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Biomedicines
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Advanced Research in Cardiovascular and Hemodynamic Monitoring
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Advanced Research in Cardiovascular and Hemodynamic Monitoring

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

Deadline for manuscript submissions: closed (30 September 2025) | Viewed by 14705

Special Issue Editors

Dr. Dustin R. Fraidenburg

E-Mail Website
Guest Editor
Department of Medicine, University of Illinois, Chicago, IL 60612, USA
Interests: critical care; sepsis; hemodynamics; shock; vasopressors; monitoring
Dr. Scott T. Benken

E-Mail Website
Guest Editor
College of Pharmacy, University of Illinois, Chicago, IL 60612, USA
Interests: critical care; sepsis; hemodynamics; shock; vasopressors; monitoring

Special Issue Information

Dear colleagues

Hemodynamic considerations in the intensive care unit are universal. There are unique aspects of hemodynamic monitoring that are continually evolving, and novel tools are needed. Additionally, many traditional therapies utilized in the critical care setting have significant but underestimated hemodynamic consequences that are necessary to understand at the physiologic, pathophysiologic, molecular, and pharmacologic levels. This Special Issue is designed to explore the biomedical basis for critical care management and capture basic studies of molecular imaging, molecular biology, and molecular medicine in the realm of cardiovascular and hemodynamic monitoring.

Dr. Dustin R. Fraidenburg
Dr. Scott T. Benken
Guest Editors

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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

  • vasopressors
  • hemodynamic monitoring
  • hypotension
  • shock
  • cardiac arrest
  • heart rate
  • blood pressure
  • critical care
  • intensive care unit

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Published Papers (6 papers)

