Search Results (1,351)

Background: Cardiac rehabilitation (CR) and mechanics are individually associated with cardiovascular outcomes in ischemic heart disease (IHD); however, their interaction remains less defined. We hypothesized that a 36-session CR program improves cardiac strain and torsional mechanics in IHD patients. Methods: Ninety IHD patients on guideline-directed medical therapy with complete revascularization were prospectively enrolled, of which 27 electively completed a 36-session standardized exercise CR program. Speckle-tracking echocardiography was utilized to assess left ventricular (LV) global longitudinal strain (GLS) and peak twist, and right ventricular free wall strain (RVFWS) at baseline and after program completion. Participants were propensity-scoring matched 1:1 with 27 patients who declined participation (No-CR). Results: Clinical characteristics were similar between groups (mean age: 63 ± 10 years, 82% male, 31% three-vessel coronary artery disease). When compared with baseline, the CR group experienced a significant improvement in LV GLS (−14.9 ± 2.9 vs. −16.2 ± 3.1%, p = 0.003), with a numerical but non-significant increase in peak LV twist (14.4 ± 7.4 vs. 16.8 ± 5.3°, p = 0.162). The No-CR group showed significant deterioration in RVFWS (−22.9 ± 4.6% vs. −19.3 ± 5.4%, p = 0.009), with no other changes including in GLS (−14.8 ± 3.1 vs. −15 ± 3.3%, p = 0.831). Follow-up comparisons between CR versus No-CR revealed significantly greater peak LV twist (16.8 ± 5.3 vs. 12.1 ± 4.2°, p = 0.001) and a healthier RVFWS (−22.2 ± 4.5 vs. −19.3 ± 5.4, p = 0.044) in CR participants. Conclusions: CR in patients with IHD improved LV GLS and, compared with No-CR, conferred better LV twist and RVFWS. Full article

Exercise training has demonstrated potential benefits in addressing the adverse effects of cardiovascular diseases, particularly myocardial infarction (MI). This study analyzed the cardioprotective effects of moderate exercise before and after MI in rats subjected to isoproterenol (ISO)-induced heart damage. Wistar rats were assigned to five groups: controls (CTRL), isoproterenol-treated (ISO), swimming before ISO (PRE + ISO), swimming after ISO (ISO + POST), and swimming both before and after ISO (PRE + ISO + POST). Cardiac function was assessed through echocardiography, while oxidative stress markers, Heme Oxygenase-1 (HO-1) and Myeloperoxidase (MPO), were quantified using biochemical assays and enzyme-linked immunosorbent assay (ELISA). Statistical analyses were conducted by one-way analysis of variance (ANOVA), accompanied by Tukey’s post hoc test. Exercise performed post-MI and both pre- and post-MI significantly reduced ISO-induced infarct size and improved left ventricular function (stroke volume (SV), ejection fraction (EF), and Tei index). HO-1 protein concentration and HO enzyme activity were restored, while swim training reduced the activity of MPO compared to the ISO group. Moderate exercise training, when appropriately timed, provides cardioprotection against ISO-induced myocardial damage by reducing oxidative stress and cardiac dysfunction. Full article

Background: Hypertrophic cardiomyopathy (HCM) is the most common inherited cardiovascular disease and affects male patients more often than women. Prior studies, however, suggested that women are diagnosed later and at advanced stages of the disease, present with more pronounced symptoms, and experience worse outcomes. Objectives: To investigate sex-specific differences in clinical, laboratory, and comprehensive imaging characteristics in a contemporary cohort of HCM patients from a tertiary referral center in Austria. Methods: We retrospectively analyzed 321 HCM patients enrolled in a prospective registry (2018–2024). All patients underwent a comprehensive baseline evaluation, including medical history, laboratory assessment, transthoracic echocardiography, and cardiac magnetic resonance imaging. Results: At diagnosis, women were significantly older (62 vs. 53 years, p < 0.001) and presented with more advanced functional class (NYHA ≥ II: 80% vs. 49%, p < 0.001). Six-minute walking distance was lower and obstructive HCM was more prevalent in women (425 vs. 505 m, p < 0.001, and 55% vs. 32%, p < 0.001, respectively). Echocardiographic assessment revealed higher diastolic filling pressures (E/E′ 18 vs. 10, p < 0.001), larger indexed atrial volumes (29.5 vs. 26.6 mL/m², p < 0.001), a higher left ventricular ejection fraction (70% vs. 62%, p < 0.001), and a larger indexed interventricular septal thickness in women (10.2 vs. 9.3 mm/m², p = 0.004). Moreover, serum levels of NT-proBNP were significantly higher in women (760 vs. 338 pg/L, p < 0.001). Conclusions: Female patients with HCM were diagnosed at an older age, presented with more advanced symptoms, had higher rates of obstructive physiology, and a phenotype characterized by diastolic dysfunction and elevated biomarkers, closely resembling heart failure with preserved ejection fraction. Recognizing these sex-specific disparities is crucial in improving diagnostic awareness and individualized therapeutic management. Full article

Background: Takotsubo cardiomyopathy (TTC) has been historically considered a contraindication for heart donation due to its transient left ventricular dysfunction. However, emerging evidence supports that hearts from donors with fully recovered Takotsubo Cardiomyopathy can be safely transplanted. Methods: This case series describes seven heart transplantations performed between January 2022 and September 2025 using donors with previously diagnosed Takotsubo cardiomyopathy. Donor characteristics, intraoperative data, echocardiography data and postoperative outcomes were analyzed. Results: The mean donor age was 33.5 years (range 18–58), with a male-to-female ratio of 6:1. All donors exhibited echocardiographic evidence of Takotsubo Cardiomyopathy at the time of brain death, with full or partial recovery before procurement. Coronary angiography excluded obstructive coronary disease. Echocardiographic follow-up demonstrated the mean LVEF increased to 52 ± 6%, reaching 58 ± 4% at 12 months, global longitudinal strain (GLS) improved progressively (from −14.2 ± 2.8% to −18.5 ± 1.9%), confirming normalization of myocardial deformation and the right ventricular function, assessed by TAPSE, rose from 15 ± 3 mm at discharge to 20 ± 2 mm at 12 months. All patients transplanted with donors who had Takotsubo cardiomyopathy are alive at the 12-month follow-up. Conclusions: Hearts from donors with resolved Takotsubo Cardiomyopathy can be safely used for transplantation without compromising early- or mid-term outcomes. Expanding donor eligibility criteria to include selected TTC donors may contribute to mitigating organ shortages in advanced heart failure patients. Full article

Objective: The aim of this study was to evaluate the impact of chronic kidney disease (CKD) on clinical presentation, laboratory parameters, ECG, and echocardiographic features of patients with chronic heart failure (CHF). Methods: This retrospective cross-sectional study included 2227 patients hospitalized in a tertiary care center due to CHF. Patients were divided into two groups based on the presence of CKD, defined as eGFR < 60 mL/min/1.73 m². Demographic, clinical, laboratory, and echocardiographic data were collected for all patients. Comparative analyses were performed to assess differences in cardiovascular risk factors, comorbidities, laboratory parameters, and echocardiographic findings between the two groups. Results: The proportion of men was significantly higher in the non-CKD group, whereas women predominated in the CKD group (p < 0.001). Dyspnea, orthopnea, leg swelling, claudication, and expectoration were significantly more frequent in patients with CKD, while chest pain and palpitations were more common in the non-CKD group (all p < 0.05). A significant difference in the distribution of NYHA functional classes was observed between the groups (p < 0.001), with NYHA class IV being more prevalent in the CKD group and classes II and III more frequent in the non-CKD group. Levels of CRP and NT-proBNP were significantly higher in the CKD group (p < 0.001). In-hospital mortality was 2.5-fold higher in patients with CKD (28.6% vs. 11.1%; p < 0.001). Conclusions: Coexistence of CKD was associated with a more severe clinical presentation, advanced functional limitation, and a distinct laboratory and echocardiographic profile in CHF patients. Full article

Cardiogenic pulmonary edema (CPE) is a life-threatening manifestation of acute heart failure characterized by rapid accumulation of fluid in the interstitial and alveolar spaces, leading to severe dyspnea, hypoxemia, and respiratory failure. The condition arises from elevated left-sided filling pressures that increase pulmonary capillary hydrostatic pressure, disrupt alveolo-capillary barrier integrity, and impair gas exchange. Neurohormonal activation further perpetuates congestion and increases myocardial workload, creating a vicious cycle of hemodynamic overload and respiratory compromise. Respiratory support is a cornerstone of management in CPE, aimed at stabilizing oxygenation, reducing the work of breathing, and facilitating ventricular unloading while definitive therapies, such as diuretics, vasodilators, inotropes, or mechanical circulatory support (MCS), address the underlying cause. Among available modalities, non-invasive ventilation (NIV) with continuous positive airway pressure (CPAP) or bilevel positive airway pressure (BiPAP) has the strongest evidence base in moderate-to-severe CPE, consistently reducing the need for intubation and providing rapid relief of dyspnea. High-flow nasal cannula (HFNC) represents an emerging alternative in patients with moderate hypoxemia or intolerance to mask ventilation, and should be considered an adjunctive option in selected patients with less severe disease or NIV intolerance, although its efficacy in severe presentations remains uncertain. Invasive mechanical ventilation is reserved for refractory cases, while extracorporeal membrane oxygenation (ECMO) and other advanced circulatory support modalities may be necessary in cardiogenic shock. Integration of respiratory strategies with hemodynamic optimization is essential, as positive pressure ventilation favorably modulates preload and afterload, synergizing with pharmacological unloading. Future directions include personalization of ventilatory strategies using advanced monitoring, novel interfaces to improve tolerability, and earlier integration of MCS. In summary, respiratory support in CPE is both a bridge and a decisive therapeutic intervention, interrupting the cycle of hypoxemia and hemodynamic deterioration. A multidisciplinary, individualized approach remains central to improving outcomes in this high-risk population. Full article

Background/Objectives: Coronary artery disease (CAD) is highly prevalent in patients undergoing vascular surgery and is a major determinant of postoperative morbidity and mortality. Preoperative anemia is a well-recognized risk factor for adverse outcomes, including major adverse cardiac events (MACEs), but its independent impact in patients with CAD undergoing abdominal aortic aneurysm (AAA) repair remains unclear. Methods: We conducted a retrospective cohort study of 410 consecutive patients undergoing open AAA repair at a tertiary vascular center between 2023 and 2025. Preoperative anemia was defined as hemoglobin < 130 g/L and significant CAD as ≥70% luminal narrowing for non-left main disease or ≥50% for left main disease. The primary outcome was MACE (cardiovascular death, myocardial infarction, or stroke) during hospitalization. Baseline covariates included age, sex, diabetes mellitus (DM), chronic kidney disease (CKD), congestive heart failure (CHF), peripheral artery disease (PAD), and other relevant comorbidities. Multivariable logistic regression models were used to evaluate associations of anemia, CAD, and their interaction with MACE. Additionally, a composite risk group was created to examine MACE rates across mutually exclusive subgroups. Results: Among 410 patients, 314 (76.6%) had CAD and 116 (28.3%) had preoperative anemia. Overall, 67 patients (16.3%) experienced MACE. In the reduced model including only anemia and CAD, anemia remained a strong independent predictor of a MACE (OR 4.46, 95% CI 2.57–7.72, p < 0.001), and CAD was also independently associated (OR 2.20, 95% CI 1.00–4.72, p = 0.044). In the full multivariable model adjusting for DM, CHF, CKD, PAD, and age, anemia was the strongest predictor (OR 4.53, 95% CI 2.49–8.26, p < 0.001), while CAD showed a borderline association (OR 2.07, 95% CI 0.94–4.57, p = 0.071). Interaction analysis indicated no statistically significant modification in risk by the combination of anemia and CAD. The composite risk group variable was omitted due to collinearity with its components. Conclusions: Preoperative anemia, particularly in patients with CAD, is a significant and independent predictor of major adverse cardiac events following open AAA repair. These findings support the importance of early identification and correction of anemia before surgery to improve perioperative cardiac outcomes in this high-risk population. Full article

Background: Cardiac amyloidosis (CA) is characterized by progressive myocardial infiltration leading to restrictive cardiomyopathy and heart failure. While left ventricular assessment has traditionally dominated prognostic evaluation, right ventricular (RV) dysfunction and RV–pulmonary artery (PA) coupling have emerged as critical determinants of outcomes. Objectives: This review synthesizes current evidence on RV–PA coupling as a prognostic marker in cardiac amyloidosis, examining measurement methodologies, prognostic significance, pathophysiological mechanisms, and clinical applications. Methods: We comprehensively reviewed the recent literature on RV–PA coupling in CA, focusing on studies published from 2020 to 2025, including both AL and ATTR subtypes. We analyzed data from multicenter cohorts, prospective registries, and validation studies examining the relationship between RV–PA coupling indices and clinical outcomes. Results: RV–PA coupling, most commonly assessed using the tricuspid annular plane systolic excursion to pulmonary artery systolic pressure (TAPSE/PASP) ratio, consistently demonstrates strong independent prognostic value for mortality and heart failure outcomes in CA patients. Impaired coupling (TAPSE/PASP < 0.45 mm/mmHg) identifies high-risk patients with hazard ratios ranging from 1.98 to 4.17 for adverse outcomes. In a multicenter cohort of 283 patients, TAPSE/PASP < 0.45 mm/mmHg was independently associated with death or heart failure hospitalization (HR 1.98, 95% CI 1.32–2.96, p = 0.001) and significantly improved risk reclassification (NRI 0.46–0.49). In ATTR-specific populations receiving disease-modifying therapy, impaired coupling (TAPSE/PASP ≤ 0.382 mm/mmHg) predicted three-year mortality with an adjusted HR of 2.99. The coupling index provides incremental value over individual RV parameters by accounting for afterload conditions and demonstrates consistent prognostic performance across both AL and ATTR subtypes. Conclusions: RV–PA coupling represents a robust, easily obtainable prognostic marker that should be routinely assessed in CA patients for risk stratification and clinical decision-making. The TAPSE/PASP ratio can be calculated from standard echocardiographic examinations without additional cost or time, making it practical for widespread implementation. Future research should focus on standardizing measurement protocols, establishing disease-specific thresholds, evaluating coupling trajectories with novel therapies, and integrating coupling assessment into staging systems and management algorithms. The strong prognostic signal, pathophysiological relevance, and ease of measurement position RV–PA coupling as an essential component of comprehensive cardiac amyloidosis evaluation. Full article

Background: Left ventricular systolic dysfunction (LVSD) is a major determinant of prognosis in patients with ischemic heart disease. Electrocardiography (ECG) is widely available, inexpensive, and may aid in identifying patients at risk. We hypothesized that a composite score derived from multiple established ECG markers could improve the detection of LVSD in patients with stable angina. Methods: In this single-center, cross-sectional study, 177 patients undergoing elective coronary angiography for stable angina were included. Patients were classified as LVSD-negative (n = 123) or LVSD-positive (n = 54) based on echocardiographic ejection fraction. ECG parameters, including fragmented QRS, pathologic Q waves, R-wave peak time, QRS duration, and frontal QRS–T angle, were assessed. Independent predictors of LVSD were identified using multivariate logistic regression. A composite ECG score was constructed by assigning one point to each abnormal parameter. Model robustness was evaluated using bootstrap resampling (1000 iterations) and 10-fold cross-validation. Results: Multivariable analysis identified prior stent implantation, fragmented QRS, pathological Q waves, R-wave peak time, frontal QRS–T angle (log-transformed), and QRS duration as independent predictors of LVSD. ROC analysis demonstrated good discriminatory performance for R-wave peak time (AUC 0.804), QRS duration (AUC 0.649), and frontal QRS–T angle (AUC 0.825) measurements. The composite ECG score showed a stepwise association with LVSD: a score of ≥2 yielded high sensitivity (88%) and negative predictive value (97%), whereas a score of ≥3 provided high specificity (100%) and positive predictive value (100%). Bootstrap resampling and cross-validation confirmed model stability and strong discriminatory performance (mean AUC, 0.964; accuracy, 0.91). Conclusions: A simple composite ECG score integrating multiple established ECG markers is associated with the robust detection of LVSD in patients with stable angina. Although not a substitute for echocardiography, this score may support early risk stratification and help identify patients who warrant further imaging evaluations. External validation in larger and more diverse populations is required before routine clinical implementation of this model. Full article

Heart failure with preserved ejection fraction (HFpEF) accounts for about half of heart failure cases and is linked to aging, obesity, diabetes, and multimorbidity, yet disease-modifying therapies remain limited. A major barrier is heterogeneity: HFpEF comprises overlapping inflammatory, fibrotic, cardiometabolic, and hemodynamic/vascular endophenotypes embedded within systemic cardiorenal and cardiohepatic cross-talk, which conventional metrics such as left ventricular ejection fraction (LVEF), natriuretic peptides (NPs), and standard imaging capture incompletely. In this narrative review, we synthesize clinical, mechanistic, and trial data to describe HFpEF endophenotypes and their multi-organ interactions; critically appraise why traditional diagnostic and enrollment strategies contributed to neutral outcomes in landmark trials; and survey emerging cardiovascular multi-omics studies. We then outline an integrative systems-biology framework that applies (i) within-layer analyses and cross-layer integration, (ii) network-based driver nomination and biomarker discovery, and (iii) target nomination to link molecular programs with circulating markers and candidate therapies. Finally, we discuss practical challenges in implementing multi-omics HFpEF research and highlight future directions such as artificial intelligence (AI)-enabled multi-omics integration, cross-organ profiling, and biomarker-guided, endotype-enriched platform trials. Collectively, these advances position HFpEF as a proving ground for precision cardiology, in which therapies are matched to molecularly defined disease programs rather than ejection-fraction cutoffs alone. Full article

Severe mitral regurgitation (MR) is one of the most common valvular heart diseases and is frequently associated with advanced left ventricular (LV) systolic dysfunction. Transcatheter edge-to-edge repair (TEER) offers effective symptom relief but may induce abrupt hemodynamic changes leading to afterload mismatch and acute LV failure. Levosimendan may help mitigate this complication by improving contractility, yet evidence supporting its use in this setting is scarce. Therefore, the aim of this study was to systematically evaluate the evidence on the effects of Levosimendan in patients with severe MR and LV dysfunction undergoing TEER. We performed a comprehensive search of PubMed, Embase, Scopus, and Google Scholar. Primary outcomes were postprocedural LV ejection fraction (LVEF) and systolic pulmonary artery pressure (sPAP). Secondary outcomes included procedural success, procedure duration, and in-hospital complications. Five studies comprising 315 patients (n = 141 Levosimendan, n = 174 controls) met the inclusion criteria. Pooled analysis showed no significant difference in postprocedural LVEF between Levosimendan-treated patients and controls (mean difference 0.45%, 95% CI [−1.46–2.35] p = 0.65) and no significant change from baseline. Similarly, postprocedural sPAP did not differ significantly. Procedural success was higher with Levosimendan, and procedure duration was shorter. These hypothesis-generating findings highlight the need for larger, prospective randomized trials to clarify the role of Levosimendan in this setting. Full article

Diabetes mellitus (DM) is a chronic disease characterised by chronic hyperglycaemia due to a defect in the production of or cell insensitivity to insulin. If left untreated, it might result in severe side effects such retinal, nephropathy, neuropathy, and cardiovascular disease. Extensive research has been made to develop more effective and less expensive alternatives to existing treatment regimes. This review aims to evaluate research done thus far to test the effect of Saccharomyces boulardii (S. boulardii or Sb) in treating DM and its complications. Searches were conducted using Scopus, Web of Science, PubMed and Google Scholar on 26 July 2025. Overall, 227 articles were identified, and 5 fulfilled the inclusion criteria. Results extracted were from two models of diabetes (type 1 and 2) and two strains of Sb. In type 1 diabetes models, a significant reduction in glycaemia was observed, while in type 2 diabetes models, a non-significant effect was noted, depending on the strain used. Furthermore, an improvement in cardiac function was observed through reduced heart rate variability, a decrease in blood pressure, an increase in C-peptide and hepatic glycogen stores, enhanced liver healing, a nephroprotective effect, as well as a reduction in oxidative stress, blood triglyceride levels, and the inflammatory response. Administration of Sb induced positive modulation of the intestinal microbiota, with a decrease in pathobionts in the stools. Overall, the few studies evaluated indicate that the use of Sb appears to be a promising approach to improve the management of diabetes and its associated metabolic and related complications. The protocol of this review is registered in PROSPERO under ID CRD420251012919. Full article

