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Risk Prediction in Mechanical Circulatory Support (MCS) and Cardiac Transplantation
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Risk Prediction in Mechanical Circulatory Support (MCS) and Cardiac Transplantation

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Cardiology".

Deadline for manuscript submissions: 15 September 2026 | Viewed by 3033

Editor

Prof. Dr. Nandini Nair

E-Mail Website
Guest Editor
Division of Cardiology, Department of Medicine, Milton S Hershey Medical Center, 500 University Drive, Hershey, PA 17033, USA
Interests: heart transplantation; heart failure; mechanical circulatory support
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Advanced heart failure therapies such as mechanical circulatory support and cardiac transplantation have evolved in the last few decades to become the standard of care for end-stage heart failure. The development of anti-rejection drugs and therapies has led to the establishment of heart transplantation as a treatment for advanced heart failure. This has also led to better outcomes and a prolonged survival of the allografts. Mechanical circulatory support rose to prominence in the setting of donor organ shortage. Currently, the 2-year survival of patients on a durable left ventricular assist device is similar to that of cardiac allograft recipients.

This Special Issue is dedicated to the use of risk stratification strategies to improve patient selection and outcomes. We encourage the submission of papers that address innovative technologies in risk stratification, the identification of risk factors, and risk modeling to improve all aspects of advanced heart failure care.

Prof. Dr. Nandini Nair
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 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-anonymized 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 Clinical Medicine 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

  • advanced heart failure
  • mechanical circulatory support (MCS)
  • cardiac transplantation
  • heart transplantation
  • risk prediction

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Published Papers (3 papers)

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Research

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15 pages, 1153 KB  
Article
Pre-Transplant C-Reactive Protein ≥ 20 mg/L Predicts Infection-Related Mortality After Heart Transplantation
by Matthias Helmschrott, Karsten M. Heil, Rasmus Rivinius, Ann-Kathrin Rahm, Philipp Ehlermann, Norbert Frey and Fabrice F. Darche
J. Clin. Med. 2026, 15(4), 1332; https://doi.org/10.3390/jcm15041332 - 8 Feb 2026
Viewed by 796
Abstract
Background: Patients after heart transplantation (HTX) require lifelong immunosuppressive therapy to prevent graft rejection, thereby increasing susceptibility to infections. C-reactive protein (CRP) is a recognized biochemical marker of system-wide inflammation and generally rises with increasing infection severity. As the prognostic relevance of [...] Read more.
Background: Patients after heart transplantation (HTX) require lifelong immunosuppressive therapy to prevent graft rejection, thereby increasing susceptibility to infections. C-reactive protein (CRP) is a recognized biochemical marker of system-wide inflammation and generally rises with increasing infection severity. As the prognostic relevance of elevated CRP (≥20 mg/L) prior to HTX has been unclear, we analyzed its effects on post-transplant outcomes. Methods: We performed a retrospective, observational, single-center study including 418 patients who received HTX at Heidelberg Heart Center between the years 2000 and 2019. HTX recipients were grouped according to pre-transplant CRP (<20 or ≥20 mg/L). We analyzed donor and recipient characteristics, post-transplant pharmacotherapy, and post-transplant mortality including causes of death. Results: Pre-transplant CRP was ≥20 mg/L in 102 of 418 HTX recipients (24.4%). These patients had a significantly higher 30-day (11.8% versus 5.1%, p = 0.019), 1-year (39.2% versus 17.4%, p < 0.001), 2-year (42.2% versus 23.1%, p < 0.001), and 5-year post-transplant mortality (47.1% versus 30.4%, p = 0.002). Infection/sepsis was more frequently the cause of death within five years after HTX among patients with a pre-transplant CRP ≥ 20 mg/L (28.4% vs. 15.8%, p = 0.005), particularly pulmonary infections (19.6% vs. 9.5%, p = 0.006). Multivariate Cox regression showed pre-transplant CRP ≥ 20 mg/L as an independent predictor of 5-year post-transplant mortality (HR: 1.630, 95% CI: 1.144–2.323, p = 0.007). Conclusions: Pre-transplant CRP ≥ 20 mg/L identifies HTX candidates at increased risk of infection-related mortality after HTX, particularly pulmonary infections. Intensified pre-transplant evaluation for occult infection and close post-transplant infectious surveillance is advisable. Full article
(This article belongs to the Special Issue Risk Prediction in Mechanical Circulatory Support (MCS) and Cardiac Transplantation)
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16 pages, 1095 KB  
Article
Prognostic Significance of Albumin in Modern Left Ventricular Assist Device Therapy: Relevance in the HeartMate 3 Era?
by Roxana Moayedifar, Muhammed Celik, Barbara Karner, Anne-Kristin Schaefer, Hebe Al Asadi, Christiane Marko, Lukas Ruoff, Daniel Zimpfer, Julia Riebandt and Thomas Schlöglhofer
J. Clin. Med. 2025, 14(17), 6193; https://doi.org/10.3390/jcm14176193 - 2 Sep 2025
Cited by 1 | Viewed by 1398
Abstract
Background/Objectives: Preoperative hypoalbuminemia is a known risk factor for adverse outcomes in cardiac surgery, but its role in patients undergoing HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation is unclear. This study evaluated the association between albumin levels and postoperative outcomes, [...] Read more.
Background/Objectives: Preoperative hypoalbuminemia is a known risk factor for adverse outcomes in cardiac surgery, but its role in patients undergoing HeartMate 3 (HM3) left ventricular assist device (LVAD) implantation is unclear. This study evaluated the association between albumin levels and postoperative outcomes, aiming to define a clinically meaningful cut-off for risk stratification. Methods: We retrospectively analyzed 205 adult patients who underwent HM3 implantation at a single center from June 2014 to December 2023. Receiver operating characteristic (ROC) analysis identified an optimal pre-implant albumin cut-off of <32 g/L. This threshold, derived using the maximal Youden Index, provided a sensitivity of 52.1%, specificity of 71.6%, and an AUC of 0.64 (95% CI 0.56–0.71), with internal bootstrapping validation confirming model stability, and calibration demonstrating good agreement between predicted and observed outcomes. Kaplan–Meier analysis assessed freedom from hemocompatibility-related adverse events (HRAEs) and survival. Cox proportional hazards models evaluated albumin and other variables as independent risk factors for HRAEs. Results: Patients with pre-implant albumin <32 g/L had higher rates of HRAEs, including stroke (24.9% vs. 8.4%, p = 0.004) and bleeding (38.1% vs. 23.2%, p = 0.012). Freedom from HRAEs was significantly lower in the hypoalbuminemia group (45.2% vs. 69.8%, p < 0.001) and competing risk-adjusted cumulative incidence for HRAE was higher, but did not reach statistical significance (p = 0.11), one-year HRAE-free survival was also reduced (68.5% vs. 85.7%, p = 0.03). In multivariable analysis, low albumin (HR 0.56, 95% CI 0.33–0.93, p = 0.026) and temporary right ventricular assist device (RVAD) support (HR 3.32, 95% CI 2.05–5.39, p < 0.001) were independent predictors of HRAEs. Conclusions: Low preoperative albumin is independently associated with increased HRAEs and reduced one-year survival after HM3 implantation. Compared with the traditional 35 g/L threshold, the ROC-derived 32 g/L cut-off offered superior balance between sensitivity and specificity, underscoring its clinical utility. Albumin may serve as a simple, pragmatic, and cost-effective biomarker for preoperative risk assessment and optimization. Full article
(This article belongs to the Special Issue Risk Prediction in Mechanical Circulatory Support (MCS) and Cardiac Transplantation)
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Review

