For most patients with chronic heart failure (HF), the clinical course of the disease includes periods of apparent clinical stability punctuated by episodes of clinical deterioration with worsening signs and symptoms, a condition referred to as worsening heart failure (WHF). Over time, episodes of WHF may become more frequent, and patients may enter a cycle of recurrent events associated with deterioration in their quality of life and functional capacity, hospitalizations, and ultimately death. WHF is apparently an old concept but seems to have acquired new boundaries in terms of definition and clinical and prognostic value due to the fast-paced evolution of the HF treatment landscape and the emergence of new drugs in this setting. As a result, the management of WHF is being reshaped. In the present paper, a group of HF experts gathered to discuss the concept, prevention, detection, and treatment of WHF.

Invasive hemodynamic monitoring devices provide relevant insights into the remote hemodynamic status of heart failure (HF) patients. Additionally, circulating biomarkers have been advocated as additive in HF management by offering prognostic information and therapeutic targets. However, limited data exist correlating serially measured biomarkers to hemodynamic pressures provided by invasive sensors. This study aims to investigate the association between serial biomarker patterns and pulmonary artery (PA) pressure dynamics in HF patients.

This study is a sub study of the MONITOR-HF trial (NTR7673), a prospective investigator-initiated multicenter randomized clinical trial conducted in chronic HF (CHF) patients. Blood samples were collected at baseline and 3, 6 and 12 months follow up, and 92 proteins (OLINK CV-III panel) were measured. The primary endpoint was the average mean PA pressure (mPAP) during the week preceding blood sample collection, in patients who received an invasive PA pressure sensor. Linear mixed models were used to evaluate the association between serial biomarker levels and mPAP, adjusting for sex and age, and correcting for multiple testing. This study included 165 patients who had a median age of 68 [IQR 61 - 75] years and were predominantly male (78%). Fifteen biomarkers were significantly associated with the 7-day average mPAP, with thirteen biomarkers maintaining consistent associations across different lag-times. The strongest associations were found between mPAP and N-terminal pro b-type natriuretic peptide (NT-proBNP), pulmonary surfactant protein D (PSP-D), insulin like growth factor binding protein 7 (IGFBP-7) and matrix metalloproteinase-2 (MMP-2).

We found a consistent association between invasive hemodynamic pressures and thirteen serially measured blood biomarkers in CHF patients. These results, which use unique information obtained from PA pressure sensors, could deepen the understanding and therapy guidance of congestive HF.

Unplanned admissions for worsening heart failure (WHF) are the largest resource cost in heart failure (HF) management. Despite advances in pharmacological agents and interventional therapy, HF remains a global epidemic. One crucial-and costly-gap in HF management is the inability to obtain objective information to identify and quantify congestion and personalize treatment plans to effectively manage WHF events without resorting to expensive, invasive methods. Although the causes of WHF are varied and complex, the universal effect of HF decompensation is the significant decline in quality of life due to symptoms of hypervolemic congestion and the resultant reduction in cardiac output, which can be quantified via increased pulmonary venous congestion due to high intracardiac filling pressures. Accessible and reliable markers of congestion could more precisely quantify the severity of WHF events and stabilize patients earlier by interrupting and reversing this process with timely introduction or modification of evidence-based treatments. Pulmonary artery and cardiac pressure sensing tools have gained evidential credence and increased clinical uptake in recent years for the prevention and treatment of WHF, as studies of implantable hemodynamic devices have iteratively and reliably demonstrated substantial reductions in WHF events. Recent advances in sensing technologies have ranged from single-parameter invasive pulmonary artery monitors to completely non-invasive multi-parameter devices incorporating multi-sensor concept technologies aided by machine learning or artificial intelligence, although many remain investigational. This review aims to evaluate the potential for novel pulmonary artery and cardiac pressure sensing technology to reshape the management of WHF from within the hospitalized and ambulatory care environments.

Levosimendan infusion in the outpatient setting improves the clinical status of heart failure (HF) patients, although its hemodynamic effects are not entirely known. Remote monitoring using the CardioMEMS™ system enables daily assessment of pulmonary artery pressure (PAP) and estimation of cardiac output (CO). We aimed to assess the hemodynamic effects of outpatient levosimendan infusion using CardioMEMS™.

All patients admitted for 6-hour levosimendan infusion (performed every 14 days) and using the CardioMEMS™ remote monitoring system were included in a prospective single-center registry. Clinical and laboratory data were recorded. Systolic, diastolic, and mean PAP, heart rate, CO, and stroke volume (SV) were assessed daily.

A total of 25 sessions were performed in three patients. There were no adverse events or significant therapy adjustments. There was a significant reduction in diastolic PAP the day after levosimendan infusion compared to baseline (day prior to infusion) (24.1±4.1 mmHg vs. 21.6±2.9 mmHg, p=0.006). Thereafter, diastolic PAP stabilized and remained significantly lower than baseline up to day 10. There were no significant differences in systolic PAP, mean PAP, heart rate, CO, or SV at any timepoint analyzed, although there was a nonsignificant increase in CO with a peak at day 6.

