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Management of Ischemia and Heart Failure—2nd Edition

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A special issue of Life (ISSN 2075-1729). This special issue belongs to the section "Medical Research".

Deadline for manuscript submissions: closed (28 February 2025) | Viewed by 7234

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Dr. Cristian Mornoş

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Cardiology Department, “Victor Babes” University of Medicine and Pharmacy, 2 Eftimie Murgu Square, 300041 Timisoara, Romania
Interests: heart failure; acute coronary syndrome; speckle tracking; tissue Doppler imaging
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Special Issue Information

Dear Colleagues,

The editors are grateful to the many researchers who contributed to the success of the first volume of this Special Issue (https://www.mdpi.com/journal/life/special_issues/ischemia_heart). Therefore, we are very pleased to announce the second volume of our Special Issue.

Heart disease is the number one cause of death in the world, and within this group, myocardial ischemia and heart failure are some of the most important entities. Heart failure is a complex syndrome responsible for high rates of death and hospitalization. Ischemic heart disease is one of the most frequent causes of heart failure and it is normally attributed to coronary artery disease, defined by the presence of one or more obstructive plaques, which determine a reduced coronary blood flow, causing myocardial ischemia and consequent heart failure. Coronary microvascular dysfunction determines an inability of coronary circulation to satisfy myocardial metabolic demands due to the imbalance of coronary blood flow regulatory mechanisms, including ion channels, leading to the development of hypoxia, fibrosis and tissue death, which may determine a loss of myocardial function, even beyond the presence of atherosclerotic epicardial plaques.

The aim of this Special Issue is to analyze and discuss the major unsolved issues from basic research to new medical and interventional options, to provide the best management strategies. The invited papers focus on left ventricular remodeling, reperfusion injury (potential targets for treatment), prognostic markers, timing and tools to achieve optimal management in patients with ischemia and heart failure, and concepts to improve heart failure networks.

Dr. Cristian Mornoş
Guest Editor

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Keywords

cardiac ischemia
heart failure
therapy
medical innovation
emerging technologies
care strategies
prognosis
treatment efficacy
clinical protocols
personalized therapies

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Published Papers (8 papers)

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9 pages, 203 KiB

Open AccessArticle

An Ignored Population in Emergency Department: Cardio-Oncology Patients

by Ömer Salt, Cafer Zorkun and Semra Aytürk Salt

Life 2025, 15(4), 608; https://doi.org/10.3390/life15040608 - 6 Apr 2025

Viewed by 291

Abstract

Background: The aim of this study was to analyze cancer patients who were admitted to the emergency department with cardiac symptoms and hospitalized in the cardiology service or cardiology intensive care unit. Methods: One hundred and thirty-one cancer patients who were hospitalized in the period of 5 years were included in the study. Age, sex, type of cancer, treatment, emergency department diagnosis, laboratory parameters, and in-hospital outcomes were evaluated. Results: The most common hospitalization diagnosis was acute coronary syndromes (69.5%, n = 91). The mortality rate was 14.5% (n = 19). The NTproBNP levels were found to be higher in all patients, and especially high in patients with LVEF < 40%. Conclusions: Cancer patients with low LVEF and elevated NTproBNP levels and increased HEART and TIMI scores have increased risk for cardiac toxicity and mortality. This patient group should be treated and followed-up with great care. Full article

(This article belongs to the Special Issue Management of Ischemia and Heart Failure—2nd Edition)

23 pages, 2103 KiB

Open AccessArticle

A Prospective Pilot Study for Prognosis of Cardiac Resynchronization Therapy Super-Response Using Electrical and Mechanical Dyssynchrony Assessment in Patients with Heart Failure and Strauss Left Bundle Branch Block Criteria

by Tariel Atabekov, Andrey Smorgon, Anna Mishkina, Sergey Krivolapov, Svetlana Sazonova, Mikhail Khlynin, Roman Batalov and Sergey Popov

