Cardiovascular Disease: From Clinical Diagnosis to Management and Treatment

Background and Objectives: SGLT2 inhibitors increase hemoglobin and hematocrit in multiple clinical settings, an effect increasingly attributed to stimulation of erythropoiesis rather than hemoconcentration. However, most mechanistic evidence derives from diabetic populations, leaving uncertainty as to whether this response depends on diabetes-related metabolic changes. To evaluate whether dapagliflozin stimulates erythropoiesis in non-diabetic patients with heart failure and to determine whether hematologic changes correlate with renal, cardiac, inflammatory, hepatic, or iron-related parameters. Materials and Methods: In this retrospective observational study, each of 68 non-diabetic heart failure patients served as their own control. Hematologic, renal, cardiac, inflammatory, hepatic, and iron parameters were assessed at three time points: one year prior to dapagliflozin initiation, at baseline, and one year after initiation of therapy. Changes were analyzed using paired tests and correlation analyses. Results: Hemoglobin, hematocrit, and red blood cell count were significantly lower at the baseline compared with values recorded one year before dapagliflozin initiation and increased significantly during the year following treatment (all p < 0.001), while mean corpuscular indices remained stable. Serum iron decreased before treatment and increased significantly after dapagliflozin initiation (p < 0.05 vs. baseline); however, changes in serum iron did not correlate significantly with changes in hemoglobin after treatment. Inflammatory markers showed a modest reduction in C-reactive protein after treatment, while composite inflammatory indices remained largely stable. Liver enzymes showed no significant longitudinal changes. Correlation analyses demonstrated no association between changes in hemoglobin and changes in eGFR (ρ = 0.202, p = 0.098) or NT-proBNP (ρ = −0.003, p = 0.981) after treatment. Hematologic variables remained strongly intercorrelated, whereas cross-system correlations were minimal, indicating that erythropoietic stimulation occurred largely independently of renal or cardiac functional trajectories. Conclusions: Dapagliflozin robustly stimulates erythropoiesis in non-diabetic patients with heart failure, independent of improvements in kidney or cardiac function. Although serum iron levels improved after treatment, the absence of a direct correlation with hemoglobin suggests that iron mobilization may act as a permissive rather than a primary driver of erythropoietic response. These findings support the concept that erythropoiesis represents a diabetes-independent pharmacologic action of SGLT2 inhibitors and may involve renal, hepatic, inflammatory, and iron-regulatory pathways beyond those described in diabetic physiology. Dedicated mechanistic studies in non-diabetic populations are warranted. Full article

Background and Objectives: Frail patients after open-heart surgery often experience worse treatment outcomes in improving physical performance and muscle strength. As the functional recovery of frail patients after open-heart surgery is slower, conventional rehabilitation is frequently insufficient to achieve treatment goals. Therefore, the inclusion of additional exercise interventions in cardiac rehabilitation is becoming more relevant. The aim of this study was to assess and compare the effectiveness of additional exercise interventions—multicomponent and computer-based programs—applied along with conventional cardiac rehabilitation in improving the functional capacity and strength of frail patients after open-heart surgery. Materials and Methods: The population of this single-center, three-arm, parallel-group, randomized controlled trial comprised 153 frail patients aged more than 65 years who underwent open-heart surgery. All patients were randomized into three groups: control (CG, n = 51), intervention 1 (IG-1, n = 51), and intervention 2 (IG-2, n = 51). All groups received conventional rehabilitation program six times/week, while the IG-1 additionally received the multicomponent dynamic training program 3 times/week, and the IG-2, the combined computer-based program 3 times/week. The primary outcome measure was change in the Short Physical Performance Battery (SPPB) score. Secondary outcome measures included the 6 min walk distance (6MWD), peak workload, grip strength, and leg press. Primary and secondary outcome measures were assessed before and after cardiac rehabilitation. Results: A total of 138 patients completed rehabilitation (46 in each group), and their data were included in the main analysis that followed a per-protocol approach. Although significant differences in the primary outcome—the SPPB score—were found in each group while performing within-group comparisons (p < 0.001), no significant pre-to-post rehabilitation differences were observed compared to all three groups (p = 0.939), and the effect sizes were small. Regarding secondary outcome measures, within-group comparison revealed significant differences in all parameters of all groups (p < 0.05), except for the grip strength of both hands in the IG-1. Between-group comparisons showed that the pre-to-post 6MWD difference between the CG and the IG-1 was significant (p = 0.014), but the effect size was small (ES = 0.240). Moreover, significant pre-and-post leg press 1RM differences (p < 0.001) were found between the CG and the IG-1 as well as between the CG and the IG-2 with the effect sizes being moderate (ES = 0.480) and large (ES = 0.613), respectively. Conclusions: Within-group comparison showed that all three rehabilitation programs are effective in improving almost all parameters of physical performance and muscle strength in frail patients after open-heart surgery. However, between-group comparisons indicated that computer-based interventions were more effective in improving leg press 1RM with a large effect size, while multicomponent training resulted in more effective gains in the 6MWD, although with a small effect size. These findings suggest that in clinical practice, computer-based exercise programs may be more suitable for patients with muscle weakness, while multicomponent exercise programs may be for those with reduced endurance. Full article