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Research

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11 pages, 762 KB  
Article
Assessing Vascular Tone and Fluid Balance in Septic and Cardiogenic Shock: A Feasibility Study on Skin Water Loss as a Diagnostic Tool
by Sabrina Kopp, Ingo Sagoschen, Susanne Helena Karbach, Martin Russwurm, Philipp Lurz, Thomas Münzel and Johannes Wild
Biomedicines 2025, 13(11), 2644; https://doi.org/10.3390/biomedicines13112644 - 28 Oct 2025
Viewed by 293
Abstract
Background/Objectives: Fluid management in shock remains a clinical challenge, with ongoing debate about optimal guidance. Despite advanced technologies, fluid balance assessment is often inadequate. The SkInShock study investigated whether transepidermal water loss (TEWL) measurements could improve fluid balance estimation and serve as [...] Read more.
Background/Objectives: Fluid management in shock remains a clinical challenge, with ongoing debate about optimal guidance. Despite advanced technologies, fluid balance assessment is often inadequate. The SkInShock study investigated whether transepidermal water loss (TEWL) measurements could improve fluid balance estimation and serve as a non-invasive marker of vascular tone in patients with septic or cardiogenic shock. Methods: In this prospective single-center feasibility study (DRKS00027981), TEWL was measured daily in eight mechanically ventilated patients using a Tewameter® (Courage+Khazaka, Cologne, Germany), which quantifies transcutaneous water evaporation. Total daily skin water loss was calculated either via direct TEWL measurements or an estimation formula (6 mL/kg/day + 20%/°C deviation from 37 °C). Systemic vascular resistance index (SVRI) was measured simultaneously using PiCCO® technology (Pulsion Medical Systems, Munich, Germany) to evaluate the relationship between TEWL and vascular tone. Results: TEWL values were consistent across most body sites, except the forehead. TEWL-based estimates of skin water loss were significantly lower than formula-based estimates (p < 0.01). Formula-based values overestimated water loss at low TEWL levels and underestimated it at higher levels, with deviations reaching ±100%. While absolute TEWL values did not correlate with SVRI, intra-individually normalized values showed a significant negative correlation, indicating that higher skin water loss corresponded to lower vascular tone. Conclusions: TEWL measurement is feasible in ICU patients and may enhance fluid balance assessment and vascular tone monitoring. Our preliminary findings indicate that this non-invasive method could complement current diagnostics but warrants further investigation in larger cohorts. Full article
(This article belongs to the Special Issue Advanced Research in Cardiovascular and Hemodynamic Monitoring)
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12 pages, 1909 KB  
Article
Can Right Heart Catheterization Improve the Prediction of Positive Response to Resynchronization Therapy?
by Karolina Barańska-Pawełczak, Wojciech Jacheć, Andrzej Tomasik, Bettina Ziaja, Michalina Mazurkiewicz, Tomasz Kukulski and Celina Wojciechowska
Biomedicines 2025, 13(2), 467; https://doi.org/10.3390/biomedicines13020467 - 14 Feb 2025
Viewed by 770
Abstract
Background/Objectives: Cardiac resynchronization therapy (CRT) is one of the interventional methods of heart failure (HF) treatment, with the criteria for CRT device implantation based on the value of the left ventricular ejection fraction, New York Heart Association functional class, QRS complex duration, [...] Read more.
Background/Objectives: Cardiac resynchronization therapy (CRT) is one of the interventional methods of heart failure (HF) treatment, with the criteria for CRT device implantation based on the value of the left ventricular ejection fraction, New York Heart Association functional class, QRS complex duration, and electrocardiographic morphology. Pulmonary hypertension is an important factor influencing the prognosis of patients with HF, but its influence on CRT is not fully understood. Aim: The main aim of the study was to determine the prognostic value of baseline right heart catheterization-derived parameters on the response to CRT. Methods: It was a single-centre study with retrospective analysis of data of 39 non-ischemic HF patients. Clinical, biochemical, echocardiographic, electrocardiographic, and hemodynamic data were obtained before the CRT device implantation, and after 6 months of follow-up, non-invasive re-assessment was performed. Various criteria for the response to CRT were assessed along with the correlation between the baseline parameters. Results: After follow-up, a significant difference was found in the reduction in symptoms associated with HF, an increase achieved in the six-minute walk test distance, and a reduction in N-terminal pro-brain natriuretic peptide concentration as well as improvement of LV function assessed in echocardiographic examination. Among all parameters assessed, the baseline higher value of the transpulmonary gradient and pulmonary vascular resistance most often had a significant negative impact on meeting the criteria of response to CRT. Conclusions: The results of the analyses show that the initial assessment of pulmonary hemodynamics may be crucial in predicting the response to CRT in patients with non-ischemic cardiomyopathy. Full article
(This article belongs to the Special Issue Advanced Research in Cardiovascular and Hemodynamic Monitoring)
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13 pages, 1441 KB  
Article
Comparison of End-Tidal Carbon Dioxide Values in ICU Patients with and Without In-Hospital Cardiac Arrest
