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Advanced Therapy for Heart Failure and Other Combined Diseases
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Advanced Therapy for Heart Failure and Other Combined Diseases

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

Deadline for manuscript submissions: 20 March 2026 | Viewed by 2676

Special Issue Editors

Dr. Gori Mauro

E-Mail Website
Guest Editor
Cardiovascular Department, Azienda Ospedaliera Papa Giovanni XXIII Hospital, 24127 Bergamo, Italy
Interests: HFpEF; acute HF; advanced HF
Dr. Marco Marini

E-Mail Website
Guest Editor
Department of Cardiovascular Sciences, Clinic of Cardiology, Ospedali Riuniti, 60100 Ancona, Italy
Interests: clinical cardiology; heart failure; acute myocardial infarction; cardiogenic shock

Special Issue Information

Dear Colleagues,

Heart failure (HF) is a leading cause of morbidity and mortality worldwide. Recently, novel treatment and management strategies in acute and worsening HF have been published. The addition of SGLT2 inhibitors and vericiguat to the therapeutic armamentarium of HF with reduced ejection fraction (HFrEF) has allowed for improved prognosis of HF patients. Moreover, in the last decade, therapeutic regimens have also been discovered for heart failure with preserved ejection fraction (HFpEF). However, drug implementation and titration represent major threats and challenges for contemporary health care systems. Possible reasons are patient-centered factors, such as lack of compliance; physician-centered factors, such as therapeutic inertia; and organizational issues, due to the disconnect between hospitals and primary care services or to the lack of personnel. Thus, more knowledge of the benefits of guidelines-directed medical therapies and HF management strategies is needed. The scope of the Special Issue is to provide readers with an in-depth view of the management of worsening heart failure, novel therapeutic regimens in HFrEF and HFpEF, and HF risk stratification strategies.

Dr. Gori Mauro
Dr. Marco Marini
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 100 words) can be sent to the Editorial Office for announcement on this website.

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 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

  • heart failure with reduced and preserved ejection fraction
  • advanced heart failure
  • inotropes
  • acute heart failure
  • GDMT

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Published Papers (4 papers)

