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Li E, Boujeddaine N, Houtman MJC, Maas RGC, Sluijter JPG, Ecker GF, Stary-Weinzinger A, van Ham WB, van der Heyden MAG. Development of new K ir2.1 channel openers from propafenone analogues. Br J Pharmacol 2025; 182:633-650. [PMID: 39419581 DOI: 10.1111/bph.17377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Revised: 08/21/2024] [Accepted: 09/24/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND AND PURPOSES Reduced inward rectifier potassium channel (Kir2.1) functioning is associated with heart failure and may cause Andersen-Tawil Syndrome, among others characterized by ventricular arrhythmias. Most heart failure or Andersen-Tawil Syndrome patients are treated with β-adrenoceptor antagonists (β-blockers) or sodium channel blockers; however, these do not specifically address the inward rectifier current (IK1) nor aim to improve resting membrane potential stability. Consequently, additional pharmacotherapy for heart failure and Andersen-Tawil Syndrome treatment would be highly desirable. Acute propafenone treatment at low concentrations enhances IK1 current, but it also exerts many off-target effects. Therefore, discovering and exploring new IK1-channel openers is necessary. EXPERIMENTAL APPROACH Effects of propafenone and 10 additional propafenone analogues were analysed. Currents were measured by single-cell patch-clamp electrophysiology. Kir2.1 protein expression levels were determined by western blot analysis and action potential characteristics were further validated in human-induced pluripotent stem cells-derived cardiomyocytes (hiPSC-CMCs). Molecular docking was performed to obtain detailed information on drug-channel interactions. KEY RESULTS Analogues GPV0019, GPV0057 and GPV0576 strongly increased the outward component of IK1 while not affecting the Kir2.1 channel expression levels. GPV0057 did not block IKr at concentrations below 0.5 μmol L-1 nor NaV1.5 current below 1 μmol L-1. Moreover, hiPSC-CMC action potential duration was also not affected by GPV0057 at 0.5 and 1 μmol L-1. Structure analysis indicates a mechanism by which GPV0057 might enhance Kir2.1 channel activation. CONCLUSION AND IMPLICATIONS GPV0057 has a strong efficiency towards increasing IK1, which makes it a good candidate to address IK1 deficiency-associated diseases.
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Affiliation(s)
- Encan Li
- Department of Medical Physiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Najla Boujeddaine
- Department of Medical Physiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marien J C Houtman
- Department of Medical Physiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Renee G C Maas
- Department of Cardiology, Laboratory of Experimental Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
- Circulatory Health Research Center, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Joost P G Sluijter
- Department of Cardiology, Laboratory of Experimental Cardiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
- Circulatory Health Research Center, Regenerative Medicine Center Utrecht, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Gerhard F Ecker
- Department of Pharmaceutical Sciences, University of Vienna, Vienna, Austria
| | | | - Willem B van Ham
- Department of Medical Physiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marcel A G van der Heyden
- Department of Medical Physiology, Division Heart and Lungs, University Medical Center Utrecht, Utrecht, The Netherlands
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Prosperi S, D’Amato A, Labbro Francia A, Monosilio S, Cestiè C, Marek Iannucci S, Netti L, Angotti D, Filomena D, Mariani MV, Myftari V, Germanò R, Cimino S, Mancone M, Badagliacca R, Maestrini V, Severino P, Vizza CD. Sodium-Glucose Cotransporter 2 Inhibitor Therapy in Different Scenarios of Heart Failure: An Overview of the Current Literature. Int J Mol Sci 2024; 25:11458. [PMID: 39519011 PMCID: PMC11546829 DOI: 10.3390/ijms252111458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2024] [Revised: 10/17/2024] [Accepted: 10/22/2024] [Indexed: 11/16/2024] Open
Abstract
Heart failure (HF) is a complex syndrome that requires tailored and patient-centered treatment. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) constitute one of the four pillars of the medical treatment of HF. However, the 2023 ESC guidelines treat HF as a single entity without making clear distinctions in phenotypes according to etiology. This creates a "gap in knowledge", causing much debate about the applicability of these drugs in peculiar clinical settings that are etiological and/or predisposing clinical conditions for HF. Furthermore, considering the variety of etiologies and different pathophysiological backgrounds of HF, one might question whether the use of SGLT2is is equally beneficial in all types of HF and whether certain drug-related properties may be exploited in different contexts. For example, SGLT2is can improve the metabolic and inflammatory state, which is fundamental in ischemic heart disease. Anti-inflammatory power can also play a paramount role in myocarditis or cardiotoxicity, while improving the congestive state and reducing filling pressure may be even more fundamental in restrictive heart disease or advanced heart disease. This review aims to gather the evidence currently present in the literature concerning the advantages or the disadvantages of using these drugs in these particular clinical settings, with the goal being an optimized and highly personalized treatment for HF.
