Search for Articles:
Title / Keyword
Author / Affiliation / Email
Journal
Article Type
 
 
Advanced Search
 
Section
Special Issue
Volume
Issue
Number
Page
 
5.9
3.3
Journals
Diagnostics
Special Issues
Recent Advances in Heart Failure: Clinical Diagnosis, Treatment, and Prognosis
share announcement

Recent Advances in Heart Failure: Clinical Diagnosis, Treatment, and Prognosis

A special issue of Diagnostics (ISSN 2075-4418). This special issue belongs to the section "Clinical Diagnosis and Prognosis".

Deadline for manuscript submissions: 30 June 2026 | Viewed by 6363

Special Issue Editors

Dr. Massimo Mapelli

E-Mail Website
Guest Editor
1. Cardiology Center Monzino, Scientific Institute for Research, Hospitalization and Healthcare (IRCCS), 20138 Milano, Italy
2. Department of Clinical Sciences and Community Health, Cardiovascular Section, University of Milan, 20122 Milan, Italy
Interests: heart failure; exercise testing; HFrEF; cardiomyo-pathies
Special Issues, Collections and Topics in MDPI journals
Dr. Irene Mattavelli

E-Mail Website
Guest Editor
Centro Cardiologico Monzino, IRCCS, 20138 Milan, Italy
Interests: heart failure; exercise testing; HFrEF; cardio-myopathies

Special Issue Information

Dear Colleagues,

This Special Issue explores the latest advancements in heart failure, focusing on innovative approaches to clinical diagnosis, emerging treatment strategies, and improved prognostic tools. It highlights cutting-edge research on biomarkers, imaging techniques, exercise evaluation, and personalized therapies, aiming to enhance patient outcomes and quality of life. The Special Issue also discusses challenges in managing heart failure and future directions for research and clinical practice.

Dr. Massimo Mapelli
Dr. Irene Mattavelli
Guest Editors

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 250 words) can be sent to the Editorial Office for assessment.

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. Diagnostics is an international peer-reviewed open access semimonthly 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

  • heart failure
  • clinical diagnosis
  • treatment advances
  • precision medicine
  • exercise evaluation
  • CPET

Benefits of Publishing in a Special Issue

  • Ease of navigation: Grouping papers by topic helps scholars navigate broad scope journals more efficiently.
  • Greater discoverability: Special Issues support the reach and impact of scientific research. Articles in Special Issues are more discoverable and cited more frequently.
  • Expansion of research network: Special Issues facilitate connections among authors, fostering scientific collaborations.
  • External promotion: Articles in Special Issues are often promoted through the journal's social media, increasing their visibility.
  • Reprint: MDPI Books provides the opportunity to republish successful Special Issues in book format, both online and in print.

Further information on MDPI's Special Issue policies can be found here.

Published Papers (4 papers)

Download All Papers
Order results
Result details
Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:

Research

13 pages, 978 KB  
Article
Gliflozins in Practice: Real-Life Use of Dapagliflozin and Empagliflozin in HFrEF Versus Clinical Trial Data
by Massimo Mapelli, Rebecca Caputo, Massimo Valenti, Filippo Maria Rubbo, Elisabetta Salvioni, Irene Mattavelli, Arianna Galotta, Arianna Piotti, Fiorella Puttini, Laura Manfrin, Carlo Vignati, Simona Costantino and Piergiuseppe Agostoni
Diagnostics 2026, 16(5), 769; https://doi.org/10.3390/diagnostics16050769 - 4 Mar 2026
Viewed by 535
Abstract
Background: Sodium/glucose cotransporter-2 inhibitors (SGLT2is), such as dapagliflozin and empagliflozin, are currently a standard therapy for heart failure (HF) patients. We report the real-world use of SGLT2is in a monocentric cohort of HF patients with reduced ejection fraction (HFrEF) and improved ejection fraction [...] Read more.
Background: Sodium/glucose cotransporter-2 inhibitors (SGLT2is), such as dapagliflozin and empagliflozin, are currently a standard therapy for heart failure (HF) patients. We report the real-world use of SGLT2is in a monocentric cohort of HF patients with reduced ejection fraction (HFrEF) and improved ejection fraction (HFimpEF), comparing patient characteristics and outcomes with those observed in large-scale randomized clinical trials (RCTs). Methods: We retrospectively analyzed a cohort of 370 stable patients with HFrEF or HFimpEF who initiated therapy with dapagliflozin or empagliflozin between June 2019 and November 2023. Baseline data, including medical history, concomitant diseases, therapy, laboratory tests, echocardiographic results and cardiopulmonary exercise tests (CPETs), were collected at the start of the therapy with SGLT2is. After a median period of 18 months, follow-up data on treatment adherence, adverse events, hospitalizations, and mortality were also reviewed. A comparison was made between patients taking dapagliflozin and those taking empagliflozin and then individual populations were compared with those from the trials. Results: Among 370 patients (81% HFrEF, 19% HFimpEF), 276 received dapagliflozin and 94 empagliflozin. Empagliflozin patients were older, had higher NYHA class and LVEF, and higher incidence of diabetes, while dapagliflozin users had greater use of sacubitril/valsartan and mineralocorticoid receptor antagonists. Both groups were older than the RCT cohorts. Dapagliflozin patients had LVEF comparable to DAPA-HF, while empagliflozin patients had higher LVEF than EMPEROR-Reduced. HF hospitalizations were more frequent in the real-world groups, but mortality was lower than in RCTs. The composite outcome of death and worsening HF was higher in the real-world dapagliflozin cohort vs. DAPA-HF but similar between the real-world empagliflozin cohort and EMPEROR-Reduced. Conclusions: In this real-world cohort, the use of empagliflozin was associated with cardio-nephro-metabolic comorbidities and dapagliflozin being prescribed more frequently for patients with isolated cardiac symptoms. While outcomes were generally favorable, they differed from those seen in RCTs, highlighting the importance of real-world data in understanding the practical application of these therapies. Full article
(This article belongs to the Special Issue Recent Advances in Heart Failure: Clinical Diagnosis, Treatment, and Prognosis)
►▼ Show Figures

Figure 1

18 pages, 1537 KB  
Article
Endothelial Activation and Stress Index (EASIX) Predicts In-Hospital Mortality in Acute Decompensated Heart Failure with Reduced Ejection Fraction
by Bülent Özlek, Veysel Ozan Tanık, Alperen Taş, Süleyman Barutçu, Buse Çuvalcıoğlu, Çağatay Tunca, Kürşat Akbuğa, Yusuf Bozkurt Şahin and Murat Akdoğan
Diagnostics 2026, 16(1), 152; https://doi.org/10.3390/diagnostics16010152 - 2 Jan 2026
Cited by 4 | Viewed by 928
Abstract
Background: Early risk stratification in acute decompensated heart failure with reduced ejection fraction (ADHF-rEF) remains challenging. The Endothelial Activation and Stress Index (EASIX)—a composite of lactate dehydrogenase, creatinine, and platelet count—reflects endothelial dysfunction, a pathophysiological contributor to early deterioration in ADHF-rEF. This study [...] Read more.
Background: Early risk stratification in acute decompensated heart failure with reduced ejection fraction (ADHF-rEF) remains challenging. The Endothelial Activation and Stress Index (EASIX)—a composite of lactate dehydrogenase, creatinine, and platelet count—reflects endothelial dysfunction, a pathophysiological contributor to early deterioration in ADHF-rEF. This study evaluated the prognostic utility of admission-based EASIX for in-hospital mortality. Methods: In this retrospective single-center cohort, 850 consecutive patients hospitalized with ADHF-rEF between January 2022 and June 2025 were analyzed. EASIX was calculated from first-day laboratory values. Logistic regression, ROC analysis, restricted cubic splines, and Kaplan–Meier survival methods were used to assess the association between EASIX and in-hospital mortality, and to evaluate its incremental value beyond established clinical and laboratory predictors. Results: In-hospital mortality was 12.4%. Higher EASIX values were significantly associated with mortality in both univariable and multivariable models (adjusted OR 1.273; p < 0.001). EASIX demonstrated moderate discriminative performance among evaluated biomarkers (AUC 0.751) and showed a clear dose–response risk gradient, with mortality rising from 1.4% in the lowest tertile to 26.2% in the highest. Incorporating EASIX into clinical and laboratory prediction models yielded substantial continuous net reclassification improvement (0.59 and 0.38, respectively). Survival curves diverged early and remained distinctly separated across EASIX strata. Conclusions: Admission EASIX is an independent predictor of in-hospital mortality in ADHF-rEF and provides complementary prognostic information beyond conventional models. This is the first study to demonstrate the prognostic value of EASIX in the ADHF-rEF setting, supporting its potential utility as an accessible endothelial stress biomarker for early risk stratification. Full article
(This article belongs to the Special Issue Recent Advances in Heart Failure: Clinical Diagnosis, Treatment, and Prognosis)
►▼ Show Figures

