Search Results (33)

Background/Objectives: Tricuspid valve surgery carries a high risk of postoperative acute kidney injury (AKI) due to pre-existing right ventricular dysfunction and congestive end-organ remodeling. We aimed to evaluate the incidence and predictors of postoperative AKI, with particular focus on the prognostic value of the TAPSE/sPAP index. Methods: This retrospective, single-center study evaluated adult patients who underwent tricuspid valve surgery (isolated/concomitant) between 2010 and 2025. The primary outcome was postoperative AKI of any stage, defined by the Kidney Disease: Improving Global Outcomes (KDIGO) criteria. Predictors were identified using a pre-specified multivariable logistic regression model including baseline estimated glomerular filtration rate (eGFR), cardiopulmonary bypass time, and EuroSCORE II; TAPSE/sPAP associations with severe renal outcomes were assessed univariably and presented as exploratory. Results: Of 80 patients, postoperative AKI occurred in 32 (40.0%), with 16 (20.0%) requiring renal replacement therapy. The pre-specified multivariable model discriminated any-stage AKI (AUC 0.86, 95% CI 0.77–0.94). Lower baseline eGFR (adjusted OR 1.82 per 10 mL/min/1.73 m² decrease, p < 0.001) and higher EuroSCORE II (adjusted OR 1.53 per point, p = 0.03) were independent predictors. The TAPSE/sPAP index was not associated with any-stage AKI (p = 0.42), but lower values predicted advanced renal outcomes, including KDIGO stage ≥ 2 AKI (OR 2.11, p = 0.03) and the requirement for renal replacement therapy (OR 2.71, p = 0.01). Outcomes did not differ between isolated (n =14) and combined procedures (n = 66; AKI 35.7% vs. 40.9%, p = 0.77). Conclusions: Lower preoperative eGFR and higher EuroSCORE II independently predict any-stage postoperative AKI. In univariable analysis, the TAPSE/sPAP index identified the subgroup with severe renal outcomes; this exploratory finding requires prospective validation. Whether perioperative renal protection depends on addressing right-sided filling pressures rather than augmenting forward flow alone requires prospective testing. Full article

Background: Pulmonary Alveolar Proteinosis (PAP) is a rare interstitial lung disease characterized by intra-alveolar accumulation of lipoproteinaceous material. Although its radiologic features are well documented, the disease’s impact on cardiovascular mechanics—specifically right ventricular (RV) adaptation—remains underexplored. This study aims to explore the correlation between radiologic severity of parenchymal involvement, quantified by high-resolution computed tomography (HRCT) scores, and right heart hemodynamics, with a focus on RV-pulmonary artery (RV-PA) coupling and interventricular interaction. Methods: This retrospective observational study analyzed 13 adult patients with confirmed PAP and 70 age- and sex-matched healthy controls. All participants underwent concurrent thoracic HRCT and transthoracic echocardiography. Structural lung damage and “crazy-paving” patterns were quantified using a total lobar HRCT score ranging from 0 to 30. Echocardiographic evaluation assessed right heart hemodynamics, using the tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure ratio (TAPSE/sPAP) as an index of RV-PA coupling and the RV/LV ratio. Given the small sample size, p-values for correlations were adjusted for multiple comparisons using the Bonferroni method, and findings should be regarded as exploratory. Results: Left ventricular parameters were preserved across both groups. However, PAP patients had significantly impaired right heart indices compared with controls, including a larger RV basal diameter (37.2 ± 2.3 vs. 32.6 ± 1.6 mm, p < 0.001), higher sPAP (38.5 ± 3.5 vs. 23.6 ± 2.9 mmHg, p < 0.001), and a higher RV/LV ratio (0.98 ± 0.19 vs. 0.60 ± 0.06, p < 0.001). Furthermore, the RV-PA coupling marker, TAPSE/sPAP, was markedly reduced in the PAP cohort (0.43 ± 0.07 vs. 0.88 ± 0.13 mm/mmHg, p < 0.001). After Bonferroni correction, elevated HRCT scores remained strongly associated with a higher RV/LV ratio (r = 0.89, p < 0.001) and a lower TAPSE/sPAP ratio (r = −0.90, p < 0.001). Subgroup analysis indicated that patients with severe radiological scores had more pronounced RV enlargement and lower RV-PA coupling reserves. Conclusions: In this exploratory analysis, radiographic severity of alveolar lipoproteinaceous accumulation in PAP was strongly associated with isolated right ventricular dysfunction and impaired RV-PA coupling, despite preserved left heart function. These hypothesis-generating findings suggest that echocardiographic assessment of TAPSE/sPAP and RV/LV ratios may be useful for the clinical follow-up of PAP patients; however, causality cannot be inferred from this small, retrospective, single-center cohort, and larger prospective studies are warranted. Full article