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Affiliation(s)
- Silvia Prosperi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Andrea D’Amato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
- Department of Cardiology, Ospedale Fabrizio Spaziani, 03100 Frosinone, Italy
| | - Aurora Labbro Francia
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Sara Monosilio
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Claudia Cestiè
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Stefanie Marek Iannucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Lucrezia Netti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Danilo Angotti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Domenico Filomena
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Vincenzo Myftari
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Rosanna Germanò
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Sara Cimino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
| | - Carmine Dario Vizza
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (S.P.); (A.L.F.); (S.M.); (C.C.); (S.M.I.); (L.N.); (D.A.); (D.F.); (M.V.M.); (V.M.); (R.G.); (S.C.); (M.M.); (R.B.); (V.M.); (P.S.); (C.D.V.)
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Lavalle C, Mariani MV, Severino P, Palombi M, Trivigno S, D'Amato A, Silvetti G, Pierucci N, Di Lullo L, Chimenti C, Summaria F, Ronco C, Badagliacca R, Miraldi F, Vizza CD. Efficacy of Modern Therapies for Heart Failure with Reduced Ejection Fraction in Specific Population Subgroups: A Systematic Review and Network Meta-Analysis. Cardiorenal Med 2024; 14:570-580. [PMID: 39284285 DOI: 10.1159/000541393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Accepted: 08/19/2024] [Indexed: 10/25/2024] Open
Abstract
INTRODUCTION The efficacy and safety of emerging therapies for heart failure with reduced ejection fraction (HFrEF) have never been compared in specific subgroups of patients. METHODS PubMed, Cochrane Registry, Web of Science, Scopus, and EMBASE libraries were used to extract data. We used the following keywords: (heart failure with reduced ejection fraction OR HFrEF) AND (treatment OR therapy) OR (cardiovascular death) OR (hospitalization for heart failure). We compared randomized clinical trials for HFrEF emerging therapies focusing on the elderly (patients >65 years old and >75 years old), chronic kidney disease (CKD) (estimated glomerular filtration rate (eGFR) < 60 mL/min), patients with diabetes mellitus (DM), coronary heart disease (CAD), New York Heart Association (NYHA) class III/IV, women, patients on sacubitril/valsartan (S/V). The primary outcome was the efficacy composite endpoint of cardiovascular death (CVD) and HF hospitalization (HFH). RESULTS S/V significantly reduced the primary outcome in patients >65 years old (RR: 0.80; 95% CI: 0.68-0.94) and with CKD (RR: 0.79; 95% CI: 0.69-0.90); dapagliflozin in patients >65 (RR: 0.72; 95% CI: 0.60-0.86) and >75 years old (RR: 0.68; 95% CI: 0.53-0.87), in those with CKD (RR: 0.72; 95% CI: 0.59-0.88), DM (RR: 0.75; 95% CI: 0.63-0.89), and CAD (RR: 0.77; 95% CI: 0.65-0.92); empagliflozin in patients >65 years old (RR: 0.78; 95% CI: 0.66-0.93), those with DM (RR: 0.72; 95% CI: 0.60-0.86), CAD (RR: 0.82; 95% CI: 0.68-0.99), women (RR: 0.59; 95% CI: 0.44-0.79), and in patients on S/V (RR: 0.64; 95% CI: 0.45-0.91); vericiguat in patients with CKD (RR: 0.84; 95% CI: 0.73-0.97) and NYHA class III/IV (RR: 0.87; 95% CI: 0.77-0.98); omecamtiv mecarbil in patients with CAD (RR: 0.90; 95% CI: 0.82-0.99) and NYHA III/IV (RR: 0.88; 95% CI: 0.80-0.97). CONCLUSION Emerging HFrEF therapies show a clinical benefit with the reduction of the primary composite endpoint of CVD and HFH, with each drug being more effective in specific patient population.
