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Chronic Heart Failure and Depressed Systolic Function

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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: closed (15 May 2022) | Viewed by 21217

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Special Issue Editors

Prof. Jacob George

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Guest Editor

Kaplan Medical Center, affiliated to the Hebrew University of Jerusalem, Jerusalem, Israel
Interests: heart failure; T lymphocytes; cardiovascular system; atherosclerosis; coronary angiography; transcatheter valvular interventions; autoantibodies; lipoproteins; coronary artery disease; diabetes; medicine

Prof. Sorel Goland

E-Mail Website
Guest Editor

Kaplan Medical Center, affiliated to the Hebrew University of Jerusalem, Jerusalem, Israel
Interests: echocardiography; hypertension; cardiology; clinical cardiology; cardiac function; heart failure; cardiac imaging; cardiomyopathies; aortic valve; valvular heart disease

Special Issue Information

Dear Colleagues,

Heart failure (HF) syndromes are related to the inability of the myocardial pump to meet tissue demands. Heart failure is a leading cause of morbidity, mortality, and hospitalizations in the Western world, and the rates of new cases continue to rise as methods of diagnosis, surveillance, and treatment are constantly being promoted and upgraded.

The leading cause of HF is systolic dysfunction, evident by a reduced left ventricular ejection fraction (typically below 40%). The etiologies of HF with reduced LV function comprise a wide array of disorders arising from the pericardium, myocardium, endocardium or the epicardial vessels.

The field of HF has become particularly vibrant in recent years due to the development of advanced methodologies of providing care for these patients and continued contemporary research appear to constantly improve their outcomes.

Prof. Jacob George
Prof. Sorel Goland
Guest Editors

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Keywords

heart failure
cardiomyopathy
valvular heart disease
resynchronization therapy
B-type natriuretic peptides
treatment
left ventricular assist device
transplantation
outcome
prognosis
myocarditis

Published Papers (7 papers)

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Research

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14 pages, 271 KiB

Open AccessArticle

Acute Bacterial Infections and Longitudinal Risk of Readmissions and Mortality in Patients Hospitalized with Heart Failure

by Tien M. H. Ng, Esther E. Oh, Yuna H. Bae-Shaaw, Emi Minejima and Geoffrey Joyce

J. Clin. Med. 2022, 11(3), 740; https://doi.org/10.3390/jcm11030740 - 29 Jan 2022

Cited by 1 | Viewed by 2069

Abstract

Aims: Infections are associated with worse short-term outcomes in patients with heart failure (HF). However, acute infections may have lasting pathophysiologic effects that adversely influence HF outcomes after discharge. Our objective was to describe the impact of acute bacterial infections on longitudinal outcomes of patients hospitalized with a primary diagnosis of HF. Methods and Results: This paper is based on a retrospective cohort study of patients hospitalized with a primary diagnosis of HF with or without a secondary diagnosis of acute bacterial infection in Optum Clinformatics DataMart from 2010–2015. Primary outcomes were 30 and 180-day hospital readmissions and mortality, intensive care unit admission, length of hospital stay, and total hospital charge, compared between those with or without an acute infection. Cohorts were compared after inverse probability of treatment weighting. Multivariable logistic regression was used to examine relationship to outcomes. Of 121,783 patients hospitalized with a primary diagnosis of HF, 27,947 (23%) had a diagnosis of acute infection. After weighting, 30-day hospital readmissions [17.1% vs. 15.7%, OR 1.11 (1.07–1.15), p < 0.001] and 180-day hospital readmissions [39.6% vs. 38.7%, OR 1.04 (1.01–1.07), p = 0.006] were modestly greater in those with an acute infection versus those without. Thirty-day [5.5% vs. 4.3%, OR 1.29 (1.21–1.38), p < 0.001] and 180-day mortality [10.7% vs. 9.4%, OR 1.16 (1.11–1.22), p < 0.001], length of stay (7.1 ± 7.0 days vs. 5.7 ± 5.8 days, p < 0.001), and total hospital charges (USD 62,200 ± 770 vs. USD 51,100 ± 436, p < 0.001) were higher in patients with an infection. Conclusions: The development of an acute bacterial infection in patients hospitalized for HF was associated with an increase in morbidity and mortality after discharge. Full article

(This article belongs to the Special Issue Chronic Heart Failure and Depressed Systolic Function)

