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Clinical Updates in Heart Failure: Innovations in Diagnosis, Therapy and Management

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

Deadline for manuscript submissions: 28 August 2026 | Viewed by 1202

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Dr. Paolo Severino

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Guest Editor

Department of Medical and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy
Interests: heart failure pathophysiology; advanced heart failure; cardiovascular imaging; hemodynamics and congestion assessment; guideline-directed medical therapy; digital health and remote HF care

Special Issue Information

Dear Colleagues,

Heart failure (HF) remains one of the most challenging cardiovascular conditions, with rising prevalence and persistently high clinical impact worldwide. Rapid advances in diagnostics, imaging, therapeutics, and digital health are offering unique opportunities to refine risk stratification, improve decongestion strategies, and personalize HF management across the disease spectrum.

This Special Issue, Clinical Updates in Heart Failure: Innovations in Diagnosis, Therapy and Management, aims to highlight innovative developments in HF care. We welcome original research and review articles focused on novel diagnostic tools, emerging pharmacological and device-based therapies, congestion and hemodynamic assessment, and cardiorenal interactions.

Topics of interest include the following

Diagnostic innovations and HF phenotyping;
GDMT optimization and therapeutic sequencing;
HFpEF, HFmrEF and right ventricular dysfunction therapies;
Imaging advances and congestion assessment;
Cardiorenal syndrome and comorbidity management;
Digital health personalized care.

We warmly invite your contributions to this Special Issue.

Dr. Paolo Severino
Guest Editor

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Keywords

heart failure
HFrEF therapy
HFpEF phenotyping
right ventricular dysfunction
renal congestion assessment
diuretic resistance
NT-proBNP dynamics
cardiac imaging
post-discharge management

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Published Papers (3 papers)

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Research

27 pages, 1434 KB

Open AccessFeature PaperArticle

Prognostic Role of Immunonutritional Indices in Elderly Patients with HFpEF: Long-Term Follow-Up of the CONUT, PNI, and CALLy Scores

by Andrea Sonaglioni, Chiara Lonati, Andrea Donzelli, Federico Napoli, Gian Luigi Nicolosi, Massimo Baravelli, Michele Lombardo and Sergio Harari

J. Clin. Med. 2026, 15(9), 3245; https://doi.org/10.3390/jcm15093245 - 24 Apr 2026

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Abstract

Background: Malnutrition and systemic inflammation are increasingly recognized as important determinants of prognosis in patients with heart failure. Several immunonutritional indices, including the Prognostic Nutritional Index (PNI), the Controlling Nutritional Status (CONUT) score, and the C-reactive protein–albumin–lymphocyte (CALLy) index, have been proposed as markers of nutritional and inflammatory status. However, their prognostic value in elderly patients with heart failure with preserved ejection fraction (HFpEF) remains incompletely defined. This study aimed to evaluate the prognostic significance of these immunonutritional indices in elderly patients with HFpEF over a long-term follow-up period. Methods: This retrospective observational study included 200 elderly patients hospitalized with HFpEF (mean age 86.6 ± 6.5 years). Clinical, laboratory, and echocardiographic parameters were collected at admission. Nutritional status was assessed using PNI, CONUT score, and CALLy index. Patients were followed for mortality during long-term follow-up. Survival analyses were performed using Cox regression models, receiver operating characteristic (ROC) curves, and Kaplan–Meier analysis. Median follow-up was 3.8 years (IQR 2.1–5.9). Results: During follow-up, 123 patients (61.5%) died, while 77 patients (38.5%) were alive at the end of observation. In univariate analysis, PNI, CONUT score, left ventricular ejection fraction (LVEF), and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio were significantly associated with mortality. In multivariate analysis, the CONUT score, LVEF, and the TAPSE/sPAP ratio remained independent predictors of mortality. ROC analysis showed strong prognostic performance for the TAPSE/sPAP ratio (AUC 0.932), CONUT score (AUC 0.925), and LVEF (AUC 0.897). Optimal cut-off values for mortality prediction were CONUT ≥ 6, LVEF ≥ 65%, and TAPSE/sPAP ≤ 0.55 mm/mmHg. Kaplan–Meier analysis confirmed significantly reduced survival among patients with higher CONUT scores, higher LVEF, and an impaired TAPSE/sPAP ratio. Conclusions: In elderly patients with HFpEF, nutritional status and cardiopulmonary functional parameters are important determinants of long-term prognosis. The CONUT score emerged as the most informative immunonutritional index, while echocardiographic parameters reflecting ventricular function and right ventricular–pulmonary arterial coupling provided additional prognostic information. Integrating nutritional assessment with echocardiographic evaluation may improve risk stratification in elderly patients with HFpEF. Full article

