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Acute and Chronic Heart Failure: Pathophysiology and New Therapeutic Developments,...
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Acute and Chronic Heart Failure: Pathophysiology and New Therapeutic Developments, 2nd Edition

A special issue of Biomedicines (ISSN 2227-9059). This special issue belongs to the section "Molecular and Translational Medicine".

Deadline for manuscript submissions: 30 November 2025 | Viewed by 4047

Special Issue Editors

Dr. Serafino Fazio

E-Mail Website
Guest Editor
Department of Internal Medicine, School of Medicine, Federico II University, Via Sergio Pansini 5, 80135 Naples, Italy
Interests: hormones and heart; cardiac failure; insulin resistance; hyperinsulinism; metabolic syndrome; nutraceuticals; pulmonary arterial hypertension; COVID-19
Special Issues, Collections and Topics in MDPI journals
Dr. Valentina Mercurio

E-Mail Website
Guest Editor
Department of Translational Medical Sciences, Federico II University, Naples, Italy
Interests: heart failure; echocardiography; right ventricular function; pulmonary vascular disease; pulmonary arterial hypertension; cardio-oncology
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Despite the considerable progress in the prevention and treatment of heart disease, heart failure is still a particularly important cause of recurring hospitalizations, with relevant social and healthcare costs, and it is burdened with significant mortality. Notably, while advances in the treatment of acute coronary syndromes with myocardial revascularization and the increased awareness in the management of cardiovascular risk factors have improved the survival of patients with ischemic heart disease, there has been a progressive increase in the number of patients with chronic heart failure.

Heart failure can result from alterations in both the left and right ventricles, which can be not only due to ischemic heart disease but also to other causes, such as valvular abnormalities, systemic hypertension, and pulmonary vascular disease. It is also noteworthy, not only for treatment purposes, to highlight the recent increase in the incidence of heart failure with reduced ejection fraction and that with preserved ejection fraction. Lately, there has also been an effort to improve the follow-up of patients with heart failure through telemedicine to reduce the number of hospital admissions and, thus, possibly, social and healthcare costs.

Therefore, we consider “Heart Failure” an extremely up-to-date and broad topic for which a Special Issue is relevant.

Dr. Serafino Fazio
Dr. Valentina Mercurio
Guest Editors

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Keywords

  • heart failure with reduced ejection fraction
  • heart failure with preserved ejection fraction
  • pathophysiological novelties
  • treatment advances
  • pulmonary arterial hypertension
  • at-home follow-up of patients with heart failure

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Published Papers (4 papers)

