Special Interview with Dr. Ying Su and Dr. Minghao Luo: Organ Interactions in Heart Failure: Physiology, Pathophysiology, and Therapeutics

9 July 2025

 

We are honored to invite the Guest Editors of this special issue of Reviews in Cardiovascular Medicine, Dr. Ying Su and Dr. Minghao Luo, for an in-depth and insightful discussion on its core theme of “Organ Interactions in Heart Failure: Physiology, Pathophysiology, and Therapeutics”. During the interview, the two experts not only shared their unique observations on the developing trends in this research field, but also reviewed the original intention and goals of the special issue. In addition, they elaborated on their expectations and thoughts regarding future research directions. Below, we present their responses regarding the thinking and planning of ideas on this topic.

 

   Ying Su, MD
   Cardiac Intensive Care Center, Zhongshan Hospital, Fudan University, Shanghai, China
   Interests: acute kidney injury; renal replacement therapy; cardiogenic shock; extracorporeal membrane oxygenation; 
   perioperative management
    

   Ming-hao Luo, MD
   Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
   Interests: systemic inflammation; organ dysfunction; immunomodulation; cardiogenic shock; sepsis
    

 

 

Q1: Could you please briefly introduce your research experience and major directions?

Dr. Su:

I am affiliated with Zhongshan Hospital, Fudan University. My research background is relatively broad and spans several areas. Early in my career, I focused primarily on acute lung injury, particularly severe pneumonia and acute respiratory distress syndrome (ARDS). As my work evolved, I gradually shifted toward critical cardiac conditions and acute kidney injury. Overall, my research covers multiple organ systems in the field of critical care, reflecting a diverse and multidisciplinary background.

Dr. Luo:

I completed my PhD in the Intensive Care Unit of the Cardiovascular Surgery Department at Zhongshan Hospital. This research focused on organ dysfunction following surgery for type A aortic dissection. From a pathophysiological standpoint, I have been particularly interested in systemic inflammatory responses and their role in multi-organ dysfunction, with an emphasis on the identification of organ failure and the development of strategies to improve organ function.

My current research continues to focus on systemic inflammation and organ dysfunction in critical illness. In addition to studying systemic inflammation caused by cardiac-related hypoperfusion, I also explore inflammation driven by other causes, such as sepsis, and its effects on the immune system and tissue perfusion. This year I have focused on mechanistic studies aimed at uncovering the pathophysiological pathways through which systemic inflammation leads to organ dysfunction, thereby bridging basic science with clinical insights.

 

Q2: Why did you choose the theme of "Organ Interactions in Heart Failure: Physiology, Pathophysiology, and Therapeutics" for this special issue? What is the particular significance of this theme within the current research field?

Dr. Su:

Heart failure and cardiogenic shock are major clinical challenges and have high incidence rates. In essence, the impairment of heart function leads to reduced systemic perfusion, accompanied by a decrease in cardiac output. This systemic syndrome results in reduced perfusion of peripheral organs. Due to several advances in cardiovascular interventional techniques, the mortality rate of patients with heart failure or cardiogenic shock has decreased significantly in recent years. However, once mortality falls to a certain threshold, it becomes increasingly difficult to achieve further improvement.

We gradually came to realize that heart failure is not merely a heart problem, but also involves interactive effects with organs such as the kidneys, liver, and lungs. Therefore, we hope this special issue can help to transform clinical practice from single-organ management to multi-organ collaborative management, as well as provide new ideas for diagnosis and treatment.

 

Q3: What key issues still need to be addressed in the treatment of cardiogenic shock?

Dr. Su:

Among patients with cardiogenic shock, the incidence of single organ dysfunction is relatively high. According to the international literature, approximately 36% of patients have at least one organ dysfunction. Among these, nearly half have multiple organ dysfunction, together with an increased risk of in-hospital mortality.

The current classification system for cardiogenic shock is still incomplete. In 2019, the Society for Cardiovascular Angiography and Interventions (SCAI) released its classification for cardiogenic shock, which it divided into five levels: A, B, C, D, and E. This classification is relatively static and does not account for dynamic progression of the patient's condition in clinical practice, with the changes in most patients being very rapid. Moreover, it does not incorporate the most important time variable, which is the speed of disease progression. In addition, the classification, management strategies, and risks for the different causes of cardiogenic shock, such as acute coronary syndrome, valvular disease, and myocarditis, are not the same.

Therefore, incorporation of dynamic assessment is essential, because simply relying on the assessment of a single time point when assessing critically ill patients is not sufficient.

In recent years, some technological advancements in cardiovascular care have emerged. These include the use of percutaneous mechanical circulatory support (e.g., aortic balloon counter-pulsation), percutaneous ECMO, percutaneous left heart assist devices or Impella, etc. The application of these new technologies can now provide a diverse range of options for patients with cardiogenic shock. However, the indications and optimal timing for their use remains controversial, and there is also a lack of consensus.

