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Acute and Chronic Heart Failure: Clinical Updates and Perspectives
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Acute and Chronic Heart Failure: Clinical Updates and Perspectives

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

Deadline for manuscript submissions: 25 August 2025 | Viewed by 6853

Special Issue Editors

Dr. Luigi Cappannoli

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Guest Editor
Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
Interests: heart failure; cardiogenic shock; ischemic heart disease; percutaneous coronary interventions; structural heart disease; percutaneous ventricular assist devices
Special Issues, Collections and Topics in MDPI journals
Dr. Cristina Aurigemma

E-Mail Website
Guest Editor
Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy
Interests: transcatheter aortic valve implantation; percutaneous coronary interventions; heart failure
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Heart failure (HF) represents the twenty-first century cardiovascular epidemic, with over 25 million cases worldwide. The increase in HF cases is partly ascribable to the "paradoxical" advancement of treatments for cardiovascular diseases, with a consequent reduction in mortality and higher incidence of cardiac dysfunction among the survivors, partly due to the increase in the general population’s longevity. The prognosis of patients with HF remains poor, with one in nine patients dying one year after diagnosis and about one half within five years; moreover, despite appropriate medical treatment, many patients have frequent hospitalizations and a reduced quality of life. Furthermore, even when symptoms are controlled, subclinical disease progression due to the underlying neurohormonal imbalance has been demonstrated.

In recent decades, several advancements have been made regarding HF treatment. Pharmacological therapy, alongside well-established therapies, has seen the introduction of new molecules. These molecules have now largely entered clinical practice and are recognized in international guidelines, such as valsartan/sacubitril, SGLT2 inhibitors and even more recent drugs such as vericiguat. Furthermore, device-based therapy has seen a significant improvement, with the development of more efficient systems of cardiac pacing and resynchronization therapy as well as the realization of continuously more efficient and less-invasive percutaneous assist devices for improving outcomes and enabling survival, even in patients with the most critical conditions.

Despite these advancements, the prognosis and quality of life of patients with HF remain often poor, and the need for further studies is urgent. Therefore, the aim of this Special Issue is to provide insights regarding the latest advancements in all aspect of heart failure treatment, both in the acute and chronic settings. In particular, original research and valuable reviews concerning the newest progress regarding HF will be welcomed.

Dr. Luigi Cappannoli
Dr. Cristina Aurigemma
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

  • acute heart failure
  • chronic heart failure
  • devices
  • drugs therapy
  • percutaneous ventricular assist devices
  • cardiogenic shock
  • arrhythmias
  • ischemic heart disease

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Published Papers (5 papers)