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Research

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9 pages, 1463 KiB  
Article
Three-Dimensional Speckle-Tracking Echocardiography-Derived Left Ventricular Global Longitudinal Strain and Mitral Annular Plane Systolic Excursion Are Associated in Healthy Adults—Insights from the MAGYAR-Healthy Study
by Attila Nemes, Nóra Ambrus and Csaba Lengyel
Biomedicines 2025, 13(3), 625; https://doi.org/10.3390/biomedicines13030625 - 4 Mar 2025
Cited by 1 | Viewed by 454
Abstract
Introduction: Mitral annular plane systolic excursion (MAPSE) is a quantitative feature of left ventricular (LV) function that can be easily measured by M-mode echocardiography. The more recent LV strains represent LV contractility, and they can be determined for the three main directions in [...] Read more.
Introduction: Mitral annular plane systolic excursion (MAPSE) is a quantitative feature of left ventricular (LV) function that can be easily measured by M-mode echocardiography. The more recent LV strains represent LV contractility, and they can be determined for the three main directions in the radial (RS), longitudinal (LS), and circumferential (CS) directions. Three-dimensional (3D) speckle-tracking echocardiography (3DSTE) seems to be ideal for the simultaneous assessment of all LV strains from the same acquired 3D dataset. Their associations, however, have not been fully analyzed in clinical settings in healthy volunteers yet. Therefore, the present study aimed to find associations between MAPSE and 3DSTE-derived LV strains in healthy circumstances. Methods: The present study consisted of 106 healthy adult volunteers (mean age 28.1 ± 6.3 years, 48 men). Complete two-dimensional Doppler echocardiography with MAPSE assessment and 3DSTE-derived LV strain measurements were performed in all cases. Results: Tendentiously reduced LV volumes with preserved LV ejection fraction were present in the case of mean MAPSE as compared to decreased/increased MAPSE. Global and regional LV-RS and LV-CS did not differ if MAPSE was increased, mean or decreased. Global LV-LS was reduced in the case of decreased MAPSE, mainly due to tendentiously higher apical LV-LS. MAPSE did not differ if global LV-RS and LV-CS were increased, mean or decreased. MAPSE was tendentiously increased in the presence of increased global LV-LS. Conclusions: Only 3DSTE-derived global LV-LS and MAPSE are associated in healthy adults; LV global strains in other directions show no relationship with MAPSE. Full article
(This article belongs to the Special Issue Acute and Chronic Heart Failure: Pathophysiology and New Therapeutic Developments, 2nd Edition)
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15 pages, 1213 KiB  
Article
The Role of the Estimated Plasma Volume Variation in Assessing Decongestion in Patients with Acute Decompensated Heart Failure
by Andreea-Maria Grigore, Mihai Grigore, Ana-Maria Balahura, Gabriela Uscoiu, Ioana Verde, Camelia Nicolae, Elisabeta Bădilă and Adriana-Mihaela Ilieșiu
Biomedicines 2025, 13(1), 88; https://doi.org/10.3390/biomedicines13010088 - 2 Jan 2025
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Abstract
Introduction and Aim: Assessing decongestion in patients with acute decompensated heart failure (ADHF) is challenging, requiring multiple parameters and often remaining imprecise. The study aimed to investigate the utility of indirectly estimating plasma variation (∆ePVS) for evaluating decongestion in ADHF patients in relation [...] Read more.
Introduction and Aim: Assessing decongestion in patients with acute decompensated heart failure (ADHF) is challenging, requiring multiple parameters and often remaining imprecise. The study aimed to investigate the utility of indirectly estimating plasma variation (∆ePVS) for evaluating decongestion in ADHF patients in relation to natriuretic peptides. Materials and Methods: This prospective, observational, single-center study included 111 patients (mean age 74 years, 40% female) hospitalized with ADHF and treated with intravenous diuretics along with optimized medical therapy. Patients were clinically and echocardiographically evaluated at admission, with blood tests performed at both admission and discharge. A decrease of ≥30% in NT-proBNP at discharge was considered a marker of decongestion. ∆ePVS was calculated using the Strauss formula: ∆ePVS (%) = 100 × [(Hb admission/Hb discharge) × (1 − Hct discharge)/(1 − Hct admission)] − 100. A negative ∆ePVS (<0%) at discharge was considered a marker of hemoconcentration. Patients were divided into two groups: G1 (∆ePVS < 0%, 81 patients) and G2 (∆ePVS ≥ 0%, 30 patients). Results: Both groups had similar left ventricular ejection fraction (LVEF) values of 46%, mean hemoglobin (Hb) (12 g/dL), and creatinine (1.16 ± 0.65 mg/dL). NT-proBNP decreased in 88% patients in G1 and in 26% patients in G2 (p < 0.001). During hospitalization, five patients from G2 died. At 6 months, rehospitalization occurred in 35% of G2 and 21% of G1 (p = 0.04), with mortality rates of 37% in G2 and 11% in G1 (p = 0.012). Multivariate regression identified ∆ePVS as the only significant predictor of NT-proBNP decrease (OR 0.11, 95% CI 0.04–0.33, p < 0.001). Conclusions: Indirect estimation of plasma volume and its variation are valuable, accessible, and cost-effective parameters for assessing decongestive treatment in ADHF patients, complementing natriuretic peptides. Full article
(This article belongs to the Special Issue Acute and Chronic Heart Failure: Pathophysiology and New Therapeutic Developments, 2nd Edition)
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12 pages, 1860 KiB  
Article
The Usefulness of Soluble ST2 Concentration in Heart Failure with Reduced Ejection Fraction to Predict Severe Impairment in Exercise Capacity Assessed in Cardiopulmonary Exercise Testing
by Magdalena Dudek, Marta Kałużna-Oleksy, Filip Sawczak, Agata Kukfisz, Aleksandra Soloch, Jacek Migaj, Maciej Lesiak and Ewa Straburzyńska-Migaj
Biomedicines 2025, 13(1), 60; https://doi.org/10.3390/biomedicines13010060 - 30 Dec 2024
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Abstract
Background/Objectives: Heart failure (HF) constitutes a complex clinical syndrome that is highly prevalent worldwide, comprises a serious prognosis, and results in a reduced quality of life. Exercise capacity is one of the most significant parameters involved in the prognosis in HF patients. [...] Read more.
Background/Objectives: Heart failure (HF) constitutes a complex clinical syndrome that is highly prevalent worldwide, comprises a serious prognosis, and results in a reduced quality of life. Exercise capacity is one of the most significant parameters involved in the prognosis in HF patients. Our objective was to evaluate the relationship between the selected cardiopulmonary exercise testing (CPET) parameters and the concentration of novel biomarker sST2 in a group of patients with heart failure with reduced ejection fraction (HFrEF). Methods: A group of 135 patients with HFrEF was enrolled in this prospective cohort study. Patients were in the stable phase of the disease in the prior 4 weeks and received optimal medical treatment. Clinical and biochemical parameters were investigated. All patients performed maximal CPET. Results: The mean (SD) concentration of sST2 was 45.5 ± 39.2 ng/mL. Based on the CPET results, the cut-off value (52.377 ng/mL) was established, optimal for the discrimination of relative peakVO2 < 12 mL/kg/min. Patients were divided into two groups according to sST2 cut-off values determined with an ROC curve (AUC 0.692, 95% CI: 0.567–0.816). The mean relative peakVO2 in patients with higher sST2 was 14.5 ± 4.6 mL/kg/min, while in the second group, it was 17.6 ± 5.2 (p = 0.002). In the sST2 ≥ 52.377 ng/mL group, 55.6% of patients achieved VO2 < 50%. Subjects with lower sST2 values obtained higher values of PETCO2 (p < 0.001) and higher values of pulse O2 (p = 0.01). VE/VCO2slope (p = 0.002) was higher in patients with increased sST2 concentration. Conclusions: The concentration of sST2 protein is substantially associated with the clinical severity of heart failure with reduced left ventricular ejection fraction assessed by functional capacity through CPET. Full article
(This article belongs to the Special Issue Acute and Chronic Heart Failure: Pathophysiology and New Therapeutic Developments, 2nd Edition)
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Review