Background: Although chronic venous insufficiency is often treated as a localized problem, it is a systemic condition that can negatively affect cardiac hemodynamics. This study investigates the associated effects of eliminating the pathologic venous reservoir on right ventricular (RV) functions, systolic pulmonary artery pressure (sPAP), and inferior vena cava (IVC) diameter in patients undergoing endovenous radiofrequency ablation (RFA) for severe great saphenous vein (GSV) insufficiency. Methods: This retrospective observational study included 154 patients who presented between September 2023 and May 2025 with GSV insufficiency (CEAP C3-C4b) and underwent endovenous RFA. Patients with major cardiopulmonary diseases were strictly excluded. Preoperative and 6-month postoperative transthoracic echocardiography records were analyzed to evaluate RV diastolic diameter, tricuspid annular plane systolic excursion (TAPSE), sPAP, the TAPSE/sPAP ratio, and IVC diameter. Results: At 6 months post-RFA, compared to preoperative values, a significant decrease was detected in the mean sPAP (14.7 ± 2.5 vs. 11.8 ± 1.8 mmHg, p < 0.001) and IVC diameter (2.1 ± 0.2 vs. 1.9 ± 0.2 cm, p < 0.001). Furthermore, significant improvements were observed in TAPSE (20.0 ± 2.0 vs. 21.5 ± 1.8 mm, p < 0.001) and the TAPSE/sPAP ratio (1.36 ± 0.15 vs. 1.82 ± 0.18 mm/mmHg, p < 0.001). Conclusions: Endovenous RFA is associated with favorable changes in right heart parameters. Eliminating pathologic extremity blood pooling may optimize venous return kinetics and subclinically improve right ventricular–pulmonary arterial coupling. Full article

Background: The TRI-SCORE was developed to predict mortality after tricuspid valve surgery and has demonstrated prognostic value in patients undergoing transcatheter tricuspid valve interventions (TTVI). Right ventricular–pulmonary arterial (RV–PA) uncoupling assessed by the TAPSE/sPAP ratio has emerged as a prognostic marker in selected populations; however, its incremental value within established risk scores remains unclear. Methods: In this prospective single-centre cohort, 109 patients undergoing TTVI were included. The original TRI-SCORE was calculated for all patients. A modified TRI-SCORE was proposed by substituting the definition of right ventricular dysfunction based on TAPSE with RV–PA uncoupling, defined as TAPSE/sPAP <0.406 using invasively measured systolic pulmonary artery pressure. The endpoints were 12-month all-cause mortality and a combined endpoint of death or cardiovascular rehospitalization. Results: At 12 months, all-cause mortality occurred in 19.3% of patients, and the combined endpoint in 40.4%. Both original and modified TRI-SCOREs were significantly associated with 12-month mortality (OR 1.80 per point increase, 95% CI 1.30–2.48; p < 0.001 and OR 1.81 per point increase, 95% CI 1.31–2.49; p < 0.001, respectively) and demonstrated comparable discrimination (AUC 0.78 for both; DeLong p = 0.90). Furthermore, both scores were significantly associated with the combined endpoint (TRI-SCORE: OR 1.36 per point increase, 95% CI 1.08–1.71; p = 0.008; modified TRI-SCORE; OR of 1.33 per one-point increase, 95% CI 1.07–1.66; p = 0.009) with modest and comparable AUCs (~0.65). Conclusion: In patients undergoing TTVI, replacing TAPSE with RV–PA uncoupling did not improve the prognostic performance of the TRI-SCORE for mortality or combined clinical outcomes. Full article