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Research

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15 pages, 1626 KiB  
Article
Patterns of Disease Progression and Outcomes of Inferior ST-Elevation Myocardial Infarction Complicated by Cardiogenic Shock: The Multicenter INSTINCT Registry
by Giulia Botti, Marina Pieri, Luigi Cappannoli, Andrea Raffaele Munafò, Mario Gramegna, Marco Gamardella, Rita Camporotondo, Cristina Aurigemma, Marco Ferlini, Stefania Guida, Angelicarosa Cascone, Filippo Russo, Giuseppe Lanzillo, Francesco Burzotta, Matteo Montorfano, Anna Mara Scandroglio and Alaide Chieffo
J. Clin. Med. 2025, 14(7), 2231; https://doi.org/10.3390/jcm14072231 - 25 Mar 2025
Viewed by 387
Abstract
Background: Cardiogenic shock (CS) is a frequent presentation of anterior ST-elevation myocardial infarction (STEMI); however, data regarding disease progression and outcomes in inferior STEMI complicated by CS are scarce. The present study aims to analyze the prevalence, patterns of disease progression, and [...] Read more.
Background: Cardiogenic shock (CS) is a frequent presentation of anterior ST-elevation myocardial infarction (STEMI); however, data regarding disease progression and outcomes in inferior STEMI complicated by CS are scarce. The present study aims to analyze the prevalence, patterns of disease progression, and outcomes of inferior STEMI-CS. Methods: The INSTINCT (Inferior ST-elevation myocardial Infarction complicated by Cardiogenic shock) Registry retrospectively included consecutive patients who developed CS following inferior STEMI treated at three centers in Italy from 2015 to 2023. Data regarding CS stage according to the Society of Cardiovascular Angiography and Interventions (SCAI) upon diagnosis of shock and during disease progression and in-hospital outcomes were collected. Patients were defined “worsening” (WPs) if the SCAI stage increased. Results: A total of 130 patients developed CS after inferior STEMI and were included in the analysis, the mean age was 69.8 ± 12.4 years, and 31.5% were female. The rate of in-hospital mortality was 22.3%; predictors of in-hospital mortality were cardiopulmonary resuscitation (CPR) > 20 min or refractory cardiac arrest (CA) (OR [CI]: 9.67 [3.17–29.51]), persistently low systolic blood pressure (SBP) (OR [CI]: 12.91 [2.47–68.82]), and increase in lactates (OR [CI]: 3.53 [1.42–7.87]) during medical management. Twenty (15.4%) patients experienced worsening CS; WPs had a significantly higher rate of in-hospital mortality (13 [65%] vs. 15 [13.6%], p < 0.001), major bleeding (4 [20%] vs. 7 [6.4%], p = 0.044), and mechanical circulatory support weaning failure (7 [35%] vs. 3 [2.7%], p = 0.032). Conclusions: The in-hospital mortality rate of inferior STEMI complicated by CS was 22.3%. Predictors of in-hospital mortality included prolonged CPR, persistently low SBP, and elevated lactates. Progression through SCAI stages was rare but associated with significantly higher mortality and complication rates. Full article
(This article belongs to the Special Issue Acute and Chronic Heart Failure: Clinical Updates and Perspectives)
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11 pages, 209 KiB  
Article
Evolution of the Quality of Care in Patients with Decompensated Heart Failure in a Venezuelan Hospital
by Yaneth Torres, Daniel Benitez, Zenaida Morillo, Juan Salazar, Julio Contreras-Velasquez and Valmore Bermudez
J. Clin. Med. 2025, 14(2), 644; https://doi.org/10.3390/jcm14020644 - 20 Jan 2025
Viewed by 762
Abstract
Background/Objectives: Several parameters have been proposed for the objective measurement of the quality of care (QoC) and breaches of care in patients with heart failure (HF). Therefore, the objective of this study was to evaluate the measures of QoC in inpatients with decompensated [...] Read more.
Background/Objectives: Several parameters have been proposed for the objective measurement of the quality of care (QoC) and breaches of care in patients with heart failure (HF). Therefore, the objective of this study was to evaluate the measures of QoC in inpatients with decompensated HF in the cardiology department of a tertiary Venezuelan hospital. Methods: An observational, descriptive, ambispective study was conducted with adults of all genders diagnosed with decompensated HF between 2022 and 2024. Sociodemographic, clinical, and therapeutic variables were assessed, as well as psychobiologic habits, measures of QoC, readmissions, and in-hospital mortality within the first 6 months of care. Results: Among the 131 subjects evaluated, the average age was 63.6 ± 14.1 years, with 58% (n = 76) being male. Among the in-hospital measures of QoC, the most common was the programming for follow-up consultations (98.5%; n = 129), followed by the prescription of beta-blockers (90.1%; n = 118). An upwards trend was also observed in the later years regarding the frequency of left ventricle ejection fraction (LVEF) assessment (p < 0.001), and the use of iSGLT2 (p = 0.03). During follow-up, 36.6% of the patients died within 6 months, with those in NYHA class IV showing a higher probability of death (OR: 3.84; CI95%: 0.89–16.55; 0.04). Conclusions: The in-hospital measures for QoC in this population were similar to those in previous reports, with LVEF assessment and iSGLT2 prescription showing a particularly significant increase in recent years. Full article
(This article belongs to the Special Issue Acute and Chronic Heart Failure: Clinical Updates and Perspectives)