Background and Objectives: Premature atrial contractions (PACs) and premature ventricular contractions (PVCs) commonly occur after coronary artery bypass grafting (CABG) surgery, with frequent ectopics linked to atrial fibrillation risk and reduced heart function. While CABG-induced inflammation causes arrhythmogenic changes, the connection between preoperative inflammatory markers and postoperative ectopic burden has not been studied. Therefore, the aim of the present study is to evaluate the association between preoperative inflammatory biomarkers and postoperative atrial and ventricular ectopic burden, and to determine their influence on clinical outcomes following elective CABG procedures. Materials and methods: This study assessed preoperative plasma levels of highly sensitive C-reactive protein (hs-CRP), von Willebrand factor (vWF), transforming growth factor-β (TGF-β), interleukin (IL)-2, IL-1β, IL-6, IL-8, and vascular endothelial growth factor (VEGF) using the Multiplex technique in patients undergoing elective CABG. A continuous 24-h ECG Holter monitoring was performed one day before CABG, as well as on days 2, 3, and 4 post-CABG. The PACs and PVCs burdens were quantified, and correlations with clinical parameters were analyzed. Results: Preoperative plasma concentrations of vWF, TGF-β, and IL-8 exhibited significant positive correlations with postoperative PACs (p < 0.001, p = 0.03, and p < 0.001, respectively). Preprocedural hs-CRP, TGF-β, IL-6, and IL-8 levels showed significant positive associations with PVCs (p < 0.0001, p < 0.0001, p = 0.02, and p < 0.0001, respectively). However, none of the tested biomarkers could predict other postoperative outcomes, such as acute kidney injury, acute liver failure, duration of inotropic support, and days of hospitalization. Conclusions: Preoperative inflammatory biomarkers may serve as predictive tools for postoperative ectopic activity following CABG. Early identification of high-risk patients could enable prophylactic strategies and improve post-CABG outcomes. Full article

Transcatheter aortic valve implantation (TAVI) has redefined the management of severe aortic stenosis, particularly in surgical high-risk patients. As the number of TAVI procedures increases, there is a growing need for effective post-procedural care. Cardiac rehabilitation (CR) has emerged as a critical component of treatment in these patients. The most recent update of the European recommendations highlights the importance of including post-TAVI patients in CR programs. However, the benefits of CR in this particular patient group still need to be fully understood. The objective of this narrative review is to summarize the safety and benefits of post-TAVI CR by evaluating its impact on functional capacity, frailty, muscular strength, mental health, quality of life, and long-term survival. While emerging evidence supports its safety and effectiveness in the aforementioned outcomes, gaps remain regarding the optimal rehabilitation protocols, including the timing, duration, and intensity of CR as well as its long-term cardiovascular benefits. Further research is needed to develop personalized approaches for different patient groups. This article highlights the current knowledge, identifies critical gaps, and underlines the need for tailored rehabilitation strategies to improve post-TAVI recovery and patient outcomes. Full article

Background and Objectives: Heart failure (HF) affects millions globally, with traditional cardiac rehabilitation (CR) improving outcomes but facing access barriers. Telehealth-based CR offers a promising alternative, yet its effectiveness and patient-centred outcomes require updated evaluation. This systematic review aimed to assess the effectiveness, accessibility, and patient-centred outcomes of telehealth-based CR compared with usual care or centre-based CR in adults with HF. Materials and Methods: This systematic review followed PRISMA 2020 guidelines. Eligible studies were randomized controlled trials involving adults with HF receiving telehealth CR (e.g., telephone, apps, remote monitoring) compared with usual care or centre-based CR; non-RCTs and studies lacking relevant outcomes were excluded. Searches of PubMed, Medline, CINAHL, EMBASE, and Web of Science identified studies published between 2020–2025. Primary outcomes were exercise capacity (six-minute walk distance [6MWD], peak VO₂) and quality of life (QoL); secondary outcomes included adherence, satisfaction, and clinical events. Meta-analyses used standardized mean differences (SMD) for 6MWD and QoL. Risk of bias was assessed using PEDro, Jadad, and RoB2 tools. Results: Fourteen randomized controlled trials (total n = 7371 participants) met the inclusion criteria. Telehealth CR significantly improved 6MWD (SMD 0.35, 95% CI 0.15–0.55, p < 0.001; 6 studies) and QoL (SMD 0.28, 95% CI 0.10–0.46, p = 0.002; 8 studies) compared to usual care, showing equivalence to center-based CR. Adherence ranged from 70–92% and satisfaction 75–96%, and hospitalizations declined in some studies, though mortality benefits were not observed. Conclusions: Telehealth CR is effective, accessible, and patient-centred for individuals with HF, performing comparably to centre-based CR and better than usual care. It should be integrated into standard HF management, supported by policy and technology investment. Evidence is limited by short follow-up durations and moderate heterogeneity among trials. Full article