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Helena Krysztofiak,1 Marta Wleklik,2 Jacek Migaj,1,3 Magdalena Dudek,1,3 Izabella Uchmanowicz,2 Magdalena Lisiak,2 Grzegorz Kubielas,2 Ewa Straburzyńska-Migaj,1,3 Maciej Lesiak,1,3 Marta Kałużna-Oleksy1,3 1 1st Department of Cardiology, University of Medical Sciences in Poznan, Poznan, Poland; 2Department of Clinical Nursing, Wroclaw Medical University, Wroclaw, Poland; 3Poznan University of Medical Sciences Hospital of Lord’s Transfiguration, Poznan, PolandCorrespondence:Izabella Uchmanowicz Department of Clinical Nursing, Wroclaw Medical University, Bartla 5, 51-618, Wroclaw, PolandTel +48 71 784 18 05Fax +48 71 345 93 24Email izabella.uchmanowicz@umed.wroc.plAbstract: Heart failure (HF) is a common complication of various cardiac diseases, and its incidence constantly increases. This is caused mainly by aging of populations and improvement in the treatment of coronary artery disease. As HF patients age, they tend to develop comorbidities, creating new problems for health-care professionals. Sarcopenia, defined as the loss of muscle mass and function, and cachexia, defined as weight loss due to an underlying illness, are muscle wasting disorders of particular relevance in the heart failure population, but they go mostly unrecognized. The coexistence of chronic HF and metabolic disorders facilitates the development of cachexia. Cachexia, in turn, significantly worsens a patient’s prognosis and quality of life. The mechanisms underlying cachexia have not been explained yet and require further research. Understanding its background is crucial in the development of treatment strategies to prevent and treat tissue wasting. There are currently no specific European guidelines or recommended therapy for cachexia treatment in HF (“cardiac cachexia”).Keywords: cardiac cachexia, heart failure, nutritional status

Anna Płotka,1 Edyta Prokop,2 Jacek Migaj,2 Ewa Straburzyńska–Migaj,2 Stefan Grajek2 1Medical Faculty I, Poznań University of Medical Sciences, Poznań, Poland, 21st Department of Cardiology, University Hospital of Lord’s Transfiguration, Poznań University of Medical Sciences, Poznań, Poland Purpose: The aim of this study was to gain a deeper insight into patients’ perception of chronic heart failure (CHF) symptoms by analyzing their compliance with nonpharmacological recommendations. Patients and methods: This was a prospective, single-center survey-based registry. Patients included in this study were hospitalized between December 2014 and January 2016 at the 1st Department of Cardiology, University Hospital of Lord’s Transfiguration, Poznan´ University of Medical Sciences, and had been diagnosed with CHF at least 3 months prior to inclusion. Participants were divided according to New York Heart Association (NYHA) functional class into mild CHF (NYHA I and II) and severe CHF (NYHA III and IV), and according to age into young (70 years). The survey included information about the patients’ sex, age, education, length of the illness and 12 questions about their perception of CHF. This study included 201 patients. The mean age was 58±15 years. Results: The younger the patients, the more often they thought that CHF is curable. The patients presenting with severe CHF tended to think that CHF is incurable significantly more often than those with mild CHF. Most of the patients considered loss of appetite, cough and vomiting the least alarming symptoms. Significantly more patients with severe CHF exercised less and reported reduced sexual activity more often in comparison to the mild CHF patients. Most of the young patients reported no changes to their sexual activity, body mass index (BMI) or exercise after diagnosis of CHF. Most of the old patients exercised less than before diagnosis of CHF. Significantly more middle-aged patients reduced their BMI, quit smoking and reported lower sexual activity after diagnosis of CHF in comparison to the other groups. Conclusion: Patients need to be better educated about the nature of CHF and the importance of lifestyle changes. Keywords: chronic heart failure, patient knowledge, patient compliance, lifestyle changes, nonpharmacological recommendations

To assess the relation between silent ischemia and objective markers of ischemia we compared ambulatory electrocardiographic (AECG) monitoring, exercise stress testing, and technetium-99m methoxyisobutyl isonitrile single-photon emission computed tomography (SPECT) in 68 patients with coronary artery disease. ST-segment depression at AECG monitoring occurred in 40%, exercise testing was positive in 88%, and SPECT was abnormal in 98% of patients. Patients with ST-segment depression had a higher incidence of 3-vessel disease (70% vs 45%, p = 0.04), shorter duration of exercise (267 +/- 109 vs 416 +/- 167 seconds, p < 0.01), lower workload achieved (5.1 +/- 1.9 vs 7.6 +/- 2.8 METs, p < 0.0002), and a greater extent of ischemia at scintigraphy (p = 0.01). Patients with a total ischemic time of >30 minutes in a 24-hour period had a lower ejection fraction (48 +/- 21% vs 70 +/- 9%, p = 0.001), a higher perfusion index at rest (2.4 +/- 0.6 vs 1.6 +/- 0.6, p = 0.001), and a greater number of segments with fixed perfusion defects (4.1 +/- 3.7 vs 1.3 +/- 1.8, p = 0.02) in comparison with those who had a shorter ischemic time. We conclude that AECG monitoring fails to identify a substantial proportion of patients with objective markers of ischemia; however, ST-segment depression reflects more significant disease. Longer total ischemic time correlates with the area of myocardial damage but not with other markers of ischemia. [ABSTRACT FROM AUTHOR]