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Research

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16 pages, 1394 KB  
Article
Effect of Concomitant Tricuspid Valve Repair on Clinical and Echocardiographic Outcomes in Patients Undergoing Left Ventricular Assist Device Implantation
by Olga N. Kislitsina, Sandeep N. Bharadwaj, Tingqing Wu, Rebecca Harap, Jane Kruse, Esther B. Vorovich, Jane E. Wilcox, Clyde W. Yancy, Patrick M. McCarthy and Duc T. Pham
J. Clin. Med. 2025, 14(21), 7554; https://doi.org/10.3390/jcm14217554 - 24 Oct 2025
Viewed by 236
Abstract
Objectives: The purpose of this study was to determine whether concomitant tricuspid valve repair (TVr) at the time of left ventricular assist device (LVAD) implantation improves outcomes in patients with ≥moderate tricuspid regurgitation (TR) and to evaluate the prognostic value of preoperative right [...] Read more.
Objectives: The purpose of this study was to determine whether concomitant tricuspid valve repair (TVr) at the time of left ventricular assist device (LVAD) implantation improves outcomes in patients with ≥moderate tricuspid regurgitation (TR) and to evaluate the prognostic value of preoperative right ventricular (RV) strain. Methods: In a retrospective analysis of 100 LVAD recipients (44 TVr; 56 No-TVr), preoperative (preop) and postoperative (postop) clinical, echocardiographic, and hemodynamic variables, including pulmonary vascular resistance (PVR) and pulmonary artery pulsatility index (PAPI), were analyzed. RV free wall strain (RV-FWS) and RV fractional area change (RV-FAC) were measured by speckle tracking. Early right heart failure (RHF) was modeled with multivariable logistic regression, and 2-year mortality was assessed with Fine–Gray competing risk regression. Preoperative and three-month measurements were compared within each of the 100 patients. Results: Baseline invasive hemodynamics, RV-FWS, and RV-FAC were similar between the TVr and No-TVr groups. TVr at the time of LVAD implantation reduced postoperative TR grade, but it did not improve RV-FWS or RV-FAC at 3 months. The No-TVr patients were more often discharged home and had lower 30-day readmissions. PVR was comparable preoperatively and at 3 months postoperatively. In adjusted analyses, preop PVR, PAPI, and TVr were not independently associated with early RHF, whereas decreased preoperative RV-FWS and lower preop RV-FAC independently predicted higher 2-year mortality. Conclusions: In LVAD recipients with ≥moderate TR, concomitant TVr lowers postoperative TR severity but does not improve early RHF, RV strain-based remodeling, or 2-year mortality. Preoperative RV deformation metrics, rather than preoperative PVR or PAPI, independently predict survival following LVAD implantation with or without TVr. Full article
(This article belongs to the Special Issue Advanced Therapy for Heart Failure and Other Combined Diseases)
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16 pages, 736 KB  
Article
Right Atrial Pressure/Pulmonary Capillary Wedge Pressure Ratio Predicts In-Hospital Mortality in Left Ventricular Assist Device Recipients
by Berhan Keskin, Aykun Hakgor, Bilge Yilmaz, Korhan Erkanli, Beytullah Cakal, Arzu Yazar, Yahya Yildiz, Bilal Boztosun and Ibrahim Oguz Karaca
J. Clin. Med. 2025, 14(13), 4784; https://doi.org/10.3390/jcm14134784 - 7 Jul 2025
Cited by 1 | Viewed by 913
Abstract
Background/Objectives: Right ventricular failure (RVF) is a major contributor to early mortality after left ventricular assist device (LVAD) implantation. While various markers of right ventricular function and right ventriculoarterial coupling have been proposed, their value in predicting in-hospital mortality remains unclear. This [...] Read more.
Background/Objectives: Right ventricular failure (RVF) is a major contributor to early mortality after left ventricular assist device (LVAD) implantation. While various markers of right ventricular function and right ventriculoarterial coupling have been proposed, their value in predicting in-hospital mortality remains unclear. This study aimed to investigate the prognostic significance of the right atrial pressure/pulmonary capillary wedge pressure (RAP/PCWP) ratio—a surrogate of RV–pulmonary artery (PA) coupling—for in-hospital mortality following LVAD implantation. Methods: This retrospective single-center study included 44 patients who underwent LVAD implantation. Preoperative clinical, echocardiographic, and invasive hemodynamic parameters were collected. The optimal RAP/PCWP ratio cut-off was determined using receiver operating characteristic (ROC) analysis. Predictors of in-hospital mortality were assessed using univariate and multivariate logistic regression. Results: Patients were stratified into high (≥0.47) and low (<0.47) RAP/PCWP ratio groups. In-hospital mortality was significantly higher in the high RAP/PCWP group (46% vs. 10%, p = 0.020). The optimal cut-off for the RAP/PCWP ratio was 0.47 (AUC: 0.829). In multivariate analysis, RAP/PCWP ratio (OR: 3.48 per 0.1 increase, p = 0.020) and INTERMACS 1–2 profile (OR: 39.19, p = 0.026) were independent predictors of in-hospital mortality. Conclusions: Preoperative RAP/PCWP ratio, as a surrogate of right ventriculoarterial coupling, independently predicts in-hospital mortality following LVAD implantation. Its incorporation into preoperative assessment may enhance risk stratification and guide clinical management in this high-risk population. Full article
(This article belongs to the Special Issue Advanced Therapy for Heart Failure and Other Combined Diseases)
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Review