Outpatient levosimendan infusion was associated with an early reduction in diastolic PAP, which was maintained for 10 days. The CardioMEMS™ system may enable a better understanding of outpatient hemodynamics in advanced HF. To our knowledge, there are no published data on this subject.

Barriers to maximizing patient benefit with implantable defibrillation devices include limited ability to tailor antitachycardia pacing (ATP) therapy in real time and identify patients at risk of heart failure (HF) events early on. The Personalized Therapy study aims to evaluate the performance of 2 algorithms, intrinsic ATP (iATP) and TriageHF, to address these barriers in routine clinical practice.

The Personalized Therapy Study was designed as a prospective, multicenter, post-market registry study expected to enroll approximately 2200 patients meeting the following criteria: (1) implanted with a study-eligible device regardless of procedure type, (2) Medtronic CareLink Network enrolled, (3) TriageHF enabled within CareLink and High-Risk Alert notifications turned ON, and (4) iATP enabled. The primary study objectives are to demonstrate iATP effectiveness in the fast ventricular tachycardia zone and estimate the positive predictive value of TriageHF high-risk status for worsening HF. Additionally, objectives include characterizing iATP effectiveness in all ventricular detection zones and characterizing TriageHF-based clinical actions and related HF hospitalizations.

This study is expected to generate real-world evidence on the performance of the iATP and TriageHF algorithms, which aim to improve clinical practice by tailoring arrhythmia and HF therapies to individual patient disease states.

Examine the performance of a simple echocardiographic "Killip score" (eKillip) in predicting heart failure (HF) hospitalizations and mortality after index event of decompensated HF hospitalization.

HF patients hospitalized at our facility between 03/2019-03/2021 who underwent an echocardiography during their index admission were included in this retrospective analysis. The cohort was divided into 4 classes of eKillip according to: stroke volume index (SVI) < 35ml/m2 > and E/E' ratio < 15 > . An eKillip Class I was defined as SVI ≥ 35ml/m2 and E/E' ≤ 15 and was used as reference.

Included 751 patients, median age 78.1 (IQR 69.3-86) years, 59% men, left ventricular ejection fraction 45 (IQR 30-60)%, brain natriuretic peptide levels 634 (IQR 331-1222)pg/ml. Compared with eKillip Class I, a graded increase in the combined endpoint of 30-day mortality and rehospitalizations rates was noted: (Class II: HR 1.77, CI 0.95-3.33, p = 0.07; Class III: HR 1.94, CI 1.05-3.6, p = 0.034; Class IV: HR 2.9, CI 1.64-5.13, p < 0.001 respectively), which overall persisted after correction for clinical (Class II: HR 1.682, CI 0.9-3.15, p = 0.105; Class III: HR 2.104, CI 1.13-3.9, p = 0.019; Class IV: HR 2.74, CI 1.54-4.85, p = 0.001 respectively) or echocardiographic parameters (Class II: HR 1.92, CI 1.02-3.63, p = 0.045; Class III: HR 1.54, CI 0.81-2.95, p = 0.189; Class IV: HR 2.04, CI 1.1-3.76, p = 0.023 respectively). Specifically, the eKillip Class IV group comprised one-third of the patient population and persistently showed increased risk of 30-day HF hospitalizations or mortality following multivariate analysis.

A simple echocardiographic score can assist identifying high-risk decompensated HF patients for recurrent hospitalizations and mortality.

Heart failure (HF) is a leading cause of hospitalizations, with over 1 million admissions annually in the USA and Europe due to signs and symptoms of congestion. Congestion in HF is now understood to result from both an absolute increase in total body fluid volume and a relative redistribution of fluid from capacitance vessels to the effective circulation. While guideline-directed medical therapy (GDMT) has greatly improved the outlook for stable HF patients, there has been little progress in managing acute HF (AHF) over the past 50 years. To address this unmet need, a group of expert clinicians met at the 63rd Annual Romanian Society of Cardiology Meeting on September 20th, 2024. They critically evaluated current evidence and identified knowledge gaps in three key areas of AHF management: (1) enhancing diuresis beyond standard therapy; (2) targeting fluid redistribution with intravenous vasodilators; and (3) applying hemodynamic profiling for personalized care. The first part of the discussion centered on enhanced diuresis strategies, covering contemporary real-world practice patterns, the relationship between residual congestion and hospital readmissions, findings from clinical trials of diuretic strategies, and recent insights into the role of GDMT in the acute setting. The panel also highlighted the limitations of existing evidence and proposed a research roadmap to optimize diuretic strategies in conjunction with GDMT in AHF, with the ultimate goal of facilitating decongestion in order to restore euvolemia and improve post-discharge outcomes.

While there is continued progress in developing therapies for patients with heart failure, the condition results in significant morbidity and a sizeable economic impact on our society. Recent advances in wearable sensors combined with machine learning algorithms give hope that heart failure can be better managed remotely and allow for improved clinical outcomes. This is a focused review of the key findings of the SEISMocardiogram In Cardiovascular Monitoring for Heart Failure I (SEISMIC-HF 1) study, presented at the American Heart Association's Scientific Sessions 2024 in Chicago, Illinois. This study showcased the ability of a machine learning algorithm to estimate pulmonary capillary wedge pressure in patients with heart failure with reduced ejection fraction, utilizing seismocardiography, photoplethysmography, and electrocardiography signals obtained non-invasively through a wearable sensor patch (CardioTag) for model input. The authors showed a significant correlation between model-predicted pulmonary capillary wedge pressure and the gold standard pressure measurement obtained from right heart catheterization. Future investigations should assess the implementation of this technology as a part of a treatment strategy for outpatient heart failure care and explore its performance in additional study populations including those with heart failure with preserved ejection fraction and in patients outside of the clinical environment.