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24 pages, 804 KB  
Review
Recalibrating Risk: A Call for South Asian-Focused Heart Failure Prediction Models
by Nandini Nair, Dongping Du, Aiswarya J. Pillai, Swarna Mahesh, Mrudula R. Munagala, Howard J. Eisen and Balakrishnan Mahesh
J. Clin. Med. 2026, 15(16), 6181; https://doi.org/10.3390/jcm15166181 - 10 Aug 2026
Viewed by 213
Abstract
Background: Heart failure (HF) represents the final common pathway of diverse cardiovascular disorders, including coronary artery disease, primary myocardial pathology, and abnormalities of cardiac conduction. These conditions arise from an interplay of genetic, environmental, and psychosocial influences, making it essential to understand [...] Read more.
Background: Heart failure (HF) represents the final common pathway of diverse cardiovascular disorders, including coronary artery disease, primary myocardial pathology, and abnormalities of cardiac conduction. These conditions arise from an interplay of genetic, environmental, and psychosocial influences, making it essential to understand these determinants to improve risk prediction and prevention. Multiple biological pathways of inflammation, fibrosis, coagulation, oxidative stress, lipid dysregulation, endothelial dysfunction, and metabolic disturbances are shaped by inherited susceptibility and modifiable exposures. Together, these mechanisms drive HF development and progression, though their relative contributions vary across populations. Methods: PubMed and Google Scholar were searched for clinical, biomedical, and interdisciplinary studies published between 1 January 2000, and 31 December 2025. Keywords included “Asian,” “adult,” “India,” “heart failure,” “risk assessment,” “prognosis,” and “predictive value.” Studies were included if they focused on South Asian Indian adults, with priority given to original research, systematic reviews, and meta-analyses. Pediatric studies and those centered on other ethnic groups were excluded. Results: Among South Asian Indians, cardiovascular disease burden remains disproportionately high compared with Western populations. Unique genetic architecture, environmental exposures, and sociocultural factors appear to contribute to earlier onset and more aggressive disease. Identifying population-specific genetic variants, clarifying psychosocial influences, and addressing environmental risks may help reduce these disparities. Conclusions: This qualitative review highlights key gaps in current knowledge. A deeper understanding of these determinants could refine HF risk stratification, guide targeted prevention strategies, and reduce the growing cardiovascular burden in South Asian Indians. There is an urgent need for South Asian specific HF risk prediction models. Full article
(This article belongs to the Special Issue Risk Prediction in Mechanical Circulatory Support (MCS) and Cardiac Transplantation)
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