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Biomedicines
Special Issues
The Treatment of Cardiovascular Diseases in the Critically Ill
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The Treatment of Cardiovascular Diseases in the Critically Ill

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

Deadline for manuscript submissions: 30 September 2025 | Viewed by 1146

Special Issue Editor

Dr. Vasileios Vazgiourakis

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Guest Editor
Academic Intensive Care Unit, University Hospital of Larissa, Larissa, Greece
Interests: molecular medicine; cardiovascular diseases; echocardiography; intensive care medicine; molecular genetics

Special Issue Information

Dear Colleagues,

Cardiovascular diseases (CVDs) are the leading cause of mortality and morbidity worldwide. Several traditional (diabetes mellitus, obesity, dyslipidemia, sedentary lifestyle), and non-traditional (genetic, autoimmunity, chronic inflammation) risk factors have been recognized to be directly correlated with cardiovascular diseases.

In the Intensive Care Unit (ICU) setting, many causes of myocardial injury are common in critically ill patients, differentiating between forms of cardiovascular disease management in this special population. For example, elevated cardiac troponin (cTn) values and marked decreases in ejection fraction (EF) are due to sepsis caused by endotoxin, with myocardial function recovering completely with normal EF once the sepsis is treated.

In these settings, it is challenging for the clinician caring for a critically ill patient to decide on a plan of action. A high index of suspicion is necessary in the ICU: The clinical presentation of these diseases is atypical or silent in the intensive care setting. Moreover, some cardiovascular syndromes are being increasingly recognized in the setting of acute severe illness in intensive care such as Takotsubo cardiomyoparhy.

The intensivist doctor deals with new complex situations and has difficult decisions to make because the patient is already admitted to the ICU and multiple possible causes for raised troponin or ECG changes coexist.

In light of these observations, we must consider the treatment of cardiovascular diseases in critically ill patients extremely important in severe acute illness or postoperative settings after admission to the ICU, as trial data obtained in different settings may or may not be fully applicable in the intensive care unit, especially when patients have multi-organ disorders (β-blockers, antiplatelet therapies and more).

This Special Issue on "The Treatment of Cardiovascular Diseases in the Critically Ill" welcomes original research articles and state-of-the-art reviews in this field. Papers should provide novel data or gather current knowledge regarding the differentiation between cardiovascular diseases in critically ill patients vs. patients with solely cardiovascular disease. A special focus on septic cardiomyopathy and Takotsubo syndrome along with a differentiation between acute coronary syndromes and arrhythmias in the ICU setting will be appreciated.

Dr. Vasileios Vazgiourakis
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. Biomedicines 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 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

  • septic cardiomyopathy
  • takotsubo syndrome
  • cardiac arrhythmias
  • acute coronary syndromes
  • antiplatelets
  • antithrombotics

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Published Papers (2 papers)