Figure 1

14 pages, 1036 KB  
Article
Clinical and Prognostic Impact of Hemodynamic Gain Index and Heart Hemodynamic Reserve in Heart Failure with Reduced and Mildly Reduced Ejection Fraction: A Multicenter Study
by Emiliano Fiori, Sara Corradetti, Giovanna Gallo, Alberto Palazzuoli, Antonio Pagliaro, Roberta Molle, Pier Giorgio Tiberi, Elisabetta Salvioni, Arianna Piotti, Paola Gugliandolo, Piergiuseppe Agostoni, Damiano Magrì and Emanuele Barbato
Diagnostics 2025, 15(18), 2366; https://doi.org/10.3390/diagnostics15182366 - 17 Sep 2025
Viewed by 835
Abstract
Background/Objectives: Cardiopulmonary exercise testing (CPET) is a well-established tool for risk stratification in patients with heart failure (HF); however, its utility is limited in routine clinical practice due to the associated cost and technical demands. The hemodynamic gain index (HGI), a non-metabolic parameter [...] Read more.
Background/Objectives: Cardiopulmonary exercise testing (CPET) is a well-established tool for risk stratification in patients with heart failure (HF); however, its utility is limited in routine clinical practice due to the associated cost and technical demands. The hemodynamic gain index (HGI), a non-metabolic parameter derived from systolic blood pressure and heart rate changes during exercise, has been demonstrated to play a promising role in HF populations. In this study, we aimed both to validate the prognostic value of the HGI and to evaluate a novel metric, heart hemodynamic reserve (HHR), in patients with HF and left ventricular ejection fraction (LVEF) below 50%. Methods: We retrospectively enrolled 479 consecutive patients with HF and reduced or mildly reduced LVEF who underwent maximal, symptom-limited CPET at three Italian university hospitals between 2012 and 2024. The HGI and HHR were computed using resting and peak exercise hemodynamic data. HHR is defined as the product of systolic blood pressure and heart rate reserve with exercise, normalized for the age-predicted maximum heart rate. The primary endpoint was a composite of cardiovascular death, urgent heart transplantation (HTx), or left ventricular assist device (LVAD) implantation. Prognostic associations were assessed using multivariable Cox regression and area under the receiver operating characteristic curves (AUCs). Results: During a median follow-up of 3.25 years, the composite outcome occurred in 56 patients (11.5%). Both the HGI and HHR were independently associated with the prespecified endpoint (HGI HR: 0.41, 95% CI: 0.20–0.83, p = 0.013; HHR HR: 0.89, 95% CI: 0.83–0.96, p = 0.004), with HHR showing a slightly higher prognostic accuracy than the HGI (AUC 0.78 vs. 0.74; p = 0.033). Conclusions: Both the HGI and HHR are independent prognostic markers in HF patients with LVEF < 50%. Their non-metabolic derivation makes them valuable tools for risk stratification in settings where CPET is unavailable. Full article
(This article belongs to the Special Issue Recent Advances in Heart Failure: Clinical Diagnosis, Treatment, and Prognosis)
►▼ Show Figures