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Affiliation(s)
- Carlo Lavalle
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Paolo Severino
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Marta Palombi
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Sara Trivigno
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Andrea D'Amato
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Giacomo Silvetti
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Nicola Pierucci
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Luca Di Lullo
- Department of Nephrology and Dialysis, Azienda USL Roma 6, Rome, Italy
| | - Cristina Chimenti
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | | | - Claudio Ronco
- Department of Nephrology and Dialysis, International Renal Research Institute, S. Bortolo Hospital, Vicenza, Italy
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Fabio Miraldi
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
| | - Carmine Dario Vizza
- Department of Clinical, Internal, Anesthesiologist and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy
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Severino P, D'Amato A, Prosperi S, Mariani MV, Myftari V, Labbro Francia A, Cestiè C, Tomarelli E, Manzi G, Birtolo LI, Marek-Iannucci S, Maestrini V, Mancone M, Badagliacca R, Fedele F, Vizza CD. Strategy for an early simultaneous introduction of four-pillars of heart failure therapy: results from a single center experience. Am J Cardiovasc Drugs 2024; 24:663-671. [PMID: 38909334 PMCID: PMC11344711 DOI: 10.1007/s40256-024-00660-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/02/2024] [Indexed: 06/24/2024]
Abstract
INTRODUCTION The 2021 European Society of Cardiology (ESC) Guidelines recommend the use of four different classes of drugs for heart failure with reduced ejection fraction (HFrEF): beta blockers (BB), sodium-glucose cotransporter-2 inhibitors (SGLT2i), angiotensin receptor/neprilysin inhibitor (ARNI), and mineralocorticoid receptor antagonists (MRAs). Moreover, the 2023 ESC updated Guidelines suggest an intensive strategy of initiation and rapid up-titration of evidence-based treatment before discharge, based on trials not using the four-pillars. We hypothesized that an early concomitantly administration and up-titration of four-pillars, compared with a conventional stepwise approach, may impact the vulnerable phase after hospitalization owing to HF. METHODS This prospective, single center, observational study included consecutive in-hospital patients with HFrEF. After performing propensity score matching, they were divided according to treatment strategy into group 1 (G1), with predischarge start of all four-pillars, with their up-titration within 1 month, and group 2 (G2) with the pre Guidelines update stepwise four-pillars introduction. HF hospitalization, cardiovascular (CV) death, and the composite of both were evaluated between the two groups at 6-month follow-up. RESULTS The study included a total of 278 patients who completed 6-month follow-up (139 for both groups). There were no differences in terms of baseline features between the two groups. At survival analysis, HF hospitalization risk was significantly lower in G1 compared with G2 (p < 0.001), while no significant differences were observed regarding CV death (p = 0.642) or the composite of CV death and HF hospitalization (p = 0.135). CONCLUSIONS In our real-world population, patients with HF treated with a predischarge and simultaneous use of four-pillars showed a reduced risk of HF hospitalization during the vulnerable phase after discharge, compared with a conventional stepwise approach.
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Affiliation(s)
- Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
| | - Andrea D'Amato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Silvia Prosperi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Vincenzo Myftari
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Aurora Labbro Francia
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Claudia Cestiè
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Elisa Tomarelli
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Giovanna Manzi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Stefanie Marek-Iannucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
| | - Carmine Dario Vizza
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy
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Almeida-Pinto N, Dschietzig TB, Brás-Silva C, Adão R. Cardiovascular effects of relaxin-2: therapeutic potential and future perspectives. Clin Res Cardiol 2024; 113:1137-1150. [PMID: 37721595 PMCID: PMC11269324 DOI: 10.1007/s00392-023-02305-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 09/04/2023] [Indexed: 09/19/2023]
Abstract
The hormone relaxin-2 has emerged as a promising player in regulating the physiology of the cardiovascular system. Through binding to the relaxin family peptide receptor 1 (RXFP1), this hormone elicits multiple physiological responses including vasodilation induction, reduction of inflammation and oxidative stress, and angiogenesis stimulation. The role of relaxin-2, or its recombinant human form known as serelaxin, has been investigated in preclinical and clinical studies as a potential therapy for cardiovascular diseases, especially heart failure, whose current therapy is still unoptimized. However, evidence from past clinical trials has been inconsistent and further research is needed to fully understand the potential applications of relaxin-2. This review provides an overview of serelaxin use in clinical trials and discusses future directions in the development of relaxin-2 mimetics, which may offer new therapeutic options for patients with heart failure.
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Affiliation(s)
- Nísia Almeida-Pinto
- Cardiovascular R&D Centre-UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
| | | | - Carmen Brás-Silva
- Cardiovascular R&D Centre-UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal
- Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
| | - Rui Adão
- Cardiovascular R&D Centre-UnIC@RISE, Department of Surgery and Physiology, Faculty of Medicine, University of Porto, 4200-319, Porto, Portugal.
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
- CIBER Enfermedades Respiratorias (Ciberes), Madrid, Spain.
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Tanisha, Amudha C, Raake M, Samuel D, Aggarwal S, Bashir ZMD, Marole KK, Maryam I, Nazir Z. Diagnostic Modalities in Heart Failure: A Narrative Review. Cureus 2024; 16:e67432. [PMID: 39314559 PMCID: PMC11417415 DOI: 10.7759/cureus.67432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2024] [Indexed: 09/25/2024] Open
Abstract
Heart failure (HF) can present acutely or progress over time. It can lead to morbidity and mortality affecting 6.5 million Americans over the age of 20. The HF type is described according to the ejection fraction classification, defined as the percentage of blood volume that exits the left ventricle after myocardial contraction, undergoing ejection into the circulation, also called stroke volume, and is proportional to the ejection fraction. Cardiac catheterization is an invasive procedure to evaluate coronary artery disease leading to HF. Several biomarkers are being studied that could lead to early detection of HF and better symptom management. Testing for various biomarkers in the patient's blood is instrumental in confirming the diagnosis and elucidating the etiology of HF. There are various biomarkers elevated in response to increased myocardial stress and volume overload, including B-type natriuretic peptide (BNP) and its N-terminal prohormone BNP. We explored online libraries such as PubMed, Google Scholar, and Cochrane to find relevant articles. Our narrative review aims to extensively shed light on diagnostic modalities and novel techniques for diagnosing HF.