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23 pages, 348 KB  
Review
Non-Invasive Wearable Technology to Predict Heart Failure Decompensation
by Jack Devin, Eden Powell, Dylan McGagh, Tyler Jones, Brian Wang, Pierre Le Page, Andrew J. M. Lewis, Oliver J. Rider, Andrew R. J. Mitchell and John A. Henry
J. Clin. Med. 2025, 14(20), 7423; https://doi.org/10.3390/jcm14207423 - 21 Oct 2025
Viewed by 583
Abstract
Heart failure (HF) remains a leading cause of recurrent hospitalisations worldwide, largely driven by acute episodes of decompensation. Early identification of impending decompensation could enable timely intervention and potentially prevent costly admissions. Non-invasive wearable devices have emerged as promising tools for continuously monitoring [...] Read more.
Heart failure (HF) remains a leading cause of recurrent hospitalisations worldwide, largely driven by acute episodes of decompensation. Early identification of impending decompensation could enable timely intervention and potentially prevent costly admissions. Non-invasive wearable devices have emerged as promising tools for continuously monitoring physiological parameters and detecting early signs of deterioration. This review summarises recent advances in wearable technologies designed to predict HF decompensation and appraises their ability to generate clinically useful alerts. It will examine various modalities designed to monitor different aspects of cardiorespiratory physiology that have the potential to detect abnormalities preceding heart failure decompensation. Broadly, these devices either monitor physical activity capacity and cardiac function or monitor changes in pulmonary fluid congestion. We will also cover evidence exploring whether these devices can generate timely alerts for interventions to improve patient outcomes and reduce hospitalisations. However, despite advances in these technologies, challenges remain regarding their accuracy and usability for remote monitoring, as well as concerns with data storage, processing, patient adherence, and integration into existing healthcare workflows. While current limitations exist, previous results warrant further research into this area, with a focus on larger randomised trials, exploring both single- and multi-sensor systems, using artificial intelligence and cost-effectiveness analysis. Overall, non-invasive wearables represent an opportunity to create a more proactive approach to HF management, with the potential to shift the paradigm from reactive treatment to anticipatory care. Full article
(This article belongs to the Special Issue Advanced Therapy for Heart Failure and Other Combined Diseases)
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15 pages, 1044 KB  
Review
Home Inotropes in Advanced Heart Failure: A Practical Review
by Paolo Manca, Maria Vittoria Matassini, Luca Fazzini, Matteo Bianco, Concetta Di Nora, Vittoria Rizzello, Samuela Carigi, Luisa De Gennaro, Maria Denitza Tinti, Renata De Maria, Furio Colivicchi, Massimo Grimaldi, Fabrizio Oliva and Mauro Gori
J. Clin. Med. 2025, 14(19), 7018; https://doi.org/10.3390/jcm14197018 - 3 Oct 2025
Viewed by 680
Abstract
Advanced heart failure (AdHF) is a progressive condition with a high morbidity and mortality burden despite optimal medical therapy. Heart transplant (HT) and left ventricular assist device (LVAD) represent the only two life-prolonging options in AdHF. Unfortunately, only a minority of AdHF patients [...] Read more.
Advanced heart failure (AdHF) is a progressive condition with a high morbidity and mortality burden despite optimal medical therapy. Heart transplant (HT) and left ventricular assist device (LVAD) represent the only two life-prolonging options in AdHF. Unfortunately, only a minority of AdHF patients are eligible for these life-saving therapies, and even patients who are candidates for HT usually incur prolonged waiting list times. Intermittent or continuous home-based inotropic therapy offers a potential solution to improve quality of life, reduce recurrent hospitalizations, and maintain organ function, both for the stabilization of patients who are ultimately candidates for life-saving therapies and for palliative care in those without other therapeutic options. In this review, we summarize the current literature on the role of home inotropes in managing AdHF, emphasizing the current evidence on the most adopted agents, the practical considerations for their administration, and the possible different preferred utilization of these agents. Finally, we address gaps in the literature and outline future research directions to enhance therapeutic options and outcomes. Full article
(This article belongs to the Special Issue Advanced Therapy for Heart Failure and Other Combined Diseases)
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