Background/Objectives: Type 2 respiratory failure (T2RF) is associated with significant morbidity and mortality, partly driven by cardiopulmonary interactions and right ventricular (RV) dysfunction. The tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio has emerged as a non-invasive marker of RV–pulmonary arterial (RV–PA) coupling; however, its prognostic value in T2RF remains insufficiently explored. This study aimed to evaluate the association between TAPSE/sPAP and short-term clinical outcomes in hospitalized T2RF patients. Methods: In this retrospective cohort study, 182 adult patients hospitalized with T2RF between January 2024 and December 2025 were included. Patients were followed from hospital admission until discharge or death, and survival status was additionally evaluated up to 60 days after admission using hospital electronic medical records and follow-up databases for Kaplan–Meier survival analysis. Complete follow-up data were available for all included patients. Demographic, clinical, laboratory, and transthoracic echocardiographic data were analyzed. Patients were stratified into low and high TAPSE/sPAP groups. The primary outcome was in-hospital mortality; secondary outcomes included 60-day all-cause mortality, non-invasive ventilation (NIV) failure, intensive care unit (ICU) admission, and length of hospital stay. Statistical analyses included receiver operating characteristic (ROC) curves, multivariable logistic regression, calibration assessment, and decision curve analysis. Results: Patients with a low TAPSE/sPAP ratio had significantly higher in-hospital mortality (38.6% vs. 12.8%, p < 0.001), higher rates of NIV failure and ICU admission, and longer hospital stays. TAPSE/sPAP demonstrated the highest predictive performance for mortality (AUC: 0.82, 95% CI: 0.75–0.88), outperforming conventional echocardiographic parameters. In multivariable analysis, TAPSE/sPAP remained an independent predictor of mortality (OR: 1.48 per 0.1 decrease, p < 0.001). The model showed good calibration (Hosmer–Lemeshow p = 0.62), and decision curve analysis confirmed its clinical utility with a higher net benefit across a wide range of threshold probabilities. Conclusions: The TAPSE/sPAP ratio was independently associated with in-hospital mortality and adverse clinical outcomes in patients with T2RF, reflecting impaired RV–PA coupling. As a readily obtainable non-invasive echocardiographic parameter, it demonstrated promising prognostic value for risk stratification in this population. However, given the retrospective single-center design of the study, these findings should be considered hypothesis-generating and require confirmation in prospective multicenter studies before routine clinical implementation can be recommended. Full article

Background: Malnutrition and systemic inflammation are increasingly recognized as important determinants of prognosis in patients with heart failure. Several immunonutritional indices, including the Prognostic Nutritional Index (PNI), the Controlling Nutritional Status (CONUT) score, and the C-reactive protein–albumin–lymphocyte (CALLy) index, have been proposed as markers of nutritional and inflammatory status. However, their prognostic value in elderly patients with heart failure with preserved ejection fraction (HFpEF) remains incompletely defined. This study aimed to evaluate the prognostic significance of these immunonutritional indices in elderly patients with HFpEF over a long-term follow-up period. Methods: This retrospective observational study included 200 elderly patients hospitalized with HFpEF (mean age 86.6 ± 6.5 years). Clinical, laboratory, and echocardiographic parameters were collected at admission. Nutritional status was assessed using PNI, CONUT score, and CALLy index. Patients were followed for mortality during long-term follow-up. Survival analyses were performed using Cox regression models, receiver operating characteristic (ROC) curves, and Kaplan–Meier analysis. Median follow-up was 3.8 years (IQR 2.1–5.9). Results: During follow-up, 123 patients (61.5%) died, while 77 patients (38.5%) were alive at the end of observation. In univariate analysis, PNI, CONUT score, left ventricular ejection fraction (LVEF), and the tricuspid annular plane systolic excursion to systolic pulmonary artery pressure (TAPSE/sPAP) ratio were significantly associated with mortality. In multivariate analysis, the CONUT score, LVEF, and the TAPSE/sPAP ratio remained independent predictors of mortality. ROC analysis showed strong prognostic performance for the TAPSE/sPAP ratio (AUC 0.932), CONUT score (AUC 0.925), and LVEF (AUC 0.897). Optimal cut-off values for mortality prediction were CONUT ≥ 6, LVEF ≥ 65%, and TAPSE/sPAP ≤ 0.55 mm/mmHg. Kaplan–Meier analysis confirmed significantly reduced survival among patients with higher CONUT scores, higher LVEF, and an impaired TAPSE/sPAP ratio. Conclusions: In elderly patients with HFpEF, nutritional status and cardiopulmonary functional parameters are important determinants of long-term prognosis. The CONUT score emerged as the most informative immunonutritional index, while echocardiographic parameters reflecting ventricular function and right ventricular–pulmonary arterial coupling provided additional prognostic information. Integrating nutritional assessment with echocardiographic evaluation may improve risk stratification in elderly patients with HFpEF. Full article