7 pages, 2671 KiB

Open AccessArticle

Clinical Implications of Sodium Zirconium Cyclosilicate Therapy in Patients with Systolic Heart Failure and Hyperkalemia

by Teruhiko Imamura, Akira Oshima, Nikhil Narang and Koichiro Kinugawa

J. Clin. Med. 2021, 10(23), 5523; https://doi.org/10.3390/jcm10235523 - 25 Nov 2021

Cited by 5 | Viewed by 2071

Abstract

Background: Sodium zirconium cyclosilicate (SZC), a newly introduced specific potassium binder, is introduced to treat hyperkalemia. However, the implications of SZC in up-titrating renin–angiotensin–aldosterone system inhibitors in patients with systolic heart failure remain unknown. Methods and Results: Patients with heart failure with left ventricular ejection fraction <50% and hyperkalemia who had completed 3-month SZC therapy were retrospectively included. Serum potassium levels, the dose of renin–angiotensin–aldosterone system inhibitors, and echocardiographic parameters during the 3-month SZC therapy as compared with the pretreatment 3-month period were investigated. A total of 24 patients (median 77 years old, 71% men, median left ventricular ejection fraction 41%) received a 3-month SZC therapy without any associated adverse events including hypokalemia. Compared with the pretreatment period, serum potassium levels decreased, doses of renin–angiotensin–aldosterone system inhibitors increased, and the left ventricular ejection fraction and plasma B-type natriuretic peptide levels improved following the 3-month SZC therapy (p < 0.05 for all). Conclusions: SZC may be a promising therapeutic option to improve hyperkalemia, indirectly allowing up-titration of renin–angiotensin–aldosterone system inhibitors and facilitating reverse remodeling in patients with heart failure with a left ventricular ejection fraction <50% and hyperkalemia. Full article

(This article belongs to the Special Issue Chronic Heart Failure and Depressed Systolic Function)

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14 pages, 2407 KiB

Open AccessArticle

Safety and Feasibility of MitraClip Implantation in Patients with Acute Mitral Regurgitation after Recent Myocardial Infarction and Severe Left Ventricle Dysfunction

by Dan Haberman, Rodrigo Estévez-Loureiro, Tomas Benito-Gonzalez, Paolo Denti, Dabit Arzamendi, Marianna Adamo, Xavier Freixa, Luis Nombela-Franco, Pedro Villablanca, Lian Krivoshei, Neil Fam, Konstantinos Spargias, Andrew Czarnecki, Isaac Pascual, Fabien Praz, Doron Sudarsky, Arthur Kerner, Vlasis Ninios, Marco Gennari, Ronen Beeri, Leor Perl, Haim Danenberg, Lion Poles, Sara Shimoni, Sorel Goland, Berenice Caneiro-Queija, Salvatore Scianna, Igal Moaraf, Davide Schiavi, Claudia Scardino, Noé Corpataux, Julio Echarte-Morales, Michael Chrissoheris, Estefanía Fernández-Peregrina, Mattia Di Pasquale, Ander Regueiro, Carlos Vergara-Uzcategui, Andres Iñiguez-Romo, Felipe Fernández-Vázquez, Danny Dvir, Maurizio Taramasso and Mony Shuvy Show full author list Hide full author list

J. Clin. Med. 2021, 10(9), 1819; https://doi.org/10.3390/jcm10091819 - 22 Apr 2021

Cited by 11 | Viewed by 2627

Abstract

Patients with severe mitral regurgitation (MR) after myocardial infarction (MI) have an increased risk of mortality. Transcatheter mitral valve repair may therefore be a suitable therapy. However, data on clinical outcomes of patients in an acute setting are scarce, especially those with reduced left ventricle (LV) dysfunction. We conducted a multinational, collaborative data analysis from 21 centers for patients who were, within 90 days of acute MI, treated with MitraClip due to severe MR. The cohort was divided according to median left ventricle ejection fraction (LVEF)—35%. Included in the study were 105 patients. The mean age was 71 ± 10 years. Patients in the LVEF < 35% group were younger but with comparable Euroscore II, multivessel coronary artery disease, prior MI and coronary artery bypass graft surgery. Procedure time was comparable and acute success rate was high in both groups (94% vs. 90%, p = 0.728). MR grade was significantly reduced in both groups along with an immediate reduction in left atrial V-wave, pulmonary artery pressure and improvement in New York Heart Association (NYHA) class. In-hospital and 1-year mortality rates were not significantly different between the two groups (11% vs. 7%, p = 0.51 and 19% vs. 12%, p = 0.49) and neither was the 3-month re-hospitalization rate. In conclusion, MitraClip intervention in patients with acute severe functional mitral regurgitation (FMR) due to a recent MI in an acute setting is safe and feasible. Even patients with severe LV dysfunction may benefit from transcatheter mitral valve intervention and should not be excluded. Full article

