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Background/Aim. Given that frequent manipulation of the abutment during immediate loading can have a negative impact on the surrounding peri-implant hard and soft tissues, the concept “one abutment at one time” (OAO) has been introduced and documented in daily clinical practice. The aim of the study was to evaluate changes in peri-implant bone levels, clinical and radiographic parameters, and patient perspectives during the six-month follow-up period. Methods. The study was designed as a randomized controlled clinical trial. Patients with bilaterally healed sites in the posterior mandible received implants with a diameter of no less than 3.5 mm and a length of at least 8 mm. Based on randomization, patients were divided into a test group and a control group. Patients who were in the test group received implants that were immediately loaded with definitive abutments. In contrast, patients in the control group received implants where healing abutments were placed, followed by temporary abutments. Implants were immediately loaded with provisional restorations within the first seven days. They were delivered over the test group’s definitive abutment and the control group’s temporary abutment. Probing depth, bleeding on probing, clinical attachment level, plaque index, and keratinized tissue width were measured. Patient-Reported Outcome Measures and the Oral Health Impact Profile - 19 (OHIP-19) questionnaires were noted. Results. Out of 24 included patients, 22 completed the six-month follow-up. Peri-implant bone loss between study groups was comparable (mesial: t = -0.798, df = 21, p = 0.434; distal: t = 1.688, df = 21, p = 0.106), without statistical inter-group significance. OHIP-19 total scores significantly decreased after three months and remained similar six months after the implant placement in both groups without statistically relevant clinical inter-group changes. Conclusion. The OAO approach and provisional abutments showed comparable effectiveness regarding the immediate loading of posterior single implants.

Freedom of expression is a fundamental human right protected by the major international human rights instruments and national constitutions. The right to freedom of expression is treated as one of the key elements of a democratic society and it can be considered essential to human dignity. However, this right is not absolute and it can, if certain preconditions are met, be subjected to limitations, as indicated by the provisions of the European Convention on Human Rights, as well as the case law of the European Court of Human Rights. Judges also enjoy the right to freedom of expression. Although the participation of judges in debates on matters of public interest is considered very important, especially when it comes to the regulation of the status of judiciary, the nature of the judicial function dictates restrictions on the freedom of expression of judicial office holders in order to protect public confidence in the judicial branch of government and its reputation. Public expression of personal views may raise dilemmas regarding the impartiality of a judge. The paper will draw attention to the importance of protecting the freedom of expression of judges, but also to the issue of necessity and legitimacy of its restrictions. Legal provisions regulating the right to freedom of expression of judges in Bosnia and Herzegovina will be examined, as well as examples from the practice of disciplinary bodies relating to the exercise of the aforementioned right. Legislative solutions adopted in Bosnia and Herzegovina will be compared with provisions adopted in other countries and subjected to critical evaluation.

Freedom of association is one of the fundamental freedoms and is considered one of the necessary elements of a free society. Isolated from other members of the community, an individual would have little chance of successfully resisting the arbitrariness of the ruler, or fighting for social changes that he deems justified. Although judges are also entitled to this right, the very nature of the judicial office may call for establishing certain restrictions on the exercise of this right in order to protect the dignity of the judicial office and public confidence in the independence and impartiality of the judiciary. The first part of the paper focuses on the importance of exercising the freedom of association of judicial office holders. Special attention will be drawn to the role that professional associations of judges play in preserving the independence of the judiciary and improving its position, as well as protecting the rule of law and a democratic order. After referring to relevant provisions of international documents and the case law of the European Court of Human Rights, the author analyzes the restrictions on the freedom of association of judges adopted in various national legislations. Special attention will be given to the justifiability of prohibiting judges from joining political parties, and the dilemmas arising from the membership of judges in secret societies, i.e. other organizations operating on similar grounds. The second part of the paper focuses on the legal framework of the freedom of association of judges in Bosnia and Herzegovina and the justifiability of restrictions imposed on the exercise of this right.

Introduction/Objective. The objective of the study was to investigate whether there are differences in therapeutic effect between initial treatments of chronic periodontitis [scaling and root planning (SRP)] alone and SRP in conjunction with injectable platelet-rich fibrin (I-PRF) application, comparing clinical parameters after three months. Methods. Twenty-four patients with chronic periodontitis who had at least two sites with probing pocket depth (PPD) ≥ 5 mm on contralateral side participated in the study. Using a split-mouth design, the patients were treated with SRP + I-PRF (study group) or SRP only (control group). The clinical parameters, clinical attachment level (CAL), gingival margin level (GML), PPD, bleeding on probing, and plaque index, were recorded on both sides. Results. Compared to baseline, both treatment modalities demonstrated an improvement in investigated clinical parameters. The mean value of CAL was reduced from 1.97 ± 0.75 (0.25–3.31) to 1.07 ± 0.44 (0.12–1.78) in the study group, whereas it decreased from 1.81 ± 0.66 (0.42–2.96) to 1.48 ± 0.55 (0.22–2.30) in the control group. Similarly, the corresponding values for GML and PPD showed statistically significant difference between the groups (p = 0.040 and p = 0.006, respectively). Conclusion. Regardless the limited number of patients in the study, initial periodontal therapy in conjunction with injectable platelet-rich fibrin proved to display significant improvement in all clinical parameters compared to initial periodontal therapy alone.

Introduction Biological complications are the most common type of complications around dental implants. They appear in two forms, peri-mucositis and peri-implantitis. The aim of our research was to analyze the above-mentioned complications regarding the time elapsed from implantation and implant loading, as well as regarding the type of dental restoration. Material and methods 18 patients with self-reported complications were examined at the Department of Periodontology and Oral medicine, School of Dental medicine, University of Belgrade. Each patient filled an anamnestic questionnaire. Clinical examination, including photographic and radiographic documentation have been performed. Results Clinical examination included 18 patients and 97 implants in total (70% female patients and 30% male patients). The average time elapsed from implants placement was 7.5 years and the average from final dental restoration was 7 years. Periodontitis was diagnosed in 85% of the patients. Complications were more common among the patients with cement-retained restorations. Conclusions Due to the limitation of our study, we can assume that periodontal disease and cement-retained restorations are the risk factors for genesis and development of the complications around dental implants. The results of our study are in consent with data found in the literature, but in order to confirm these results it is necessary to perform analysis on a larger sample and with longer follow-up.

Infertility is a serious global reproductive health problem. According to the World Health Organization, between 7% and 15% of all couples of reproductive age in the world are infertile. Assisted reproductive techniques have enabled infertile couples to experience parenthood. Therefore, from the perspective of the reproductive autonomy realization, the application of assisted reproductive methods is indisputably justified. On the other hand, the development of new reproductive technologies raises complex ethical dilemmas. The most controversial assisted reproductive technique is surrogacy, which entails an agreement or contract by which a woman (surrogate mother) agrees to bear a child for another person or couple. Commercial surrogacy, unlike the altruistic one, implies that intended parents will pay a cash amount as to the surrogate mother, as compensation for the services provided, which exceeds the reasonable costs associated with pregnancy. The paper aims to respond to the question whether commercial surrogacy is ethically less acceptable than the altruistic one, or whether the objections to commercial surrogacy are in fact aimed at cases involving perverted practices, which could be avoided by the adoption of appropriate legal solutions. In particular, the paper focuses on the problem of commodification and its relation to the value of human dignity. As part of the analysis of this problem, the author points to the danger of developing "commodification in the broader sense" (Radin), as well as the mechanisms by which the legislator can potentially preclude this tendency. The analysis covers the solutions adopted in comparative law, as well as the relevant legal provisions in the legislation of Bosnia and Herzegovina (i.e. its entities: Republika Srpska and Federation of Bosnia and Herzegovina).

Introduction Gingival recession is the most common mucogingival anomaly, as well as the most frequent periodontal plastic surgery indication. The surgical procedure and healing of the wound result in scar formation, which impacts oral soft tissue aesthetics. The aim of this study was to evaluate the characteristics of a postsurgical scar after gingival recession treatment using the mucosal scarring index (MSI). Material and methods In accordance with the MSI, ten standardized and calibrated photographs of the postsurgical site, taken 3-6 months following the surgical procedure, were analyzed. That included the evaluation of six parameters: scar appearance, scar length, suture marks, contour, color, and overall appearance. 30 professionals divided into the three groups conducted the scar analysis: 10 dental students (S), 10 periodontology and oral medicine residents (SS) and 10 periodontal specialists (SP). Results the average MSI values showed the following results: S: 3.63 ± 2.71, SS: 3.63 ± 2.83 and SP: 3.12 ± 2.75. There was no difference between the MSI values obtained in the three groups (p=0.544). Conclusion Due to the similar MSI values among all the groups, a conclusion may be drawn that by the application of this index, the aesthetic evaluation of the postsurgical scar after the gingival recession treatment can be done in a fast and simple way. Further research based on a larger sample and various surgical procedures is necessary in order to confirm these statements.

Introduction. Gingival recession is a displacement of gingival margin apically to cementenamel junction. Objective. The aim of this study was to compare the results achieved with two different surgical procedures used in gingival recession treatment. Methods. Ten patients with bilateral buccal recession on maxillary canines or premolars were included in the study. Professional teeth cleaning was performed before surgery. Recession on the experimental side was treated with connective tissue graft in combination with coronally advanced, split thickness flap (tunnel technique). Control side recession was treated with connective tissue graft in combination with trapezoidal coronally advanced, full thickness flap. Coin toss was used for side decision. The following parameters were evaluated before surgery and 6 months post-op: Vertical Recession Dimension, Clinical Attachment Level, Apico-coronal width of the keratinized tissue, Healing index (Laundry), RES index, and Patient evaluation of esthetic results. Student’s t-test was used for statistical analysis. Results. Six months after surgery, mean root coverage was 91.5±14.1% and 90.1±14.6% on the experimental and on the control side, respectively. RES index, Healing index (Laundry) and Patient Subjective evaluation of esthetic results showed significantly better results (p≤0.05). Conclusion. Both surgical procedures produce highly successful clinical results based on evaluated parameters, but this tunnel technique provides significantly better esthetic results. [Projekat Ministarstva nauke Republike Srbije, br. III 41008: Interakcija etiopatogenetskih mehanizama parodontopatije i periimplantitisa sa sistemskim bolestima današnjice]

Background/Aim. Immediate loading is considered to be the most innovative technique in contemporary implant dentistry. Recent clinical and experimental findings have demonstrated that only implants with high primary stability can be subjected to immediate loading protocol with predictable results. It is generally accepted that the most important prerequsite for successful osseointegration is achievement and maintenance of implant stability. The aim of this in vivo study was to investigate the possibility for successful application of immediate loading protocol in implant systems with different surface properties. Methods. In the experimental study 2 mongrel dogs were edentulated bilaterally in the mandibular and maxillary premolar areas. After 3 months implants were placed in a pattern 4 different commercially available implants per quadrant (n = 32): Mk III TiUnite (Nobel Biocare, Sweden), ITI TPS (Straumann, Switzerland), 3IOsseotite (Implant Innovation, USA) and XiVE Cell-Plus (Friadent, Germany). Implants were subjected to immediate loading with 4 unit gold cast bridges, 2 days post implantation. The assessment of implant stability and immediate loading possibilities were done by performing Resonance frequency analysis (RFA). Results. After a 6- month loading period all bridges were in function and all implants occurred well osseointegrated. When summarizing the Implant Stability Quotient (ISQ) values, it was noted that resonance frequency was significantly higher for mandibular implants. The results of this experimental setting showed that all evaluated surfaces achieved good implant stability. Increase of ISQ values was found for all implants in the mandible and partially decrease of ISQ values for maxillary implants after 6 months of functional loading with 4 unit bridges. Conclusions. Investigated endooseal implants did not show different degree of osseointegration, because there was not statisticaly significant difference among observed parameters (ISQh i ISQp) between implant systems.

Introduction. Fibrin, fibronectin, platelet derived growth factor, and transforming growth factors from platelet concetrate are crucial for tissue reparation and regeneration. Objective. This study was designed to evaluate clinical effectiveness of activated platelet-rich fibrin (PRF) membrane in treatment of gingival recession. Methods. 19 gingival recessions Miller class I or II were treated with a coronally advanced flap and the PRF membrane (PRF group). Following the elevation of the flap, bone and root surfaces were covered with the PRF membrane. After suturing, the PRF membrane was covered with a coronally advanced flap. In the same patients, 19 other gingival recessions were treated with CTG in combination with the coronally advanced flap (the CTG group). Clinical recordings were made of vertical recession depth (VRD), probing depth (PD), clinical attachment level (CAL) and keratinized tissue width (KTW) before and 12 months after mucogingival surgical treatment. Clinical evaluation of healing events was estimated with recordings of the healing index (HI). Recordings of HI were performed in the 1st, 2nd and 3rd week post-surgically. Results. Mean root coverage was significant in both groups (the PRF group 79.94% and the CTG group 88.56% %; p

The association between type 2 diabetes mellitus (T2DM) and heart failure (HF) has been firmly established; however, the entity of diabetic myocardial disorder (previously called diabetic cardiomyopathy) remains a matter of debate. Diabetic myocardial disorder was originally described as the occurrence of myocardial structural/functional abnormalities associated with T2DM in the absence of coronary heart disease, hypertension and/or obesity. However, supporting evidence has been derived from experimental and small clinical studies. Only a minority of T2DM patients are recognized as having this condition in the absence of contributing factors, thereby limiting its clinical utility. Therefore, this concept is increasingly being viewed along the evolving HF trajectory, where patients with T2DM and asymptomatic structural/functional cardiac abnormalities could be considered as having pre-HF. The importance of recognizing this stage has gained interest due to the potential for current treatments to halt or delay the progression to overt HF in some patients. This document is an expert consensus statement of the Heart Failure Association of the ESC and the ESC Working Group on Myocardial & Pericardial Diseases. It summarizes contemporary understanding of the association between T2DM and HF and discuses current knowledge and uncertainties about diabetic myocardial disorder that deserve future research. It also proposes a new definition, whereby diabetic myocardial disorder is defined as systolic and/or diastolic myocardial dysfunction in the presence of diabetes. Diabetes is rarely exclusively responsible for myocardial dysfunction, but usually acts in association with obesity, arterial hypertension, chronic kidney disease and/or coronary artery disease, causing additive myocardial impairment., (© 2024 European Society of Cardiology.)

Aims: Natriuretic peptide (NP) uptake varies in Emergency Departments (EDs) across Europe. The 'Peptide for Life' (P4L) initiative, led by Heart Failure Association, aims to enhance NP utilization for early diagnosis of heart failure (HF). We tested the hypothesis that implementing an educational campaign in Western Balkan countries would significantly increase NP adoption rates in the ED., Methods and Results: This registry examined NP adoption before and after implementing the P4L-ED study across 10 centres in five countries: Bosnia and Herzegovina, Croatia, Montenegro, North Macedonia, and Serbia. A train-the-trainer programme was implemented to enhance awareness of NP testing in the ED, and centres without access received point-of-care instruments. Differences in NP testing between the pre-P4L-ED and post-P4L-ED phases were evaluated. A total of 2519 patients were enrolled in the study: 1224 (48.6%) in the pre-P4L-ED phase and 1295 (51.4%) in the post-P4L-ED phase. NP testing was performed in the ED on 684 patients (55.9%) during the pre-P4L-ED phase and on 1039 patients (80.3%) during the post-P4L-ED phase, indicating a significant absolute difference of 24.4% (95% CI: 20.8% to 27.9%, P < 0.001). The use of both NPs and echocardiography significantly increased from 37.7% in the pre-P4L-ED phase to 61.3% in the post-P4L-ED phase. There was an increased prescription of diuretics and SGLT2 inhibitors during the post-P4L-ED phase., Conclusions: By increasing awareness and providing resources, the utilization of NPs increased in the ED, leading to improved diagnostic accuracy and enhanced patient care., (© 2023 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Cardiomyopathies represent significant contributors to cardiovascular morbidity and mortality. Over the past decades, a progress has occurred in characterization of the genetic background and major pathophysiological mechanisms, which has been incorporated into a more nuanced diagnostic approach and risk stratification. Furthermore, medications targeting core disease processes and/or their downstream adverse effects have been introduced for several cardiomyopathies. Combined with standard care and prevention of sudden cardiac death, these novel and emerging targeted therapies offer a possibility of improving the outcomes in several cardiomyopathies. Therefore, the aim of this document is to summarize practical approaches to the treatment of cardiomyopathies, which includes the evidence-based novel therapeutic concepts and established principles of care, tailored to the individual patient aetiology and clinical presentation of the cardiomyopathy. The scope of the document encompasses contemporary treatment of dilated, hypertrophic, restrictive and arrhythmogenic cardiomyopathy. It was based on an expert consensus reached at the Heart Failure Association online Workshop, held on 18 March 2021., (© 2023 European Society of Cardiology.)

Competing Interests: Conflict of interest: none declared

Objective: To assess the potential correlation between clinical peri-implant parameters and the presence of Porphyromonas gingivalis in different peri-implant conditions., Material and Methods: The study included 30 patients from the Department of Periodontology and Oral Medicine divided into three equal groups, defined according to the following diagnoses: peri-implantitis (PI), peri-implant mucositis (PM), and peri-implant health (HI). Clinical parameters such as peri-implant probing depth (PPD), bleeding on probing (BOP), suppuration on probing (SUP), and plaque index (PI) were recorded. The samples of peri-implant crevicular fluid were collected and relative levels of Porphyromonas gingivalis were analyzed using Real-Time PCR (Reverse transcriptase - real-time polymerase chain reaction)., Results: The mean patient age was 51.33 ± 12.61 years. The mean value for Porphyromonas ginigvalis relative level was higher in the PI group (14.80 ±31.51) compared to PM and HI group (0.48 ± 1.34 and 0.06 ± 0.12, respectively). This parameter significantly differed between PI and HI (p=0.012), as well as PI and PM (p=0.049). The mean whole mouth probing pocket depth (PPD) in the PI group (4.02mm ± 0.77mm) was also significantly greater compared to the other two groups (3.39mm ± 0.52mm in PM and 1.97mm ± 0.54mm in the HI group. The SUP in the PI (mean value of 18%) group was more frequent than in PM (mean value of 14%) while the SUP was not detected in the HI group. The correlation between clinical parameters and relative levels of Porphyromonas gingivalis was not significant., Conclusions: The findings of this research indicate higher relative levels of Porphyromonas gingivalis in peri-implant lesions, especially in peri-implantitis., Competing Interests: Conflict of interest The authors have declared no conflict of interest.

The aging population, higher burden of predisposing conditions and comorbidities along with improvements in therapy all contribute to the growing prevalence of heart failure (HF). Although the majority of trials have not demonstrated age-dependent heterogeneity in the efficacy or safety of medical treatment for HF, the latest trials demonstrate that older participants are less likely to receive established drug therapies for HF with reduced ejection fraction. There remains reluctance in real-world clinical practice to prescribe and up-titrate these medications in older people, possibly because of (mis)understanding about lower tolerance and greater propensity for developing adverse drug reactions. This is compounded by difficulties in the management of multiple medications, patient preferences and other non-medical considerations. Future research should provide a more granular analysis on how to approach medical and device therapies in elderly patients, with consideration of biological differences, difficulties in care delivery and issues relevant to patients' values and perspectives. A variety of approaches are needed, with the central principle being to 'add years to life - and life to years'. These include broader representation of elderly HF patients in clinical trials, improved education of healthcare professionals, wider provision of specialised centres for multidisciplinary HF management and stronger implementation of HF medical treatment in vulnerable patient groups., Competing Interests: Disclosure: AJSC is Editor-in-Chief and GMCR is Deputy Editor-in-Chief of Cardiac Failure Review; this did not influence peer review. All other authors have no conflict of interests to declare., (Copyright © 2022, Radcliffe Cardiology.)

Guideline-directed medical therapy (GDMT) has the potential to reduce the risks of mortality and hospitalisation in patients with heart failure (HF) with reduced ejection fraction (HFrEF). However, real-world data indicate that many patients with HFrEF do not receive optimised GDMT, which involves several different medications, many of which require up-titration to target doses. There are many challenges to implementing GDMT, the most important being patient-related factors (comorbidities, advanced age, frailty, cognitive impairment, poor adherence, low socioeconomic status), treatment-related factors (intolerance, side-effects) and healthcare-related factors that influence availability and accessibility of HF care. Accordingly, international disparities in resources for HF management and limited public reimbursement of GDMT, coupled with clinical inertia for treatment intensification combine to hinder efforts to provide GDMT. In this review paper, authors aim to provide solutions based on available evidence, practical experience, and expert consensus on how to utilise evolving strategies, novel medications, and patient profiling to allow the more comprehensive uptake of GDMT. Authors discuss professional education, motivation, and training, as well as patient empowerment for self-care as important tools to overcome clinical inertia and boost GDMT implementation. We provide evidence on how multidisciplinary care and institutional accreditation can be successfully used to increase prescription rates and adherence to GDMT. We consider the role of modern technologies in advancing professional and patient education and facilitating patient-provider communication. Finally, authors emphasise the role of novel drugs (especially sodium-glucose co-transporter 2 inhibitors), and a tailored approach to drug management as evolving strategies for the more successful implementation of GDMT., (© 2021 European Society of Cardiology.)

Endomyocardial biopsy (EMB) is an invasive procedure, globally most often used for the monitoring of heart transplant rejection. In addition, EMB can have an important complementary role to the clinical assessment in establishing the diagnosis of diverse cardiac disorders, including myocarditis, cardiomyopathies, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumors. Improvements in EMB equipment and the development of new techniques for the analysis of EMB samples has significantly improved the diagnostic precision of EMB. The present document is the result of the Trilateral Cooperation Project between the Heart Failure Association of the European Society of Cardiology, Heart Failure Society of America, and the Japanese Heart Failure Society. It represents an expert consensus aiming to provide a comprehensive, up-to-date perspective on EMB, with a focus on the following main issues: (1) an overview of the practical approach to EMB, (2) an update on indications for EMB, (3) a revised plan for heart transplant rejection surveillance, (4) the impact of multimodality imaging on EMB, and (5) the current clinical practice in the worldwide use of EMB., (Copyright © 2021. Published by Elsevier Inc.)

Aims: The Heart Failure Association (HFA) of the European Society of Cardiology (ESC) developed the HFA Atlas to provide a contemporary description of heart failure (HF) epidemiology, resources, reimbursement of guideline-directed medical therapy (GDMT) and activities of the National Heart Failure Societies (NHFS) in ESC member countries., Methods and Results: The HFA Atlas survey was conducted in 2018-2019 in 42 ESC countries. The quality and completeness of source data varied across countries. The median incidence of HF was 3.20 [interquartile range (IQR) 2.66-4.17] cases per 1000 person-years, ranging from ≤2 in Italy and Denmark to >6 in Germany. The median HF prevalence was 17.20 (IQR 14.30-21) cases per 1000 people, ranging from ≤12 in Greece and Spain to >30 in Lithuania and Germany. The median number of HF hospitalizations was 2671 (IQR 1771-4317) per million people annually, ranging from <1000 in Latvia and North Macedonia to >6000 in Romania, Germany and Norway. The median length of hospital stay for an admission with HF was 8.50 (IQR 7.38-10) days. Diagnostic and management resources for HF varied, with high-income ESC member countries having substantially more resources compared with middle-income countries. The median number of hospitals with dedicated HF centres was 1.16 (IQR 0.51-2.97) per million people, ranging from <0.10 in Russian Federation and Ukraine to >7 in Norway and Italy. Nearly all countries reported full or partial reimbursement of standard GDMT, except ivabradine and sacubitril/valsartan. Almost all countries reported having NHFS or working groups and nearly half had HF patient organizations., Conclusions: The first report from the HFA Atlas has shown considerable heterogeneity in HF disease burden, the resources available for its management and data quality across ESC member countries. The findings emphasize the need for a systematic approach to the capture of HF statistics so that inequalities and improvements in care may be quantified and addressed., (© 2021 European Society of Cardiology.)

Endomyocardial biopsy (EMB) is an invasive procedure, globally most often used for the monitoring of heart transplant (HTx) rejection. In addition, EMB can have an important complementary role to the clinical assessment in establishing the diagnosis of diverse cardiac disorders, including myocarditis, cardiomyopathies, drug-related cardiotoxicity, amyloidosis, other infiltrative and storage disorders, and cardiac tumours. Improvements in EMB equipment and the development of new techniques for the analysis of EMB samples have significantly improved diagnostic precision of EMB. The present document is the result of the Trilateral Cooperation Project between the Heart Failure Association of the European Society of Cardiology, the Heart Failure Society of America, and the Japanese Heart Failure Society. It represents an expert consensus aiming to provide a comprehensive, up-to-date perspective on EMB, with a focus on the following main issues: (i) an overview of the practical approach to EMB, (ii) an update on indications for EMB, (iii) a revised plan for HTx rejection surveillance, (iv) the impact of multimodality imaging on EMB, and (v) the current clinical practice in the worldwide use of EMB., (© 2021 Elsevier Inc. and Journal of Cardiac Failure. [Published by Elsevier Inc.] All rights reserved.)

Heart failure (HF) is the major contributor to cardiovascular morbidity and mortality. Given its rising prevalence, the costs of HF care can be expected to increase. Multidisciplinary management of HF can improve quality of care and survival. However, specialized HF programmes are not widely available in most European countries. These circumstances underlie the suggestion of the Heart Failure Association (HFA) of the European Society of Cardiology (ESC) for the development of quality of care centres (QCCs). These are defined as health care institutions that provide multidisciplinary HF management at all levels of care (primary, secondary and tertiary), are accredited by the HFA/ESC and are implemented into existing health care systems. Their major goals are to unify and improve the quality of HF care, and to promote collaboration in education and research activities. Three types of QCC are suggested: community QCCs (primary care facilities able to provide non-invasive assessment and optimal therapy); specialized QCCs (district hospitals with intensive care units, able to provide cardiac catheterization and device implantation services), and advanced QCCs (national reference centres able to deliver advanced and innovative HF care and research). QCC accreditation will require compliance with general and specific HFA/ESC accreditation standards. General requirements include confirmation of the centre's existence, commitment to QCC implementation, and collaboration with other QCCs. Specific requirements include validation of the centre's level of care, service portfolio, facilities and equipment, management, human resources, process measures, quality indicators and outcome measures. Audit and recertification at 4-6-year intervals are also required. The implementation of QCCs will evolve gradually, following a pilot phase in selected countries. The present document summarizes the definition, major goals, development, classification and crucial aspects of the accreditation process of the HFA/ESC QCC Programme., (© 2020 European Society of Cardiology.)

Heart failure (HF) constitutes the growing cardiovascular burden and the major public health issue, but comprehensive statistics on HF epidemiology and related management in Europe are missing. The Heart Failure Association (HFA) Atlas has been initiated in 2016 in order to close this gap, representing the continuity directly rooted in the European Society of Cardiology (ESC) Atlas of Cardiology. The major aim of the HFA Atlas is to establish a contemporary dataset on HF epidemiology, resources and reimbursement policies for HF management, organization of the National Heart Failure Societies (NHFS) and their major activities, including education and HF awareness. These data are gathered in collaboration with the network of NHFS of the ESC member and ESC affiliated countries. The dataset will be continuously improved and advanced based on the experience and enhanced understanding of data collection in the forthcoming years. This will enable revealing trends, disparities and gaps in knowledge on epidemiology and management of HF. Such data are highly needed by the clinicians of different specialties (aside from cardiologists and cardiac surgeons), researchers, healthcare policy makers, as well as HF patients and their caregivers. It will also allow to map the snapshot of realities in HF care, as well as to provide insights for evidence-based health care policy in contemporary management of HF. Such data will support the ESC/HFA efforts to improve HF management ant outcomes through stronger recommendations and calls for action. This will likely influence the allocation of funds for the prevention, treatment, education and research in HF., (© 2020 European Society of Cardiology.)

Aims: Impact of type 2 diabetes mellitus (T2DM) on non-thromboembolic outcomes in atrial fibrillation (AF) is insufficiently explored. This prospective cohort study of AF patients aimed (i) to analyse the association between T2DM and heart failure (HF) events (including new-onset HF), and all-cause and cardiovascular mortality, (ii) to assess the impact of baseline T2DM treatment on outcomes, and (iii) to explore characteristics of new-onset HF phenotypes in relation to T2DM status., Methods and Results: Of 1803 AF patients (515/1288, with/without prior HF), 389 (22%) had T2DM at baseline. After 5 years of median follow-up, T2DM patients had an 85% greater risk of HF events [adjusted hazard ratio (aHR) 1.85; 95% confidence interval (CI) 1.51-2.28; P < 0.001], including a 45% increased risk for new-onset HF (1.45; 1.17-2.28; P = 0.015). T2DM conferred a 56% higher all-cause (1.56, 1.22-2.01; P = 0.003) and a 48% higher cardiovascular mortality (1.48; 1.34-1.93; P = 0.007). Fine-Gray analysis, with mortality as a competing risk, confirmed greater HF risk among T2DM patients. All risks were highest among insulin-treated patients. The prevalence of new-onset HF phenotypes was as follows: 67% preserved ejection fraction (HFpEF), 20% mid-range ejection fraction (HFmrEF) and 13% reduced ejection fraction (HFrEF). On time-dependent Cox regression, adjusted for baseline characteristics and an interim acute coronary event, T2DM increased aHRs for new-onset HFpEF (2.38; 1.30-4.58; P <0.001) and the combined HFmrEF/HFrEF (1.77; 1.11-3.62; P = 0.017)., Conclusions: Atrial fibrillation patients with T2DM have independently increased risk of new-onset/recurrent HF events, cardiovascular and all-cause mortality, particularly when insulin-treated. The prevailing phenotype of new-onset HF was HFpEF; T2DM conferred higher risk of both HFpEF and HFmrEF/HFrEF., (© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.)

Aims: This study aimed to assess age- and sex-related differences in management and 1-year risk for all-cause mortality and hospitalization in chronic heart failure (HF) patients., Methods and Results: Of 16 354 patients included in the European Society of Cardiology Heart Failure Long-Term Registry, 9428 chronic HF patients were analysed [median age: 66 years; 28.5% women; mean left ventricular ejection fraction (LVEF) 37%]. Rates of use of guideline-directed medical therapy (GDMT) were high (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta-blockers and mineralocorticoid receptor antagonists: 85.7%, 88.7% and 58.8%, respectively). Crude GDMT utilization rates were lower in women than in men (all differences: P ≤ 0.001), and GDMT use became lower with ageing in both sexes, at baseline and at 1-year follow-up. Sex was not an independent predictor of GDMT prescription; however, age >75 years was a significant predictor of GDMT underutilization. Rates of all-cause mortality were lower in women than in men (7.1% vs. 8.7%; P = 0.015), as were rates of all-cause hospitalization (21.9% vs. 27.3%; P < 0.001) and there were no differences in causes of death. All-cause mortality and all-cause hospitalization increased with greater age in both sexes. Sex was not an independent predictor of 1-year all-cause mortality (restricted to patients with LVEF ≤45%). Mortality risk was significantly lower in patients of younger age, compared to patients aged >75 years., Conclusions: There was a decline in GDMT use with advanced age in both sexes. Sex was not an independent predictor of GDMT or adverse outcomes. However, age >75 years independently predicted lower GDMT use and higher all-cause mortality in patients with LVEF ≤45%., (© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.)

Cardiomyopathies are a heterogeneous group of heart muscle diseases and an important cause of heart failure (HF). Current knowledge on incidence, pathophysiology and natural history of HF in cardiomyopathies is limited, and distinct features of their therapeutic responses have not been systematically addressed. Therefore, this position paper focuses on epidemiology, pathophysiology, natural history and latest developments in treatment of HF in patients with dilated (DCM), hypertrophic (HCM) and restrictive (RCM) cardiomyopathies. In DCM, HF with reduced ejection fraction (HFrEF) has high incidence and prevalence and represents the most frequent cause of death, despite improvements in treatment. In addition, advanced HF in DCM is one of the leading indications for heart transplantation. In HCM, HF with preserved ejection (HFpEF) affects most patients with obstructive, and ∼10% of patients with non-obstructive HCM. A timely treatment is important, since development of advanced HF, although rare in HCM, portends a poor prognosis. In RCM, HFpEF is common, while HFrEF occurs later and more frequently in amyloidosis or iron overload/haemochromatosis. Irrespective of RCM aetiology, HF is a harbinger of a poor outcome. Recent advances in our understanding of the mechanisms underlying the development of HF in cardiomyopathies have significant implications for therapeutic decision-making. In addition, new aetiology-specific treatment options (e.g. enzyme replacement therapy, transthyretin stabilizers, immunoadsorption, immunotherapy, etc.) have shown a potential to improve outcomes. Still, causative therapies of many cardiomyopathies are lacking, highlighting the need for the development of effective strategies to prevent and treat HF in cardiomyopathies., (© 2019 The Authors. European Journal of Heart Failure © 2019 European Society of Cardiology.)

Background: We assessed the prevalence of newly diagnosed prediabetes and type-2 diabetes mellitus (T2DM), and their impact on long-term mortality in patients hospitalized for worsening heart failure with reduced ejection fraction (HFrEF)., Methods: We included patients hospitalized with HFrEF and New York Heart Association (NYHA) functional class II-III. Baseline two-hour oral glucose tolerance test was used to classify patients as normoglycaemic or having newly diagnosed prediabetes or T2DM. Outcomes included post-discharge all-cause and cardiovascular mortality during the median follow-up of 2.1 years., Results: At baseline, out of 150 patients (mean-age 57 ± 12 years; 88% male), prediabetes was diagnosed in 65 (43%) patients, and T2DM in 29 (19%) patients. These patients were older and more often with NYHA class III symptoms, but distribution of comorbidities was similar to normoglycaemic patients. Taking normoglycaemic patients as a reference, adjusted risk of all-cause mortality was significantly increased both in patients with prediabetes (hazard ratio, 2.6; 95% confidence interval (CI), 1.1-6.3; p = 0.040) and in patients with T2DM (hazard ratio, 5.3; 95% CI, 1.7-15.3; p = 0.023). Likewise, both prediabetes (hazard ratio, 2.9; 95% CI, 1.1-7.9; p = 0.041) and T2DM (hazard ratio, 9.7; 95% CI 2.9-36.7; p = 0.018) independently increased the risk of cardiovascular mortality compared with normoglycaemic individuals. There was no interaction between either prediabetes or T2DM and heart failure aetiology or gender on study outcomes (all interaction p-values > 0.05)., Conclusions: Newly diagnosed prediabetes and T2DM are highly prevalent in patients hospitalized for worsening HFrEF and NYHA functional class II-III. Importantly, they impose independently increased long-term risk of higher all-cause and cardiovascular mortality.

The coexistence of type 2 diabetes mellitus (T2DM) and heart failure (HF), either with reduced (HFrEF) or preserved ejection fraction (HFpEF), is frequent (30-40% of patients) and associated with a higher risk of HF hospitalization, all-cause and cardiovascular (CV) mortality. The most important causes of HF in T2DM are coronary artery disease, arterial hypertension and a direct detrimental effect of T2DM on the myocardium. T2DM is often unrecognized in HF patients, and vice versa, which emphasizes the importance of an active search for both disorders in the clinical practice. There are no specific limitations to HF treatment in T2DM. Subanalyses of trials addressing HF treatment in the general population have shown that all HF therapies are similarly effective regardless of T2DM. Concerning T2DM treatment in HF patients, most guidelines currently recommend metformin as the first-line choice. Sulphonylureas and insulin have been the traditional second- and third-line therapies although their safety in HF is equivocal. Neither glucagon-like preptide-1 (GLP-1) receptor agonists, nor dipeptidyl peptidase-4 (DPP4) inhibitors reduce the risk for HF hospitalization. Indeed, a DPP4 inhibitor, saxagliptin, has been associated with a higher risk of HF hospitalization. Thiazolidinediones (pioglitazone and rosiglitazone) are contraindicated in patients with (or at risk of) HF. In recent trials, sodium-glucose co-transporter-2 (SGLT2) inhibitors, empagliflozin and canagliflozin, have both shown a significant reduction in HF hospitalization in patients with established CV disease or at risk of CV disease. Several ongoing trials should provide an insight into the effectiveness of SGLT2 inhibitors in patients with HFrEF and HFpEF in the absence of T2DM., (© 2018 The Authors. European Journal of Heart Failure © 2018 European Society of Cardiology.)

Background: In addition to thromboembolism, atrial fibrillation (AF) may also predispose to major adverse cardiovascular events (MACE) attributable to coronary artery disease (CAD), including myocardial infarction (MI). The 2MACE score (2 points - Metabolic syndrome and Age≥75years, 1 point - MI/revascularization, Congestive heart failure/ejection-fraction <40%, and thrombo-Embolism) was recently proposed to help identify AF patients at risk of MACE. We assessed the predictive validity of the 2MACE score for MACE occurrence in AF patients free of CAD at baseline., Methods: Non-valvular AF patients (n=794) without CAD (mean-age, 62.5±12.1years, metabolic syndrome, 34.0%; heart failure/ejection-fraction <40%, 25.7%; thromboembolism, 9.7%) were prospectively followed for 5years, or until MACE (composite of non-fatal/fatal MI, revascularization and cardiovascular death). At inclusion, CAD was excluded by medical history, exercise-stress testing and/or coronary angiography. Also, the 2MACE score was determined., Results: At follow-up, 112 patients experienced MACE (2.8%/year). The 2MACE score demonstrated adequate discrimination (C-statistic, 0.699; 95% confidence interval [CI], 0.648-0.750; P<0.001) and calibration (Hosmer-Lemeshow P=0.79) for MACE. The score was significantly associated with MACE, with the adjusted Hazard Ratio (aHR) of 1.56 (95%CI, 1.35-1.73; P<0.001). As for individual outcomes, the score predicted MI (n=46; aHR, 1.49; 95%CI 1.23-1.80), revascularization (n=32; aHR, 1.41; 95%CI, 1.11-1.80) and cardiovascular death (n=34; aHR, 1.43; 95%CI, 1.14-1.81), all P<0.001., Conclusions: The 2MACE score successfully predicts future MACE, including incident MI, coronary revascularization and cardiovascular death in AF patients free of CAD at baseline. It may have a role in risk-stratification and primary prevention of MACE in AF patients., (Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.)

The prevalence of heart failure (HF) is increasing, representing a major cause of death and disability, and a growing financial burden on healthcare systems. Despite the use of effective treatments with both drugs and devices, mortality remains high. There is therefore a need for new and effective therapeutic agents. Ivabradine is a specific sinus node inhibiting agent that was approved in 2005 by the European Medicines Agency, alone or in combination with a beta-blocker. Trimetazidine is a cytoprotective, anti-ischaemic agent established in the treatment of angina pectoris. In the 2012 European Society of Cardiology (ESC) guidelines for diagnosis and treatment of HF, ivabradine was recommended in symptomatic HF patients who are in sinus rhythm with left ventricular ejection fraction ≤35 % and heart rate higher than 70 beats per minute, despite optimal medical therapy, including maximally tolerated dose of beta-blocker. The role of trimetazidine in this setting was not mentioned. In the 2016 ESC guidelines, recommendations for ivabradine are unchanged but trimetazidine is included for the treatment of angina pectoris with HF. This article discusses the need for new therapeutic options in HF and reviews clinical evidence in support of these two therapeutic options., Competing Interests: Disclosure: The authors have no conflicts of interest to declare.

Acute heart failure (AHF) is one of the most important cardiovascular syndromes associated with high cardiovascular morbidity, and is the major cause of admission in emergency departments worldwide. The clinical complexity of AHF has significantly increased, mostly due to the comorbidities: diabetes, arterial hypertension, dyslipidemia, obesity, peripheral vascular disease, renal insufficiency and anemia. Numerous clinical trials have demonstrated a frequent association of AHF and diabetes. Since AHF is a very heterogeneous condition, it is important to identify clinical and laboratory parameters useful for risk stratification of these populations. Hyperglycemia may be one of the most convenient, since it is widely measured, easily interpreted, and inexpensive. Acute coronary syndrome (ACS), arrhythmias and poor compliance to chronic medications are considered to be the most frequent precipitating factors of AHF in diabetics. Several studies identified diabetes as the most prominent independent predictor of morbidity and mortality in both acute and chronic heart failure (HF) patients. The following parameters were identified as the independent predictors of in-hospital mortality in patients with AHF and diabetes: older age, systolic blood pressure <100 mmHg, ACS, non-compliance, history of hypertension, left ventricular ejection fraction (LVEF) <50%, serum creatinine >1.5 mg/dL, marked elevation of natriuretic peptides, hyponatremia, treatment at admission without ACE inhibitors/ARBs/β-blockers, and no percutaneous coronary intervention (PCI) as a treatment modality. The most frequent cause of AHF is ACS, both with ST segment elevation (STEMI) or without (NSTEMI). Hyperglycemia is very common in these patients and although frequently unrecognized and untreated, has a large in-hospital and mortality significance.

Despite a myriad of causes, pericardial diseases present in few clinical syndromes. Acute pericarditis should be differentiated from aortic dissection, myocardial infarction, pneumonia/pleuritis, pulmonary embolism, pneumothorax, costochondritis, gastroesophageal reflux/neoplasm, and herpes zoster. High-risk features indicating hospitalization are: fever >38 °C, subacute onset, large effusion/tamponade, failure of non-steroidal anti-inflammatory drugs (NSAIDs), previous immunosuppression, trauma, anticoagulation, neoplasm, and myopericarditis. Treatment comprises 10-14-days NSAID plus 3 months colchicine (2 × 0.5 mg; 1 × 0.5 mg in patients <70 kg). Corticosteroids are avoided, except for autoimmunity, as they facilitate the recurrences. Echo-guided pericardiocentesis (±fluoroscopy) is indicated for tamponade and effusions >2 cm. Smaller effusions are drained if neoplastic, purulent or tuberculous etiology is suspected. In recurrent pericarditis, repeated testing for autoimmune and thyroid disease is appropriate. Pericardioscopy and pericardial/epicardial biopsy may clarify the etiology. Familial clustering was recently associated with tumor necrosis factor receptor-associated periodic syndrome (TNFRSF1A gene mutation). Treatment includes 10-14 days NSAIDs with colchicine 0.5 mg bid for up to 6 months. In non-responders, low-dose steroids, intrapericardial steroids, azathioprine, and cyclophosphamide can be tried. Successful management with interleukin-1 receptor antagonist (anakinra) was recently reported. Pericardiectomy remains the last option in >2 years severely symptomatic patients. In constriction, expansion of the heart is impaired by the rigid, chronically inflamed/thickened pericardium (no thickening ~20 %). Chest radiography, echocardiography, computerized tomography, magnetic resonance imaging, hemodynamics, and endomyocardial biopsy indicate the diagnosis. Pericardiectomy is the only treatment for permanent constriction. Predictors of poor survival are prior radiation, renal dysfunction, high pulmonary artery pressures, poor left ventricular function, hyponatremia, age, and simultaneous HIV and tuberculous infection.

Background/aim: Immediate loading is considered to be the most innovative technique in contemporary implant dentistry. Recent clinical and experimental findings have demonstrated that only implants with high primary stability can be subjected to immediate loading protocol with predictable results. It is generally accepted that the most important prerequsite for successful osseointegration is achievement and maintenance of implant stability. The aim of this in vivo study was to investigate the possibility for successful application of immediate loading protocol in implant systems with different surface properties., Methods: In the experimental study 2 mongrel dogs were edentulated bilaterally in the mandibular and maxillary premolar areas. After 3 months implants were placed in a pattern 4 different commercially available implants per quadrant (n = 32): Mk III TiUnite (Nobel Biocare, Sweden), ITI TPS (Straumann, Switzerland), 31-Osseotite (Implant Innovation, USA) and XiVE Cell-Plus (Friadent, Germany). Implants were subjected to immediate loading with 4 unit gold cast bridges, 2 days post implantation. The assessment of implant stability and immediate loading possibilities were done by performing Resonance frequency analysis (RFA)., Results: After a 6-month loading period all bridges were in function and all implants occurred well osseointegrated. When summarizing the Implant Stability Quotient (ISQ) values, it was noted that resonance frequency was significantly higher for mandibular implants. The results of this experimental setting showed that all evaluated surfaces achieved good implant stability. Increase of ISQ values was found for all implants in the mandible and partially decrease of ISQ values for maxillary implants after 6 months of functional loading with 4 unit bridges., Conclusions: Investigated endooseal implants did not show different degree of osseointegration, because there was not statisticaly significant difference among observed parameters (ISQh i ISQp) between implant systems.

Hemodynamic instability is the major concern in surgical patients with pericardial diseases, since general anesthesia and positive pressure ventilation may precipitate cardiac tamponade. In advanced constriction diastolic impairment and myocardial fibrosis/atrophy may cause low cardiac output during and after surgery. Elective surgery should be postponed in unstable patients with pericardial comorbidities. Pericardial effusion should be drained percutaneously (in local anesthesia) and pericardiectomy performed for constrictive pericarditis before any major surgical procedure. In emergencies, volume expansion, catecholamines, and anesthetics keeping cardiac output and systemic resistance should be applied. Etiology of pericardial diseases is an important issue is the preoperative management. Patients with neoplastic pericardial involvement have generally poor prognosis and any elective surgical procedure should be avoided. For patients with acute viral or bacterial infection or exacerbated metabolic, uremic, or autoimmune diseases causing significant pericardial effusion, surgery should be postponed until the causative disorder is stabilized and signs of pericarditis have resolved.