by Kaitlyn Dalton, Jeffrey J. Mucksavage, Dustin R. Fraidenburg, Kevin He, James Chang, Maria Panlilio-Villanueva, Tianxiu Wang and Scott T. Benken
Biomedicines 2025, 13(2), 412; https://doi.org/10.3390/biomedicines13020412 - 8 Feb 2025
Viewed by 1508
Abstract
Objective: The purpose of this study was to evaluate the utility of end-tidal carbon dioxide (ETCO2) values as a predictive marker of in-hospital cardiac arrest (IHCA). This was achieved by comparing the trends of ETCO2 values in mechanically ventilated [...] Read more.
Objective: The purpose of this study was to evaluate the utility of end-tidal carbon dioxide (ETCO2) values as a predictive marker of in-hospital cardiac arrest (IHCA). This was achieved by comparing the trends of ETCO2 values in mechanically ventilated ICU patients that experienced an IHCA versus patients that did not. Methods: A single-center, retrospective, observational, and comparative cohort study at an academic medical center. Mechanically ventilated adults in the ICU who received continuous ETCO2 monitoring were included. Patients who were transferred to our facility already intubated, experienced an out-of-hospital cardiac arrest, or had a do-not-resuscitate order were excluded. Extracted data points included demographics, comorbidities, vitals, labs, and outcomes. Patients were grouped into IHCA and non-IHCA cohorts, and the trends of ETCO2 values were compared at multiple time points for 48 h before the IHCA or after intubation (time zero) for the groups, respectively. An ROC curve was constructed to determine the predictive value of ETCO2 for IHCA. Results: A total of 207 patients were included, of which 104 (50.2%) had an IHCA and 103 (49.8%) did not. There were no differences in the mean SOFA scores at the initiation of mechanical ventilation (8.5 vs. 7.6). The ETCO2 values were decreased in the IHCA cohort, and significantly different at each time point analyzed from 300 min until immediately prior to the arrest (p < 0.001). The ETCO2 values were a mean of 20.0 mmHg in the IHCA cohort at the index time vs. 34.7 mmHg in the non-IHCA cohort (p < 0.001). The ROC analysis demonstrated moderate reliability, with an AUC = 0.687 (p < 0.0001, 95% CI 0.613–0.761) and with an ETCO2 of less than 23 mmHg, demonstrating a 67% sensitivity and a 71% specificity, as well as a 70% PPV for predicting the IHCA from our sample. Conclusions: Patients typically have rapid clinical deteriorations prior to cardiac arrest, and monitoring ETCO2 is easily achieved at the bedside while aiding in clinical decision making. The ETCO2 values in our study were significantly decreased in the IHCA cohort prior to cardiac arrest compared to the stable values in those that did not experience an IHCA, indicating that ETCO2 monitoring may have utility in predicting cardiac arrest. Further study is warranted to evaluate if predictive models utilizing ETCO2 can be constructed to predict IHCAs in mechanically ventilated ICU patients. Full article
(This article belongs to the Special Issue Advanced Research in Cardiovascular and Hemodynamic Monitoring)
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11 pages, 780 KB  
Article
Mitral Valve Transcatheter Edge-to-Edge Repair (MV-TEER) in Patients with Secondary Mitral Regurgitation Improves Hemodynamics, Enhances Renal Function, and Optimizes Quality of Life in Patients with Advanced Renal Insufficiency
by Birgit Markus, Julian Kreutz, Giorgios Chatzis, Styliani Syntila, Jannis Kuchenbuch, Charlotte Mueller, Maryana Choukeir, Bernhard Schieffer and Nikolaos Patsalis
Biomedicines 2024, 12(11), 2648; https://doi.org/10.3390/biomedicines12112648 - 20 Nov 2024
Cited by 1 | Viewed by 1667
Abstract
Background/Objectives: Secondary mitral regurgitation (MR) is a common valvular heart disease burdening the prognosis of patients with co-existing chronic heart failure. Transcatheter edge-to-edge mitral valve repair (MV-TEER) is a minimally invasive treatment option for high-risk patients. However, the effects of MV-TEER on expanded [...] Read more.
Background/Objectives: Secondary mitral regurgitation (MR) is a common valvular heart disease burdening the prognosis of patients with co-existing chronic heart failure. Transcatheter edge-to-edge mitral valve repair (MV-TEER) is a minimally invasive treatment option for high-risk patients. However, the effects of MV-TEER on expanded hemodynamics, tissue perfusion, and quality of life, particularly in patients with advanced renal failure, remain underexplored. Methods: This prospective, single-center study evaluated the impact of MV-TEER on hemodynamics, renal function, and quality of life in 45 patients with severe MR. Non-invasive bioimpedance monitoring with NICaS® was used to assess hemodynamics pre- and 3–5 days post-procedure. Quality of life was assessed using the EQ-5D-3L questionnaire before and 3 months post-procedure. For further analysis, patients were divided into subgroups based on the estimated baseline glomerular filtration rate (eGFR < 35 mL/min vs. eGFR ≥ 35 mL/min). Results: A significant reduction in systemic vascular resistance (SVR; p = 0.003) and an increase in eGFR (p = 0.03) were observed in the entire cohort after MV-TEER, indicating improved tissue perfusion. Notably, particularly patients with eGFR < 35 mL/min showed a significant increase in cardiac output (CO; p = 0.035), cardiac index (CI; p = 0.031), and eGFR (p = 0.018), as well as a reduction in SVR (p = 0.007). Consistent with these findings, quality of life significantly improved, with the EQ-5D-3L index and EQ-VAS score increasing from 0.44 to 0.66 (p < 0.001) and from 51.7% to 62.9% (p < 0.001). Full article
(This article belongs to the Special Issue Advanced Research in Cardiovascular and Hemodynamic Monitoring)
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Review

