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Acute Cardiovascular Care in the Cardiological Intensive Care Unit: What...
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Acute Cardiovascular Care in the Cardiological Intensive Care Unit: What Is New?

A special issue of Journal of Cardiovascular Development and Disease (ISSN 2308-3425). This special issue belongs to the section "Acquired Cardiovascular Disease".

Deadline for manuscript submissions: 31 October 2026 | Viewed by 6362

Special Issue Editors

Dr. Francesca Giordana

E-Mail Website
Guest Editor
Division of Cardiology, S. Croce e Carle Hospital, 12100 Cuneo, Italy
Interests: acute cardiovascular care (especially cardiogenic shock, acute and advanced heart failure, and acute coronary syndromes); chronic heart failure; pulmonary hypertension; adult echocardiography
Special Issues, Collections and Topics in MDPI journals
Dr. Andrea Falcetta

E-Mail Website
Guest Editor Assistant
Division of Cardiology, S. Croce e Carle Hospital, 12100 Cuneo, Italy
Interests: acute cardiovascular care (especially cardiogenic shock, acute and advanced heart failure, and acute coronary syndromes); chronic heart failure; adult echocardiography

Special Issue Information

Dear Colleagues,

Over the past three years, acute cardiovascular care in the Cardiological Intensive Care Unit (CICU) has rapidly evolved, driven by new evidence, updated guidelines, and technological innovation. This Special Issue, "Acute Cardiovascular Care in the Cardiological Intensive Care Unit: What Is New?", aims to highlight emerging strategies in the management of critically ill cardiac patients.

Recent position papers and guidelines—such as the 2023 ESC Guidelines on Acute Coronary Syndromes, the 2023 ESC Position Statement on Cardiogenic Shock, and the 2022 ESC Guidelines on Pulmonary Embolism—emphasize more precise phenotyping of critically ill patients and a multidisciplinary approach to care. Advances in hemodynamic monitoring (e.g., pulmonary artery catheterization and echocardiographic profiling), early initiation of mechanical circulatory support (IABP, Impella, and ECMO), and refined decision algorithms are reshaping the management of cardiogenic shock.

In acute coronary syndromes, particularly in complex and high-risk settings, data from registries and trials such as CULPRIT-SHOCK, DANAMI-3, and IABP-SHOCK II continue to inform tailored interventional strategies. In pulmonary embolism, risk-adapted reperfusion strategies have gained traction following recent ESC updates.

New frontiers also include the application of non-invasive ventilation in acute heart failure, myocarditis phenotyping and management, and the reclassification of cardiomyopathies based on genetics and inflammatory profiles.

We welcome original research, reviews, and clinical cases/case series that reflect these trends and promote excellence in cardiovascular intensive care.

Dr. Francesca Giordana
Guest Editor

Dr. Andrea Falcetta
Guest Editor Assistant

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. Journal of Cardiovascular Development and Disease 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 2700 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

  • cardiological intensive care unit (CICU)
  • cardiogenic shock
  • acute heart failure
  • mechanical circulatory support
  • acute coronary syndromes
  • pulmonary embolism
  • non-invasive ventilation
  • myocarditis
  • cardiomyopathies

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Published Papers (3 papers)

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Review

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42 pages, 2902 KB  
Review
Cardiogenic Shock Management in the Modern Era: A Narrative Review of Percutaneous Mechanical Circulatory Support Devices
by Srijit Jana, Makayla Wijesinghe, Michael V. DiCaro, KaChon Lei, Nazanin Houshmand and Chowdhury Ahsan
J. Cardiovasc. Dev. Dis. 2026, 13(1), 9; https://doi.org/10.3390/jcdd13010009 - 22 Dec 2025
Cited by 1 | Viewed by 4900
Abstract
Cardiogenic shock (CS) remains a significant clinical challenge with persistently high mortality rates. Defined by impaired cardiac output resulting in end-organ hypoperfusion, CS commonly arises from acute myocardial infarction (AMI-CS) or acute exacerbations of heart failure (HF-CS). The severity of CS is classified [...] Read more.
Cardiogenic shock (CS) remains a significant clinical challenge with persistently high mortality rates. Defined by impaired cardiac output resulting in end-organ hypoperfusion, CS commonly arises from acute myocardial infarction (AMI-CS) or acute exacerbations of heart failure (HF-CS). The severity of CS is classified by the Society for Cardiovascular Angiography and Interventions (SCAI) into stages A (at risk) through E (extremis), which informs treatment strategies, including pharmacotherapy and mechanical circulatory support (MCS). Recent advancements in percutaneous mechanical circulatory support devices, including intra-aortic balloon pumps (IABPs), Impella devices, TandemHeart, Protek-Duo, and veno-arterial extracorporeal membrane oxygenation (VA-ECMO), have transformed management paradigms by offering targeted hemodynamic support. While DanGer-SHOCK, a pivotal randomized trial, demonstrated improved outcomes with early Impella use in anterior STEMI-associated CS, the trial’s focus population and center expertise suggest that its findings should be interpreted in the context of broader AMI-CS and HF-CS presentations. Device selection is guided by shock severity, anatomical considerations, comorbidities, and institutional capabilities. This review synthesizes current evidence, evaluates the clinical utility and efficacy of existing and emerging percutaneous MCS technologies, and highlights ongoing clinical trials and future directions in optimizing CS management. Emphasis is placed on individualized patient selection, evidence-based deployment of MCS devices, and multidisciplinary team collaboration, which collectively represent a critical transition towards improving clinical outcomes in CS. Full article
(This article belongs to the Special Issue Acute Cardiovascular Care in the Cardiological Intensive Care Unit: What Is New?)
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Other

