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Clinical Diagnostics and Therapeutics Advances in Acute and Chronic Heart Failure

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Special Issue Editors

Dr. Ilaria Battistoni

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Department of Cardiovascular Sciences, UTIC, Ospedali Riuniti, 60100 Ancona, Italy
Interests: acute heart failure; chronic heart failure; heart failure; cardiology

Dr. Emilia D'Elia

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Cardiology Unit, Cardiovascular Department, ASST Papa Giovanni XXIII, 24127 Bergamo, Italy
Interests: heart failure; heart failure with preserved ejection fraction (HFpEF); heart transplant

Special Issue Information

Dear Colleagues,

Heart failure (HF) remains a popular topic of discussion and an area of significant interest within the cardiovascular community due to its growing prevalence and the substantial burden it places on healthcare systems worldwide. Despite advancements in diagnostic and therapeutic strategies, many aspects of HF management remain underexplored, particularly the "gray zones", where clinical decisions are complex and nuanced. Moreover, worsening and advanced HF are still underdiagnosed conditions, with their management often varying from center to center, and lacking common guidelines both in terms of management and pharmacotherapy. In this regard, this Special Issue delves into these areas, offering insights from real-life evidence and addressing the multifaceted challenges faced by clinicians. We aim to bridge the gap between clinical trial data and everyday practice, providing a comprehensive overview of contemporary issues in HF management. By highlighting novel research findings, and expert opinions, this issue seeks to foster a deeper understanding of HF, ultimately improving patient outcomes and advancing the field.

Dr. Ilaria Battistoni
Dr. Emilia D'Elia
Guest Editors

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Research

11 pages, 596 KiB

Open AccessArticle

The Effectiveness of Sacubitril/Valsartan in Systemic Sclerosis Patients with Heart Failure: A Retrospective Analysis

by Nouran Eshak, Mahmoud Abdelnabi, Jaxon Quillen, Micheal Pham, Joseph Hentz and Vivek Nagaraja

J. Clin. Med. 2025, 14(12), 4054; https://doi.org/10.3390/jcm14124054 - 8 Jun 2025

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Abstract

Introduction: Cardiac involvement in patients with systemic sclerosis (SSc) can present variably from being asymptomatic to manifesting with heart failure, conduction abnormalities, pulmonary hypertension, and pericardial effusion. Symptomatic cardiac involvement portends a poor prognosis and worse overall survival. Sacubitril/valsartan (SV), an angiotensin receptor neprilysin inhibitor, has been shown to significantly reduce hospitalization rates and morbidity in patients with heart failure with reduced ejection fraction (HFrEF). This study aimed to investigate the effects of SV treatment in patients with SSc and heart failure. Methods: A retrospective analysis of patients with SSc was conducted using an electronic data capture tool. Patients with SSc treated with SV between January 2015 and August 2023 were identified. Comprehensive clinical phenotyping and longitudinal data analysis were performed to characterize the sub-type of patients and evaluate clinical outcomes, including hospitalizations and mortality, laboratory markers, and echocardiographic findings. Results: Twenty-four patients with SSc were treated with SV for a mean duration of 20.6 months. HFrEF was the primary indication for SV use in 91% of patients, primarily due to non-ischemic cardiomyopathy (87.5%). There was a significant reduction in systolic blood pressure from 128 mmHg to 114 mmHg (p < 0.001) and NT-proBNP levels from 15,130 pg/mL to 5082 pg/mL (p = 0.046). In the 19 patients with baseline and follow-up echocardiograms, there was a significant improvement in LVEF from 40.3% to 47.7% (p = 0.014). Hypotension was a common side effect leading to discontinuation of SV (n = 4, 16.7%). Serum creatinine had trends of improvement (1.9 mg/dL to 1.3 mg/d), though it did not reach statistical significance (p = 0.057). Conclusions: This study showed that SV effectively improved cardiac symptoms and function in patients with SSc presenting with HFrEF. Further prospective studies are needed to confirm these findings and explore the role of SV in the treatment of other manifestations of SSc. Full article

(This article belongs to the Special Issue Clinical Diagnostics and Therapeutics Advances in Acute and Chronic Heart Failure)

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14 pages, 1021 KiB

Open AccessArticle

Combination Between Biomarkers and Echocardiographic Data for Prediction of Left Ventricular Reverse Remodelling in Cardiac Resynchronization Therapy

by Matteo Beltrami, Alessandro Galluzzo, Giacomo Bonacchi, Luca Checchi, Giuseppe Ricciardi, Laura Perrotta, Manuel Garofalo, Alessandro Paoletti Perini, Alessio Mattesini, Paolo Pieragnoli and Alberto Palazzuoli

J. Clin. Med. 2025, 14(10), 3496; https://doi.org/10.3390/jcm14103496 - 16 May 2025

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Abstract

Purpose: Although biomarkers of myocardial fibrosis and inflammation have been proposed as potential modulators of response to cardiac resynchronization therapy (CRT), their clinical utility and interaction with echocardiographic parameters remain incompletely understood. This study aims to assess the dynamic changes in these biomarkers, their relationship with echocardiographic variables, and their association with structural response to CRT. Methods: We retrospectively evaluated 86 consecutive patients referred for CRT with symptomatic heart failure, left ventricular (LV) ejection fraction ≤ 35%, QRS width ≥ 130 ms and LBBB morphology. We measured sST-2, Gal-3, NTpro-BNP and eGFR at baseline and after 1 year of CRT. An echocardiographic reduction of LV end-systolic volume ≥ 15% was used to define a patient as a responder to CRT. Results: The mean baseline and follow-up values of Gal-3 (responders: 24.1 [16.8;32] ng/mL, non-responders: 30 [20;39.3] ng/mL, p = 0.03) and sST2 (responders: 28.5 [20;36] ng/mL, non-responders: 34.5 [25;37.7] ng/mL, p = 0.03) were lower in responders than non-responders. Responders showed a significant reduction between baseline and follow-up values of ΔGal-3 (−12.1% vs. −2.5%, p = 0.04), ΔsST2 (−30.8% vs. 2.2%, p < 0.001), ΔNT-proBNP (−16.4% vs. 5.2, p = 0.04) and ΔeGFR (6.7 ± 24.3% vs. -6.3 ± 27.9%, p = 0.03). At the multivariate analyses, baseline Gal-3 [cut-off: 38.5 ng/mL, AUC: 0.63, p = 0.03, (OR 7.13 [1.12;45.41], p = 0.03), together with TAPSE > 17.5 mm (OR 10.86 [3.15;37.44], p < 0.001) significantly correlated with the structural response to CRT in several prediction models. Among echocardiographic parameters, TAPSE remained the strongest predictive factor of positive response to CRT at the univariate and multivariate analyses. Conclusions: In patients with heart failure and reduced ejection fraction undergoing CRT, Gal-3 and TAPSE are significantly associated with a positive structural response to CRT. Full article

(This article belongs to the Special Issue Clinical Diagnostics and Therapeutics Advances in Acute and Chronic Heart Failure)

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