Background and Objectives: It is known that neutrophils are involved in the pro-inflammatory processes and thus, can have a great impact on the pathophysiology of heart failure (HF). Moreover, hypercholesterolemia heightens neutrophil production, thereby accelerating cardiovascular inflammation. However, there is a lack [...] Read more.
Background and Objectives: It is known that neutrophils are involved in the pro-inflammatory processes and thus, can have a great impact on the pathophysiology of heart failure (HF). Moreover, hypercholesterolemia heightens neutrophil production, thereby accelerating cardiovascular inflammation. However, there is a lack of information about the relation of low inflammation to the state of stress, hypercholesterolemia, and pro-thrombotic statement in patients with chronic HF. Therefore, we aimed to determine whether platelet, cholesterol and cortisol levels differ in a different inflammatory condition groups according to the neutrophil count in patients diagnosed with CHF with reduced ejection fraction (CHFrEF), and whether there is a correlation between those readings. Materials and Methods: The average of neutrophil count was 4.37 × 109 L; therefore, 180 patients were separated into two groups: one with relatively a higher inflammatory environment (neutrophil count ≥ 4.37 × 109 L (n = 97)) and one with a relatively lower inflammatory environment (neutrophil count < 4.38 × 109 L (n = 83)). We also determined the levels of lymphocytes, monocytes, platelet count (PLT), mean platelet volume (MPV), platelet aggregation, the levels of cortisol and cholesterol and the concentrations of C reactive protein (CRP) and fibrinogen. Results: We found that CRP, fibrinogen and cortisol concentrations were statistically significantly higher in the group with higher neutrophil counts. However, there were no differences among cholesterol concentration and other markers of platelet function between the groups. We also showed that PLT, leukocyte and monocyte counts were higher in the group with a higher neutrophil count, and the PLT correlated with other cell type count and CRP. In addition, the neutrophil count correlated with concentrations of fibrinogen, evening cortisol and CRP. Conclusions: Cortisol, fibrinogen and CRP levels, PLT and monocyte counts were higher in the CHFrEF patient group with higher neutrophil counts. The cholesterol levels and platelet function readings did not differ between the groups. The neutrophil count correlated with evening cortisol concentration. Full article
(This article belongs to the Special Issue Heart Failure)
10 pages, 1823 KiB  
Article
Beneficial Effect of Left Ventricular Remodeling after Early Change of Sacubitril/Valsartan in Patients with Nonischemic Dilated Cardiomyopathy
by Hyue-Mee Kim, Kyung-Hee Kim, Jin-Sik Park and Byung-Hee Oh
Medicina 2021, 57(5), 416; https://doi.org/10.3390/medicina57050416 - 25 Apr 2021
Cited by 4 | Viewed by 3016
Abstract
Background and Objectives: Evidence for effectiveness of early change from angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs) to sacubitril/valsartan is lacking. We aimed to investigate whether early changes to sacubitril/valsartan could improve outcomes in patients with nonischemic dilated cardiomyopathy (DCM) [...] Read more.