Background/Objectives : Advanced calcific aortic stenosis, with or without coronary artery disease [CAD], may lead to severe systolic dysfunction. The aim of the study was to reveal clinical and laboratory parameters that may differentiate patients with severe aortic stenosis with and without systolic dysfunction. Methods : A retrospective, single-center study included all consecutive patients diagnosed with severe aortic stenosis with overt heart failure. Patients with hematological and neoplastic diseases were excluded. Demographic, clinical and laboratory data were analysed. Neutrophil-to-lymphocyte [NLR], monocyte-to-lymphocyte [MLR], and platelet-to-lymphocyte [PLR] ratios were calculated. The study group was divided based on left ventricular ejection fraction [LVEF]. Results : The final study population comprised 301 patients [133 males [44%]; median [Q1-3] age of 80 [75-83] years]. Co-morbidities included CAD [48.8%], arterial hypertension [75.4%], diabetes mellitus [n = 124, 41.2%], atrial fibrillation [39.2%], chronic kidney disease [60.8%]. Fifty-seven patients presented with LVEF ≤ 40% (heart failure with reduced ejection fraction (HFrEF)) and 244 with LVEF > 40%. In the multivariable analysis, N-terminal pro-B-type natriuretic peptide [NTproBNP] [ p < 0.001, OR 1.000, 95%CI 1.000-1.000], baseline MLR [ p < 0.020, OR 7.393, 95%CI 1.363-40.091] and female sex [ p < 0.001, OR 0.308, 95%CI 0.160-0.593] were revealed as significant predictors of HFrEF. Baseline MLR weakly correlated with EuroScore II [Spearman r = 0.141, p = 0.015] and NTproBNP [r = 0.142, p = 0.014]. Cut-off values were established as 0.36 for MLR and 3927 pg/mL for NTproBNP. After excluding 147 patients with CAD, there was still a statistically significant difference in MLR between the subgroups [ p = 0.024]. Conclusions : Increased values of MLR and NTproBNP together with female sex are predictive parameters for LVEF ≤ 40% in patients with severe aortic stenosis.

(1) Background: Left ventricular assist devices (LVADs) represent mechanical support in end-stage congestive heart failure and are characterized by satisfactory long-term results. Uric acid (UA) represents one of the early heart failure markers whose usefulness was postulated in clinical practice. (2) Methods: Twenty-nine male patients with a median age of 58 (51-62) years were referred for LVAD implantation due to end-stage congestive heart failure in the mean (SD) New York Heart Association (NYHA) status class 3.3 (0.6). Preoperative and postoperative right ventricular (RV) characteristics were compared with serum uric acid concentration within 12 (8-15) months following the implantation. (3) Results: Significant correlations between postoperative uric acid concentration and right ventricular dimension (r = 0.604, p = 0.005), tricuspid annulus plane systolic excursion (TAPSE) (r = -0.496, p = 0.022), left ventricular ejection fraction (r = -0.463, p = 0.046), and N-terminal pro-B-type natriuretic peptide (NT-pro-BNP) (r = 0.505, p = 0.041) were noted. (4) Conclusions: The analysis shows the association between the postoperative RV diameter and TAPSE results in LVAD patients and uric acid concentration. Serum uric acid can be regarded as a possible right ventricular dysfunction marker in LVAD patients.