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Affiliation(s)
- Tanisha
- Department of Internal Medicine No. 4, O.O. Bogomolets National Medical University, Kyiv, UKR
| | - Chaithanya Amudha
- Department of Medicine and Surgery, Saveetha Medical College and Hospital, Chennai, IND
| | - Mohammed Raake
- Department of Surgery, Annamalai University, Chennai, IND
| | - Dany Samuel
- Department of Radiology, Medical University of Varna, Varna, BGR
| | | | - Zainab M Din Bashir
- Department of Medicine and Surgery, Combined Military Hospital (CMH) Lahore Medical College and Institute of Dentistry, Lahore, PAK
| | - Karabo K Marole
- Department of Medicine and Surgery, St. George's University School of Medicine, St. George's, GRD
| | - Iqra Maryam
- Department of Radiology, Allama Iqbal Medical College, Lahore, PAK
| | - Zahra Nazir
- Department of Internal Medicine, Combined Military Hospital, Quetta, PAK
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7
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Palazzuoli A, Severino P, D’Amato A, Myftari V, Tricarico L, Correale M, Dattilo G, Fioretti F, Nodari S. Distinct Profiles and New Pharmacological Targets for Heart Failure with Preserved Ejection Fraction. Rev Cardiovasc Med 2024; 25:270. [PMID: 39139408 PMCID: PMC11317327 DOI: 10.31083/j.rcm2507270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 04/15/2024] [Accepted: 04/19/2024] [Indexed: 08/15/2024] Open
Abstract
Background Heart failure with preserved ejection fraction (HFpEF) is a multifactorial condition with a variety of pathophysiological causes and morphological manifestations. The inclusion criteria and patient classification have become overly simplistic due to the customary differentiation regarding the ejection fraction (EF) cutoff. EF is considered a measure of systolic function; nevertheless, it only represents a portion of the true contractile state and has been shown to have certain limits due to methodological and hemodynamic irregularities. Methods As a result, broader randomized clinical trials have yet to incorporate the most recent criteria for HFpEF diagnosis, leading to a lack of data consistency and confusion in interpreting the results. The primary variations between the bigger clinical trials published in this context concerning patient selection and echocardiographic characteristics were analyzed. For all these reasons, we aim to clarify the main features and clinical impact of HFpEF in a study combining imaging, bio-humoral analysis, and clinical history to identify the specific subgroups that respond better to tailored treatment. Results Disparate clinical characteristics and a lack of uniform diagnostic standards may cause suboptimal therapeutic feedback. To optimize treatment, we suggest shifting the paradigm from the straightforward EF measurement to a more comprehensive model that considers additional information, such as structural traits, related disorders, and biological and environmental data. Therefore, by evaluating certain echocardiographic and clinical factors, a stepwise diagnostic procedure may be useful in identifying patients at high risk, subjects with early HFpEF, and those with evident HFpEF. Conclusions The present assessment underscores the significance of the precision medicine approach in guaranteeing optimal patient outcomes by providing the best care according to each distinct profile.
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Affiliation(s)
- Alberto Palazzuoli
- Cardiovascular Diseases Unit, Cardio Thoracic and Vascular Department Le Scotte Hospital University of Siena, 53100 Siena, Italy
| | - Paolo Severino
- Department of Clinical, Internal Anesthesiological and Cardiovascular Sciences University La Sapienza Rome, 00161 Roma, Italy
| | - Andrea D’Amato
- Department of Clinical, Internal Anesthesiological and Cardiovascular Sciences University La Sapienza Rome, 00161 Roma, Italy
| | - Vincenzo Myftari
- Department of Clinical, Internal Anesthesiological and Cardiovascular Sciences University La Sapienza Rome, 00161 Roma, Italy
| | - Lucia Tricarico
- UO Cardiologia Universitaria – Intensive Coronary Unit Policlinico Riuniti Foggia, 71122 Foggia, Italy
| | - Michele Correale
- UO Cardiologia Universitaria – Intensive Coronary Unit Policlinico Riuniti Foggia, 71122 Foggia, Italy
| | - Giuseppe Dattilo
- Cardiology Unit, Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy
| | - Francesco Fioretti
- Cardiology Section, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Spedali Civili Hospital and University of Brescia, 25123 Brescia, Italy
| | - Savina Nodari
- Cardiology Section, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, Spedali Civili Hospital and University of Brescia, 25123 Brescia, Italy
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8
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D’Amato A, Severino P, Prosperi S, Mariani MV, Germanò R, De Prisco A, Myftari V, Cestiè C, Labbro Francia A, Marek-Iannucci S, Tabacco L, Vari L, Marano SL, Di Pietro G, Lavalle C, Sardella G, Mancone M, Badagliacca R, Fedele F, Vizza CD. The Role of High-Sensitivity Troponin T Regarding Prognosis and Cardiovascular Outcome across Heart Failure Spectrum. J Clin Med 2024; 13:3533. [PMID: 38930061 PMCID: PMC11204386 DOI: 10.3390/jcm13123533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 06/12/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
Background: Cardiac troponin release is related to the cardiomyocyte loss occurring in heart failure (HF). The prognostic role of high-sensitivity cardiac troponin T (hs-cTnT) in several settings of HF is under investigation. The aim of the study is to assess the prognostic role of intrahospital hs-cTnT in patients admitted due to HF. Methods: In this observational, single center, prospective study, patients hospitalized due to HF have been enrolled. Admission, in-hospital peak, and discharge hs-cTnT have been assessed. Patients were followed up for 6 months. Cardiovascular (CV) death, HF hospitalization (HFH), and worsening HF (WHF) (i.e., urgent ambulatory visit/loop diuretics escalation) events have been assessed at 6-month follow up. Results: 253 consecutive patients have been enrolled in the study. The hs-cTnT median values at admission and discharge were 0.031 ng/mL (IQR 0.02-0.078) and 0.031 ng/mL (IQR 0.02-0.077), respectively. The risk of CV death/HFH was higher in patients with admission hs-cTnT values above the median (p = 0.02) and in patients who had an increase in hs-cTnT during hospitalization (p = 0.03). Multivariate Cox regression analysis confirmed that hs-cTnT above the median (OR: 2.06; 95% CI: 1.02-4.1; p = 0.04) and increase in hs-cTnT during hospitalization (OR:1.95; 95%CI: 1.006-3.769; p = 0.04) were predictors of CV death/HFH. In a subgroup analysis of patients with chronic HF, hs-cTnT above the median was associated with increased risk of CV death/HFH (p = 0.03), while in the subgroup of patients with HFmrEF/HFpEF, hs-cTnT above the median was associated with outpatient WHF events (p = 0.03). Conclusions: Inpatient hs-cTnT levels predict CV death/HFH in patients with HF. In particular, in the subgroup of chronic HF patients, hs-cTnT is predictive of CV death/HFH; while in patients with HFmrEF/HFpEF, hs-cTnT predicts WHF events.
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Affiliation(s)
- Andrea D’Amato
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
- Department of Cardiology, Ospedale Fabrizio Spaziani, 03100 Frosinone, Italy
| | - Paolo Severino
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Silvia Prosperi
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Rosanna Germanò
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Andrea De Prisco
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Vincenzo Myftari
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Claudia Cestiè
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Aurora Labbro Francia
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Stefanie Marek-Iannucci
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Leonardo Tabacco
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Leonardo Vari
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Silvia Luisa Marano
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Gianluca Di Pietro
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Carlo Lavalle
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Gennaro Sardella
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Massimo Mancone
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
| | | | - Carmine Dario Vizza
- Department of Clinical, Internal, Anaesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (P.S.); (S.P.); (R.G.); (A.D.P.); (V.M.); (C.C.); (A.L.F.); (S.M.-I.); (L.T.); (L.V.); (S.L.M.); (G.D.P.); (C.L.); (G.S.); (M.M.); (R.B.); (C.D.V.)
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9
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D’Amato A, Severino P, Mancone M, Mariani MV, Prosperi S, Colombo L, Myftari V, Cestiè C, Labbro Francia A, Germanò R, Pierucci N, Fanisio F, Marek-Iannucci S, De Prisco A, Scoccia G, Birtolo LI, Manzi G, Lavalle C, Sardella G, Badagliacca R, Fedele F, Vizza CD. Prognostic Assessment of HLM Score in Heart Failure Due to Ischemic Heart Disease: A Pilot Study. J Clin Med 2024; 13:3322. [PMID: 38893033 PMCID: PMC11172826 DOI: 10.3390/jcm13113322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2024] [Revised: 05/14/2024] [Accepted: 05/29/2024] [Indexed: 06/21/2024] Open
Abstract
Background: Ischemic heart disease (IHD) represents the main cause of heart failure (HF). A prognostic stratification of HF patients with ischemic etiology, particularly those with acute coronary syndrome (ACS), may be challenging due the variability in clinical and hemodynamic status. The aim of this study is to assess the prognostic power of the HLM score in a population of patients with ischemic HF and in a subgroup who developed HF following ACS. Methods: This is an observational, prospective, single-center study, enrolling consecutive patients with a diagnosis of ischemic HF. Patients were stratified according to the four different HLM stages of severity, and the occurrence of CV death, HFH, and worsening HF events were evaluated at 6-month follow-up. A sub-analysis was performed on patients who developed HF following ACS at admission. Results: The study included 146 patients. HLM stage predicts the occurrence of CV death (p = 0.01) and CV death/HFH (p = 0.003). Cox regression analysis confirmed HLM stage as an independent predictor of CV death (OR: 3.07; 95% IC: 1.54-6.12; p = 0.001) and CV death/HFH (OR: 2.45; 95% IC: 1.43-4.21; p = 0.001) in the total population of patients with HF due to IHD. HLM stage potentially predicts the occurrence of CV death (p < 0.001) and CV death/HFH (p < 0.001) in patients with HF following ACS at admission. Conclusions: Pathophysiological-based prognostic assessment through HLM score is a potentially promising tool for the prediction of the occurrence of CV death and CV death/HFH in ischemic HF patients and in subgroups of patients with HF following ACS at admission.
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Affiliation(s)
- Andrea D’Amato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Silvia Prosperi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Lorenzo Colombo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Vincenzo Myftari
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Claudia Cestiè
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Aurora Labbro Francia
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Rosanna Germanò
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Nicola Pierucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | | | - Stefanie Marek-Iannucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Andrea De Prisco
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Gianmarco Scoccia
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Giovanna Manzi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Gennaro Sardella
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
| | | | - Carmine Dario Vizza
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico 155, 00161 Rome, Italy; (A.D.); (P.S.); (M.M.); (S.P.); (L.C.); (V.M.); (C.C.); (A.L.F.); (R.G.); (N.P.); (S.M.-I.); (A.D.P.); (G.S.); (L.I.B.); (G.M.); (C.L.); (G.S.); (R.B.); (C.D.V.)
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10
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Severino P, Mancone M, D'Amato A, Mariani MV, Prosperi S, Alunni Fegatelli D, Birtolo LI, Angotti D, Milanese A, Cerrato E, Maestrini V, Pizzi C, Foà A, Vestri A, Palazzuoli A, Vizza CD, Casale PN, Mather PJ, Fedele F. Heart failure 'the cancer of the heart': the prognostic role of the HLM score. ESC Heart Fail 2024; 11:390-399. [PMID: 38011913 PMCID: PMC10804198 DOI: 10.1002/ehf2.14594] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 11/29/2023] Open
Abstract
AIMS The multi-systemic effects of heart failure (HF) resemble the spread observed during cancer. We propose a new score, named HLM, analogous to the TNM classification used in oncology, to assess the prognosis of HF. HLM refers to H: heart damage, L: lung involvement, and M: systemic multiorgan involvement. The aim was to compare the HLM score to the conventional New York Heart Association (NYHA) classification, American College of Cardiology/American Heart Association (ACC/AHA) stages, and left ventricular ejection fraction (LVEF), to assess the most accurate prognostic tool for HF patients. METHODS AND RESULTS We performed a multicentre, observational, prospective study of consecutive patients admitted for HF. Heart, lung, and other organ function parameters were collected. Each patient was classified according to the HLM score, NYHA classification, ACC/AHA stages, and LVEF assessed by transthoracic echocardiography. The follow-up period was 12 months. The primary endpoint was a composite of all-cause death and rehospitalization due to HF. A total of 1720 patients who completed the 12 month follow-up period have been enrolled in the study. 520 (30.2%) patients experienced the composite endpoint of all-cause death and rehospitalization due to HF. 540 (31.4%) patients were female. The mean age of the study population was 70.5 ± 12.9. The mean LVEF at admission was 42.5 ± 13%. Regarding the population distribution across the spectrum of HLM score stages, 373 (21.7%) patients were included in the HLM-1, 507 (29.5%) in the HLM-2, 587 (34.1%) in the HLM-3, and 253 (14.7%) in the HLM-4. HLM was the most accurate score to predict the primary endpoint at 12 months. The area under the receiver operating characteristic curve (AUC) was greater for the HLM score compared with the NYHA classification, ACC/AHA stages, or LVEF, regarding the composite endpoint (HLM = 0.645; NYHA = 0.580; ACC/AHA = 0.589; LVEF = 0.572). The AUC of the HLM score was significantly better compared with the LVEF (P = 0.002), ACC/AHA (P = 0.029), and NYHA (P = 0.009) AUC. CONCLUSIONS The HLM score has a greater prognostic power compared with the NYHA classification, ACC/AHA stages, and LVEF assessed by transthoracic echocardiography in terms of the composite endpoint of all-cause death and rehospitalization due to HF at 12 months of follow-up.