Background and Objectives: Evidence for effectiveness of early change from angiotensin II receptor blockers (ARBs) or angiotensin-converting enzyme inhibitors (ACEIs) to sacubitril/valsartan is lacking. We aimed to investigate whether early changes to sacubitril/valsartan could improve outcomes in patients with nonischemic dilated cardiomyopathy (DCM) in real-world practice. Materials and Methods: A total of 296 patients with nonischemic DCM who were treated with ARB or ACEI continuously (group A, n = 150) or had their medication switched to sacubitril/valsartan (group S, n = 146) were included. The sacubitril/valsartan group was divided into early change (within 60 days, group S/E, n = 59) and late change (group S/L, n = 87) groups. Changes in echocardiographic parameters from the time of initial diagnosis to the last follow-up were analyzed. Results: Patients in group S showed greater left ventricular (LV) end-diastolic dimension (EDD) (group A vs. S, 61.7 ± 7.4 vs. 66.5 ± 8.0, p < 0.001) and lower LV ejection fraction (LVEF) (28.9 ± 8.2% vs. 23.9 ± 7.5%, p < 0.001) than those in group A at initial diagnosis. During a median follow-up of 76 months, patients in group S/E, ∆ LVEF (%) and ∆ LVESD (mm) were significantly improved compared with those in patients in group A (group A vs. S/E, ∆ LVEF, p = 0.036; ∆ LVESD, p = 0.023) or S/L (group S/E vs. S/L, ∆ LVEF, p = 0.05; ∆ LVESD, p = 0.005). Among patients whose medications were switched to sacubitril/valsartan, those with an earlier change showed a significant correlation with greater LVEF improvement (r = −0.367, p < 0.001) and LV reverse remodeling (r = 0.277, p < 0.001). Conclusions: in patients with nonischemic DCM, an early switch to sacubitril/valsartan was associated with greater improvement in LV function. Patients might benefit in terms of LV function by early switching to sacubitril/valsartan. Full article
(This article belongs to the Special Issue Heart Failure)
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17 pages, 1255 KiB  
Article
The E/e’ Ratio—Role in Risk Stratification of Acute Heart Failure with Preserved Ejection Fraction
by Marilena-Brîndușa Zamfirescu, Liviu-Nicolae Ghilencea, Mihaela-Roxana Popescu, Gabriel Cristian Bejan, Sean Martin Maher, Andreea-Catarina Popescu and Maria Dorobanțu
Medicina 2021, 57(4), 375; https://doi.org/10.3390/medicina57040375 - 13 Apr 2021
Cited by 6 | Viewed by 3150
Abstract
Background and Objectives: Heart failure with preserved ejection fraction (HFpEF) remains a worldwide management problem. Although there is a general effort for characterizing this population, few studies have assessed the predictive value of the echocardiographic E/e’ ratio in patients with acute HFpEF. [...] Read more.
Background and Objectives: Heart failure with preserved ejection fraction (HFpEF) remains a worldwide management problem. Although there is a general effort for characterizing this population, few studies have assessed the predictive value of the echocardiographic E/e’ ratio in patients with acute HFpEF. The aim of the study was to identify groups with different prognosis in patients hospitalized with a first acute episode of HFpEF. Materials and Methods: The primary endpoint of the study was heart failure readmissions (HFR) at 6 months, while the secondary outcome was six-month mortality. We consecutively enrolled 91 patients hospitalized for the first time with acute HFpEF. We examined the E/e’ ratio as an independent predictor for HFR using univariate regression. Results: We identified and validated the E/e’ ratio as an independent predictor for HFR. An E/e’ ratio threshold value of 13.80 was calculated [(area under the receiver operating characteristic curve (AUROC) = 0.693, sensitivity = 78.60%, specificity = 55%, p < 0.004)] and validated as an inflection point for an increased number of HFR. Thus, we divided the study cohort into two groups: group 1 with an E/e’ ratio < 13.80 (n = 39) and group 2 with an E/e’ ratio > 13.80 (n = 49). Compared to group 1, group 2 had an increased number of HFR (p = 0.003) and a shorter time to first HFR (p = 0.002). However, this parameter did not influence all-cause mortality within six months (p = 0.84). Conclusions: The dimensionless E/e’ ratio is a useful discriminator between patients with acute HFpEF. An E/e’ value over 13.80 represents a simple, yet effective instrument for assessing the HFR risk. However, all-cause mortality at six months is not influenced by the E/e’ ratio. Full article
(This article belongs to the Special Issue Heart Failure)
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9 pages, 334 KiB  
Article
Clinical Impact of the Time in Therapeutic Range on Early Hospital Readmission in Patients with Acute Heart Failure Treated with Oral Anticoagulation in Internal Medicine
by Rubén Ángel Martín-Sánchez, Noel Lorenzo-Villalba, Alberto Elpidio Calvo-Elías, Ester Emilia Dubón-Peralta, Cynthia Elisa Chocrón-Benbunan, Carmen María Cano-de Luque, Lidia López-García, María Rivas-Molinero, Cristina Outón-González, Javier Marco-Martínez, Elpidio Calvo-Manuel, Emmanuel Andres and Manuel Méndez-Bailón
Medicina 2021, 57(4), 365; https://doi.org/10.3390/medicina57040365 - 9 Apr 2021
Cited by 2 | Viewed by 2241
Abstract
Background and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) and the risk [...] Read more.