Aims: Many studies show the association between malnutrition and poor prognosis in heart failure (HF) patients. Our research aimed to analyse sex differences in patients with HF with reduced ejection fraction (HFrEF), emphasizing nutritional status and the influence of selected parameters on the prognosis., Methods and Results: We enrolled 276 consecutive patients diagnosed with HFrEF. Nutritional status was assessed using Mini Nutritional Assessment (MNA), geriatric nutritional risk index (GNRI), and body mass index (BMI). The mean follow-up period was 564.4 ± 346.3 days. The analysed group included 81.2% of men. The median age was 58, interquartile range (IQR) 49-64 years. Among all patients, almost 60% were classified as NYHA III or IV. Half of the participants were at risk of malnutrition, and 2.9% were malnourished. During follow-up, 72 (26.1%) patients died. The female sex was not associated with a higher occurrence of malnutrition (P = 0.99) or nutritional risk (P = 0.85), according to MNA. Coherently, GNRI scores did not differ significantly between the sexes (P = 0.29). In contrast, BMI was significantly higher in males (29.4 ± 5.3 vs. 25.9 ± 4.7; P < 0.001). Impaired nutritional status assessed with any method (MNA, GNRI, BMI) was not significantly associated with a worse prognosis. In multivariable analysis, NYHA class, lower estimated glomerular filtration rate, higher B-type natriuretic peptide (BNP), higher N-terminal fragment of proBNP, and higher uric acid were independent of sex and age predictors of all-cause mortality., Conclusion: There were no sex differences in the nutritional status in the HFrEF patients, apart from lower BMI in females. Impaired nutritional status was not associated with mortality in both men and women., Competing Interests: Conflict of interest: None declared., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background: Heart failure (HF) is a global problem that stimulates research on markers associated with the diagnosis and course of the disease. Soluble suppression of tumorigenicity-2 (sST2) is a receptor for interleukin-33 and is associated with increased mortality rates in HF patients. Malnutrition in HF is also connected with inflammation and is associated with worse prognosis. The present study aimed to evaluate the relationship between sST2 concentration and the nutritional status of patients with HF with reduced ejection fraction (HFrEF)., Material and Methods: 138 patients with HFrEF were enrolled in this cross-sectional study. Nutritional status was assessed using Geriatric Nutritional Risk Index (GNRI) and Controlling Nutritional Status (CONUT). The mean age was 53.6 ± 10.8 years., Results: In the group with sST2 > 32.9 ng/mL, the GNRI score was higher and the associated risk of malnutrition was more common (29% vs. 12%; p = 0.011). Coherently in the group with sST2 > 32.9 ng/mL the median CONUT score was worse (2 [IQR 1-3] vs. 1 [IQR 0-2]; p = 0.0016) and the risk of malnutrition defined by this tool was also more prevalent (p = 0.0079). This relationship was independent of the concentration of natriuretic peptides, age and sex., Conclusions: According to available research, this research is the first study showing that sST2 concentration is related with nutritional status in HFrEF patients. sST2 may help to evaluate the necessity for nutritional intervention in HFrEF patients.

Diagnosis of heart failure with preserved ejection fraction (HFpEF) may be challenging owing to the heterogeneous clinical presentation and comorbidities in this population of patients, along with the limited availability of standard diagnostic tools, including natriuretic peptide tests and functional testing. This expert opinion summarizes the current state of knowledge on the identification and therapy for patients with HFpEF based on recent European and American recommendations. This expert opinion aims to aid clinicians in HFpEF management.

Introduction: Heart failure (HF) patients discharged from a hospital are at a high risk of death and rehospitalization. Scarce data are available on the use of sacubitril / valsartan in this population in Poland., Objective: The aim of this study was to compare the efficacy and tolerability of sacubitril / valsartan in the group of Polish patients who participated in the TRANSITION study with the patients recruited at other sites., Patients and Methods: This is a post hoc secondary analysis of the TRANSITION study comparing sacubitril / valsartan initiation pre- vs postdischarge in 991 patients hospitalized for acute decompensated HF with reduced ejection fraction (HFrEF). The Polish subgroup consisted of 104 patients., Results: Significant differences were identified in the characteristics of Polish vs non‑Polish populations. At baseline, the Polish population showed higher proportion of men, higher body mass index, lower heart rate, N‑terminal pro-B‑type natriuretic peptide and high‑sensitivity troponin T levels, and significantly lower New York Heart Association class. The Polish patients were better managed in terms of implanted electrotherapy devices, percutaneous coronary interventions, and drug therapy, and were more often hospitalized. The primary end point of achieving the target dose of sacubitril / valsartan at treatment week 10 was met by 45.6% of the Polish patients and 48.4% of the non‑Polish population (P = 0.61). Approximately 90% of the Polish patients received and maintained any sacubitril / valsartan dose for 2 weeks over 10‑week treatment vs 87.5% of the non‑Polish patients (P = 0.36). The rate of permanent sacubitril / valsartan treatment discontinuation was low in both Polish (3.9%) and non‑Polish populations (6.4%) (P = 0.33)., Conclusions: Sacubitril / valsartan can be used safely in the early period after an episode of acute HF both in the Polish and non‑Polish patients with HFrEF, and the likelihood to achieve the maximum dose is the same despite significant differences between the studied populations.

New parameters and markers are constantly being sought to help better assess patients with heart failure (HF). ST2 protein has gained interest as a potential biomarker in cardiovascular disease. It is known that the IL-33/ST2L system belongs to the cardioprotective pathway, which prevents the fibrosis, hypertrophy, and apoptosis of cardiomyocytes and also inhibits the inflammatory response. Soluble ST2 (sST2) is involved in the immune response and secreted in response to the mechanical overload of the myocardium, thus providing information on the processes of myocardial remodeling and fibrosis. A total of 110 hospitalized patients diagnosed with heart failure with reduced ejection fraction (HFrEF) were included in the study. Clinical and biochemical parameters were studied. During the follow-up, 30.9% patients died and 57.3% patients reached the composite endpoint. Using ROC curves, the reference cut-off point for sST2 was determined to be 45.818 pg/mL for all-cause deaths. Significantly higher concentrations of inflammatory parameters and natriuretic peptides were found in the group of patients with higher sST2 concentrations. sST2 protein is an independent risk factor for all-cause deaths of patients with HFrEF.