Life 2025, 15(4), 605; https://doi.org/10.3390/life15040605 - 5 Apr 2025

Viewed by 289

Abstract

Electrical and mechanical dyssynchrony (MD) underlies left ventricular (LV) contractile dysfunction in patients with heart failure (HF) and left bundle branch block (LBBB). In some cases, cardiac resynchronization therapy (CRT) almost completely reverses LV contractile dysfunction. The LBBB electrocardiographic Strauss criteria and MD assessment were proposed to improve CRT response. However, using these techniques separately does not improve LV contraction in 20–40% of patients after CRT device implantation. We aimed to evaluate whether the combined use of electrocardiography (ECG), speckle-tracking echocardiography (STE) and cardiac scintigraphy could improve the prognosis of CRT super-response in patients with HF and Strauss LBBB criteria during a 6-month follow-up period. The study prospectively included patients with HF, classified as New York Heart Association (NYHA) functional class (FC) II–III in sinus rhythm with Strauss LBBB criteria and reduced left ventricular ejection fraction (LVEF). Before and 6 months after CRT device implantation, ECG, STE and cardiac scintigraphy were performed. The study’s primary endpoint was the NYHA class improvement ≥ 1 and left ventricle end systolic volume decrease > 30% or LVEF improvement > 15% after 6 months of CRT. Based on collected data, we developed a prognostic model regarding the CRT super-response. Out of 54 (100.0%) patients, 39 (72.2%) had a CRT super-response. Patients with CRT super-response were likelier to have a greater S wave amplitude in V₂ lead (p = 0.004), higher rates of global longitudinal strain (GLS) (p = 0.001) and interventricular delay (IVD) (p = 0.005). Only three indicators (S wave amplitude in V₂ lead, GLS and IVD) were independently associated with CRT super-response in univariable and multivariable logistic regression. We created a prognostic model based on the logistic equation and calculated a cut-off value (>0.73). The resulting ROC curve revealed a discriminative ability with an AUC of 0.957 (sensitivity 87.2%; specificity 100.0%). The electrical and mechanical dyssynchrony assessment using ECG, STE and cardiac scintigraphy is useful in the prediction of CRT super-response in patients with HF and Strauss LBBB criteria during a 6-month follow-up period. Our prognostic model can identify patients who are super-responders to CRT. Full article

(This article belongs to the Special Issue Management of Ischemia and Heart Failure—2nd Edition)

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22 pages, 952 KiB

Open AccessArticle

The Value of Clinical Variables and the Potential of Longitudinal Ultrasound Carotid Plaque Assessment in Major Adverse Cardiovascular Event Prediction After Uncomplicated Acute Coronary Syndrome

by Leonid L. Bershtein, Alexey N. Sumin, Anna V. Kutina, Marina D. Lunina, Dmitrii S. Evdokimov, Tatyana V. Nayden, Viktoriya E. Gumerova, Igor N. Kochanov, Arkadii A. Ivanov, Svetlana A. Boldueva, Ekaterina D. Evdokimova, Elizaveta V. Zbyshevskaya, Alina E. Evtushenko, Vartan K. Piltakyan and Sergey A. Sayganov

