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Obesity is one of the most significant independent risk factor for developing heart failure (HF) through direct and indirect mechanisms. Excessive secretion of aldosterone and activation of the renin­angiotensin system (RAAS) in obese patients leads to sodium retention and an increase in extracellular volume, which contributes to the development of heart failure and increased cardiovascular risk. Abdominal visceral obesity is associated not only with an increased risk for the development of heart failure with preserved ejection fraction (HFpEF), but also with a high risk for the development of diabetes mellitus and hypertension in both sexes, but more dominantly in women, with an increase in incidence with menopause. Multiple studies and meta-­analyses have confirmed that obese patients with heart failure regardless of ejection fraction (HFpEF and HFrEF) have better survival compared to those of normal or underweight, a phenomenon known as the obesity paradox. The HF­ACTION trial showed that even small improvements in cardiorespiratory fitness could lead to significant improvements in cardiovascular outcomes, reducing the impact of the obesity paradox on the clinical outcome of heart failure. The ESC recommendations for heart failure advise weight loss in order to prevent cardiovascular disease in obese and overweight patients, and gradual weight loss should be considered in patients with heart failure and BMI > 35 kg/m², while in patients with heart failure and BMI<35 kg/m², weight loss is not recommended. The goal of bariatric procedures is to prevent or delay the onset of heart failure, not only by reducing body weight but also by reducing risk factors. The randomized DAPA­HF trial showed that the use of dapagliflozin proved to reduce the composite outcome of worsening heart failure or cardiovascular death in heart failure patients with BMI>30 kg/m² and in HF patients with BMI<30 kg/m² . The EMPEROR­ preserved and DELIVER trials showed that therapy with SGLT2 inhibitors in patients with HFpEF and BMI>30kg/m² reduces the risk of hospitalization and cardiovascular death. It is recommended that patients in the terminal stage of heart failure in the pre-­transplantation period and placed on the list for heart transplantation achieve target values of BMI<30 kg/m² in order to achieve a better clinical outcome and reduce mortality after transplantation. [ABSTRACT FROM AUTHOR]

Introduction: Cardiac resynchronization therapy (CRT) is standard for heart failure patients with low left ventricular ejection fraction (LVEF ≤35%) and QRS duration ≥130ms despite optimal medical treatment1. Patients and Methods: This is a retrospective study that involved patients with implanted biventricular heart electrostimulators with (CRT-D) or without (CRT-P) defibrillator functions since 2011 to April 2018. The goal was to assess the CRT efficiency during check-ups after 6 months. Results: Including 40 patients, 23 men and 17 women of an average age of 66.3 years. There were 4 (10%) patients with ischemic cardiomyopathy (IDCM), while 36 (90%) of the non-ischemic cardiomyopathy (NIDCM) had equal gender distribution. The average width of the QRS was 160 ms, and 75% of patients presented with typical Strauss left bundle branch block (LBBB). At the time of implantation, 6 (15%) patients had atrial fibrillation. The average LVEF value was 28%, and their NYHA status was III. CRTD was implanted in all patients with IDCM. CRT-P was implanted in 19 and CRT-D in 17 patients with NIDCM. In 36 (85%) patients, there was an improvement of LVEF of which 11 (all with NIDCM, sinus rhythm and typical LBBB) achieved almost normal heart function (LVEF ≥50%) with regression of LV volume. There was no improvement in NYHA status with 5 (12.5%) patients, and with 6 (15%) there was deterioration or there was no improvement in LVEF. Four (10%) patients were hospitalized for acute heart failure. The average LVEF was 45.4% and the NYHA status was I/II. Sudden deaths or syncope in CRT-P patients were absent, while appropriate and necessary treatment of tachyarrhythmia occurred in 3 patients with CRT-D. Lethal outcomes were with 3 patients (one non-cardiac and two non-sudden cardiac deaths). Conclusion: Targeted patient selection with proper left ventricular lead implantation and optimal device programming improves the response rate to resynchronization therapy. [ABSTRACT FROM AUTHOR]

Introduction: Anemia is frequent in patients with chronic heart failure (CHF) and is connected to a worse prognosis, regardless the severity and type. The correction of anemia contributes to the improvement of health, which also reduces the number of hospitalizations, improves the survival rate and the quality of life.1-3 Patients and Methods: This retrospective analysis includes patients with CHF and a reduced systolic function of the left ventricle who have been treated for the last three years at the Department of Cardiology University Hospital Centre "Sestre milosrdnice" in Zagreb. The method of parallel sample was used to compare the data of a hundred patients with anemia and a hundred patients without anemia. Using the statistical analysis of multiple factors it was attempted to determine the influence of anemia as an independent risk factor in the number of repeated hospitalizations. Results: Although patients with anemia were older than those without anemia (median 77 (66-85): 67.5 (58-75.3); p <0.0001, Mann-Whitney), it was determined that patients with CHF and anemia were hospitalized more frequently than those who have CHF without anemia (median 4 (3- 6):2 (1-4); p <0.0001, Mann-Whitney). Patients with anemia were more often examined in the unified urgent reception (median (4 (3-6): 2 (1-4); p <0.0001, Mann-Whitney). Conclusion: Anemia in patients with CHF represents a significant factor of a bad prognosis and can cause more frequent hospitalizations and examinations in the emergency department. Even treating these patients with high doses of oral iron hasn't led to a clinical improvement, so a new protocol was introduced with a proven and beneficial treatment of these patients with high dose intravenous iron. [ABSTRACT FROM AUTHOR]

Cardiopulmonary exertion testing (CPET) is a non-invasive diagnostic method for monitoring of cardiopulmonary response to the load. This test enables evaluation of the function and capacity of the cardiovascular, pulmonary and metabolic system.1 Therefore, ergospirometry has become an important clinical tool for assessing physical ability in patients with heart failure and other cardiorespiratory conditions. Ergospirometry test is considered the gold standard in testing of the functional abilities of cardiorespiratory system and planning individualized physical activity for patients undergoing cardiologic rehabilitation. The nurse has an integral role in the implementation of ergospirometry testing. In addition to helping patients manage their cardiovascular problems, her tasks are also the proper preparation of the room, equipment, and patient for an optimal test performance. During the test, occurrence of symptoms/complications such as fatigue, heart arrhythmia and syncope are possible. Therefore, the nurse working in the ergospirometry laboratory should know very well indications and contraindications for the test and should be skilled in cardiopulmonary resuscitation. Much of the sister's work in ergospirometry takes place long before the diagnostic test is carried out. Continuous education, development of medical and psychological skills is an integral part of work and progress in the ergometric laboratory. [ABSTRACT FROM AUTHOR]