Considering the rare incidence of transthyretin amyloidosis cardiomyopathy (ATTR-CM) in Poland, patients encounter difficulties at the stages of diagnosis and treatment. For successful diagnosis, it is vital to raise the suspicion of ATTR-CM, that is, to identify typical clinical scenarios such as heart failure with preserved ejection fraction or the red flags of amyloidosis. In most cases, it is possible to establish the diagnosis on the basis of noninvasive tests. This article presents the recommended diagnostic algorithms including laboratory workup, imaging tests (in particular, isotope scanning), and genetic tests. Since ATTR-CM should be differentiated from light chain amyloidosis, we also discuss aspects related to hematological manifestations and invasive diagnosis. We describe neurological signs and symptoms in patients with amyloidosis and present therapeutic options, including the causative treatment of ATTR-CM with the only currently approved drug, tafamidis. We also discuss drugs that are being assessed in ongoing clinical trials. We outline differences in the symptomatic treatment of heart failure in ATTR-CM and recommendations for nonpharmacological treatment and monitoring of the disease. Finally, we underline the need for providing access to the causative treatment with tafamidis as part of a drug program, as in other rare diseases, so that patients with ATTR-CM can be treated according to the European Society of Cardiology guidelines on heart failure and cardiomyopathy.

Despite advances in the treatment of heart failure (HF), the rate of hospitalisation for exacerbations of the disease remains high. One of the underlying reasons is that recommended guidelines for the management of HF are still too rarely followed in daily practice. Disease exacerbation requiring inpatient treatment is always afactor that worsens the prognosis, and thus signals disease progression. This is also akey moment when therapy should be modified for HF exacerbation, or initiated in the case of newly diagnosed disease. Inpatient treatment and the peri‑discharge period is the time when the aetiology and mechanism of HF decompensation should be established. Therapy should be individualised based on aetiology, HF phenotype, and comorbidities; it should take into account the possibilities of modern treatment. According to the recommendations of the European Society of Cardiology (ESC), patients with HF should receive multidisciplinary management. Cooperation between the various members of the multidisciplinary team taking care of patients with HF improves the efficiency and quality of treatment. This document expands and details the information on the peri‑discharge management of HF contained in the 2021 ESC guidelines and the 2022 American Heart Association (AHA)/American College of Cardiology (ACC)/Heart Failure Society of America (HFSA) guidelines.

Coronary artery bypass revascularization is still the optimal treatment for complex coronary artery disease with good long-term results. The relation between inflammatory activation in the post-operative period and the long-term prognosis was already postulated. The possible predictive role of preoperative inflammatory indexes after the off-pump coronary artery bypass grafting technique on long term survival was the aim of the study. Study population included 171 patients with a median age of 64 years (59-64) operated on using off-pump technique between January and December 2014. Patients enrolled in the current study were followed-up for 8 years. We conducted a multivariable analysis of pre-operative and post-operative inflammatory markers based on analysis of the whole blood count. The overall survival rate was 80% for the total follow-up period, while 34 deaths were reported (30-days mortality rate of 1%). In the multivariable analysis, a pre-operative value of systemic inflammatory response index (SIRI) >1.27 (HR = 6.16, 95% CI 2.17-17.48, p = 0.012) revealed a prognostic value for long-term mortality assessment after off-pump surgery. Preoperative inflammatory activation evaluated by systemic inflammatory reaction index (SIRI) possess a prognostic value for patients with complex coronary artery disease. The SIRI value above 1.27 indicates a worse late prognosis after off-pump coronary artery bypass (AUC = 0.682, p<0.001)., Competing Interests: The authors have declared that no competing interests exist., (Copyright: © 2022 Urbanowicz et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.)

Objective: The aim of this study was to analyse the understanding of heart failure (HF) by the general public and find the best way to raise people's awareness of this issue., Methods: This prospective, survey-based registry involved 501 people over 18 years old. The survey included information on the participants' gender, education, place of residence, medical history, involvement in any area of healthcare, and having relatives suffering from HF. The participants were divided into three age groups, young (< 40 years), middle aged (40-65 years) and elderly (> 65 years), and two groups, depending on whether the participant's relative was a HF sufferer or not., Conclusion: Despite an increasing prevalence of heart failure, the general public still has insufficient knowledge on symptoms, causes and treatment methods of this disease. New methods of disseminating information should be considered in order to stop an escalating problem of low awareness of heart failure.

The incidence of both diabetes mellitus type 2 and heart failure is rapidly growing, and the diseases often coexist. Sodium-glucose co-transporter 2 inhibitors (SGLT2i) are a new antidiabetic drug class that mediates epithelial glucose transport at the renal proximal tubules, inhibiting glucose absorption-resulting in glycosuria-and therefore improving glycemic control. Recent trials have proven that SGLT2i also improve cardiovascular and renal outcomes, including reduced cardiovascular mortality and fewer hospitalizations for heart failure. Reduced preload and afterload, improved vascular function, and changes in tissue sodium and calcium handling may also play a role. The expected paradigm shift in treatment strategies was reflected in the most recent 2021 guidelines published by the European Society of Cardiology, recommending dapagliflozin and empagliflozin as first-line treatment for heart failure patients with reduced ejection fraction. Moreover, the recent results of the EMPEROR-Preserved trial regarding empagliflozin give us hope that there is finally an effective treatment for patients with heart failure with preserved ejection fraction. This review aims to assess the efficacy and safety of these new anti-glycemic oral agents in the management of diabetic and heart failure patients.

Purpose: Clinical practice forces the necessity to conduct a clinical trial concerning the group of outpatients with chronically advanced heart failure in III or IV NYHA functional class, frequently requiring hospitalizations due to HF exacerbation, and often left without any additional therapeutic option. The current trial aims to determine the efficacy and safety of repeated levosimendan infusions in the group of severe outpatients with reduced ejection fraction (HFrEF)., Material and Methods: LEIA-HF (LEvosimendan In Ambulatory Heart Failure Patients) is a multicentre, randomized, double-blind, placebo-controlled, phase 4 clinical trial to determine whether the repetitive use of levosimendan reduces the incidence of adverse cardiovascular events in ambulatory patients with chronic, advanced HFrEF. A total of 350 patients will be randomized in a 1:1 ratio to receive either levosimendan or placebo, which will be administered as continuous 24 ​h infusions, every 4 weeks for 48 weeks (12 infusions in total - phase I), and followed by double-blind 6 visits, every 4 weeks (phase II of the trial including the option of restarting levosimendan or placebo, based on the fulfillment of additional criteria). The primary endpoint for efficacy assessment will be death from any cause or unplanned hospitalization for HF assessed together, whichever occurs first, in a 12-month follow-up period., Conclusions: A well-designed study with a consistent protocol, including the drug side effects, comprehensive clinical assessment, appropriate definition of endpoints, and monitoring therapy, may provide a complete overview of the effectiveness and safety profile of the repetitive levosimendan administration in ambulatory severe HFrEF patients., Competing Interests: Declaration of competing interest Agnieszka Tycińska, Marek Gierlotka and Grzegorz Grześk – received honoraria and consulting fee from Orion Pharma; Jacek Kubica, Ewa Straburzyńska-Migaj and Robert Zymliński – received honoraria from Orion Pharma. No conflict of interests is declared by: Stanisław Bartuś, Mariusz Gąsior, Renata Główczyńska, Miłosz Jaguszewski, Jarosław D. Kasprzak, Jacek Legutko, Pprzemysław Leszek, Jadwiga Nessler, Giuseppe Pacileo, Piotr Ponikowski, Bożena Sobkowicz, Janina Stępińska, Wojciech Wojakowski, and Barbara Zawiślak., (Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.)

Background: Cardiovascular diseases, apart from commonly known risk factors, are related to inflammation. There are several simple novel markers proposed to present the relation between inflammatory reactions activation and atherosclerotic changes. They are easily available from whole blood count and include neutrophil to lymphocyte ratio (NLR), monocyte to lymphocyte ratio (MLR), and platelets to lymphocyte ratio (PLR). The RDW results were excluded from the analysis., Method and Results: The study based on retrospective single-centre analysis of 682 consecutive patients (131 (19%) females and 551 (81%) males) with median age of 66 years (60-71) who underwent off-pump coronary artery bypass grafting (OPCAB) procedure. During the median 5.3 +/- 1.9 years follow-up, there was a 87% cumulative survival rate. The laboratory parameters including preoperative MLR > 0.2 (HR 2.46, 95% CI 1.33-4.55, p = 0.004) and postoperative NLR > 3.5 (HR 1.75, 95% CI 1.09-2.79, p = 0.019) were found significant for long-term mortality prediction in multivariable analysis., Conclusion: Hematological indices NLR and MLR can be regarded as significant predictors of all-cause long-term mortality after OPCAB revascularization. Multivariable analysis revealed preoperative values of MLR > 0.2 and postoperative values of NLR > 3.5 as simple, reliable factors which may be applied into clinical practice for meticulous postoperative monitoring of patients in higher risk of worse prognosis.

(1) Background: The combination of candidate selection, immunosuppressive therapy adjustment, and scrutinous monitoring is a cornerstone for optimizing long-term survival after a heart transplant. Neutrophil-to-lymphocyte ratio (NLR) is a simple marker of inflammatory reactions activation and may play a clinical role as a predictive marker in oncological and cardiovascular diseases. The aim of the study was to find simple hematologic indices available from whole blood count to help in immunosuppressive therapy monitoring. (2) Methods: Thirty patients (23 men and 7 women) with a mean age of 43 +/- 13 years who had undergone orthotopic heart transplantation were enrolled into the study. The blood samples for whole blood count and Tacrolimus level were collected during outpatient visits in heart transplant recipients every two months for 18 months after first year post transplantation. (3) Results: There was a significant correlation between Tacrolimus overdose (>15 ng/mL) and NLR (Spearman's rho 0.99, p < 0.001) and mean platelet volume (Spearman's rho 0.989, p < 0.001). The ROC analysis for NLR above 3.62 showed predictive properties for Tacrolimus overdose (over 15 ng/mL) (AUC =0.633, p = 0.008) with a sensitivity of 50% and specificity of 83.73%. (4) Conclusions: Our results suggest that NLR above 3.62 may be regarded as a simple indicator of tacrolimus overdose.