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26 pages, 1900 KB  
Systematic Review
Effect Modification by Acute Coronary Syndrome Prevalence on Non-Invasive Ventilation Efficacy in Acute Cardiogenic Pulmonary Edema: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
by Marek Tomala, Monika Durak, Magdalena Borówka, Paweł Szkarłat and Maciej Kłaczyński
J. Cardiovasc. Dev. Dis. 2026, 13(3), 135; https://doi.org/10.3390/jcdd13030135 - 12 Mar 2026
Viewed by 644
Abstract
Non-invasive ventilation (NIV) reduces mortality in patients with acute cardiogenic pulmonary edema (ACPE). However, the 3CPO trial reported null results. Therefore, we hypothesized that the prevalence of acute coronary syndrome (ACS) would influence the effectiveness of NIV. A systematic literature review was conducted [...] Read more.
Non-invasive ventilation (NIV) reduces mortality in patients with acute cardiogenic pulmonary edema (ACPE). However, the 3CPO trial reported null results. Therefore, we hypothesized that the prevalence of acute coronary syndrome (ACS) would influence the effectiveness of NIV. A systematic literature review was conducted to identify randomized controlled trials (RCTs) comparing NIV and standard oxygen therapy in patients with ACPE from PubMed, CENTRAL, and Embase databases through December 2025. Random-effects meta-analysis and REML meta-regression were utilized, and evidence quality was evaluated using GRADE. (PROSPERO: CRD420251142245). Fourteen RCTs (n = 1967) were included in the analysis. NIV significantly reduced hospital mortality (RR 0.75, 95% CI 0.58–0.96; I2 = 0%) and endotracheal intubation (RR 0.49, 95% CI 0.35–0.68). Meta-regression revealed that study-level ACS prevalence was significantly associated with the magnitude of NIV’s mortality effect (β1 = −0.023 per 1% increase in ACS, p = 0.008; R2 = 46.2%). The equilibrium point occurred at an ACS prevalence of 14.1% (95% CI 5.2–23.0%). At 3CPO’s ACS prevalence of 27%, the model predicted an RR of 0.75 (95% CI 0.58–0.97). The observed 3CPO RR was 0.97 (95% CI 0.66–1.43); the confidence intervals overlap substantially, and 3CPO was underpowered for mortality as an isolated endpoint. The mortality benefit of NIV appears to be associated with the prevalence of ACS among treated patients, though this ecological finding requires confirmation at the individual-patient level. Full article
(This article belongs to the Special Issue Acute Cardiovascular Care in the Cardiological Intensive Care Unit: What Is New?)
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9 pages, 11089 KB  
Case Report
The Co-Occurrence of Pertrochanteric Fracture and Acute Coronary Syndrome in a Geriatric Patient: A Case Report and Review of the Literature
by Jozef Dodulík, Jiří Demel, Jan Mrózek, Jiří Vrtal, Jiří Plášek and Jan Václavík
J. Cardiovasc. Dev. Dis. 2026, 13(3), 132; https://doi.org/10.3390/jcdd13030132 - 11 Mar 2026
Viewed by 367
Abstract
Background: Managing elderly patients with simultaneous acute cardiovascular and orthopedic emergencies presents a unique challenge. While ST-elevation myocardial infarction (STEMI) requires prompt revascularization and dual antiplatelet therapy (DAPT), pertrochanteric femoral fractures usually necessitate early surgical fixation to reduce morbidity and mortality. However, the [...] Read more.
Background: Managing elderly patients with simultaneous acute cardiovascular and orthopedic emergencies presents a unique challenge. While ST-elevation myocardial infarction (STEMI) requires prompt revascularization and dual antiplatelet therapy (DAPT), pertrochanteric femoral fractures usually necessitate early surgical fixation to reduce morbidity and mortality. However, the combination of these conditions complicates both standard treatment pathways. Case presentation: We present the case of an 86-year-old woman admitted after a low-energy fall, with a radiologically confirmed unstable pertrochanteric fracture of the right femur (AO/OTA 31-A2). Upon routine electrocardiogram, anterior STEMI with new-onset atrial fibrillation was diagnosed. Although asymptomatic from a cardiac perspective, bedside echocardiography revealed a severely reduced left ventricular ejection fraction of 10%. Urgent coronary angiography demonstrated a critical mid-left anterior descending lesion, successfully treated with rotational atherectomy, intravascular lithotripsy, and stent implantation. She was initiated on DAPT (aspirin + clopidogrel) and anticoagulated with low-molecular-weight heparin. Given the extremely high bleeding risk, surgical intervention for the femoral fracture was deemed unsafe. Instead, conservative management with skeletal traction (6 kg) was employed. Despite optimal supportive care and early rehabilitation, the patient experienced a complicated hospital course, including delirium, hematuria, and lower respiratory tract infection. She passed away 52 days post-admission. Conclusions: This case illustrates the complexity of clinical decision-making in geriatric patients with competing acute conditions. Current evidence on how to proceed in patients requiring both antithrombotic therapy and urgent orthopedic surgery is limited. Multidisciplinary teams must carefully weigh the risks and benefits of both surgical and conservative strategies. Further guidelines addressing such scenarios in elderly patients are urgently needed. Full article
(This article belongs to the Special Issue Acute Cardiovascular Care in the Cardiological Intensive Care Unit: What Is New?)
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