Heart disease encompasses a range of conditions that affect the heart, including coronary artery disease, arrhythmias, congenital heart defects, heart valve disease, and conditions that affect the heart muscle. Intervention strategies can be categorized according to when they are administered and include: 1) Monitoring cardiac function using sensor technology to inform diagnosis and treatment, 2) Managing symptoms by restoring cardiac output, electrophysiology, and hemodynamics, and often serving as bridge-to-recovery or bridge-to-transplantation strategies, and 3) Repairing damaged tissue, including myocardium and heart valves, when management strategies are insufficient. Each intervention approach and technology require specific material properties to function optimally, relying on materials that support their action and interface with the body, with new technologies increasingly depending on advances in materials science and engineering. This review explores material properties and requirements driving innovation in advanced intervention strategies for heart disease and highlights key examples of recent progress in the field driven by advances in materials research.

ZOLL Heart Failure Management System (ZOLL HFMS) is a non-invasive, remote monitoring device that employs radiofrequency signals transmitted through an adhesive patch embedded with integrated sensors to evaluate lung fluid levels. By analyzing trends in lung fluid status and related parameters, ZOLL HFMS may facilitate the early detection of heart failure (HF) decompensation and enable timely interventions. Insights from the recent BMAD trial (Impact of heart failure management using thoracic fluid monitoring from a novel wearable sensor: Results of the Benefits of Microcor [µCor™] in Ambulatory Heart Failure) highlight its promise in those with recent HF hospitalization, demonstrating a reduction in time to first HF readmission and improvement in quality of life. In this review, we summarize data on the ZOLL HFMS, with a focus on its lung fluid analysis mechanism for early HF decompensation detection and the accuracy of its measurements compared to other modalities. Then, we examine key outcomes from the recent BMAD trial, highlighting their clinical relevance and identifying gaps that warrant further investigation in future clinical trials. Lastly, we outline potential directions for integrating this technology into routine HF management.

In the past 6 years, significant breakthroughs have been achieved in the treatment of heart failure (HF), especially in drug therapy. The classification of chronic HF and the treatment methods for HF and its complications are also constantly being updated. In order to apply these results to the diagnosis and treatment of patients with HF in China and further improve the level of diagnosis and treatment of HF in China, the HF Group of Chinese Society of Cardiology, Chinese Medical Association, Chinese College of Cardiovascular Physician, Chinese HF Association of Chinese Medical Doctor Association, and Editorial Board of Chinese Journal of Cardiology have organized an expert group and update the consensus and evidence-based treatment methods in the field of HF based on the latest clinical research findings at home and abroad, combined with the national conditions and clinical practice in China, and referring to the latest foreign HF guidelines while maintaining the basic framework of the 2018 Chinese Guidelines for Diagnosis and Treatment of HF.

Congestion is the hallmark and the main therapeutic target in patients with decompensated heart failure (HF). Residual clinical congestion is defined as a high left ventricular diastolic pressure associated with signs and symptoms of HF, such as dyspnoea, rales and oedema, persisting despite guideline-directed medical treatment. Residual congestion in the predischarge and early post-discharge phase is the major risk factor for HF readmission and mortality. Therefore, prompt recognition of congestion and rapid optimisation of medical and device therapy are crucial to induce remission in this malignant process. In this paper we discuss the definitions, prevalence and prognosis of HF decompensation; the significance of assessing residual congestion in HF patients; the results of observational and randomised clinical trials to detect and treat residual congestion; and the current guidelines to prevent recurrent HF decompensation in the context of residual congestion. Strategies to detect and address residual congestion are crucial to stopping readmissions after an acute HF hospitalisation and improving long-term prognosis.

Hypoplastic left heart syndrome (HLHS) is one of the most complex congenital heart defects (CHD), characterized by a hypoplastic left ventricle (LV), dominant right ventricle (RV) and small left-sided heart structures. The introduction of the Norwood operation has significantly improved outcomes, with 5-year survival reported up to 65 %. Despite these advances, post-operative morbidity and mortality remain high, and the long-term complications in adult survivors represent a challenge. The number of HLHS patients with Fontan circulation is expected to double in the next 20 years, leading to a growing population requiring specialized care from adult congenital heart disease (ACHD) teams. This article reviews current management strategies for HLHS, outlines potential long-term complications, and highlights existing knowledge gaps. Specific considerations in this population include the assessment of the neo-aorta and aortic arch, and systemic RV dysfunction in the setting of a Fontan circulation. The proposed surveillance strategy emphasizes the need for vigilant monitoring and timely intervention to treat the complications unique to this population, ensuring better outcomes for HLHS patients reaching adulthood.