Frailty syndrome (FS) has recently attracted attention as one of the major predictors of heart failure (HF) course severity. We aimed to develop a simple tool for predicting frailty in hospitalized HF patients using routine clinical parameters. A total of 153 hospitalized patients diagnosed with heart failure with reduced ejection fraction (HFrEF) were included in the study. Presence of FS was assessed with the SHARE-FI questionnaire. Clinical and biochemical parameters were collected. Using ROC curves and logistic regression analysis, a model predicting FS presence was developed and tested. Proposed model includes five variables with following cut-off values (1 point for each variable): age > 50 years, systolic pressure on admission < 110 mmHg, total cholesterol < 4.85 mmol/L, bilirubin ≥ 15.5 mmol/L, and alanine aminotransferase ≤ 34 U/L. Receiving 5 points was considered a high risk of FS with positive and negative predictive values (NPV), 83% and 72%, respectively, and specificity of 97%. Awarding 2 points or less ruled out FS in the studied group with negative predictive value 94%. The presented novel, simple score predicts FS in HFrEF patients with routine clinical parameters and has good positive and negative predictive values.

Despite significant advances in HF diagnosis and treatment over the recent decades, patients still characterize poor long-term prognosis with many recurrent hospitalizations and reduced health-related quality of life (HRQoL). We aimed to check the potential relationship between clinical, biochemical, or echocardiographic parameters and HRQoL in patients with HF with reduced ejection fraction (HFrEF). We included 152 adult patients hospitalized due to chronic HFrEF. We used the WHOQoL-BREF questionnaire to assess HRQoL and GNRI to evaluate nutritional status. We also analyzed several biochemical parameters and left ventricle ejection fraction. Forty (26.3%) patients were hospitalized due to HF exacerbation and 112 (73.7%) due to planned HF evaluation. The median age was 57 (48-62) years. Patients with low somatic HRQoL score had lower transferrin saturation (23.7 ± 11.1 vs. 29.7 ± 12.5%; p = 0.01), LDL (2.40 (1.80-2.92) vs. 2.99 (2.38-3.60) mmol/L; p = 0.001), triglycerides (1.18 (0.91-1.57) vs. 1.48 (1.27-2.13) mmol/L; p = 0.006) and LVEF (20 (15-25) vs. 25 (20-30)%; p = 0.003). TIBC (64.9 (58.5-68.2) vs. 57.7 (52.7-68.6); p = 0.02) was significantly higher in this group. We observed no associations between HRQoL and age or gender. The somatic domain of WHOQoL-BREF in patients with HFrEF correlated with the clinical status as well as biochemical and echocardiographic parameters. Assessment of HRQoL in HFrEF seems important in everyday practice and can identify patients requiring a special intervention.

Levosimendan was developed as a treatment for acute decompensation of severe heart failure (HF). Its use has evolved during recent years, and new HF treatment strategies in different settings have been developed. This case series aimed to show indications for the use of levosimendan and to discuss the treatment response in various settings. Repetitive levosimendan infusions were found to be safe and effective. They seemed to prolong the time of clinical stability, although they did not alter the eventual natural history of HF, with increasing frequency of hospitalisations and rising natriuretic peptide levels.

Background: Off-pump coronary artery bypass grafting (OPCAB) is believed to limit inflammatory reaction. Neutrophil to lymphocyte ratio (NLR) is one of the more common and easily accessible markers of inflammatory response. The aim of the study was to compare postoperative results of NLR with mid-term OPCAB results., Methods: In total, 224 patients (198 (88%) men and 26 (12%) women) with mean age 65 +/- 9 years who underwent OPCAB though median full sternotomy in our department in 2018 enrolled into the study. We scrupulously collected the postoperative mid-term results, including survival rate, clinical status and risk for major adverse events, and compared them with perioperative laboratory results., Results: A three-year follow-up was completed by 198 individuals (90% survival rate) with 12 (5%) showing major adverse cardiovascular (MACE) events risk. In the multivariable analysis, the laboratory parameters noticed on the 1st postoperative day were statistically significantly predictive of survival, including neutrophils (HR 1.59, 1.33-1.89 95%CI, p < 0.0001), platelets (HR 1.01, 1.01-1.01 95%CI, p = 0.0065), NLR (HR 1.47, 1.3-1.65 95%CI, p < 0.0001) and postoperative ejection fraction (HR 0.9, 0.87-0.95 95%CI, p < 0.0001)., Conclusions: Postoperative NLR above 4.6, as an inflammatory reaction marker, is related to mid-term mortality in OPCAB patients.