Life 2025, 15(3), 431; https://doi.org/10.3390/life15030431 - 9 Mar 2025

Viewed by 671

Abstract

Due to the routine use of endovascular revascularization and improved medical therapy, the majority of acute coronary syndrome (ACS) cases now have an uncomplicated course. However, in spite of the currently accepted secondary prevention standards, the residual risk of remote major adverse cardiovascular events (MACEs) after ACS remains high. Ultrasound carotid/subclavian atherosclerotic plaque assessment may represent an alternative approach to estimate the MACE risk after ACS and to control the quality of secondary prevention. Aim: To find the most important clinical predictors of MACEs in contemporary patients with predominantly uncomplicated ACS treated according to the Guidelines, and to study the potential of the longitudinal assessment of quantitative and qualitative ultrasound carotid/subclavian atherosclerotic plaque characteristics for MACE prediction after ACS. Methods: Patients with ACS, obstructive coronary artery disease (CAD) confirmed by coronary angiography, and carotid/subclavian atherosclerotic plaque (AP) who underwent interventional treatment were prospectively enrolled. The exclusion criteria were as follows: death or significant bleeding at the time of index hospitalization; left ventricular ejection fraction (EF) <30%; and statin intolerance. The clinical variables potentially affecting cardiovascular prognosis after ACS as well as the quantitative and qualitative AP characteristics at baseline and 6 months after the index hospitalization were studied as potential MACE predictors. Results: A total of 411 primary patients with predominantly uncomplicated ACS were included; AP was detected in 343 of them (83%). The follow-up period duration was 450 [269; 634] days. MACEs occurred in 38 patients (11.8%): seven—cardiac death, twenty-five—unstable angina/acute myocardial infarction, and six—acute ischemic stroke. In multivariate regression analyses, the most important baseline predictors of MACEs were diabetes (HR 2.22, 95% CI 1.08–4.57); the decrease in EF by every 5% from 60% (HR 1.22, 95% CI 1.03–1.46); the Charlson comorbidity index (HR 1.24, 95% CI 1.05–1.48); the non-prescription of beta-blockers at discharge (HR 3.24, 95% CI 1.32–7.97); and a baseline standardized AP gray scale median (GSM) < 81 (HR 2.06, 95% CI 1.02–4.19). Among the predictors assessed at 6 months, after adjustment for other variables, only ≥ 3 uncorrected risk factors and standardized AP GSM < 81 (cut-off value) at 6 months were significant (HR 3.11, 95% CI 1.17–8.25 and HR 3.77, 95% CI 1.43–9.92, respectively) (for all HRs above, all p-values < 0.05; HR and 95% CI values varied minimally across regression models). The baseline quantitative carotid/subclavian AP characteristics and their 6-month longitudinal changes were not associated with MACEs. All predictors retained significance after the internal validation of the models, and models based on the baseline predictors also demonstrated good calibration; the latter were used to create MACE risk calculators. Conclusions: In typical contemporary patients with uncomplicated interventionally treated ACS, diabetes, decreased EF, Charlson comorbidity index, non-prescription of beta-blockers at discharge, and three or more uncontrolled risk factors after 6 months were the most important clinical predictors of MACEs. We also demonstrated that a lower value of AP GSM reflecting the plaque vulnerability, measured at baseline and after 6 months, was associated with an increased MACE risk; this effect was independent of clinical predictors and risk factor control. According to our knowledge, this is the first demonstration of the independent role of longitudinal carotid/subclavian AP GSM assessment in MACE prediction after ACS. Full article

(This article belongs to the Special Issue Management of Ischemia and Heart Failure—2nd Edition)

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14 pages, 987 KiB

Open AccessArticle

Predictors of Adverse Cardiovascular Events After CABG in Patients with Previous Heart Failure

by Alla Garganeeva, Elena Kuzheleva, Olga Tukish, Michail Kondratiev, Karina Vitt, Sergey Andreev, Yury Bogdanov and Oksana Ogurkova

Life 2025, 15(3), 387; https://doi.org/10.3390/life15030387 - 28 Feb 2025

Viewed by 632

Abstract

Coronary artery disease (CAD) is the primary risk factor for heart failure (HF) development. Coronary artery bypass graft (CABG) surgery remains the gold-standard treatment for multivessel coronary artery disease. The purpose of this study was to identify predictors of cardiovascular events in patients after CABG by looking at clinical parameters, examining biomarkers of inflammation and fibrosis, and assessing patients’ adherence to heart failure therapy before CABG. The prospective observational study included consecutively hospitalized patients with HF and CAD eligible for CABG (n = 82). The study’s primary endpoint was a combination (MACE) of cardiac death, hospitalization with HF, acute ischemic events requiring unplanned revascularization, or stroke. The enzyme-linked immunosorbent assay was performed to assess serum levels of NGAL, GDF-15, NTproBNP, TGF beta, and hsCRP. The participants’ medication adherence level was assessed using the Morisky–Green scale. A total of 37 events were registered (45.1%) at follow-up (36 (26; 43) months). All patients were divided into two groups: Group 1 (n = 45) comprised patients without the combined endpoint, and Group 2 (n = 37) comprised patient who suffered adverse cardiovascular events. A high GDF-15 level and low adherence based on the Morisky–Green scale were independent predictors of a MACE at follow-up. The median time before the development of the MACE which was predicted based on Kaplan–Meier analysis in the group with a GDF-15 value less than 2064 pg/mL was 64 (50; 80) months, and in the group with a GDF-15 value more than or equal to 2064 pg/mL, it was 40 (34; 46) months (p < 0.001). Higher GDF-15 values and poor adherence to treatment are associated with adverse cardiovascular events in patients with HF and CAD who have undergone CABG. However, further studies are needed to support the use of GDF-15 as a prognostic marker in real-life clinical practice. Full article