(This article belongs to the Special Issue Clinical Updates in Heart Failure: Innovations in Diagnosis, Therapy and Management)

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18 pages, 2299 KB

Open AccessArticle

Uric Acid Variability Is Associated with Poor Prognosis in Heart Failure

by Viana Copeland, Shir Elimeleh, Assi Milwidsky, Noam Makmal, Ranel Loutati, Boris Fishman, Yishay Wasserstrum, Moti Zwilling, Elad Maor and Ehud Grossman

J. Clin. Med. 2026, 15(6), 2330; https://doi.org/10.3390/jcm15062330 - 18 Mar 2026

Viewed by 408

Abstract

Aims: Elevated uric acid (UA) levels correlate with worse heart failure (HF) outcomes, but past studies used single UA measurements. The effect of intra-individual UA fluctuations, beyond mean levels, is unclear. This study assesses the relationship between serum UA variability and adverse clinical outcomes in HF patients. Methods: We analyzed 18,115 HF patients from the SHEBAHEART registry (2009–2025) with at least three UA measurements within three years of diagnosis. UA variability was quantified as the mean deviation (MD) from each patient’s average UA level and divided into quartiles: Q1 (≤−0.69 mg/dL), Q2–Q3 (>−0.69 and <1.53 mg/dL, reference), and Q4 (≥1.53 mg/dL). All-cause mortality was the primary outcome and HF hospitalization was secondary. Cox regression, propensity score matching, and subgroup analyses were used. Results: Over a median follow-up of 4.3 years (IQR 1.6–7.7), 36% of patients were hospitalized for HF and 65.5% died. UA variability showed a graded association with outcomes. Low variability (Q1) was linked to reduced mortality (HR 0.79, 95% CI 0.75–0.83) and HF hospitalization (HR 0.84, 95% CI 0.79–0.90), while high variability (Q4) increased mortality (HR 1.58, 95% CI 1.51–1.69) and hospitalization risk (HR 1.17, 95% CI 1.10–1.25) (all p < 0.001). These associations remained after propensity score matching and across HF subgroups. Conclusions: UA variability is a robust, independent predictor of mortality and HF hospitalization. Serial UA monitoring may enhance risk stratification in HF management. Full article

(This article belongs to the Special Issue Clinical Updates in Heart Failure: Innovations in Diagnosis, Therapy and Management)

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11 pages, 250 KB

Open AccessArticle

Differences in Scalp Hair Trace Element Concentrations in Patients with Preserved Left Ventricular Ejection Fraction (HFpEF) Compared with Controls: A Hypothesis-Generating Study

by Tomasz Urbanowicz, Anetta Hanć, Zofia Kasperowicz, Oliwier Adamczak, Ievgen Spasanenko, Katarzyna Gabriel, Andrzej Tykarski, Zbigniew Krasiński and Beata Krasińska

J. Clin. Med. 2026, 15(5), 2029; https://doi.org/10.3390/jcm15052029 - 6 Mar 2026

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Abstract

Background: The pathophysiology of HFpEF is complex and characterized by systemic inflammation, metabolic dysregulation, and endothelial dysfunction. Trace element involvement in redox balance, mitochondrial function, and calcium signaling is postulated. This cross-sectional analysis aimed to investigate possible differences in hair scalp trace element concentrations in patients with HFpEF and controls. Material and methods: Fifty-eight consecutive patients were enrolled (HFpEF n = 37; controls n = 21). HFpEF diagnosis was established using the HFA-PEFF diagnostic algorithm by two independent cardiologists blinded to hair analysis results. Scalp hair samples were analyzed using inductively coupled plasma mass spectrometry (ICP-MS). Results: HFpEF patients demonstrated higher hair concentrations of magnesium (17.8 (7.3–47.5) vs. 14.0 (6.7–29.0) µg/g, p = 0.037), copper (57.24 (33.87–84.76) vs. 12.96 (9.85–26.02) µg/g, p < 0.001), calcium (322 (106–1330) vs. 145 (74–672) µg/g, p = 0.006), and lead (0.257 (0.164–0.563) vs. 0.159 (0.079–0.283) µg/g, p = 0.03). Conclusions: In this exploratory analysis, HFpEF was associated with differences in selected scalp hair trace element concentrations. The interaction between magnesium, calcium, copper, and lead were noted, with higher concentrations in HFpEF phenotypes. These findings are hypothesis-generating and warrant confirmation in larger cohorts incorporating serum/urine measurements and exposure assessment. Full article

(This article belongs to the Special Issue Clinical Updates in Heart Failure: Innovations in Diagnosis, Therapy and Management)

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