Background and objectives: Patients with heart failure (HF) often present with non-valvular atrial fibrillation and require oral anticoagulation with coumarin anticoagulants such as acenocoumarol. The objective of this study was to evaluate the relationship between time in therapeutic range (TTR) and the risk of early readmission. Materials and Methods: A retrospective descriptive study was carried out on hospitalized patients with a diagnosis of HF between 2014 and 2018 who had adverse effects due to oral anticoagulation with acenocoumarol (underdosing, overdosing, or hemorrhage). Clinical, analytical, therapeutic, and prognostic variables were collected. TTR is defined as the duration of time in which the patient’s International Normalized Ratio (INR) values were within a desired range. Early readmission was defined as readmission within 30 days after hospital discharge. Patients were divided into two groups depending on whether or not they had a TTR less than 60% (TTR < 60%) over the 6 months prior to the adverse event. Results: In the cohort of 304 patients, the mean age was 82 years, 59.9% of the patients were female, and 54.6% had a TTR < 60%. Patients with TTR < 60% had a higher HAS-BLED score (4.04 vs. 2.59; p < 0.001) and INR (6 vs. 5.31; p < 0.05) but lower hemoglobin (11.67 vs. 12.22 g/dL; p < 0.05). TTR < 60% was associated with early readmission after multivariate analysis (OR: 2.05 (CI 95%: 1.16–3.61)). They also had a higher percentage of hemorrhagic events and in-hospital mortality but without reaching statistical significance. Conclusions: Patients with HF and adverse events due to acenocoumarol often have poor INR control, which is independently associated with a higher risk of early readmission. Full article
(This article belongs to the Special Issue Heart Failure)
9 pages, 889 KiB  
Article
Impact of Lactate Clearance on Early Outcomes in Pediatric ECMO Patients
by Julia Merkle-Storms, Ilija Djordjevic, Carolyn Weber, Soi Avgeridou, Ihor Krasivskyi, Christopher Gaisendrees, Navid Mader, Ferdinand Kuhn-Régnier, Axel Kröner, Gerardus Bennink, Anton Sabashnikov, Uwe Trieschmann, Thorsten Wahlers and Christoph Menzel
Medicina 2021, 57(3), 284; https://doi.org/10.3390/medicina57030284 - 18 Mar 2021
Cited by 13 | Viewed by 2411
Abstract
Background and Objectives: Pediatric extracorporeal membrane oxygenation (ECMO) support is often the ultimate therapy for neonatal and pediatric patients with congenital heart defects after cardiac surgery. The impact of lactate clearance in pediatric patients during ECMO therapy on outcomes has been analyzed. Materials [...] Read more.
Background and Objectives: Pediatric extracorporeal membrane oxygenation (ECMO) support is often the ultimate therapy for neonatal and pediatric patients with congenital heart defects after cardiac surgery. The impact of lactate clearance in pediatric patients during ECMO therapy on outcomes has been analyzed. Materials andMethods: We retrospectively analyzed data from 41 pediatric vaECMO patients between January 2006 and December 2016. Blood lactate and lactate clearance have been recorded prior to ECMO implantation and 3, 6, 9 and 12 h after ECMO start. Receiver operating characteristic (ROC) analysis was used to identify cut-off levels for lactate clearance. Results: Lactate levels prior to ECMO therapy (9.8 mmol/L vs. 13.5 mmol/L; p = 0.07) and peak lactate levels during ECMO support (10.4 mmol/L vs. 14.7 mmol/L; p = 0.07) were similar between survivors and nonsurvivors. Areas under the curve (AUC) of lactate clearance at 3, 9 h and 12 h after ECMO start were significantly predictive for mortality (p = 0.017, p = 0.049 and p = 0.006, respectively). Cut-off values of lactate clearance were 3.8%, 51% and 56%. Duration of ECMO support and respiratory ventilation was significantly longer in survivors than in nonsurvivors (p = 0.01 and p < 0.001, respectively). Conclusions: Dynamic recording of lactate clearance after ECMO start is a valuable tool to assess outcomes and effectiveness of ECMO application. Poor lactate clearance during ECMO therapy in pediatric patients is a significant marker for higher mortality. Full article
(This article belongs to the Special Issue Heart Failure)
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14 pages, 347 KiB  
Article
Platelet Activity and Its Correlation with Inflammation and Cell Count Readings in Chronic Heart Failure Patients with Reduced Ejection Fraction
by Aušra Mongirdienė, Jolanta Laukaitienė, Vilius Skipskis, Lolita Kuršvietienė and Julius Liobikas
Medicina 2021, 57(2), 176; https://doi.org/10.3390/medicina57020176 - 18 Feb 2021
Cited by 7 | Viewed by 2768
Abstract
Background and objectives: There has been an increasing interest in the role of inflammation in thrombosis complications in chronic heart failure (HF) patients. The incidence of thrombosis in HF has been shown to be the highest in patients classified as NYHA IV [...] Read more.