(This article belongs to the Special Issue Chronic Heart Failure and Depressed Systolic Function)

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13 pages, 1390 KiB

Open AccessArticle

Association of Guideline-Based Medical Therapy with Malignant Arrhythmias and Mortality among Heart Failure Patients Implanted with Cardioverter Defibrillator (ICD) or Cardiac Resynchronization-Defibrillator Device (CRTD)

by Tal Hasin, Ilia Davarashvili, Yoav Michowitz, Rivka Farkash, Haya Presman, Michael Glikson and Moshe Rav-Acha

J. Clin. Med. 2021, 10(8), 1753; https://doi.org/10.3390/jcm10081753 - 17 Apr 2021

Cited by 3 | Viewed by 2153

Abstract

Aim: Evaluate prevalence of heart failure (HF) medications and their association with ventricular arrhythmia (VA) and survival among patients implanted with primary prevention implantable cardiac defibrillator (ICD)/cardiac resynchronization therapy + defibrillator (CRTD) devices. Methods: Association of treatment and dose (% guideline recommended target) of beta-adrenergic receptor antagonist (BB), angiotensin-antagonists (AngA), and mineralocorticoid-antagonists (MRA), after ICD/CRTD implant with VA and mortality was retrospectively analyzed. Results: Study included 186 HF patients; 42.5% and 57.5% implanted with ICD and CRTD, respectively. During 3.8 (2.1;6.7) years; 52 (28%) had VA and 77 (41.4%) died. Treatment (% of patients) included: BB (83%), AngA (87%), and MRA (59%). Median doses were 25(12.5;50)% of target for all medications. BB treatment >25% target dose was associated with reduced VA incidence. In the multivariable model including age, gender, diabetes, heart rate, and medication doses, increased BB dose was associated with reduced VA (hazard ratio (HR) 0.443 95% CI 0.222–0.885; p = 0.021). In the multivariable model for overall mortality including age, gender, renal disease, VA, and medical treatment, VA was associated with increased mortality (HR 2.672; 95% CI 1.429–4.999; p = 0.002) and AngA treatment was associated with reduced mortality (HR 0.515; 95% CI 0.285–0.929; p = 0.028). Conclusions: In this cohort of real-life HF patients discharged after ICD/CRTD implant, prevalence of guideline-based HF medications was high, albeit with low doses. Higher BB dose was associated with reduced VA, while AngA was associated with improved survival. Full article

(This article belongs to the Special Issue Chronic Heart Failure and Depressed Systolic Function)

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17 pages, 2641 KiB

Open AccessArticle

Treatment of Heart Failure Patients with Anxiolytics Is Associated with Adverse Outcomes, with and without Depression

by Donna R. Zwas, Andre Keren, Offer Amir and Israel Gotsman

J. Clin. Med. 2020, 9(12), 3967; https://doi.org/10.3390/jcm9123967 - 07 Dec 2020

Cited by 5 | Viewed by 2065

Abstract

Background: Few studies have evaluated the effect of pharmacologic treatment of anxiety on outcomes in heart failure (HF) patients. This study examined the impact of treatment with anxiolytics on clinical outcomes in a real-world sample of HF patients with and without depression. Methods: Patients diagnosed with HF were retrieved from a large HMO database. Patients prescribed anxiolytic medication and patients diagnosed with depression and/or prescribed anti-depressant medication were followed for cardiac-related hospitalizations and death. Results: The study cohort included 6293 HF patients. Treatment with anxiolytics was associated with decreased one-year survival compared to untreated individuals, with a greater reduction in survival seen in patients diagnosed with depression and/or treated with anti-depressants. Multi-variable analysis adjusting for age, sex, NYHA class, cardiac risk factors and laboratory parameters found that treatment with anxiolytics remained a predictor of mortality even when adjusting for depression. Depression combined with anxiolytic treatment was predictive of increased mortality, and treatment with anxiolytics alone, depression alone and anxiolytic treatment together with depression were each associated with an increased hazard ratio for a composite outcome of death and hospitalization. Conclusions: In this real-world study of HF patients, both treatment with anxiolytics and depression were associated with increased mortality, and anxiolytic therapy remained a predictor of mortality when adjusting for depression. Treatment of anxiety together with depression was associated with the highest risk of mortality. Safe and effective treatment for anxiety and depression is warranted to alleviate the detrimental impact of these disorders on quality and of life and adverse events. Full article