Drug use–associated infective endocarditis (DUA-IE) is an increasingly important clinical problem that affects younger patients and poses substantial diagnostic, therapeutic, and surgical challenges. We conducted a retrospective cohort study of adults with definite infective endocarditis treated at a tertiary referral center between 2017 and 2022, comparing patients with DUA-IE to those with non–drug use–associated infective endocarditis. Of the 189 patients, 43 (22.8%) had DUA-IE. These patients were significantly younger and had higher rates of HIV and hepatitis C coinfections. Staphylococcus aureus was the predominant pathogen, and right-sided valve involvement was more frequent; however, left-sided disease predominated among patients requiring valve surgery. Compared with non-DUA-IE patients, those with DUA-IE had larger vegetations, higher inflammatory markers, more frequent complications(including sepsis, embolic events, and heart failure), higher rates of emergency surgical intervention, longer hospitalizations, and increased in-hospital mortality rates. In conclusion, DUA-IE represents a distinct and more aggressive form of infective endocarditis, characterized by severe infection, increased complication rates, and a substantial surgical burden despite the younger patient age, underscoring the need for integrated infectious disease, surgical, and addiction-focused care models for these patients. Full article

Cardiovascular disease is the leading cause of morbidity and mortality worldwide, with ischemic and structural heart diseases being key contributors. While the 12-lead electrocardiogram (ECG) is a common low-cost diagnostic test, its interpretation is limited by human variability. Through machine learning with large diverse ECG data sets and artificial intelligence (AI) algorithms, ECG analysis can be automated for pattern recognition with higher accuracy. AI-augmented ECG algorithms have been demonstrated to be able to detect myocardial infarction with high accuracy and reduce door-to-balloon coronary intervention times. Similar models can be utilized to detect subtle ECG waveforms suggestive of current or future asymptomatic left ventricular dysfunction, aortic stenosis, and hypertrophic cardiomyopathy. Despite these promising results, there is concern for generalizability and bias or errors in training data. As AI systems evolve to multimodal integration, AI-augmented ECG has the potential to redefine cardiovascular diagnostics and enable earlier detection, risk stratification, and precision-guided interventions. Full article

Background/Objectives: Numerous studies have documented cardioprotective effects of adiponectin in animal models of cardiometabolic disease (CMD). Adiponectin receptor agonist ALY688 has demonstrated functional significance against pressure overload-induced cardiac remodeling events in a mouse model of heart failure with reduced ejection fraction (HFrEF), potentially through modulation of the systemic metabolome. However, the specific metabolites and their pathophysiological contribution to cardioprotection in cardiac hypertrophy or heart failure remain unclear. This study aimed to characterize systemic metabolic alterations across five tissues in HFrEF and determine how ALY688 modifies these pathways to mediate cardioprotection in the transverse aortic constriction (TAC) model. Methods: Targeted metabolic profiling was performed on heart, liver, muscle, epididymal white adipose tissue (eWAT), and serum collected five weeks post-surgery from wild-type male C57BL/6 mice. Mice underwent either Sham or TAC-induced left ventricular pressure overload, with or without daily subcutaneous ALY688 administration. Metabolites were quantified using liquid chromatography–tandem mass spectrometry (LC–MS/MS) and statistically analyzed at the tissue level. Results: Consistent with pathological cardiac remodeling, the comprehensive metabolomic analysis revealed that TAC induced widespread disruption of systemic metabolic homeostasis. ALY688 treatment significantly modified several key metabolite classes, including triglycerides (TGs) and glycosylceramides (HexCer). Notably, ALY688 also altered multiple gut-derived metabolites, including trimethylamine N-oxide (TMAO), 5-aminovaleric acid (5-AVA), and glycodeoxycholic acid (GDCA), highlighting a potential gut–liver–heart axis mediating its cardioprotective effects. Conclusions: These findings demonstrate that ALY688 mitigates TAC-induced metabolic dysregulation across multiple tissues. The identified metabolic signatures suggest that ALY688 exerts cardioprotective effects, at least in part, through restoration of systemic metabolic homeostasis and engagement of a gut–liver–heart metabolic axis. These results provide mechanistic insight into adiponectin receptor agonism and support further exploration of ALY688 as a potential therapeutic strategy for HFrEF. Full article