Background and objectives: There has been an increasing interest in the role of inflammation in thrombosis complications in chronic heart failure (HF) patients. The incidence of thrombosis in HF has been shown to be the highest in patients classified as NYHA IV (New York Heart association). It is stated that inflammation is regulated by platelet-induced activation of blood leukocytes. We aimed to compare the platelet and cell count readings in chronic HF with reduced ejection fraction (HFrEF) patients according to NYHA functional class and to evaluate the correlation between those readings. Materials and methods: A total of 185 patients were examined. The results of heart echoscopy (TEE) testing; fibrinogen, N-terminal pro b-type natriuretic peptide (NT-proBNP), C reactive protein (CRP), and cortisol concentrations; complete blood counts; and a 6 min walking test were assessed and platelet aggregation was determined. Results: Mean platelet volume (MPV) increased with deterioration of a patient’s state (p < 0.005). Lymphocyte count and percentage were the lowest in the NYHA IV group (p < 0.005). Neutrophil and monocyte percentage and count were the highest (p < 0.045) in the NYHA IV group. Adenosine diphosphate (ADP)- and ADR-induced platelet aggregation was higher in the NYHA III group compared to NYHA II and I groups (p < 0.023). NYHA functional class correlated with mean platelet volume (MPV) (r = 0.311, p = 0.0001), lymphocyte count (r = −0.186, p = 0.026), monocyte count (p = 0.172, p = 0.041), and percentage (r = 0.212, p = 0.011). CRP concentration correlated with NT-proBNP (r = 0.203, p = 0.005). MPV correlated with fibrinogen concentration (r = 0.244, p = 0.004). Conclusions: (1) MPV could be considered as an additional reading reflecting a patient’s condition, however the use of MPV to identify patients at risk of hypercoagulable state should be evaluated in more extensive studies; (2) increased neutrophil and monocyte counts could indicate a higher inflammatory state in chronic HFrEF. Full article
(This article belongs to the Special Issue Heart Failure)

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7 pages, 2687 KiB  
Brief Report
Could a Multi-Marker and Machine Learning Approach Help Stratify Patients with Heart Failure?
by Manuela Lotierzo, Romain Bruno, Amanda Finan-Marchi, Fabien Huet, Eran Kalmanovich, Glaucy Rodrigues, Anne-Marie Dupuy, Jérôme Adda, David Piquemal, Sylvain Richard, Jean-Paul Cristol and François Roubille
Medicina 2021, 57(10), 996; https://doi.org/10.3390/medicina57100996 - 22 Sep 2021
Cited by 1 | Viewed by 2223
Abstract
Half of the patients with heart failure (HF) have preserved ejection fraction (HFpEF). To date, there are no specific markers to distinguish this subgroup. The main objective of this work was to stratify HF patients using current biochemical markers coupled with clinical data. [...] Read more.