(This article belongs to the Special Issue Management of Ischemia and Heart Failure—2nd Edition)

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16 pages, 1988 KiB

Open AccessArticle

Myocardial Work Analysis in ST-Elevation Myocardial Infarction: Insights into Left Ventricular Ejection Fraction—A Pilot Study

by Alexandra-Cătălina Frișan, Mihai-Andrei Lazăr, Raluca Șoșdean, Marius Simonescu, Daniel-Miron Brie, Aniko Mornoș, Silvia Ana Luca, Ioana Ionac and Cristian Mornoș

Life 2025, 15(3), 338; https://doi.org/10.3390/life15030338 - 21 Feb 2025

Viewed by 838

Abstract

(1) Background: Left ventricular ejection fraction (LVEF) is traditionally used to assess prognosis in acute ST-elevation myocardial infarction (STEMI) patients. However, LV myocardial work (MW), evaluated echocardiographically, offers additional prognostic information by considering loading conditions. (2) Methods: This prospective study investigated the prognostic value of MW indices in 119 consecutive STEMI patients treated with primary percutaneous coronary angioplasty, stratified into three LVEF categories: reduced (≤40%), mildly reduced (41–49%), and preserved LVEF (≥50%). Transthoracic echocardiography was performed before discharge, and the primary endpoint included heart failure hospitalization, ventricular arrhythmias, all-cause mortality and new acute coronary syndromes. (3) Results: Patients with preserved or mildly reduced LVEF had higher global longitudinal strain, global work index, global constructive work (GCW), and global work efficiency, as well as lower global wasted work (GWW), compared to those with reduced LVEF. GCW was the strongest predictor of adverse outcomes in the preserved LVEF group (AUC = 0.730, p = 0.035), while GWW demonstrated robust predictive performance in the reduced LVEF group (AUC = 0.787, p = 0.001). (4) Conclusions: MW indices, particularly GCW and GWW, provide significant prognostic value in distinct LVEF categories in STEMI patients. These findings indicate that MW enhances risk stratification and informs management in this patient population. Full article

(This article belongs to the Special Issue Management of Ischemia and Heart Failure—2nd Edition)

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15 pages, 949 KiB

Open AccessArticle

A Multicenter Retrospective Study Evaluating Distal Radial Access vs. Conventional Transradial or Transvenous Access for Endovascular Treatment of Malfunctioning Dialysis Fistulas

by Roberto Minici, Massimo Venturini, Giuseppe Guzzardi, Federico Fontana, Andrea Coppola, Filippo Piacentino, Marco Spinetta, Davide Costa, Maria Chiara Brunese, Pasquale Guerriero, Biagio Apollonio, MGJR Research Team, Nicola De Rosi, Raffaele Serra and Domenico Laganà

Life 2024, 14(11), 1382; https://doi.org/10.3390/life14111382 - 28 Oct 2024

Viewed by 1038

Abstract

Background: This study aims to evaluate the feasibility, efficacy, and safety of distal transradial access (dRA) for the endovascular management of malfunctioning dialysis fistulas. This study also compares dRA with conventional access techniques, such as proximal radial and transvenous access, focusing on technical success, clinical outcomes, and vascular access site complications (VASCs). Methods: A retrospective multicenter study was conducted across four hospitals, including 292 patients treated between January 2019 and June 2024. Of these, 57 patients underwent dRA, and 235 received proximal radial or transvenous access. Key outcomes included technical success (successful completion of the procedure), clinical success (restoration of functional dialysis access), and complication rates. Data were collected on procedure times and complication profiles. Results: Technical success was achieved in 96.5% of patients undergoing dRA, compared to 98.3% in those receiving conventional access (p = 0.388). Clinical success was similar between groups (96.5% vs. 97%, p = 0.835). The overall complication rate was 10.5% for dRA and 8.5% for conventional access (p = 0.632). Cannulation time was longer for dRA (109.1 vs. 91.9 s, p < 0.001), but total procedure duration was comparable between the groups. No major complications were observed in either cohort, and improved post-procedure access flow rates were recorded in all patients. Conclusions: Distal transradial access is a feasible and effective approach for the endovascular management of malfunctioning dialysis fistulas, with outcomes comparable to conventional access techniques. It provides a safe alternative, particularly for patients with complex fistulas, while maintaining a low complication profile. Full article