Ambulatory hemodynamic monitoring (AHM) of heart failure (HF) using pulmonary artery pressure (PAP) is marked by frequent changes in HF medications. We are beginning to learn how medication titrations during AHM affect mean PAP (mPAP) measured in the seated position, which reflects most waking hours.

We analyzed the 12-month data from the PROACTIVE-HF trial of the Cordella Cordella, Endotronix Inc, Naperville, Illinois, United States) PAP sensor system. Seated mPAP was examined in the 14-days before and after isolated changes in medications; only those medications with ≥10 titrations were analyzed. Dependent sample Wilcoxon-signed rank test was used to compare changes in mPAP with titrations.

We analyzed 456 subjects (age: 64 years, females: 40%, Black: 18%, HF with reduced ejection fraction: 46%). Loop diuretics (LD) were up-titrated 176 times in 133 patients and down-titrated 113 times in 96 patients. Before LD up-titration, mPAP increased by 1.6 ± 1.0 mm Hg; afterwards, it decreased by 2.3 ± 1.0 mm Hg (P < 0.001), with most reduction occurring within 1 week. Down-titration of LD was followed by an increase of 1.8 ± 1.3 mm Hg (P = 0.004) over the next several days. Similar trends were observed across categories of ejection fraction (≤40% and >40%). Angiotensin receptor neprilysin inhibitor (ARNI) up-titration decreased mPAP by 1.8 ± 1.9 mm Hg (P = 0.042), whereas down-titration increased mPAP by 1.5 ± 1.4 (P = 0.094). Mineralocorticoid receptor antagonist (MRA) up-titration tended to decrease mPAP (1.6 ± 2.5 mm Hg, P = 0.286,) whereas down-titration was followed by a significant increase in mPAP of 3.2 ± 1.6 mm Hg (P = 0.001).

The AHM platform using seated mPAP data provided valuable insights into its short-term responses to isolated changes in HF medications. The seated mPAP changed expectedly in response to the titration of LD, whereas the degree of response varied for ARNI and MRA. Ongoing investigation will further characterize the timing and variability of responses to inform algorithms for ambulatory management of PAP.

Pulmonary Arterial Hypertension (PAH) is an uncommon condition with high mortality. It is an underrecognized condition both in developing and developed countries, especially in developing countries, due to a lack of advanced healthcare facilities and resources for timely diagnosis. More than half of the individuals diagnosed with PAH live less than five years after diagnosis. In recent years, tremendous advancements have been made in diagnostic and therapeutic strategies for PAH patients. Phosphodiesterase 5 (PDE5) inhibitors, endothelin receptor antagonists, and prostacyclin inhibitors in various forms (oral, inhaled, intravenous, or subcutaneous) have been the cornerstone of medical treatment. Atrial septostomy, heart and lung transplant, balloon pulmonary angioplasty, and pulmonary thromboendarterectomy are existing therapeutic options currently available. There has been a continuous effort to introduce newer therapies to improve life expectancy and modify disease. Newer therapies have shown promising results but require future data to guarantee long-term safety and efficacy. We aim to discuss a few of these critical updates in the constantly evolving field of PAH.

Digital health interventions including telehealth, mobile health, artificial intelligence, big data, robotics, extended reality, computational and high-fidelity bench simulations are an integral part of the path toward precision medicine. Current applications encompass risk factor modification, chronic disease management, clinical decision support, diagnostics interpretation, preprocedural planning, evidence generation, education, and training. Despite the acknowledged potential, their development and implementation have faced several challenges and constraints, meaning few digital health tools have reached daily clinical practice. As a result, the Portuguese Society of Cardiology Study Group on Digital Health set out to outline the main digital health applications, address some of the roadblocks hampering large-scale deployment, and discuss future directions in support of cardiovascular health at large.

eHealth products have the potential to enhance heart failure (HF) care by identifying at-risk patients. However, existing risk models perform modestly and require extensive data, limiting their practical application in clinical settings. This study aims to address this gap by validating a more suitable risk model for eHealth integration.

We developed the Maastricht Decompensation Questionnaire (MDQ) based on expert opinion to assess HF patients' fluid status using common signs and symptoms. Subsequently, the MDQ was administered to a cohort of HF outpatients at Maastricht University Medical Centre. Patients with ≥ 10 MDQ points were categorised as 'decompensated', patients with < 10 MDQ points as 'not decompensated'. HF nurses, blinded to MDQ scores, served as the gold standard for fluid status assessment. Patients were classified as 'correctly' if MDQ and nurse assessments aligned; otherwise, they were classified as 'incorrectly'.

A total of 103 elderly HF patients were included. The MDQ classified 50 patients as 'decompensated', with 17 of them being correctly classified (34%). Additionally, 53 patients were categorised as 'not decompensated', with 48 of them being correctly classified (90%). The calculated area under the curve was 0.69 (95% confidence interval: 0.57-0.81; p < 0.05). Cronbach's alpha reliability coefficient for the MDQ was 0.85.

The MDQ helps identify decompensated HF patients through clinical signs and symptoms. Further trials with larger samples are needed to confirm its validity, reliability and applicability. Tailoring the MDQ to individual patient profiles may improve its accuracy.