Half of the patients with heart failure (HF) have preserved ejection fraction (HFpEF). To date, there are no specific markers to distinguish this subgroup. The main objective of this work was to stratify HF patients using current biochemical markers coupled with clinical data. The cohort study included HFpEF (n = 24) and heart failure with reduced ejection fraction (HFrEF) (n = 34) patients as usually considered in clinical practice based on cardiac imaging (EF ≥ 50% for HFpEF; EF < 50% for HFrEF). Routine blood tests consisted of measuring biomarkers of renal and heart functions, inflammation, and iron metabolism. A multi-test approach and analysis of peripheral blood samples aimed to establish a computerized Machine Learning strategy to provide a blood signature to distinguish HFpEF and HFrEF. Based on logistic regression, demographic characteristics and clinical biomarkers showed no statistical significance to differentiate the HFpEF and HFrEF patient subgroups. Hence a multivariate factorial discriminant analysis, performed blindly using the data set, allowed us to stratify the two HF groups. Consequently, a Machine Learning (ML) strategy was developed using the same variables in a genetic algorithm approach. ML provided very encouraging explorative results when considering the small size of the samples applied. The accuracy and the sensitivity were high for both validation and test groups (69% and 100%, 64% and 75%, respectively). Sensitivity was 100% for the validation and 75% for the test group, whereas specificity was 44% and 55% for the validation and test groups because of the small number of samples. Lastly, the precision was acceptable, with 58% in the validation and 60% in the test group. Combining biochemical and clinical markers is an excellent entry to develop a computer classification tool to diagnose HFpEF. This translational approach is a springboard for improving new personalized treatment methods and identifying “high-yield” populations for clinical trials. Full article
(This article belongs to the Special Issue Heart Failure)
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6 pages, 1550 KiB  
Case Report
Drastic Cardiac Reverse Remodeling Following Catheter Ablation in Patients with Atrial Fibrillation and Heart Failure
by Takahisa Koi, Naoya Kataoka, Teruhiko Imamura and Koichiro Kinugawa
Medicina 2021, 57(5), 511; https://doi.org/10.3390/medicina57050511 - 20 May 2021
Cited by 1 | Viewed by 2887
Abstract
In the management of atrial fibrillation in patients with heart failure, rate control is recommended, whereas the implication of rhythm control remains controversial. We experienced a 65-year-old man who had compensated heart failure due to hypertensive heart disease and atrial fibrillation with well-controlled [...] Read more.
In the management of atrial fibrillation in patients with heart failure, rate control is recommended, whereas the implication of rhythm control remains controversial. We experienced a 65-year-old man who had compensated heart failure due to hypertensive heart disease and atrial fibrillation with well-controlled heart rate (<100 bpm). At three months following the catheter ablation procedure, the left ventricular ejection fraction improved from 40% up to 65%. The implication of rhythm control using catheter ablation in improving cardiac reverse remodeling should be validated in large-scale clinical studies. Full article
(This article belongs to the Special Issue Heart Failure)
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5 pages, 1035 KiB  
Case Report
Cardiac Amyloidosis-Challenging Diagnosis and Unclear Clinical Picture
by Sylwia Kozak, Krzysztof Ulbrich, Maciej Migacz, Krzysztof Szydło, Katarzyna Mizia-Stec and Michał Holecki
Medicina 2021, 57(5), 450; https://doi.org/10.3390/medicina57050450 - 6 May 2021
Cited by 4 | Viewed by 2559
Abstract
Cardiac amyloidosis (CA) is a rare systemic disease determined by the extracellular deposition of amyloid protein in the heart. The protein can accumulate in any part of the heart: myocardium, vessels, endocardium, valves, epicardium and parietal pericardium. The types of CA include the [...] Read more.
Cardiac amyloidosis (CA) is a rare systemic disease determined by the extracellular deposition of amyloid protein in the heart. The protein can accumulate in any part of the heart: myocardium, vessels, endocardium, valves, epicardium and parietal pericardium. The types of CA include the following types: light chain (AL), amyloidosis AA (Amyloid A) and transthyretin (ATTR). The detection of specific subtypes remains of great importance to implement the targeted treatment. We present the case of a 65-year-old woman, who was admitted with severe deterioration of exercise capacity, a bilateral reduction of physiological vesicular murmur, ascites and edema of lower extremities. CA was suspected due to echocardiographic examination results, which led to further examination and final diagnosis. The aim of this study is to improve the disease awareness among clinicians and shorten the delay between the first symptoms and the diagnosis establishment resulting in a better outcome. Full article
(This article belongs to the Special Issue Heart Failure)
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