(This article belongs to the Special Issue Management of Ischemia and Heart Failure—2nd Edition)

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10 pages, 1189 KiB

Open AccessArticle

Fractional Flow Reserve Implications for Clinical Decision Making in Coronary Artery Disease

by Andrei Grib, Marcel Abras, Artiom Surev and Livi Grib

Life 2024, 14(10), 1326; https://doi.org/10.3390/life14101326 - 18 Oct 2024

Viewed by 1177

Abstract

Fractional flow reserve (FFR) is regarded as the gold standard for assessing the functional significance of coronary artery lesions. However, its utilization in clinical practice remains limited. This study aims to determine whether FFR results can influence treatment decisions for coronary artery disease compared to visual assessments of angiographic images. We conducted a retrospective study involving 63 patients diagnosed with either chronic coronary syndrome (n = 39, 61.9%) or acute coronary syndrome (n = 24, 38.1%) who underwent an FFR assessment. Three experienced interventional cardiologists (>300 PCI procedures/year) reevaluated 105 ambiguous coronary lesions in these patients, blinded to the FFR results. The objective was to assess lesion significance and determine the treatment strategy based on a visual angiographic evaluation. The three operators reached concordant agreement (≥two operators) to perform PCI in 60 (57.1%) of the evaluated lesions based on the angiographic assessment. Of these, nine lesions (15%) were deemed functionally non-significant by FFR (FFR > 0.80). Conversely, they agreed to defer PCI in 45 (42.9%) lesions, but 4 lesions (8.9%) were found to be functionally significant (FFR ≤ 0.80) and required a re-evaluation for PCI. Visual-guided decision making by interventional cardiologists shows variability and does not always align with the functional significance of coronary lesions as determined by FFR. Incorporating FFR into routine decision making could enhance treatment accuracy and patient outcomes. Full article

(This article belongs to the Special Issue Management of Ischemia and Heart Failure—2nd Edition)

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16 pages, 1609 KiB

Open AccessSystematic Review

Outcomes of Left Ventricular Assist Devices as Destination Therapy: A Systematic Review with Meta-Analysis

by Emad Ali Al Khoufi

Life 2025, 15(1), 53; https://doi.org/10.3390/life15010053 - 3 Jan 2025

Viewed by 1170

Abstract

Background: Heart failure (HF) is a chronic condition that significantly affects morbidity and mortality. For patients with end-stage HF who are not candidates for heart transplantation, left ventricular assist devices (LVADs) provide mechanical circulatory support as a long-term solution, known as destination therapy (DT). Objective: This meta-analysis aims to synthesize evidence on the survival rates, complications, and quality-of-life improvements associated with LVADs used as destination therapy in patients with end-stage HF. Methods: A systematic search of databases, including PubMed, Embase, Cochrane Library, Web of Science, and Scopus, was conducted to identify relevant studies. Studies were selected based on predefined inclusion and exclusion criteria. Data from 12 studies were extracted and analyzed using a random-effects model. Survival rates, complications (e.g., infection and bleeding), and quality-of-life measures were the primary outcomes evaluated. Results: The analysis showed significant improvements in survival, with a pooled effect size of 0.848 (95% CI: 0.306–1.390, p = 0.002). Complication rates varied, with infections and bleeding being the most common adverse events. Quality of life also improved significantly post-LVAD implantation, with a standardized mean difference of 0.78 (95% CI: 0.65–0.91). Conclusions: LVADs as destination therapy provide a viable option for improving the survival and quality of life of end-stage HF patients, despite the associated risks of complications. Further research is needed to refine patient selection and management strategies to optimize outcomes. Full article

(This article belongs to the Special Issue Management of Ischemia and Heart Failure—2nd Edition)

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