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Affiliation(s)
- Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular SciencesSapienza University of RomeViale del PoliclinicoRomeItaly
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular SciencesSapienza University of RomeViale del PoliclinicoRomeItaly
| | - Andrea D'Amato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular SciencesSapienza University of RomeViale del PoliclinicoRomeItaly
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular SciencesSapienza University of RomeViale del PoliclinicoRomeItaly
| | - Silvia Prosperi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular SciencesSapienza University of RomeViale del PoliclinicoRomeItaly
| | | | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular SciencesSapienza University of RomeViale del PoliclinicoRomeItaly
| | - Danilo Angotti
- Department of Clinical, Internal, Anesthesiology and Cardiovascular SciencesSapienza University of RomeViale del PoliclinicoRomeItaly
| | - Alberto Milanese
- Department of Public Health and Infectious DiseaseSapienza University of RomeRomeItaly
| | - Enrico Cerrato
- Interventional Cardiology UnitSan Luigi Gonzaga University Hospital, Orbassano and Rivoli Infermi HospitalRivoli (Turin)Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular SciencesSapienza University of RomeViale del PoliclinicoRomeItaly
| | - Carmine Pizzi
- Department of Experimental, Diagnostic and Specialty Medicine‐DIMESUniversity of Bologna, IRCCS Sant'Orsola‐Malpighi HospitalBolognaItaly
| | - Alberto Foà
- Department of Experimental, Diagnostic and Specialty Medicine‐DIMESUniversity of Bologna, IRCCS Sant'Orsola‐Malpighi HospitalBolognaItaly
| | - Annarita Vestri
- Department of Public Health and Infectious DiseaseSapienza University of RomeRomeItaly
| | - Alberto Palazzuoli
- Cardiovascular Diseases UnitLe Scotte Hospital, University of SienaSienaItaly
| | - Carmine Dario Vizza
- Department of Clinical, Internal, Anesthesiology and Cardiovascular SciencesSapienza University of RomeViale del PoliclinicoRomeItaly
| | - Paul N. Casale
- Department of Cardiology and Population Health SciencesWeill Cornell Medical CollegeNew YorkNYUSA
| | - Paul J. Mather
- Division of Cardiovascular MedicineUniversity of PennsylvaniaPhiladelphiaPAUSA
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11
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D'Amato A, Prosperi S, Severino P, Myftari V, Labbro Francia A, Cestiè C, Pierucci N, Marek-Iannucci S, Mariani MV, Germanò R, Fanisio F, Lavalle C, Maestrini V, Badagliacca R, Mancone M, Fedele F, Vizza CD. Current Approaches to Worsening Heart Failure: Pathophysiological and Molecular Insights. Int J Mol Sci 2024; 25:1574. [PMID: 38338853 PMCID: PMC10855688 DOI: 10.3390/ijms25031574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2023] [Revised: 01/20/2024] [Accepted: 01/23/2024] [Indexed: 02/12/2024] Open
Abstract
Worsening heart failure (WHF) is a severe and dynamic condition characterized by significant clinical and hemodynamic deterioration. It is characterized by worsening HF signs, symptoms and biomarkers, despite the achievement of an optimized medical therapy. It remains a significant challenge in cardiology, as it evolves into advanced and end-stage HF. The hyperactivation of the neurohormonal, adrenergic and renin-angiotensin-aldosterone system are well known pathophysiological pathways involved in HF. Several drugs have been developed to inhibit the latter, resulting in an improvement in life expectancy. Nevertheless, patients are exposed to a residual risk of adverse events, and the exploration of new molecular pathways and therapeutic targets is required. This review explores the current landscape of WHF, highlighting the complexities and factors contributing to this critical condition. Most recent medical advances have introduced cutting-edge pharmacological agents, such as guanylate cyclase stimulators and myosin activators. Regarding device-based therapies, invasive pulmonary pressure measurement and cardiac contractility modulation have emerged as promising tools to increase the quality of life and reduce hospitalizations due to HF exacerbations. Recent innovations in terms of WHF management emphasize the need for a multifaceted and patient-centric approach to address the complex HF syndrome.