(This article belongs to the Special Issue Chronic Heart Failure and Depressed Systolic Function)

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Review

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23 pages, 1512 KiB

Open AccessReview

Contemporary Pillars of Heart Failure with Reduced Ejection Fraction Medical Therapy

by Eldad Rahamim, Dean Nachman, Oren Yagel, Merav Yarkoni, Gabby Elbaz-Greener, Offer Amir and Rabea Asleh

J. Clin. Med. 2021, 10(19), 4409; https://doi.org/10.3390/jcm10194409 - 26 Sep 2021

Cited by 5 | Viewed by 7221

Abstract

Heart failure with reduced ejection fraction (HFrEF) is a clinical condition associated with cardiac contractility impairment. HFrEF is a significant public health issue with a high morbidity and mortality burden. Pathological left ventricular (LV) remodeling and progressive dilatation are hallmarks of HFrEF pathogenesis, ultimately leading to adverse clinical outcomes. Therefore, cardiac remodeling attenuation has become a treatment goal and a standard of care over the last three decades. Guideline-directed medical therapy mainly targeting the sympathetic nervous system and the renin–angiotensin–aldosterone system (RAAS) has led to improved survival and a reduction in HF hospitalization in this population. More recently, novel pharmacological therapies targeting other pathways implicated in the pathophysiology of HFrEF have emerged at an exciting rate, with landmark clinical trials demonstrating additive clinical benefits in patients with HFrEF. Among these novel therapies, angiotensin receptor–neprilysin inhibitors (ARNI), sodium–glucose cotransporter-2 inhibitors (SGLT2i), vericiguat (a novel oral guanylate cyclase stimulator), and omecamtiv mecarbil (a selective cardiac myosin activator) have shown improved clinical benefit when added to the traditional standard-of-care medical therapy in HFrEF. These new comprehensive data have led to a remarkable change in the medical therapy paradigm in the setting of HFrEF. This article will review the pivotal studies involving these novel agents and present a suggestive paradigm of pharmacological therapy representing the 2021 European Society of Cardiology (ESC) guidelines for the treatment of chronic HFrEF. Full article

(This article belongs to the Special Issue Chronic Heart Failure and Depressed Systolic Function)

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7 pages, 205 KiB

Open AccessReview

Medical Therapy of Heart Failure with Reduced Ejection Fraction—A Call for Comparative Research

by Gad Cotter, Beth A. Davison, Alexandre Mebazaa, Koji Takagi, Maria Novosadova, Yonathan Freund and Alain Cohen-Solal

J. Clin. Med. 2021, 10(9), 1803; https://doi.org/10.3390/jcm10091803 - 21 Apr 2021

Cited by 1 | Viewed by 1923

Abstract

The armamentarium of therapies for patients with heart failure and reduced ejection fraction (HFREF) has increase substantially with the introduction of Angiotensin Receptor Neprilysin Inhibitor (ARNi), sodium glucose cotransport inhibitors (SGLTis), ivabradine, and Vericinguat, bringing to seven the number of potential therapies for HFREF. In the current review we highlight available data on the different classes of medications. Renin angiotensin blockers (RAASbs) and beta blockers (BBs) were shown to have very substantial effects in patients with HFREF. These medications are generic and hence relatively inexpensive. They have a 30-year track record of relatively benign short- and long-term safety profiles and should remain the cornerstone of therapy for patients with HFREF. ARNis are effective in further reducing adverse effects and should replace RAASbs in symptomatic HFREF patients, despite their relatively high prices. The addition of SGLTis (congested patients), Ivabradine (tachycardic patients), and Vericinguat (hypertensive patients) should be considered in patients who remain symptomatic despite optimal doses of RAASbs/ARNis, MRAs, and BBs. Comparative studies examining the efficacy of these medications, and strategies and prioritizing some over others should be considered as, given their similar side effects on heart rate, blood pressure, and renal function, it is highly unlikely that all can be given to the same patient. Full article

(This article belongs to the Special Issue Chronic Heart Failure and Depressed Systolic Function)

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