Background: Prognostic heterogeneity in heart failure (HF) is substantial and not fully captured by conventional left-sided echocardiographic parameters. Growing evidence highlights the importance of right ventricular–pulmonary arterial (RV–PA) interaction in HF pathophysiology and outcomes. The echocardiographic tricuspid annular plane systolic excursion-to-systolic pulmonary artery pressure (TAPSE/sPAP) ratio has been proposed as a simple noninvasive surrogate of RV–PA coupling, yet its prognostic value across the HF spectrum remains incompletely defined. Methods: This systematic review followed PRISMA guidelines and was registered in INPLASY. PubMed, Scopus, and EMBASE were searched from inception through January 2026 for observational studies evaluating the prognostic value of TAPSE/sPAP in adult patients with HF. Study selection, data extraction, and risk-of-bias assessment were performed independently by two reviewers. Owing to substantial heterogeneity, a qualitative synthesis with weighted pooled descriptive statistics was performed. Results: Fifteen observational studies including 5389 patients were analyzed, with a median follow-up of approximately 1.9 years, ranging from in-hospital outcomes to long-term follow-up of up to 15 years. Study populations encompassed a wide range of HF phenotypes and clinical settings, including acute and chronic HF, preserved and reduced ejection fraction, valvular heart disease, infiltrative cardiomyopathies, and advanced HF. Across studies, reduced TAPSE/sPAP was generally associated with adverse outcomes, including all-cause mortality and HF-related events, with reported hazard ratios ranging from approximately two- to five-fold. Prognostically relevant TAPSE/sPAP cut-off values tended to cluster within a relatively narrow range, with most thresholds between 0.36 and 0.40 and a weighted median of approximately 0.36. When reported, TAPSE/sPAP showed favorable discriminative performance for adverse outcomes. Overall methodological quality was predominantly fair. Conclusions: Across heterogeneous HF populations, impaired TAPSE/sPAP appears to be a consistent marker of adverse prognosis. These findings support TAPSE/sPAP as a practical, noninvasive indicator of RV–PA uncoupling that may contribute to risk stratification and phenotyping in heart failure. Prospective studies focusing on specific HF phenotypes are needed to clarify its role in longitudinal monitoring and therapeutic decision-making. Full article

Background: Echocardiography is essential for diagnosing and guiding therapy in aortic stenosis (AS). Cardiac damage staging systems may better characterize myocardial and extracardiac involvement. We aim to evaluate the presence and progression of cardiac damage across the clinical course of AS. Methods: A single-center retrospective cohort study was conducted, which included consecutive patients who ultimately underwent TAVR and had retrievable serial echocardiograms at moderate AS, first severe AS, and pre-TAVR symptomatic severe AS (2017–2021). A total of 179 patients were evaluated (mean age 82.7 [5.9] years at moderate AS; 46% male, p = 0.27). Cardiac damage was classified according to two established staging systems. Results: The median time from moderate to severe AS was 32 months (IQR 18–48). Most echocardiographic parameters deteriorated primarily at symptom onset, whereas moderate AS and first severe (asymptomatic) AS showed broadly similar profiles. However, left ventricular global longitudinal strain (LV GLS) was already impaired at the first severe stage, and right ventricular–arterial coupling (RVAc, TAPSE/sPAP) progressively worsened as AS advanced to the severe stage, independently of symptom status (LV GLS −18.1%, n = 163; −17.1%, n = 143; and −14.9%, n = 143; RVAc 1.0, n = 131; 0.8, n = 130; and 0.7, n = 130), respectively; overall p < 0.05. Both staging systems demonstrated increasing cardiac damage with AS progression. Conclusions: Cardiac damage may occur early in AS. The marked deterioration at symptom onset underscores the importance of systematic myocardial assessment and supports prospective studies to evaluate whether integrating LV GLS and RVAc as sensitive early markers of disease progression improves risk stratification. Full article

Background/Objectives: It is widely acknowledged that healthy highlanders (HL) present with significantly higher pulmonary arterial pressure (PAP) compared to healthy lowlanders (LL). However, whether this elevated PAP solely signifies a response to hypoxia at altitude or is also linked to right ventricular (RV) dysfunction is still unknown. Therefore, we assessed RV function in HL and LL using speckle-tracking-derived strain analysis. Methods: This case-control study evaluates echocardiographic RV free wall strain (RVFWS) in LL and HL in Kyrgyzstan. A RVFWS over −20% for men and a RVFWS of −21% for women were considered indicators of RV dysfunction. Subgroup analysis included individuals with and without risk for pulmonary hypertension (PH), defined as a TRV > 2.8 m/s. Results: A total of 59 participants (21 LL, 38 HL), with a mean ± SD age of 43 ± 8 versus 48 ± 10 years, were included and assessed at their living altitude. RVFWS in HL and LL was −27.3% ± 4.7 versus −27.0% ± 6.0 (mean difference 0.13%, 95%CI −2.65 to 2.92, p = 0.852). The conventional RV indices RV FAC (42% ± 6 vs. 38% ± 8), TAPSE (2.2 cm ± 0.2 vs. 2.0 cm ± 0.3), and TDI S’ (14.2 cm/s ± 1.9 vs. 12.1 cm/s ± 1.8), however, did differ significantly between LL and HL. HL with and without risk for PH did not differ in RVFWS and in the conventional RV indices. Conclusions: Despite significant differences in conventional RV markers, healthy highlanders generally did not differ in RVFWS compared with lowlanders, indicating maintained RV systolic function at high altitude. Our findings suggest that elevated PAP in HL reflects adaptation rather than RV dysfunction, underscoring the need for refined diagnostic criteria for clinically relevant high-altitude pulmonary hypertension. Full article

Introduction: Primary Sjögren’s (pSS) is an autoimmune disease that affects several organs, especially the heart, and raises cardiovascular risk. Investigating the associations of hemoglobin-to-red cell distribution width (RDW) ratio (HRR), vitamin D status, and cardiac function could provide valuable insights and biomarkers regarding early cardiovascular risk in patients with pSS. Method: This cross-sectional study involved 61 patients diagnosed with pSS based on ACR/EULAR criteria. Data on demographics, hematological (Hb, RDW), echocardiography, and serum vitamin D levels were collected. Echocardiograms were conducted by trained cardiologists following established guidelines, while vitamin D levels were measured using ELISA. Statistical analyses, including univariate linear regression, were performed with SPSS in order to identify whether HRR tertiles were related to cardiac function and vitamin D status. Results: A study of 61 pSS patients (mean age 59.8 years, 89% female) revealed that patients with a lower hemoglobin-to-RDW ratio (HRR ≤ 0.98) had significantly higher pulmonary artery pressures (PAPs) and lower values for the tricuspid annular plane systolic excursion (TAPSE)/PAPs ratio, contributing to poor right heart function. These associations were particularly strong in patients with insufficient levels of vitamin D (<30 ng/mL), while differences in other echocardiographic parameters remained nonsignificant between HRR groups. Conclusions: These findings underscore the clinical value of HRR as a composite biomarker that reflects the interplay between anemia, inflammation, and cardiovascular health in primary Sjögren’s disease. They also suggest that vitamin D status may be an important therapeutic consideration to mitigate cardiopulmonary risks in this population. Full article

Background: The prognostic use of both the echocardiographic parameters tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP) in dogs with pulmonary hypertension (PH) has shown conflicting results. The ratio of TAPSE/sPAP, not yet described in dogs, is used for the evaluation and risk assessment in people with PH and is a validated surrogate for right ventricular to pulmonary artery coupling with lower values being associated with poor outcome. This study aimed to describe TAPSE/sPAP in dogs with precapillary PH (PCPH) due to various diseases. It demonstrates the correlation of this ratio with echocardiographic indices, its association with heart failure (HF) and its prognostic value. Methods: Medical records and echocardiographic data from 95 client-owned dogs with estimated mild (n = 10), moderate (n = 31) or severe (n = 54) PCPH were retrospectively reviewed. Body weight-independent TAPSE/sPAP ratios were obtained, and short-term and overall survival until death from all causes or cardio-pulmonary death (CPD) were assessed. Results: TAPSE/sPAP was lower in dogs with HF and correlated with other echocardiographic variables commonly altered in dogs with PCPH. Different TAPSE/sPAP ratios, such as nTAPSE/(sPAP(m/s)), were independent predictors of short-term CPD, as was having pulmonary thromboembolism. For overall survival only HF was a risk factor of CPD. The cut-off value of <1.05 for nTAPSE/(sPAP(m/s)) was associated with shorter survival for dogs dying from CPD. Conclusions: The TAPSE/sPAP ratio is a non-invasive echocardiographic parameter that provides prognostic information, especially in short-term survival, in dogs with PCPH and may aid in risk stratification. Full article

Chronic thromboembolic pulmonary disease (CTEPD) with or without pulmonary hypertension (PH) is characterized by persistent perfusion defects and progressive pulmonary vascular dysfunction after acute pulmonary embolism (PE), despite adequate anticoagulant therapy. We aimed at assessing clinical, hemodynamic, and functional evolution in patients screened for CTEPD with persistent lung perfusion scintigraphy (Q-scan) defects to identify non-invasive predictors of right ventricular (RV) impairment and development of exercise-induced pulmonary hypertension (ExPH). We analyzed 55 patients with a history of PE and no prior cardiopulmonary disease, stratified by perfusion (Q)-scan at 4 months into Q-scan-positive (n = 35) and Q-scan-negative (n = 20). At that time, all patients underwent echocardiography, cardiopulmonary exercise testing (CPET), and exercise stress echocardiography (ESE). Clinical evaluation and resting echocardiography were repeated at 24, 36, and 48 months. At baseline, Q-positive patients had higher NT-proBNP levels and greater PESI scores. At 4 months, they exhibited a higher prevalence of exercise-induced pulmonary hypertension (ExPH) on both CPET and ESE (p < 0.001). Both groups showed a partial recovery of echocardiographic parameters over time; however, Q-positive patients featured significantly higher systolic (s) pulmonary artery pressure (PAP) and mean PAP and a lower TAPSE/sPAP ratio (p < 0.001), increased eccentricity index, and shorter right ventricle (RV) outflow tract acceleration time at 48 months, suggestive of persistent RV-PA uncoupling and of a higher subclinical hemodynamic burden. Persistent Q-scan defects identify a post-PE population at risk for long-term RV dysfunction and ExPH, even in the absence of pulmonary hypertension at rest. CPET and ESE at 4 months provide useful prognostic information, supporting their integration into structured follow-up strategies to identify patients early on with evolving pulmonary vascular disease. Full article

Background: Lung transplantation (LTx) is a life-saving intervention for patients with advanced interstitial lung disease (ILD), markedly improving pulmonary function, exercise capacity, and right heart function, yet it is often accompanied by increased risks of metabolic, cardiovascular, and renal complications. Methods: We conducted a longitudinal analysis of 102 ILD patients post-LTx, integrating pulmonary, cardiovascular, metabolic, and functional parameters. Recovery was assessed using lung function parameters (FVC, DLCO, TLC, ITGV, and FEV1), 6MWD, Borg scores, sPAP, TAPSE, BMI, and weight, while the comorbidity burden was monitored via the Comorbidity–Polypharmacy Score (CPS). Results: Patients showed marked post-LTx improvements, with FVC and DLCO increasing by +37.99% and +42.90%, 6MWD by +166.5 m, and dyspnea decreasing by −3.25 points (Borg scale). Right heart function improved (sPAP −23.79 mmHg and TAPSE increased). Despite these gains, renal function (eGFR −14.14 mL/min/1.73 m²/year) and platelet counts (−17.79 × 10⁹/L/year) declined, while the CPS nearly doubled (16 to 30), reflecting rising comorbidities, including hypertension, diabetes, osteoporosis, reflux, and malignancies. Conclusions: While LTx significantly enhances pulmonary function, exercise capacity, and hemodynamics in ILD patients, it also triggers complex systemic adaptations and a rising comorbidity burden, underscoring the need for dynamic risk stratification and integrated care to balance the benefits and burden over time. Full article