Heart failure (HF) management increasingly relies on innovative solutions to enhance monitoring and care. Wearable devices, originally popularized for fitness tracking, show promise in clinical decision-making for HF. This study explores the application and potential for the broader integration of wearable technology in HF management, emphasizing remote monitoring and personalized care.

A comprehensive literature review was performed to assess the role of wearables in HF management, focusing on functionalities like vital sign tracking, patient engagement, and clinical decision support. Clinical outcomes and barriers to adopting wearable technology in HF care were critically analyzed.

Wearable devices increasingly track physiological parameters relevant to HF, such as heart rate, physical activity, and sleep. They can identify at-risk patients, promote lifestyle changes, facilitate early diagnosis, and accurately detect arrhythmias that lead to decompensation. Additionally, wearables may assess fluid status, identifying early signs of decompensation to prevent hospitalization and supporting therapeutic adjustments. They also enhance physical activity and optimize cardiac rehabilitation programs, improving patient outcomes. Both wearable and implanted cardiac devices enable continuous, non-invasive monitoring through small devices. However, challenges like data integration, regulatory approval, and reimbursement impede their widespread adoption.

Wearable technology can transform HF management through continuous monitoring and early interventions. Collaboration among involved parties is essential to overcome integration challenges and validate most of these devices in clinical practice.

Chronic heart failure (CHF) is a major cause of morbidity and mortality worldwide, placing a significant burden on health care systems. The concept of telemedicine for CHF was first introduced in the late 1990s, and since 2010, studies have demonstrated its potential to improve patient outcomes and reduce health care costs. Over the following decade, technological advancements and changes in health care policy led to the development of more sophisticated telemedicine solutions for CHF, including remote patient management through invasive or noninvasive telemonitoring devices, mobile apps, and virtual consultations. Years of public funding in Germany have generated evidence that remote patient management improves outcomes for patients with CHF, such as quality of life, and reduces hospital admissions. Based on these data, the Federal Joint Committee (Gemeinsamer Bundesausschuss; G-BA) decided, independently of the current European Society of Cardiology recommendations, to incorporate telemedicine as a standard digital intervention for high-risk patients with reduced left ventricular ejection fraction in Germany in 2020.

This review aims to illustrate the journey from the initial concept through pioneering studies that led to telemedicine's integration into standard care, and to share current experiences that have positioned Germany as a leader in cardiovascular telemedicine.

We review and discuss existing literature and evidence on the development and implementation of telemonitoring for CHF in Germany over the past 20 years. Relevant studies, reports, and guidelines were identified through a comprehensive search of electronic databases, including PubMed, Google Scholar, and specialized journals focused on CHF telemonitoring.

Pioneering studies, such as the TIM-HF2 (Telemedical Interventional Management in Heart Failure II) and IN-TIME (Influence of Home Monitoring on Mortality and Morbidity in Heart Failure Patients with Impaired Left Ventricular Function) trials, demonstrated the effectiveness of remote patient management applications for patients with CHF in Germany and their applicability to current practices involving both invasive and noninvasive methods. Collaborations between researchers and technology developers overcame barriers, leading to sustainable improvements in patient care. Ongoing research on artificial intelligence applications for prioritizing and interpreting individual health data will continue to transform digital health care.

The establishment of telemedical care for patients with HF across Europe is likely to benefit from experiences in Germany, where significant improvements have been achieved in the care of patients with HF.

There is an unmet need for early detection of heart failure decompensation, allowing patients to be managed remotely and avoid hospitalization.

The purpose of this study was to compare a strategy utilizing data from a wearable HF sensor for management following a HF hospitalization to usual care.

Eligible subjects were discharged from the hospital within the previous 10 days and had a HF event in the previous 6 months. The concurrent control study was divided into 2 arms; a control arm, BMAD-HF and an open-label intervention arm, BMAD-TX. The HFMS (Heart Failure Monitoring System) was worn by subjects for up to 90 days. Device data was blinded to investigators and subjects in the BMAD-HF control arm but provided proactively in the BMAD-TX intervention arm. The impact of HF management with the HFMS was evaluated by Kaplan-Meier analysis of time to first HF hospitalization.

A total of 522 subjects were enrolled in the study at 93 sites. A total of 245 subjects in BMAD-HF and 249 in BMAD-TX were eligible for intention-to-treat analysis. There were 276 hospitalizations in 189 subjects at 90 days, of which 108 events were determined to be heart failure related in 82 subjects. The subjects in the arm managed using HFMS data to direct HF therapy had a 38% lower HF hospitalization rate during the 90 days following a HF hospitalization compared to subjects in the control arm (HR: 0.62; P = 0.03).

In patients with a recent HF hospitalization, a strategy of using HFMS data for HF management is associated with a 38% relative risk reduction in 90-day HF rehospitalization. (Benefits of Microcor in Ambulatory Decompensated Heart Failure [BMAD-TX]; NCT04096040; Benefits of Microcor in Ambulatory Decompensated Heart Failure [BMAD-HF]; NCT03476187).

This work presents the design, fabrication, and rigorous validation of a flexible, wireless, capacitive pressure sensor for the full-range continuous monitoring of ventricular pressure. The proposed system consists of an implantable set and an external readout device; both modules were designed to form an RCL resonant circuit for passive, wireless pressure sensing and signal retrieving. Using surface micromachining and flexible electronics techniques, a two-variable capacitor array and a dual-layer planar coil were integrated into a flexible ergonomic substrate, avoiding hybrid-like connections in the implantable set. The proposed arrangement (capacitor array and dual-layer coil) allows us to optimize the operation pressure range and sensing distance. The use of polyimide as both the flexible substrate and the passivation material is a key feature, ensuring a biocompatible, implantable set that is mechanically flexible and can be folded to a compact size to achieve minimally invasive implantation. An external readout device has also been developed using a discrete printed circuit board (PCB) approach to support pressure measurements. The pressure responsivity of the sensor was validated to the laboratory level using a controlled pressure chamber. The results obtained show that the capacitance value of the sensor changed from 5.68 pF to 33.26 pF as the pressure varied from 0 to 300 mmHg. Correspondingly, the resonance frequency of the implantable set shifted from 12.75 MHz to 5.27 MHz. The sensitivity of the capacitive sensor was approximately 0.58 pF/mmHg and the typical response time was 220 ms. The wireless system performance was evaluated in both air and synthetic biological tissue using a Maxwell-Wien bridge circuit. The results showed a sensing distance longer than 3.5 cm, even under moderate misalignment conditions (up to 1.5 cm). The output voltage was successfully measured, ranging from 502.54 mV to 538.29 mV, throughout the full pressure range, with a measurement error of ±2.2 mV.

The "International Society for Heart and Lung Transplantation Guidelines for the Evaluation and Care of Cardiac Transplant Candidates-2024" updates and replaces the "Listing Criteria for Heart Transplantation: International Society for Heart and Lung Transplantation Guidelines for the Care of Cardiac Transplant Candidates-2006" and the "2016 International Society for Heart Lung Transplantation Listing Criteria for Heart Transplantation: A 10-year Update." The document aims to provide tools to help integrate the numerous variables involved in evaluating patients for transplantation, emphasizing updating the collaborative treatment while waiting for a transplant. There have been significant practice-changing developments in the care of heart transplant recipients since the publication of the International Society for Heart and Lung Transplantation (ISHLT) guidelines in 2006 and the 10-year update in 2016. The changes pertain to 3 aspects of heart transplantation: (1) patient selection criteria, (2) care of selected patient populations, and (3) durable mechanical support. To address these issues, 3 task forces were assembled. Each task force was cochaired by a pediatric heart transplant physician with the specific mandate to highlight issues unique to the pediatric heart transplant population and ensure their adequate representation. This guideline was harmonized with other ISHLT guidelines published through November 2023. The 2024 ISHLT guidelines for the evaluation and care of cardiac transplant candidates provide recommendations based on contemporary scientific evidence and patient management flow diagrams. The American College of Cardiology and American Heart Association modular knowledge chunk format has been implemented, allowing guideline information to be grouped into discrete packages (or modules) of information on a disease-specific topic or management issue. Aiming to improve the quality of care for heart transplant candidates, the recommendations present an evidence-based approach.

Cardiac relaxation is a complex process that involves various interconnected characteristics and, along with contractile properties, determines stroke volume. Perioperative ischemia-reperfusion injury and left ventricular diastolic dysfunction (DD) are characterized by the left ventricle's inability to receive a sufficient blood volume under adequate preload. Baseline DD and perioperative DD have an impact on postoperative complications, length of hospital stay, and major clinical outcomes in a variety of cardiac pathologies. Several baseline and perioperative factors, such as age, female sex, hypertension, left ventricle hypertrophy, diabetes, and perioperative ischemia-reperfusion injury, contribute to the risk of DD. The recommended diagnostic criteria available in guidelines have not been validated in the perioperative settings and still need clarification. Timely diagnosis of DD might be crucial for effectively treating postoperative low cardiac output syndrome. This implies the need for an individualized approach to fluid infusion strategy, cardiac rate and rhythm control, identification of extrinsic causes, and administration of drugs with lusitropic effects. The purpose of this review is to consolidate scattered information on various aspects of diastolic dysfunction in cardiac surgery and provide readers with well-organized and clinically applicable information.

Despite treatment advancements, HF mortality remains high, prompting interest in reducing HF-related hospitalizations through remote monitoring. These advances are necessary considering the rapidly rising prevalence and incidence of HF worldwide, presenting a burden on hospital resources. While traditional approaches have failed in predicting impending HF-related hospitalizations, remote hemodynamic monitoring can detect changes in intracardiac filling pressure weeks prior to HF-related hospitalizations which makes timely pharmacological interventions possible. To ensure successful implementation, structural integration, optimal patient selection, and efficient data management are essential. This review aims to provide an overview of the rationale, the available devices, current evidence, and the implementation of remote hemodynamic monitoring.

Heart failure (HF) as a syndrome which is normally associated with significant reduction of cardiac output has evolved to include conditions such those of moderate and preserved ejection fraction. While the prevalence of HF in the population is increasing, it is not HF with reduced ejection fraction that is driving the trajectory upward for mortality. There is some evidence to suggest that a better understanding of the pathophysiology, novel pharmacological strategies, devices, as well as remote monitoring of the hemodynamics seem to account for a reduction in the cardiovascular mortality and re-hospitalization in some cohorts with HF. However, the all-cause mortality associated with HF has not been reduced significantly by the current interventions. To explore the potential approaches needed for the strategies and avenues to reduce all-cause mortality in patients with HF, it would be helpful to evaluate the evidence in the literature directed at the care of patients with chronic/acute decompensated HF. It is evident that ambulatory measurements of pressures and volume are pivotal in a better management of HF but unless the interventions extend to an improvement in the renal function, the chances of reducing all-cause mortality seems modest. Therefore, future directions of interventions must not only be directed at close monitoring of pressures and volume simultaneously in HF patients but also at improving renal function. Moreover, it is clear that venous congestion plays a detrimental role in the deterioration of renal function and until measures are in place to reduce it, all-cause mortality will not decrease.

To review the most recent clinical trials and data regarding epidemiology, pathophysiology, diagnosis, and treatment of heart failure with preserved ejection fraction with an emphasis on the recent trends in cardiometabolic interventions.

Heart failure with preserved ejection fraction makes up approximately half of overall heart failure and is associated with significant morbidity, mortality, and overall burden on the healthcare system. It is a complex, heterogenous syndrome and clinical trials, to this point, have not revealed quite as many effective treatment options when compared to heart failure with reduced ejection fraction. Nevertheless, there is an expanding amount of data insight into the pathogenesis of this disease and the potential for newer therapies and management strategies. Heart failure with preserved ejection fraction pathology has been found to be linked to abnormal energetics, myocyte hypertrophy, cell signaling, inflammation, ischemia, and fibrosis. These mechanisms also intricately overlap with the significant comorbidities often associated with heart failure with preserved ejection fraction including, but not limited to, atrial fibrillation, chronic kidney disease, hypertension, obesity and coronary artery disease. Treatment of this disease, therefore, should focus on the management and strict regulation of these comorbidities by pharmacologic and nonpharmacologic means. In this review, a clinical update is provided reviewing the most recent clinical trials and data regarding epidemiology, pathophysiology, diagnosis, and treatment of heart failure with preserved ejection fraction with an emphasis on the recent trend in cardiometabolic interventions.

Heart failure (HF) and moderate-to-severe mitral regurgitation (MR) with residual elevations in left atrial pressure (LAP) after MitraClip may remain symptomatic and experience subsequent HF readmissions. The V-Wave interatrial shunt system is a permanent interatrial septal implant that shunts blood from the left-to-right atrium and serves to continuously unload the left atrium. Although the V-Wave shunt has previously been studied in patients with HF, the safety and feasibility of its deployment at the time of the MitraClip procedure is unknown. The V-Wave Shunt MitraClip Study (NCT04729933) is an early feasibility study that aims to demonstrate the safety and efficacy of implantation of the V-Wave shunt device at the time of MitraClip procedure. Patients with moderate-to-severe secondary MR with left ventricular ejection fraction 20% to 50% and New York Heart Association functional class III/IV symptoms despite optimal medical therapy, residual mean LAP ≥20 mm Hg after MitraClip, and mean LAP-right atrial pressure difference ≥5 mm Hg are included. The primary safety end point is a composite outcome of all-cause death, stroke, myocardial infarction device embolization, cardiac tamponade, or device-related re-intervention or surgery at 30 days. Patients will be followed up to 5 years. Enrollment is ongoing, with 30-day results expected by the end of 2024. The V-Wave Shunt Mitraclip Study aims to demonstrate the safety and efficacy of the implantation of the V-Wave interatrial shunt device at the time of index MitraClip placement which may serve as an adjunctive method by which continuous left atrial unloading may be achieved.

Comprehensive knowledge of the left atrium (LA) and its pathophysiology has emerged as an important clinical and research focus in the heart failure (HF) arena. Although studies on HF focusing on investigating left ventricular remodeling are numerous, those on atrial structural and functional changes have received comparatively less attention. Studies on LA remodeling have recently received increasing attention, and LA pressure (LAP) has become a novel target for advanced monitoring and is a potential therapeutic approach for treating HF. Various devices specifically designed for the direct measurement of LAP have been developed to optimize HF treatment by reducing LAP. This review focuses on LA hemodynamic monitoring and effective LAP decompression.

The scarcity of donors coupled with the improvements in left ventricular assist devices (LVAD) technology has led to the use of LVAD as a bridge to transplantation (BTT).

The authors provide an overview of the current status of LVAD BTT implantation with special focus ranging from patient selection and pre-implantation optimization to post-transplant outcomes.

The United Network for Organ Sharing 2018 policy amendment resulted in a significant reduction in the number of LVADs used for BTT in the US. To overcome this issue, modifications in the US allocation policy to consider factors such as days on device support, age, and type of complications may be necessary to potentially increase implantation rates.

In patients with chronic heart failure (HF), the MONITOR-HF trial demonstrated the efficacy of pulmonary artery (PA)-guided HF therapy over standard of care in improving quality of life and reducing HF hospitalizations and mean PA pressure. This study aimed to evaluate the consistency of these benefits in relation to clinically relevant subgroups.