This study aimed to investigate the role of appetite loss and malnutrition in patients with heart failure with reduced ejection fraction (HFrEF). In this prospective, observational, single-center study, we enrolled 120 consecutive adults with HFrEF. We analyzed the selected clinical, echocardiographic, and biochemical parameters. Appetite loss and malnutrition were assessed by CNAQ (Council on Nutrition Appetite Questionnaire) and MNA (Mini Nutritional Assessment)/GNRI (Geriatric Nutritional Risk Index) questionnaires, respectively.Most patients were men (81.7%), mean age was 55.1 ± 11.3 years, and mean left ventricular ejection fraction was 23.9 ± 8.0%. The mean CNAQ score was 28.8 ± 3.9, mean MNA-23.1 ± 2.6, and mean GNRI-113.0 ± 12.3. Based on ROC curves, we showed that a sodium concentration <138 mmol/L had the greatest discriminating power for diagnosing impaired nutritional status (MNA ≤ 23.5) with a sensitivity of 54.5% and specificity of 77.8%. The threshold of HDL <0.97 mmol/L characterized 40.7% sensitivity and 86% specificity, B-type natriuretic peptide >738.6 pg/dL had 48.5% sensitivity and 80.8% specificity, high-sensitivity C-reactive protein >1.8 mg/L had 94.9% sensitivity and 42.9% specificity, and bilirubin >15 µmol/L had 78.2% sensitivity and 56.9% specificity. Nutritional status and appetite assessed by MNA/GNRI and CNAQ questionnaires showed poor correlations with other findings in HFrEF patients.

Background: Cardiovascular disease is still the leading cause of death among men and women. The gender related survival differences following off-pump surgery was the subject of the study with relation to coronary arteries diameters according to sizes of intraluminal shunts applied during surgery., Methods: We retrospectively collected data of 2,772 patients who were referred for surgical revascularization in our department between 2010 and 2018 with mean follow up period of 76 months. Patients underwent coronary artery bypass grafting with off-pump technique (OPCAB) with intraluminal shunts application during each anastomosis., Results: The multivariate Cox's proportional hazards model revealed male sex as significant all-cause mortality risk factor [hazard ratio (HR) =4.62; 95% confidence interval (CI): (3.12-6.83)]. The survival proportion was significantly lower in male than female (73% vs. 94%; P<0.0001) within 130 months of follow up despite favorable results of coronary artery diameters. Mean ± standard deviation (SD) diameters of coronary arteries measured by shunts applied during off-pump revascularization were 1.81±0.28 vs. 1.7±0.26 mm (P<0.0001) for left anterior descending artery (LAD) anastomosis, 1.78±0.27 vs. 1.71±0.29 mm (P<0.0001) for circumflex artery (Cx) anastomosis and 1.77±0.28 vs. 1.72±0.31 mm (P>0.05) for right coronary artery (RCA) anastomosis in men and women subgroups, respectively., Conclusions: Female sex is associated with better overall late survival following surgical revascularization despite smaller diameters of coronary arteries in direct measurement with the use of intraluminal shunt application., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-3356). The authors have no conflicts of interest to declare., (2021 Journal of Thoracic Disease. All rights reserved.)

BACKGROUND Congestive heart failure is a challenging problem due to increasing prevalence in developed countries. Patients admitted due to decompensated congestive heart failure symptoms who do not respond to medical treatment require mechanical circulatory support. Patients with biventricular failure are at particularly high mortality risk. MATERIAL AND METHODS We analyzed the function of 49 pumps (POLVAD-MEV, FRK Intra-cordis, Poland) implanted to rescue INTERMACS 1 and 2 profile patients referred to our department due to severe congestive heart failure. All patients were waiting for heart transplantation and were readmitted due to acute decompensations of congestive biventricular heart failure with resistance to medical therapy. RESULTS During the observational period, there were no technical problems in pump function. The mean duration of pump therapy was 30.6±8.3 (5-49) days. The risk for right-sided pump complications included clots formation on the following parts of the pump: outflow tract (1, 2%), membrane (13, 27%), dome (6, 12.5%), and periphery (1, 2%). The overall risk for device thrombosis was 41%. The risk for thromboembolic complications was CRP-dependent regarding conglomerates of fibrin and platelets formation (p<0.05). The risk for left-sided pump complications included clots formation on the outflow tract (1, 2%), membrane (9, 19%) and dome (3, 6%). The overall risk for device thrombosis was 27%. The risk for clots formation on the membrane (P<0.05) and dome of the pump depended on time (P<0.07). CONCLUSIONS Mechanical circulatory support with a paracorporeal pump is a safe option for biventricular heart dysfunction as a bridge to heart transplantation. The risk for thrombi formation is relatively high but acceptable within 30 days after implantation.

Comprehensive cardiac rehabilitation (CR) is a mainstay of the secondary prevention of cardiovascular disease. In the European Society of Cardiology guidelines, comprehensive cardiovascular rehabilitation has the highest class of recommendation and level of evidence as an effective method for the treatment of patients with ST-segment elevation myocardial infarction, after myocardial revascularization, with chronic coronary syndrome, for CVD prevention in clinical practice, and in patients with heart failure (HF). This document presents an expert opinion of the Cardiac Rehabilitation and Exercise Physiology Section of the Polish Cardiac Society concerning the definition, goals, target population, organization of rehabilitation services, standard clinical indications and methods of implementation. Moreover, it describes psychosocial risk factors influencing the course of CR and secondary prevention of cardiovascular disease in patients undergoing CR. Comprehensive CR is as a process that should be implemented as soon as possible, continued without interruption, and consist of multiple stages. Moreover, it should be tailored to the individual clinical situation and should be accepted by the patient and their family, friends, and caregivers.