Figure 1

27 pages, 1734 KB  
Article
Anemia in Heart Failure: Diagnostic Insights and Management Patterns Across Ejection Fraction Phenotypes
by Otilia Țica and Ovidiu Țica
Diagnostics 2025, 15(16), 2079; https://doi.org/10.3390/diagnostics15162079 - 19 Aug 2025
Cited by 5 | Viewed by 3601
Abstract
Background: Anemia is a common comorbidity in heart failure (HF) and has been associated with adverse clinical consequences. This retrospective, descriptive cohort study examined phenotype-specific differences in anemia severity, clinical presentation, comorbid burden, and in-hospital management across HF subtypes classified by left ventricular [...] Read more.
Background: Anemia is a common comorbidity in heart failure (HF) and has been associated with adverse clinical consequences. This retrospective, descriptive cohort study examined phenotype-specific differences in anemia severity, clinical presentation, comorbid burden, and in-hospital management across HF subtypes classified by left ventricular ejection fraction (LVEF). Methods: We retrospectively analyzed 443 adult patients hospitalized with concurrent HF and anemia from January 2022 to December 2024. Patients were stratified by LVEF into HFrEF (<40%), HFmrEF (40–49%), and HFpEF (≥50%). All patients included met WHO criteria for anemia. Demographic, clinical, paraclinical, and therapeutic data were extracted, and descriptive statistical methods were used to evaluate intergroup differences. No formal time-to-event analyses (e.g., Kaplan–Meier curves) were performed; instead, exploratory cumulative readmission analyses using fixed follow-up windows were conducted. In-hospital mortality was recorded and stratified by HF phenotype. Results: The cohort comprised 213 (48.0%) HFrEF, 118 (26.6%) HFmrEF, and 112 (25.3%) HFpEF patients. The distribution of anemia severity, management strategies, and comorbidity profiles varied significantly across phenotypes. Severe anemia predominated in the HFmrEF cohort (54.2%), whereas mild anemia was most common in HFpEF (52.1%) and HFrEF (52.1%). Mean hemoglobin concentrations were 8.39 ± 1.79 g/dL (HFmrEF), 9.07 ± 2.47 g/dL (HFpEF), and 8.62 ± 1.94 g/dL (HFrEF). Rates of atrial fibrillation (48.2% in HFpEF), hypertensive ECG changes (63.4% in HFpEF), and ischemic-lesion patterns (>50% in HFrEF) differed by cohort. Echocardiographically, grade III mitral regurgitation and severe pulmonary hypertension each affected 25.4% of HFmrEF patients, whereas HFpEF patients most often exhibited grade II mitral regurgitation (42.9%) and moderate pulmonary hypertension (42.9%). HFrEF patients had severe pulmonary hypertension. Intravenous (IV) iron was the primary treatment modality, with highest utilization in HFmrEF. IV iron use ranged from 69.9% (HFrEF) to 84.8% (HFmrEF), with transfusion rates of 5.6% (HFrEF)–16.1% (HFpEF). Comorbid burdens differed by phenotype: HFrEF was associated with structural heart disease, HFmrEF with vascular and hepatic pathology, and HFpEF with metabolic and degenerative comorbidities. Discharge pharmacotherapy reflected phenotype-specific treatment patterns. Conclusions: This real-world descriptive analysis highlights substantial variation in anemia burden and management across the HF spectrum. While limited to descriptive findings, our analysis highlights the heterogeneity of anemia in HF and describes observed associations across phenotypes, without implying causality. These findings should be interpreted as hypothesis-generating. These findings are observational, exploratory, and cannot establish a causal relationship between intravenous iron use and survival. Full article
(This article belongs to the Special Issue Recent Advances in Heart Failure: Clinical Diagnosis, Treatment, and Prognosis)
►▼ Show Figures

Figure 1

Show export options expand_more Show export options expand_less
Select all
Export citation of selected articles as:
 
Displaying articles 1-4
Back to TopTop