Search

Heart failure with reduced ejection fraction (HFrEF) is a very complex clinical syndrome. Evidence based drug therapy is rapidly improving in the field of heart failure, more and more modern drug therapies are available. However, in the complex, multidisciplinary treatment of heart failure, timely diagnosis and treatment of co-morbidities is essential because it is possible to effectively treat them with targeted therapy. Iron deficiency is very common across the spectrum of heart failure. Iron is an essential microelement, it plays important role in many physiological processes, such as energy-producing processes. It is therefore easy to understand that low iron levels can also play a role in heart failure. It has previously been proven that, independent of iron deficiency, it impairs patients functional capacity, performance and quality of life. Several clinical trials have analyzed the practical benefits of intravenous iron supplementation, but the results obtained were not clear. However, based on current research results and a meta-analysis of clinical trials, based on the European heart failure recommendation renewed in 2023, intravenous iron supplementation is recommended in order to reduce symptoms and improve quality of life (IA indication) and should be considered in order to reduce hospital admissions (IIaA indication) in patients with HFrEF and HFmrEF. Intensive research is ongoing on whether the definition of iron deficiency may need to be reconsidered, and instead of ferritin level, the clinical significance of transferrin saturation is preferred.

The structure of aspirated coronary thrombus in ST-segment elevation myocardial infarction (STEMI) is still being studied. Our aims were to characterize coronary thrombi of different ages, focusing on the appearance of activated protein C (APC/PC) and its relation to the elements of neutrophil extracellular traps (NETs), and the factors closely related to fibrin as factor XIII (FXIII) and α2 plasmin inhibitor (α2-PI). The thrombi of n = 24 male patients with atherosclerotic coronary plaque rupture related to native coronary artery occlusion were selected for histopathology analysis. Thrombus age was distinguished as fresh, lytic, and organized, and then analyzed by immunofluorescent staining and confocal microscopy. FXIII was present at a high level and showed a high degree of co-localization with fibrin in all stages of thrombus evolution. The amount of α2-PI was low in the fresh thrombi, which increased significantly to the lytic phase. It was evenly distributed and consistently associated with fibrin. APC/PC appeared in the fresh thrombus and remained constant during its evolution. The presence of NET marker and CD66b was most dominant in the lytic phase. APC/PC co-localization with the elements of NET formation shows its role in NET degradation. These observations suggest the importance of searching for further targeted therapeutic strategies in STEMI patients. [ABSTRACT FROM AUTHOR]

Organ injury and impairment are commonly observed in patients with acute heart failure (AHF), and congestion is an essential pathophysiological mechanism of impaired organ function. Congestion is the predominant clinical profile in most patients with AHF; a smaller proportion presents with peripheral hypoperfusion or cardiogenic shock. Hypoperfusion further deteriorates organ function. The injury and dysfunction of target organs (i.e. heart, lungs, kidneys, liver, intestine, brain) in the setting of AHF are associated with increased risk for mortality. Improvement in organ function after decongestive therapies has been associated with a lower risk for post-discharge mortality. Thus, the prevention and correction of organ dysfunction represent a therapeutic target of interest in AHF and should be evaluated in clinical trials. Treatment strategies that specifically prevent, reduce or reverse organ dysfunction remain to be identified and evaluated to determine if such interventions impact mortality, morbidity and patient-centred outcomes. This paper reflects current understanding among experts of the presentation and management of organ impairment in AHF and suggests priorities for future research to advance the field.

In this study, the authors describe the occurrence of a rare and representative antlion species, namely Dendroleon longicruris (C.-k. Yang, 1986), in northern and central Vietnam. This is the first time that this species has been found in the fauna of Vietnam. The most important distinguishing, phenological and distribution features are given. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

Serum angiotensin-converting enzyme (ACE) is the only biomarker routinely used in the laboratory diagnostics of sarcoidosis, and ACE inhibitor (ACEi) drugs are among the most prescribed drugs worldwide. Taking ACEi can mislead medical teams by lowering ACE activity, delaying diagnosis and giving a false impression of disease activity of sarcoidosis. We aimed to develop a simple method to detect the presence of ACEi drugs in samples, to investigate the ACEi medication-caused interference and consequences in a retrospective study. ACE activity and the level of ACE inhibition were determined for 1823 patients with suspected sarcoidosis. These values were compared with the therapeutic information at the first and follow-up visits. A total of 302 patients had biochemical evidence of an ACEi drug effect during diagnostic ACE activity testing. In their case, ACE activity was significantly lower (median(IQR): 4.41 U/L(2.93–6.72)) than in patients not taking ACEi (11.32 U/L(8.79–13.92), p<0.01). In 62 sarcoidosis patients, the ACEi reduced ACE activity to the reference range or below. Only in 40 % of the cases was the medication list recorded in the outpatient chart and only in 3 cases was low ACE activity associated with ACEi use. 67 % of the repeated ACE activity measurements were also performed during ACEi therapy. Our study revealed that the use of ACEi is common in patients with suspected sarcoidosis. The ACE activity lowering effect of ACEi drugs may escape the attention of medical teams which can lead to diagnostic errors and unnecessary tests. Nevertheless, these pitfalls can be avoided by using a method suggested by our team. [ABSTRACT FROM AUTHOR]

This paper introduces a numerical scheme that efficiently predict Raman amplifier behaviors with diverse pump configurations. The scheme handles both Raman pumps in both directions and multiple incoherent pumps with broad spectra. Incorporating frequency-dependent loss, Raman gain, and inter-signal Raman gain, it enables accurate evaluation of signal evolution and optimization for flat gain in wavelength-division multiplexing (WDM) systems. For backward pumps, which interact with all signals and pumps due to the nonlinear Raman gain effect, we employ an iterative optimization method that converges to a solution with acceptable small error after a few optimization cycles. This approach effectively addresses the inherent boundary value problem associated with backward propagating pumps. Validation with measurements demonstrates the scheme's accuracy, empowering researchers and engineers to design and optimize Raman amplifiers for superior performance in optical telecommunication systems. [ABSTRACT FROM AUTHOR]