Background: Sleep-disordered breathing (SDB), particularly Cheyne–Stokes respiration (CSR), is highly prevalent among patients hospitalized with acute decompensated heart failure (ADHF) and is associated with worse clinical outcomes. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated cardiorenal benefits in heart failure, but their effects on nocturnal respiratory parameters remain underexplored. Objectives: This study aims to evaluate the impact of SGLT2i therapy on key respiratory and cardiac indices including CSR burden, oxygenation, and right heart function in patients with ADHF and reduced left ventricular ejection fraction. Methods: In this single-center prospective cohort study, 60 patients with ADHF, LVEF < 40%, and a baseline apnea–hypopnea index (AHI) > 5 were assessed before and three months after the initiation of SGLT2i therapy. Sleep respiratory parameters were measured using home polygraphy (ApneaLink^TM), while cardiac and renal indices were evaluated by echocardiography, NT-proBNP, and the estimated glomerular filtration rate (eGFR). Structural and functional echocardiographic changes were analyzed both at baseline and following the 3-month treatment period. Patient-reported outcomes were assessed using the Epworth Sleepiness Scale (ESS) and Kansas City Cardiomyopathy Questionnaire (KCCQ). Results: After 3 months of SGLT2i therapy, significant improvements were observed in daytime sleepiness (ESS: −2.68 points; p < 0.001), CSR index (−5.63 events/h; p < 0.001), AHI (−3.07 events/h; p < 0.001), ODI (−6.11 events/h; p < 0.001), and mean nocturnal SpO₂ (+1.95%; p < 0.001). KCCQ scores increased by 9.16 points (p < 0.001), indicating improved quality of life. Cardiac assessments revealed reductions in NT-proBNP (−329.6 pg/mL; p < 0.001) and E/e′ ratio (−1.08; p < 0.001), with no significant change in LVEF or chamber dimensions. Right ventricular function improved, as evidenced by the increased TAPSE/sPAP ratio (+0.018; p < 0.001). Renal function remained stable, with a non-significant upward trend in eGFR. Conclusions: This exploratory study suggests that SGLT2 inhibitors may be associated with the attenuation of Cheyne–Stokes respiration and an improvement in right heart function in patients with ADHF, warranting further investigation in controlled trials. These findings highlight the potential of SGLT2is to address overlapping cardio-respiratory dysfunction in this high-risk population. Full article

Background/Objectives: Low-grade systemic inflammation, characteristic of heart failure (HF), is a nonspecific inflammatory syndrome that affects the entire body. Macrophage migration inhibitory factor 1 (MIF-1) is a pro-inflammatory cytokine, a key mediator of the innate immune response, and may serve as a potential biomarker of monocyte homing and activation in HF with reduced and mildly reduced ejection fraction (HFrEF, HFmrEF). Methods: We evaluated 70 hemodynamically stable patients with left ventricular EF (LVEF) < 50% by means of echocardiography and blood sampling. Results: We report significant correlations between MIF-1, LVEF (r = −0.33, p = 0.005), LV global longitudinal strain (LVGLS, r = 0.41, p = 0.0004), and tricuspid annular plane systolic excursion (TAPSE, r = −0.37, p = 0.001). MIF-1 levels in HFrEF patients were relatively higher, but not significantly different from those observed in HFmrEF. MIF-1 showed significant associations with TAPSE to systolic pulmonary artery pressure ratio (TAPSE/sPAP, p < 0.0001). Also, patients with TAPSE/sPAP < 0.40 mm/mmHg had significantly higher levels of MIF-1 (p = 0.009). Moreover, ischemic cardiomyopathy (ICM) was more frequent in patients with MIF-1 concentrations above 520 pg/mL (57.1% MIF-1^hi vs. 28.6% MIF-1^lo, p = 0.029). In terms of congestion, MIF-1 showed significant associations with the presence of peripheral edema (p = 0.007), but none was found with self-reported dyspnea (p = 0.307) and New York Heart Association (NYHA) class (p = 0.486). Also, no relationship was reported with N-terminal pro-B-type natriuretic peptide concentrations (NT-proBNP, r = 0.14, p = 0.263). However, the six-minute walk distance was greater in individuals in the MIF-1^lo group when compared to those in the MIF-1^hi group (404.0 ± 127.4 vs. 324.8 ± 124.1 m, p = 0.010). Conclusions: Beyond identifying inflammatory biomarkers related to disease severity, linking MIF-1 to various pathophysiological mechanisms may highlight the active involvement of the monocyte-macrophage system in HF. This system holds notable significance in congestion-related conditions, acting as a major source of reactive oxygen species that perpetuate inflammation. Full article