We are currently witnessing an increase in the integration of big data with AI. The AI models based on big data are gradually being introduced into the medical system. However, the application of AI for the cardiovascular system is still at an early stage.

The theme of this special issue is highly inclusive, and the arrangement of its contents are relatively open. We welcome contributions that address common clinical issues in the management of heart failure or cardiogenic shock, regardless of the relative importance of the issue. We also hope to focus more attention on controversial or widely discussed topics. Even if only partial consensus is reached on certain aspects, this could still be very meaningful.

 

Q4: What changes in clinical practice need to be made in the management of patients with heart failure?

Dr. Su:

The central theme here is to emphasize the multidisciplinary diagnosis and treatment model, as well as the philosophy for managing patients with heart failure or cardiogenic shock. When managing patients with critical cardiogenic shock, the focus should not be solely on cardiac function recovery, and equal attention must also be paid to other organ functions. For instance, in cardiorenal syndrome, bidirectional interactions occur between the heart and kidneys. Additionally, patients with right heart dysfunction typically present with hepatic congestion and intestinal dysfunction (digestive system insufficiency), since these organs can exert mutual influence on each another.

The main goal of this special issue is to emphasize the shift in clinical perspective from a heart-centered focus towards a broader, critical care-oriented approach to patient management and prognosis.

 

Q5: In terms of risk assessment and treatment methods, what key breakthrough directions are expected to emerge in future?

Dr. Su:

Personally, I would like this special issue to include research on early warning indicators for patients with cardiogenic shock. This includes emerging biomarkers, especially those unrelated to cardiac function, as well as novel monitoring techniques. For example, new methods for assessing microcirculatory perfusion in shock could be integrated into risk assessment systems to help with earlier identification of high-risk patients.

In terms of treatment, the appropriate timing for various therapeutic strategies (e.g., mechanical circulatory support) and the prevention and management of different complications are also highly relevant topics.

We welcome authors to share their treatment experiences so that together we can advance the clinical management of cardiogenic shock.

 

Q6: As the planners of this special issue, what topics do you hope the submissions will focus on? How will these topics play a role in the field of heart failure research?

Dr. Luo:

The theme of this special issue focuses on therapies that integrate physiological and pathophysiological perspectives. Therefore, it is important to focus on research relating to the integration of mechanisms and clinical applications, such as organ interactions that involve several of the proposed pathophysiological mechanisms. For example, the traditional view holds that hemodynamic and neuro-immune mechanisms may lead to activation of the renin-angiotensin system (RAS). Furthermore, heart failure involves a mechanism leading to insufficient perfusion, together with an inflammatory immune mechanism. To date, there has been relatively little research on the consequences of multi-organ damage caused by these mechanisms acting in concert. In some cases, such as the heart-kidney, heart-lung, or heart-brain axes, there are still no mechanistic models to explain the causes and final clinical outcomes. Therefore, I believe it is critical to combine clinical research with basic research, and this should be an important component of our special issue.

The involvement of multiple organs in heart failure naturally highlights the importance of interdisciplinary integration. The connections and interactions between different organs mean that physicians specializing in critical care medicine, cardiology, nephrology and respiratory medicine are all implicated in patient management. In this issue, doctors from different specialties have the opportunity to report their experiences on the patients they have treated. Besides the cardiogenic shock patients encountered in critical care, there are also heart failure patients in general wards who may exhibit interactions between different organ functions. Therefore, the interdisciplinary experiences also provide a very important perspective.

Finally, as mentioned by Dr. Su, although the classification of cardiogenic shock is divided into different types, it is still considered as a broad category. However, there are many different clinical manifestations and molecular phenotypes for different heart failures. By focusing on specific organ functions or interactions between organs, novel perspectives on different types of heart failure can be obtained, with different strategies for intervention and predictive research. Individualized treatment strategies can then be applied after performing various analyses of data from the model.

 

Q7: For authors who plan to submit their work to this special issue, what specific suggestions do you have? What are the key elements in terms of topic selection, research design, and writing?

1. Topic selection:

Dr. Luo:

When selecting a topic, a crucial consideration is to focus on clinically meaningful problems—those with real-world impact and practical relevance. On this basis, it is important to integrate basic pathophysiological research with clinical investigation by using data from multiple sources to address key clinical questions. Such topics will be given priority. Therefore, actual clinical significance and clinical impact should be demonstrated, as well as the possibility of combining mechanisms into clinical practice.

Dr. Su:

Challenges encountered during the management of patients with heart failure or cardiogenic shock, regardless of their scope, are all welcome for submission. As mentioned by Dr Luo, the key point is that they be clinically meaningful. Regardless of whether the work is clinical or translational, it may be acceptable as long as it addresses issues that are relevant to clinical practice. Contributions that focus on a specific treatment strategy, a particular drug, or the prevention of complications can be valuable—provided they involve rigorous scientific methodology and are supported by data.