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Affiliation(s)
- Andrea D'Amato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Silvia Prosperi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Vincenzo Myftari
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Aurora Labbro Francia
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Claudia Cestiè
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Nicola Pierucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Stefanie Marek-Iannucci
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Rosanna Germanò
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | | | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
| | | | - Carmine Dario Vizza
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, 00161 Rome, Italy
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12
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Severino P, Prosperi S, D'Amato A, Cestiè C, Myftari V, Maestrini V, Birtolo LI, Filomena D, Mariani MV, Lavalle C, Badagliacca R, Mancone M, Fedele F, Vizza CD. Telemedicine: an Effective and Low-Cost Lesson From the COVID-19 Pandemic for the Management of Heart Failure Patients. Curr Heart Fail Rep 2023; 20:382-389. [PMID: 37665424 PMCID: PMC10589137 DOI: 10.1007/s11897-023-00624-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/09/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE The purpose of this review is to explore the benefits and controversies that telemedicine (TM), applied to patients with heart failure (HF), can provide in terms of diagnosis, therapeutic management, and prognosis improvement. During the coronavirus disease 19 (COVID-19) outbreak, TM emerged as the most effective and feasible method available to ensure continuous care for chronic diseases. Among these, HF, characterized by high mortality, morbidity, and the need for frequent visits, may benefit of the TM role. HF patients are affected by frequent exacerbations undergoing a progressive prognosis impoverishment, strongly depending on the disease's management. A precise clinical handling is always required, with a constant optimization of the therapy, a continuous control of risk factors, and a sensitive attention to any change in symptoms, clinical signs, and laboratory tests. In this context, TM has shown to improve therapy adherence and HF: patients' self-care, impacting the prognosis even if specific results are controversial. Major evidence shows that TM may allow an adequate primary prevention, reducing the impact of the main cardiovascular risk factors. TM can also be useful for the secondary prevention, early detecting a likely HF exacerbation before it becomes clinically manifest, thereby lowering the need for hospitalization. Moreover, an optimal up-titration of the therapy and an increase in treatment adherence are feasible by using TM. However, some studies did not show unambiguous results, and uncertainties still remain.
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Affiliation(s)
- Paolo Severino
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy.
| | - Silvia Prosperi
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Andrea D'Amato
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Claudia Cestiè
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Vincenzo Myftari
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Viviana Maestrini
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Lucia Ilaria Birtolo
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Domenico Filomena
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Marco Valerio Mariani
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Carlo Lavalle
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Roberto Badagliacca
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Massimo Mancone
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Francesco Fedele
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
| | - Carmine Dario Vizza
- Department of Clinical, Internal, Anesthesiology and Cardiovascular Sciences, Sapienza University of Rome, Viale del Policlinico, 155, 00161, Rome, Italy
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13
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Lin Y, Zhang L, Hu X, Gao L, Ji M, He Q, Xie M, Li Y. Clinical Usefulness of Speckle-Tracking Echocardiography in Patients with Heart Failure with Preserved Ejection Fraction. Diagnostics (Basel) 2023; 13:2923. [PMID: 37761290 PMCID: PMC10529773 DOI: 10.3390/diagnostics13182923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/20/2023] [Accepted: 08/31/2023] [Indexed: 09/29/2023] Open
Abstract
Heart failure with preserved ejection fraction (HFpEF) is defined as HF with left ventricular ejection fraction (LVEF) not less than 50%. HFpEF accounts for more than 50% of all HF patients, and its prevalence is increasing year to year with the aging population, with its prognosis worsening. The clinical assessment of cardiac function and prognosis in patients with HFpEF remains challenging due to the normal range of LVEF and the nonspecific symptoms and signs. In recent years, new echocardiographic techniques have been continuously developed, particularly speckle-tracking echocardiography (STE), which provides a sensitive and accurate method for the comprehensive assessment of cardiac function and prognosis in patients with HFpEF. Therefore, this article reviewed the clinical utility of STE in patients with HFpEF.
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Affiliation(s)
- Yixia Lin
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Li Zhang
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Xiaoqing Hu
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Lang Gao
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mengmeng Ji
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Qing He
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Mingxing Xie
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
| | - Yuman Li
- Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China; (Y.L.); (L.Z.); (X.H.); (L.G.); (M.J.); (Q.H.)
- Clinical Research Center for Medical Imaging in Hubei Province, Wuhan 430022, China
- Hubei Province Key Laboratory of Molecular Imaging, Wuhan 430022, China
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14
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Correale M, Tricarico L, Iacoviello M, Brunetti ND. SGLT2 Inhibitors: Statins or ACE-Inhibitors of the 21st Century? J Clin Med 2023; 12:jcm12072695. [PMID: 37048778 PMCID: PMC10095017 DOI: 10.3390/jcm12072695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 03/14/2023] [Indexed: 04/08/2023] Open
Abstract
Current guidelines propose therapeutic algorithms based on left ventricular ejection fraction values and clinical presentations; however, these guidelines do not specify which of the four pillar drugs to start first [...]
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Affiliation(s)
- Michele Correale
- Cardiothoracic Department, University Hospital Policlinico Riuniti, 71100 Foggia, Italy
| | - Lucia Tricarico
- Cardiothoracic Department, University Hospital Policlinico Riuniti, 71100 Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Massimo Iacoviello
- Cardiothoracic Department, University Hospital Policlinico Riuniti, 71100 Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
| | - Natale Daniele Brunetti
- Cardiothoracic Department, University Hospital Policlinico Riuniti, 71100 Foggia, Italy
- Department of Medical and Surgical Sciences, University of Foggia, 71100 Foggia, Italy
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