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19 pages, 1629 KiB  
Review
Targeting Inflammation and Iron Deficiency in Heart Failure: A Focus on Older Adults
by Daniela Maidana, Andrea Arroyo-Álvarez, Guillermo Barreres-Martín, Andrea Arenas-Loriente, Pedro Cepas-Guillen, Raphaela Tereza Brigolin Garofo, Pedro Caravaca-Pérez and Clara Bonanad
Biomedicines 2025, 13(2), 462; https://doi.org/10.3390/biomedicines13020462 - 13 Feb 2025
Viewed by 1303
Abstract
Background/Objectives: Heart failure (HF) is a leading cause of morbidity and mortality worldwide, with a higher prevalence among older adults. Iron deficiency (ID), affecting up to 50% of HF patients, is closely linked to chronic inflammation, exacerbating HF outcomes. This review aims [...] Read more.
Background/Objectives: Heart failure (HF) is a leading cause of morbidity and mortality worldwide, with a higher prevalence among older adults. Iron deficiency (ID), affecting up to 50% of HF patients, is closely linked to chronic inflammation, exacerbating HF outcomes. This review aims to explore the interplay between inflammation, ID, and HF, focusing on older patients, and to identify therapeutic gaps and emerging treatment strategies. Methods: A comprehensive review of the literature was conducted, emphasizing the pathophysiological mechanisms of inflammation and ID in HF, the challenges of current diagnostic criteria, and the limitations of available treatments. Emerging pharmacological and diagnostic approaches were analyzed. Results: Chronic inflammation in HF, particularly in older adults, promotes functional ID through elevated hepcidin levels, impairing iron availability and worsening anemia. Current diagnostic criteria, relying heavily on ferritin, often misclassify ID due to inflammation. Intravenous (IV) iron therapy shows clinical benefits in patients with <50% left ventricular ejection fraction (LVEF), but the evidence is limited in heart failure with preserved ejection fraction (HFpEF). Emerging therapies, such as Sodium-Glucose Cotransporter-2 inhibitors (SGLT2is) and prolyl hydroxylase inhibitors like Roxadustat, offer promising avenues to improve iron metabolism and outcomes. Conclusions: ID and inflammation significantly impact HF progression, particularly inolder adults. Refining diagnostic criteria and exploring innovative therapies are critical to addressing these challenges. Future research should prioritize personalized approaches targeting inflammation and ID, especially in underrepresented populations, such as HFpEF and elderly patients. Full article
(This article belongs to the Special Issue Acute and Chronic Heart Failure: Pathophysiology and New Therapeutic Developments, 2nd Edition)
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