2. Research design:

Dr. Luo:

Firstly, we emphasize the rigor of research design. For basic or animal experiments, the focus is not on the experiments themselves, but on whether research into the underlying pathophysiological mechanism has clear clinical translational value, i.e., whether it provides mechanistic insights for the benefit of clinical practice, as well as providing a theoretical foundation for future translational studies.

We particularly welcome clinical studies. For retrospective studies, special attention should be paid to sample size, research methodology, and statistical analysis. Although randomized controlled trials (RCTs) are still relatively scarce in this field, any RCT submissions must strictly adhere to reporting guidelines. Internationally recognized reporting standards currently exist for both retrospective and prospective studies. Therefore, we emphasize that a rigorous research design and methodology are essential, and that comprehensive reporting of key elements must not be overlooked.

Dr. Su:

Retrospective research studies have inherent disadvantages and therefore require more rigor during preparation for submission. The data collection process should be as complete as possible, and any limitations of the research design should be clearly stated.

The statistical analysis should also be as rigorous as possible, and it is preferable to discuss the research methods with statistical experts. The overall requirements for high quality articles are constantly improving, and the standardization and rationale of statistical methods are particularly crucial.

In terms of research design, the main research endpoints are usually the mortality rate, adverse cardiac events, hospitalization rate, and other classic outcomes. However, as mentioned by Dr. Luo, attention should also be paid to other indicators for assessing organ dysfunction, and these should be incorporated into the design of the research endpoints. In other words, there is no need to limit the outcomes to a single indicator. For primary endpoints in which it is difficult to obtain positive results, alternative or secondary outcomes can also be considered to allow a more comprehensive evaluation of the intervention effect.

3. Writing of submissions

Dr. Luo:

In terms of preparing submissions, several points are particularly worthy of attention. Firstly, in the research content it is important to avoid focusing solely on the outcomes of a single organ. Numerous studies have focused on the insufficient perfusion caused by cardiogenic shock or heart failure, and its impact on healthcare costs. However, a research study that covers multiple organ functions is more in line with clinical reality, while also increasing its innovation value and potential impact. This multi-organ interaction perspective reflects the core theme highlighted in this special issue: "Interactions between Organs".

Secondly, special attention should be paid to the presentation of a clear structure, as well as to the reproducibility of the methodology. Key elements of the research design should be clearly described in the methodology section, such as the inclusion and exclusion criteria, basis for groupings, etc. These details not only lend credibility to the research, but also provide valuable references and direction for subsequent related research. In summary, writing of the research submission should reflect the breadth and depth of the content, while demonstrating rigor and methodological standardization. These attributes will help to improve the quality of the paper and increase its academic impact.

 

Q8：For young researchers and clinicians, how do you suggest they conduct interdisciplinary collaboration to better address research into multi-organ interactions in heart failure?

Dr. Luo:

Many young clinical doctors and researchers often feel isolated at the beginning of their careers, with no clear direction on how to start their research work. In this regard, I believe there are several key points that deserve special attention.

First, be proactive in establishing your research network. This can be achieved by frequent attendance at academic conferences in various disciplines. As an example, the study of multi-organ interactions involves multiple systems such as the heart, lungs, and kidneys. Therefore, heart failure research is not limited to cardiovascular conferences, but can also include conferences on respiration, kidneys, and nerves that cover issues related to organ function. These interdisciplinary conferences provide important platforms that help to broaden our horizons, meet peers, and build collaborative networks.

Second, start with small projects to accumulate experience. For instance, one can begin with retrospective studies based on existing clinical data or experimental resources, and address specific problems within one's own capabilities. During this process, practical experience can be gained in research design, data processing, and manuscript writing, thus laying the foundation for future larger-scale or interdisciplinary collaborative research.

Thirdly, the leveraging of team resources enables the establishment of cross-disciplinary collaboration. Complete research projects cannot be accomplished by single individuals, and especially by young doctors. Therefore, they should fully utilize the resources available within their department or hospital to collaborate with experts in statistics, bioinformatics, image analysis, etc. to form cross-disciplinary research teams. The researcher should identify their own weaknesses so that appropriate cooperation and assistance can be sought. This helps to compensate for the lack of expertise, while also contributing to the scientific rigor of the research work. In summary, when conducting research, young doctors should be proactive, pragmatic, and skilled at integrating resources. They should start on small projects, grow through cooperation and collaboration, and gradually build their own research path and academic influence.

 

This interview not only showcases the profound expertise and forward-thinking of Dr. Su Ying and Dr. Luo Minghao in the field of heart failure and multi-organ interaction, but further highlights the importance of the transformative concept "from organ to system" in clinical management. The planning and promotion of this special issue should help the relevant fields embrace a more multi-dimensional, integrated and precise development path. We sincerely invite all researchers and clinical colleagues to continue following this column and jointly explore collaborative strategies to address the complex mechanism of heart failure.

Special Issue Details：https://www.imrpress.com/journal/RCM/special_issues/organ_interactions_HF

 

Manuscripts should be submitted via our online editorial system at https://imr.propub.com by registering and logging in to this website. Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers).