Background/Objectives: Loop diuretics are among the most commonly used drugs in patients with heart failure with reduced ejection fraction (HFrEF). Higher doses of these diuretics are associated with poorer clinical status and may contribute to malnutrition. The study aims to assess the relationship between the use of high-dose loop diuretics and nutritional status in patients with HFrEF. Methods: The study included 353 hospitalized patients with HFrEF. Nutritional status was assessed using the Mini Nutritional Assessment (MNA), the Geriatric Nutritional Index (GNRI), and the CONtrolling NUTritional status (CONUT). Patients were divided into three groups according to the daily dose of loop diuretics (defined as furosemide equivalent = 1 × furosemide dose and 2 × torsemide dose): low dose (LD), 40 mg/day or no treatment; medium dose (MD), 41–160 mg/day; or high dose (HD), >160 mg/day. Results: Of the evaluated patients, the mean MNA score was 23.31 ± 2.93 points, and 49.8% were at risk of malnutrition or malnourished. According to the MNA, patients in HD and MD groups had worse nutritional status than the LD group, similarly according to the GNRI. For CONUT, the differences were significant between all groups: nutritional status was the worst in the HD group, intermediate in the MD group, and the best in the LD group. Conclusions: The intake of loop diuretics, especially in high doses, correlates with an elevated risk of malnutrition in patients with HFrEF independently of sex, age, NYHA class, and left ventricular ejection fraction.

Aims: Paediatric acute heart failure (AHF) differs from adult cases, and less numerous population limits research aimed at improving clinical practice and prognosis. We aimed to evaluate outcomes and prognostic factors in the paediatric population of AHF patients with left ventricular ejection fraction (EF) < 50%, or systemic right ventricular fractional area change 5% improvement in EF on follow-up echocardiography before discharge (n = 115) and those with EF deterioration, ≤5% EF improvement, or death during hospitalization (n = 47). The study contained 58% males and 42% females. The median age was 1 [interquartile range (IQR) 0–8] year, 14 (IQR 2–101) months. The mortality rate was 12.3%. Acute heart failure aetiologies included congenital heart defects (51.2%), cardiomyopathy (20.4%), infections (14.2%), arrhythmias (11.7%), and others (2.5%). Our study demonstrated independent factors of worse outcomes: cardiomyopathies aetiology [odds ratio (OR) 2.762 (1.210–6.307)], older age [OR 1.006 (1.000–1.011)], and factors of better prognosis: infective aetiology [OR 0.083 (0.010–0.664)], higher EF [OR 0.953 (0.905–0.999)], oxygen saturation (SpO2) [OR 0.951 (0.905–0.992)]. In contrast to CHF exacerbation, de novo AHF had better outcomes (P = 0.014). Conclusion: Acute heart failure with systolic dysfunction in children has an unfavourable prognosis, however most patients improved during hospitalization. In our study, cardiomyopathy aetiology predicted worse outcomes. In turn, infective aetiology, younger age, higher EF, and SpO2 were independent factors of better prognosis.

Pulmonary hypertension (PH) frequently complicates heart failure with reduced ejection fraction (HFrEF) and worsens prognosis. Right heart catheterization (RHC) remains the diagnostic gold standard, but natriuretic peptides may help identify patients requiring invasive assessment. We retrospectively analyzed 563 HFrEF patients who underwent RHC. Patients with and without PH were compared. Associations between B-type natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (NT-proBNP) and RHC parameters were assessed using correlations, restricted cubic splines, logistic regression and receiver operating characteristic (ROC) curves. PH was present in 443 patients (78.7%). Of the study group, 87 (15.5%) were females and 476 (84.5%) were males, the median age was 55 years and the median ejection fraction was 20%. Patients with PH had significantly higher BNP (p < 0.001), NT-proBNP (p < 0.001), New York Heart Association (NYHA) class (p < 0.001) and lower ejection fraction (p < 0.001). Increase in PH risk (p < 0.001), mean pulmonary artery pressure (p < 0.001), pulmonary vascular resistance (PVR) (p < 0.001) and pulmonary arterial wedge pressure (p < 0.001) and decrease in cardiac index (p < 0.001) were associated with an increase in BNP up to approximately 500 pg/mL and NT-proBNP up to approximately 3000 pg/mL. BNP and NT-proBNP were independent predictors of PH and PVR > 5 Wood units. BNP and NT-proBNP predicted PH with area under the curve (AUC) 0.798 and 0.727, respectively, while prediction of PVR > 5 Wood units (AUC 0.661 and 0.664, respectively) or cardiac index < 2.0 L/min/m² was less accurate (AUC 0.607 and 0.623, respectively). Measurement of plasma natriuretic peptides may support PH screening in HFrEF, but their limited ability to detect severe precapillary component confirms RHC as the definitive tool for hemodynamic phenotyping.

Background: Coronary artery anomalies (CAAs) are rare and heterogeneous congenital abnormalities. However, some of them are associated with serious consequences, including myocardial ischemia, heart failure, and even death. This study aimed to characterize symptoms, course, treatment, and prognosis of different types of CAAs. Methods: This single-centre retrospective cohort study included 38 consecutive paediatric patients hospitalised in the Department of Paediatric Cardiology due to a diagnosis of CAAs between 01.2012–03.2025. Patients were divided into two groups: anomalous origin of the coronary arteries (Origin anomalies) and coronary artery fistulae (CAF), respectively, 20 and 18 patients. The collected data included clinical symptoms, laboratory tests, electrocardiography, echocardiographic parameters, course of treatment and long-term follow-up. Results: The mean age of the analysed group was 3.32 ± 5.35 years (range: 1 day − 16 years; IQR0-4.25). The study group included 42% males. During the follow-up, no patient died. There were significant differences between groups in the occurrence of dyspnoea ( p < 0.001), cyanosis ( p = 0.048), echocardiographic parameters: mitral insufficiency ( p = 0.001), left ventricle dilatation ( p < 0.001), left ventricular end diastolic diameter z-score ( p = 0.023) and end systolic diameter z-score ( p = 0.004) and lower ejection fraction ( p = 0.001), which was more prevalent in the origin anomalies group than in the CAF group. Moreover, lower haemoglobin ( p = 0.006) and haematocrit ( p = 0.005) were observed in the origin anomalies group compared to the CAF group. Conclusions: Our study showed that prompt diagnosis and treatment, including transcatheter or surgical intervention, were associated with clinical improvement and no mortality observed during the follow-up period in the study group. Symptoms like dyspnoea, cyanosis, syncope, no weight gain, feeding disorder and fatigue, especially in younger children, should prompt us to expand the diagnosis and look for diseases such as CAAs. Additionally, patients with origin anomalies had more frequent cyanosis, dyspnoea, mitral insufficiency, left ventricle dilatation and lower ejection fraction, haematocrit, and haemoglobin levels than patients with CAF.

Introduction: Accurate risk stratification is an important element of management in patients with advanced heart failure (adHF). Objectives: We aimed to determine factors associated with three–year mortality in patients with adHF who underwent qualification for heart transplantation. Material and methods: We retrospectively analyzed the data of 417 consecutive adult patients with adHF hospitalized in the Cardiology Department between 2011 and 2017. We included patients with New York Heart Association classes III–IV with at least two episodes of proven congestion requiring high-dose intravenous diuretics in the last 12 months. Exclusion criteria were acute HF, inotropic support, any previous heart surgery, inflammatory diseases, chronic kidney and liver disease, severe obstructive pulmonary disease and hematologic, autoimmune or neoplastic diseases. We analysed prognostic value of the model for end-stage liver disease (MELD), which reflects multiorgan dysfunction. The primary endpoint was death during three years of follow-up. Results: In the overall population of 293 patients the median age was 56 (51–61) years, and 92.8% of the patients were male. During the follow-up period, 160 patients reached the primary endpoint. The MELD-XI score hazard ratio (HR) 1.197; 95% CI (confidence interval) (1.131–1.267), p < 0.001), PLR value [HR 1.100; 95% CI (1.080–1.130), p < 0.001], uric acid [HR 1.013; 95% CI (1.002–1.024), p = 0.0169] and sodium HR 1.079; 95% CI (1.044–1.115), p < 0.001] serum concentrations were independent factors of three–year mortality. Conclusions: Higher MELD-XI scores and PLR values as well as higher uric acid and lower serum sodium concentrations are associated with worse outcomes in patients with adHF. Introduction: Accurate risk stratification is an important element of management in patients with advanced heart failure (adHF). Objectives: We aimed to determine factors associated with three–year mortality in patients with adHF who underwent qualification for heart transplantation. Material and methods: We retrospectively analyzed the data of 417 consecutive adult patients with adHF hospitalized in the Cardiology Department between 2011 and 2017. We included patients with New York Heart Association classes III–IV with at least two episodes of proven congestion requiring high-dose intravenous diuretics in the last 12 months. Exclusion criteria were acute HF, inotropic support, any previous heart surgery, inflammatory diseases, chronic kidney and liver disease, severe obstructive pulmonary disease and hematologic, autoimmune or neoplastic diseases. We analysed prognostic value of the model for end-stage liver disease (MELD), which reflects multiorgan dysfunction. The primary endpoint was death during three years of follow-up. Results: In the overall population of 293 patients the median age was 56 (51–61) years, and 92.8% of the patients were male. During the follow-up period, 160 patients reached the primary endpoint. The MELD-XI score hazard ratio (HR) 1.197; 95% CI (confidence interval) (1.131–1.267), p < 0.001), PLR value [HR 1.100; 95% CI (1.080–1.130), p < 0.001], uric acid [HR 1.013; 95% CI (1.002–1.024), p = 0.0169] and sodium HR 1.079; 95% CI (1.044–1.115), p < 0.001] serum concentrations were independent factors of three–year mortality. Conclusions: Higher MELD-XI scores and PLR values as well as higher uric acid and lower serum sodium concentrations are associated with worse outcomes in patients with adHF.