Competing Interests: The authors declare no conflict of interest.

Background: Advanced heart failure (AdvHF) is associated with high morbidity and mortality. Patients with this clinical condition are potential candidates for heart transplantation or mechanical circulatory support. Initially, however, they are usually supported with inotropic drugs. Recent studies have suggested that levosimendan, independently of hemodynamic improvements, may lead to outcome benefits., Objectives: To present clinical experiences concerning the indications, effectiveness, tolerance, and safety of levosimendan in the real-life therapy of patients with decompensated AdvHF in 3 cardiac centers in Poland., Material and Methods: This is a prospective, observational, three-center study. Forty-nine patients with AdvHF admitted with decompensation were included (88% men, mean age 58 years, 65% ischemic etiology, left ventricular ejection fraction (LVEF) in median 20%) and followed up for an early (3 months) and prolonged period (1 year) after infusion of levosimendan. Patients were analyzed in relation to death., Results: Levosimendan therapy was associated with reduced HF symptoms and signs, New York Heart Association (NYHA) class and level of B-type natriuretic peptide (BNP) at discharge. Five patients died during hospitalization, a further 10 during the three-month follow-up and 3 died during the next nine-month follow-up. During the three-month follow-up, 22 patients were re-hospitalized due to HF and in the next nine-month follow-up 8 were re-hospitalized. A multivariate analysis indicated the QRS duration at discharge (hazard ratio (HR) = 1.02; 95% confidence interval (95% CI) = 1.003-1.03; p = 0.018), high-sensitivity C-reactive protein (hsCRP) (HR = 1.01; 95% CI = 1.004-1.02; p = 0.002), and simultaneous dobutamine infusion (HR = 6.54; 95% CI = 1.4-30.5; p = 0.017) were independent risk factors for death in the one-year follow-up. There were no side effects leading to the interruption of the levosimendan infusion., Conclusions: The use of levosimendan was safe and associated with clinical improvement and reduction in BNP level in AdvHF patients hospitalized due to HF decompensation, although the mortality and re-hospitalization rate during the one-year follow-up remains high.

Background: Nowadays, heart failure (HF) is a significant health problem due to steady increase in diagnosis, unpredictable acute decompensations and high mortality rate. Early risk stratifications of clinical deterioration are essential in preventing life-threatening events and ensuring proper patients management. Increased neutrophil to lymphocytes ratio (NTLR) above 6 is associated with the risk of re-hospitalizations and increased mortality., Objectives: To compare NTLR and clinical, laboratory and hemodynamic results obtained from patients re-hospitalized within six-month intervals due to HF decompensation., Material and Methods: We evaluated 41 patients (n = 36 males (87%) and n = 5 females (13%), mean age 50 ±10 years) admitted to our hospital at least twice within six-month interval due to decompensation of chronic heart failure (CHF) between 2017 and 2019. All patients were divided into 2 groups depending on the NTLR values., Results: There was no death in presented group during the observational time. We observed a significant difference in cardiac index (CI) - 2.4 ±0.5 compared to 2.6 ±0.6 L/m2/min - between the 1st and 2nd admission (p = 0.0356). The right ventricle systolic pressure (RVSP) results related to NTLR level revealed significant difference (43 ±14 mm Hg compared to 59 ±21 mm Hg, p = 0.0438). We observed a significant increase of pulmonary vascular resistance (PVR) values (175 ±106 compared to 438 ±300 dyn*s*cm-5, p = 0.0386) in patients with NTLR above 6., Conclusions: Neutrophil to lymphocyte ratio may be an easy and suitable tool for monitoring of the HF progression. According to our study, the ratio correlates with PVR and RVSP increase.

We are constantly looking for new parameters and markers that can help in the assessment of patients with various diseases, including cardiac disorders; this can translate into better care and improved prognosis. Suppression of tumorigenicity 2 (ST2) has recently gained interest as a potential biomarker in many fields: it is involved in many inflammatory diseases and allergies, including asthma, rheumatoid arthritis and inflammatory bowel disease, and it participates in cardiovascular pathophysiology. Suppression of tumorigenicity 2 is being investigated as a promising biomarker in heart diseases. The interaction of interleukin 33 (IL-33) and ST2L is part of a cardioprotective pathway that prevents fibrosis and inhibits inflammatory response, hypertrophy and apoptosis of cardiomyocytes. In this review, we try to summarize the current knowledge about the usefulness of soluble ST2 (sST2) in cardiology. Clinical data show promising results for the possibility of using sST2 in various diseases, such as arrhythmia, hypertension, myocarditis, acute aortic syndrome, and coronary artery disease (CAD). This novel biomarker may also play a role in heart transplantation and perioperative care.