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Research

14 pages, 1084 KiB  
Article
Effect of Levosimendan Use on All-Cause Mortality in Out-of-Hospital Cardiac Arrest Survivors After Extracorporeal Cardiopulmonary Resuscitation
by Da-Long Chen, Yu-Kai Lin, Guei-Jane Wang and Kuan-Cheng Chang
Biomedicines 2025, 13(4), 955; https://doi.org/10.3390/biomedicines13040955 - 13 Apr 2025
Viewed by 244
Abstract
Background: Survivors of out-of-hospital cardiac arrest (OHCA) after external cardiopulmonary resuscitation (ECPR) have a mortality rate as high as 50–70%. The use of vasoactive inotropes worsen the mortality rate at admission. The administration of levosimendan within 72 h of ECPR facilitates extracorporeal membrane [...] Read more.
Background: Survivors of out-of-hospital cardiac arrest (OHCA) after external cardiopulmonary resuscitation (ECPR) have a mortality rate as high as 50–70%. The use of vasoactive inotropes worsen the mortality rate at admission. The administration of levosimendan within 72 h of ECPR facilitates extracorporeal membrane oxygenation (ECMO) weaning, so it is important to determine whether levosimendan improves mortality. Methods: This retrospective cohort study included 158 patients with OHCA of cardiac origin who had undergone ECPR and were hospitalized between January 2015 and December 2024. This study was conducted in the intensive care unit of China Medical University Hospital, Taichung, Taiwan. Twenty-three patients received levosimendan within 72 h, whereas the others did not receive levosimendan. Primary endpoints included ECMO weaning failure rate and 90-day all-cause mortality rate. Kaplan–Meier survival curve analysis was also performed. Covariates for all-cause mortality were estimated and adjusted by using Cox regression modeling. Results: The levosimendan group exhibited lower rates of ECMO weaning failure and 90-day all-cause mortality than the control group (13.0% vs. 52.6% and 17.4% vs. 57.0%, respectively; both p < 0.001). The 90-day survival curve analysis revealed that the levosimendan and control groups had survival rates of 82.6% and 43.0%, respectively (log-rank p < 0.001). Administration of levosimendan within 72 h resulted in a odds ratio of 0.36 (95% confidence interval: 0.18−0.79, p = 0.01). Conclusions: Administering levosimendan within 72 h of ECPR could be a protective factor in improving all-cause mortality. Full article
(This article belongs to the Special Issue The Treatment of Cardiovascular Diseases in the Critically Ill)
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12 pages, 765 KiB  
Article
The Hospital Frailty Risk Score as a Predictor of Mortality, Complications, and Resource Utilization in Heart Failure: Implications for Managing Critically Ill Patients
by Nahush Bansal, Eun Seo Kwak, Abdel-Rhman Mohamed, Vaishnavi Aradhyula, Mohanad Qwaider, Alborz Sherafati, Ragheb Assaly and Ehab Eltahawy
Biomedicines 2025, 13(3), 760; https://doi.org/10.3390/biomedicines13030760 - 20 Mar 2025
Viewed by 488
Abstract
Background: Frailty, with a high prevalence of 40–80% in heart failure, may have a significant bearing on outcomes in patients. This study utilizes the Hospital Frailty Risk Score (HFRS), a validated tool derived from the administrative International Classification of Diseases, 10th Revision, Clinical [...] Read more.
Background: Frailty, with a high prevalence of 40–80% in heart failure, may have a significant bearing on outcomes in patients. This study utilizes the Hospital Frailty Risk Score (HFRS), a validated tool derived from the administrative International Classification of Diseases, 10th Revision, Clinical Modifications (ICD-10-CM) codes, in investigating the mortality, morbidity, and healthcare resource utilization among heart failure hospitalizations using the Nationwide Inpatient Sample (NIS). Methods: A retrospective analysis of the 2021 NIS database was assessed to identify adult patients hospitalized with heart failure. These patients were stratified by the HFRS into three groups: low frailty (LF: <5), intermediate frailty (IF: 5–15), and high frailty (HF: >15). The outcomes analyzed included inpatient mortality, length of stay (LOS), hospitalization charges, and complications including cardiogenic shock, cardiac arrest, acute kidney injury, and acute respiratory failure. These outcomes were adjusted for age, race, gender, the Charlson comorbidity score, hospital location, region, and teaching status. Multivariate logistic and linear regression analyses were used to assess the association between frailty and clinical outcomes. STATA/MP 18.0 was used for statistical analysis. Results: Among 1,198,988 heart failure admissions, 47.5% patients were in the LF group, whereas the IF and HF groups had 51.1% and 1.4% patients, respectively. Compared to the LF group, the IF group showed a 4-fold higher (adjusted OR = 4.60, p < 0.01), and the HF group had an 11-fold higher (adjusted OR 10.90, p < 0.01) mortality. Frail patients were more likely to have a longer length of stay (4.24 days, 7.18 days, and 12.1 days in the LF, IF, and HF groups) and higher hospitalization charges (USD 49,081, USD 84,472, and USD 129,516 in the LF, IF, and HF groups). Complications were also noticed to be significantly (p < 0.01) higher with increasing frailty from the LF to HF groups. These included cardiogenic shock (1.65% vs. 4.78% vs. 6.82%), cardiac arrest (0.37% vs. 1.61% vs. 3.16%), acute kidney injury (19.2% vs. 54.9% vs. 74.6%), and acute respiratory failure (29.6% vs. 51.2% vs. 60.3%). Conclusions: This study demonstrates the application of HFRS in a national dataset as a predictor of outcome and resource utilization measures in heart failure admissions. Stratifying patients based on HFRS can help in holistic assessment, aid prognostication, and guide targeted interventions in heart failure. Full article
(This article belongs to the Special Issue The Treatment of Cardiovascular Diseases in the Critically Ill)
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