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21 pages, 1029 KB  
Review
Remote Hemodynamic Monitoring in Heart Failure Management: A Comprehensive Review of Recent Advances and Clinical Challenges
by Carmen M. Galvez-Sánchez, Julio A. Camacho-Ruiz, Lorys Castelli and Rosa M. Limiñana-Gras
Biomedicines 2025, 13(11), 2731; https://doi.org/10.3390/biomedicines13112731 (registering DOI) - 7 Nov 2025
Abstract
Background/Objectives: Heart Failure (HF) remains a leading cause of hospitalization and mortality worldwide, representing a significant burden on patients and healthcare systems. Despite advances in pharmacological and device-based therapies, readmission rates remain high and traditional monitoring approaches often fail to detect early physiological [...] Read more.
Background/Objectives: Heart Failure (HF) remains a leading cause of hospitalization and mortality worldwide, representing a significant burden on patients and healthcare systems. Despite advances in pharmacological and device-based therapies, readmission rates remain high and traditional monitoring approaches often fail to detect early physiological deterioration. This review examines the clinical utility and implementation challenges of remote hemodynamic monitoring in HF, highlighting its role in improving patient outcomes and guiding precision care. Method: A comprehensive narrative review was conducted using PubMed, Scopus, and Web of Science databases to identify peer-reviewed English-language studies published in the past ten years. Results: Monitoring hemodynamic status is essential for preventing HF readmissions, as elevated filling pressures often precede symptoms. Previous studies suggest that traditional methods may be less effective in detecting early changes, which could contribute to delays in initiating treatment. Remote monitoring offers continuous, individualized assessment and has shown potential to reduce hospitalizations, though its effectiveness varies across populations and settings. Telemonitoring primarily targets patients at higher risk of hospitalization, such as those classified as New York Heart Association(NYHA) class III and individuals with comorbidities that exacerbate HF. Remote hemodynamic monitoring presents notable clinical advantages, although its widespread adoption faces several challenges (i.e., the invasiveness of some monitoring systems; limited patient adherence due to technical complexity or cognitive and physical barriers; difficulties associated with comorbidities; variability in the efficacy of monitoring strategies across populations; difficulties faced by healthcare teams in managing and interpreting large volumes of real-time data; cost-effectiveness issues related to devices and infrastructure costs). Addressing these limitations will be essential to fully understanding the potential of remote monitoring in HF care. Conclusions: Remote hemodynamic monitoring enables early detection of physiological deterioration in HF, allowing timely interventions that reduce hospitalizations and improve outcomes. Emerging evidence suggests that, in contrast to traditional approaches, this method has the potential to support more personalized, data-driven care. Integrating biopsychosocial, gender, and intersectional perspectives further aligns this strategy with precision medicine, enhancing its effectiveness and equity in clinical practice. Despite promising recent advances, further research is essential to broaden the scientific evidence base and to enhance support for clinical decision-making. Full article
(This article belongs to the Special Issue Advanced Research in Cardiovascular and Hemodynamic Monitoring)
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27 pages, 24451 KB  
Review
Point-of-Care Ultrasound Use in Hemodynamic Assessment
by Ahmed Noor, Margaret Liu, Alan Jarman, Travis Yamanaka and Malvika Kaul
Biomedicines 2025, 13(6), 1426; https://doi.org/10.3390/biomedicines13061426 - 10 Jun 2025
Cited by 3 | Viewed by 9527
Abstract
Hemodynamic assessment is critical in emergency and critical care for preventing, diagnosing, and managing shock states that significantly affect patient outcomes. Point-of-care ultrasound (POCUS) has become an invaluable, non-invasive, real-time, and reproducible tool for bedside decision-making. Advancements such as Doppler imaging, advanced critical [...] Read more.
Hemodynamic assessment is critical in emergency and critical care for preventing, diagnosing, and managing shock states that significantly affect patient outcomes. Point-of-care ultrasound (POCUS) has become an invaluable, non-invasive, real-time, and reproducible tool for bedside decision-making. Advancements such as Doppler imaging, advanced critical care ultrasonography, and transesophageal echocardiography (TEE) have expanded its utility, enabling rapid and repeatable evaluations, especially in complex mixed shock presentations. This review explores the role of POCUS in hemodynamic monitoring, emphasizing its ability to assess cardiac output, filling pressures, and vascular congestion, facilitating shock classification and guiding fluid management. We highlight an extensive array of POCUS techniques for evaluating right and left cardiac function and review existing literature on their advantages, limitations, and appropriate clinical applications. Beyond assessing volume status, this review discusses the role of POCUS in predicting fluid responsiveness and supporting more individualized, precise management strategies. Ultimately, while POCUS is a powerful tool for rapid, comprehensive hemodynamic assessment in acute settings, its limitations must be acknowledged and thoughtfully integrated into clinical decision-making. Full article
(This article belongs to the Special Issue Advanced Research in Cardiovascular and Hemodynamic Monitoring)
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