Review

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34 pages, 475 KiB  
Review
Heart Failure in Older Patients: An Update
by Massimo Montalto, Federica D’Ignazio, Sara Camilli, Silvino Di Francesco, Marco Fedele, Francesco Landi and Antonella Gallo
J. Clin. Med. 2025, 14(6), 1982; https://doi.org/10.3390/jcm14061982 - 14 Mar 2025
Cited by 1 | Viewed by 1988
Abstract
Heart failure (HF) is a clinical syndrome with high incidence and prevalence and high morbidity and death rate, even in the short term, representing a serious public health issue, mainly in older people. It is a growing cause for hospital admission in this [...] Read more.
Heart failure (HF) is a clinical syndrome with high incidence and prevalence and high morbidity and death rate, even in the short term, representing a serious public health issue, mainly in older people. It is a growing cause for hospital admission in this age group, being frequently associated with several comorbidities, further aggravating the disease’s course. Moreover, older HF patients are usually affected by clinical conditions, like frailty, malnutrition, and cachexia, which significantly impact the overall management of HF and need to be properly identified and treated. Diagnosing and managing HF in older patients may be very complicated and challenging. Although specific data on treatment of both acute and chronic HF in older subjects are limited and mainly extrapolated from large-scale clinical trials, the standard pharmacological management may be considered well-tolerated and generally safe. In any case, a personalized and tailored approach is mandatory and is based on severity of comorbidities, overall status, and prognosis, above all in frailer and more comorbid subjects, due to the higher rate of drug interactions, side effects, and therapy discontinuation in this population. In this scenario, palliative care has become a fundamental part of HF management in the elderly in order to improve their care and the quality of life. Moreover, an increasing number of promising pharmacological options deserve further investigation in order to support clinicians in optimizing management of comorbid and frailer patients. In this work, we provide detailed and updated insight into clinical, therapeutic, and prognostic features of both acute and chronic HF in the older population. Full article
(This article belongs to the Special Issue Acute and Chronic Heart Failure: Clinical Updates and Perspectives)
11 pages, 1112 KiB  
Review
VExUS Protocol Along Cardiorenal Syndrome: An Updated Review
by Amelia Campos-Sáenz de Santamaría, Zoila Stany Albines Fiestas, Silvia Crespo-Aznarez, Laura Karla Esterellas-Sánchez, Marta Sánchez-Marteles, Vanesa Garcés-Horna, Claudia Josa-Laorden, Alejandro Alcaine-Otín, Ignacio Gimenez-Lopez and Jorge Rubio-Gracia
J. Clin. Med. 2025, 14(4), 1334; https://doi.org/10.3390/jcm14041334 - 17 Feb 2025
Viewed by 1392
Abstract
Heart failure (HF) is a major cause of hospitalization, often leading to acute kidney injury (AKI) due to venous congestion. The Venous Excess Ultrasound (VExUS) score, introduced by Beaubin-Souligny, is a bedside tool for assessing congestion severity and guiding decongestive therapy. VExUS has [...] Read more.
Heart failure (HF) is a major cause of hospitalization, often leading to acute kidney injury (AKI) due to venous congestion. The Venous Excess Ultrasound (VExUS) score, introduced by Beaubin-Souligny, is a bedside tool for assessing congestion severity and guiding decongestive therapy. VExUS has demonstrated prognostic value in predicting AKI, HF readmission, and mortality. Indeed, guiding decongestive therapy through the VExUS score has been shown to significantly improve the likelihood of achieving faster decongestion. Objectives: This review aims to discuss the potential role of VExUS and analyze the recent findings about its relevance in guiding decongestive therapy in patients with acute decompensated HF. Methods: A comprehensive literature review was conducted, which identified journal articles focused on VExUS and manual reviews of relevant peer-reviewed journals. Conclusions: VExUS is a promising tool for evaluating venous congestion in cardiorenal patients, thereby improving fluid and diuretic management. It provides real-time, non-invasive monitoring that enhances clinical decision-making. However, its accuracy depends on operator expertise, and further research is needed to validate its application across different patient populations. Full article
(This article belongs to the Special Issue Acute and Chronic Heart Failure: Clinical Updates and Perspectives)
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14 pages, 1431 KiB  
Review
Constrictive Pericarditis and Protein-Losing Enteropathies: Exploring the Heart–Gut Axis
by Lucia Ilaria Birtolo and Endrit Shahini
J. Clin. Med. 2024, 13(17), 5150; https://doi.org/10.3390/jcm13175150 - 30 Aug 2024
Cited by 1 | Viewed by 1818
Abstract
Background/Objectives: Constrictive pericarditis very rarely causes protein-losing enteropathy (PLE) induced by secondary intestinal lymphangiectasia. This study thoroughly reviewed the literature to shed light on the clinical management of PLE provoked by intestinal lymphangiectasia following constrictive pericarditis. Methods: We performed a PubMed [...] Read more.
Background/Objectives: Constrictive pericarditis very rarely causes protein-losing enteropathy (PLE) induced by secondary intestinal lymphangiectasia. This study thoroughly reviewed the literature to shed light on the clinical management of PLE provoked by intestinal lymphangiectasia following constrictive pericarditis. Methods: We performed a PubMed search using the keywords enteropathy, protein-losing enteropathy, pericarditis, acute pericarditis, pericardial effusion, recurrent pericarditis, constrictive pericarditis, noninfectious pericarditis, idiopathic pericarditis, and infective pericarditis, with only English-language publications included. Results: Although constrictive pericarditis is primarily idiopathic, less common causes include infectious etiologies, connective/autoimmune tissue disorders, previous cardiac surgery, congenital syndromes, and cancer. On the one hand, PLE secondary to intestinal lymphangiectasia may cause a severe cellular immune deficiency that could raise infection hazards due to lymphocytopenia and hypogammaglobulinemia. On the other hand, lymphocytopenia may cause anergy and mask an underlying tuberculous etiology of constrictive pericarditis. Cardiac catheterization is the most useful diagnostic tool for constrictive pericarditis, though it may be misdiagnosed in rare cases. The videocapsule endoscopy and double-balloon enteroscopy techniques can detect small bowel lymphangiectasias distal to the Treitz ligament. MRI or a CT scan helps confirm constrictive pericarditis, visualize lymphangiectasias, and reveal features specific to the underlying etiology of PLE. Radioisotopic techniques may ensure PLE diagnosis in challenging cases, whereas fecal alpha1-antitrypsin can estimate gastrointestinal protein loss. Conclusions: Constrictive pericarditis is rarely associated with PLE. The cardio-intestinal abnormalities of PLE caused by constrictive pericarditis are frequently reversed following a complete pericardiectomy, though its ability to invert severe hypoalbuminemia is currently unknown. Full article
(This article belongs to the Special Issue Acute and Chronic Heart Failure: Clinical Updates and Perspectives)
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