The effect of PA-guided HF therapy was evaluated in the MONITOR-HF trial among predefined subgroups based on age, sex, atrial fibrillation, diabetes mellitus, left ventricular ejection fraction, HF aetiology, cardiac resynchronization therapy, and implantable cardioverter defibrillator. Outcome measures were based upon significance in the main trial and included quality of life-, clinical-, and PA pressure endpoints, and were assessed for each subgroup. Differential effects in relation to the subgroups were assessed with interaction terms. Both unadjusted and multiple testing adjusted interaction terms were presented.

The effects of PA monitoring on quality of life, clinical events, and PA pressure were consistent in the predefined subgroups, without any clinically relevant heterogeneity within or across all endpoint categories (all adjusted interaction P-values were non-significant). In the unadjusted analysis of the primary endpoint quality-of-life change, weak trends towards a less pronounced effect in older patients (Pinteraction = .03; adjusted Pinteraction = .33) and diabetics (Pinteraction = .01; adjusted Pinteraction = .06) were observed. However, these interaction effects did not persist after adjusting for multiple testing.

This subgroup analysis confirmed the consistent benefits of PA-guided HF therapy observed in the MONITOR-HF trial across clinically relevant subgroups, highlighting its efficacy in improving quality of life, clinical, and PA pressure endpoints in chronic HF patients.

Heart failure is a prevalent and severe medical condition characterized by the heart's inability to pump blood efficiently, leading to poor circulation and symptoms such as pulmonary congestion. Despite advancements in medical treatments, many patients continue to experience significant symptoms with reduced quality of life. This article explores the left atrial coronary sinus shunt as an innovative interventional strategy to address hemodynamic issues in heart failure. The shunt aims to decrease left atrial pressure and alleviate pulmonary congestion by creating a connection between the left atrium and the coronary sinus.

Pulmonary hypertension associated with left heart disease (PH-LHD) remains the most common cause of pulmonary hypertension globally. Etiologies include heart failure with reduced and preserved ejection fraction and left-sided valvular heart diseases. Despite the increasing prevalence of PH-LHD, there remains a paucity of knowledge about the hemodynamic definition, diagnosis, treatment modalities, and prognosis among clinicians. Moreover, clinical trials have produced mixed results on the usefulness of pulmonary vasodilator therapies for PH-LHD. In this expert review, we have outlined the critical role of meticulous hemodynamic evaluation and provocative testing for cases of diagnostic uncertainty. Therapeutic strategies-pharmacologic, device-based, and surgical therapies used for managing PH-LHD-are also outlined. PH-LHD in advanced heart failure, and the role of mechanical circulatory support in PH-LHD is briefly explored. An in-depth understanding of PH-LHD by all clinicians is needed for improved recognition and outcomes among patients with PH-LHD.

Cardiac implantable electronic devices (CIEDs) offer the benefit of remote monitoring and decision making and find particular applications in special populations such as the elderly. Less transportation, reduced costs, prompt diagnosis, a sense of security, and continuous real-time monitoring are the main advantages. On the other hand, less physician-patient interactions and the technology barrier in the elderly pose specific problems in remote monitoring. CIEDs nowadays are abundant and are mostly represented by rhythm control/monitoring devices, whereas hemodynamic remote monitoring devices are gaining popularity and are evolving and becoming refined. Future directions include the involvement of artificial intelligence, yet disparities of availability, lack of follow-up data, and insufficient patient education are still areas to be improved. This review aims to describe the role of CIED in the very elderly and highlight the merits and possible drawbacks.

Inadequate inclusion in clinical trial enrollment may contribute to health inequities by evaluating interventions in cohorts that do not fully represent target populations.

The aim of this study was to determine if characteristics of patients with heart failure (HF) enrolled in a pivotal trial are associated with who receives an intervention after approval.

Demographics from 2,017,107 Medicare patients hospitalized for HF were compared with those of the first 10,631 Medicare beneficiaries who received implantable pulmonary artery pressure sensors. Characteristics of the population studied in the pivotal CHAMPION (CardioMEMS Heart Sensor Allows Monitoring of Pressure to Improve Outcomes in NYHA Class III Heart Failure Patients) clinical trial (n = 550) were compared with those of both groups. All demographic data were analyzed nationally and in 4 U.S. regions.

The Medicare HF cohort included 80.9% White, 13.3% African American, 1.9% Hispanic, 1.3% Asian, and 51.5% female patients. Medicare patients <65 years of age were more likely to be African American (33%) and male (58%), whereas older patients were mostly White (84%) and female (53%). Forty-one percent of U.S. HF hospitalizations occurred in the South; demographic characteristics varied significantly across all U.S. regions. The CHAMPION trial adequately represented African Americans (23% overall, 35% <65 years of age), Hispanic Americans (2%), and Asian Americans (1%) but underrepresented women (27%). The trial's population characteristics were similar to those of the first patients who received pulmonary artery sensors (82% White, 13% African American, 1% Asian, 1% Hispanic, and 29% female).

Demographics of Centers for Medicare and Medicaid Services beneficiaries hospitalized with HF vary regionally and by age, which should be considered when defining "adequate" representation in clinical studies. Enrollment diversity in clinical trials may affect who receives early application of recently approved innovations.