Background. Heart failure (HF) is characterized by unfavorable prognosis. Disease trajectory of HF, however, may vary, and risk assessment of patients remains elusive. In our study, we sought to determine the prognostic impact of endocan—a novel biomarker of endothelial dysfunction and low-grade inflammation—in patients with heart failure. Methods. In outpatients with chronic HF, baseline values of endocan were determined and clinical follow-up for a minimum of 18 months obtained. A multivariate Cox proportional hazard model was built for HF-related death or hospitalization requiring inotropic support. Results. A total of 120 patients (mean age 71 years, 64% male, mean LVEF 36%) were included. During a mean follow-up of 656±109 days, 50 patients (41.6%) experienced an event. On Cox multivariate analysis, endocan values emerged as an independent predictor of HF prognosis (HR, 1.471 CI 95% 1.183-1.829, p=0.001, for each 1 ng/mL increase) even after adjustment for age, gender, HF etiology, LVEF, NYHA class, NT-proBNP, and exercise tolerance. Conclusions. Endocan is an independent predictor of HF-related events in chronic HF individuals and represents a promising tool for risk assessment of HF patients.

Interpretation and evaluation of images obtained by different contrast-enhanced diagnostic tools in patients on extracorporeal membrane oxygenation (ECMO) support can be extremely challenging due to profound pump-related alterations in haemodynamics and contrast media enhancement patterns. We present a case of a 65-year old patient on veno-arterial ECMO with a pseudo-filling defect of the arterial system on contrast-enhanced computed tomography scan, resembling aortic dissection.

Background: Heart failure with preserved ejection fraction (HFpEF) is a complex and heterogeneous clinical syndrome. In the absence of effective and potent treatment strategies, the main challenge in HFpEF management remains the availability of strong predictors of unfavourable outcomes. In our study, we sought to evaluate the potential prognostic value of heart rate turbulence (HRT) and variability (HRV) parameters on mortality in ambulatory HFpEF patients. Methods: This was a case–control study comparing HRT and HRV parameters in HFpEF survivors vs. non-survivors. Patients from the RESPOND Heart Failure Registry with HFpEF who underwent 24 h ECG monitoring (Holter) were included; HRT parameters (i.e., turbulence onset (TO) and turbulence slope (TS)) and HRV parameters (i.e., standard deviation of NN intervals (SDNN)) derived from 24 h Holter ECGs were calculated in patients who died within 12 months, and compared to their age-, gender-, LVEF-, ECHO-, aetiology-, and therapy-matched alive controls. Results: A total of 22 patients (mean age 80 ± 7 years, 18% female, mean LVEF 57 ± 9%) were included in the final analysis. In deceased patients, values of TO were significantly higher, and values of TS and SDNN were significantly lower as compared to survivors. Conclusions: HRT and HRV parameters have the ability to differentiate individuals with HFpEF who are at the greatest risk of unfavourable outcomes. The extent of autonomic disbalance as determined by HRT and HRV could potentially assist in the prognostic assessment and risk stratification of HFpEF patients.

(1) Background: Aquatic exercise training is a relatively understudied exercise modality in patients with CAD; with the present study, we sought to compare the impact of short-term 14-day water- and land-based exercise training on heart rate variability (HRV). (2) Methods: We randomized 90 patients after a recent CAD event (myocardial infarction and/or revascularization within 2 months prior to inclusion) to either (i) water-based or (ii) land-based exercise training (14 days, two 30 min sessions daily), or (iii) controls. Before and after the intervention period, all participants underwent 20 min 12-channel high-resolution ECG recordings with off-line HRV analysis, including conventional linear time- and frequency-domain analysis (using the Welch method for fast-Fourier transformation), and preselected non-linear analysis (Poincaré plot-derived parameters, sample entropy, and the short-term scaling exponent α1 obtained by detrended fluctuation analysis). (3) Results: Eighty-nine patients completed the study (mean age 60 ± 8 years; 20 % women). We did not detect significant differences in baseline- or age-adjusted end-of-study HRV parameters, but aquatic exercise training was associated with a significant increase in the linear LF/HF parameter (from 2.6 [1.2–4.0] to 3.0 [2.1–5.5], p = 0.046) and the non-linear α1 parameter (from 1.2 [1.1–1.4] to 1.3 [1.2–1.5], p = 0.043). (4) Conclusions: Our results have shown that a short-term 14-day aquatic exercise training program improves selected HRV parameters, suggesting this mode of exercise is safe and may be beneficial in patients with CAD.

Background and Objectives: Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery, associated with increased morbidity and prolonged hospital stays. Oxidative stress has been implicated in POAF pathogenesis, with malondialdehyde (MDA), a marker of lipid peroxidation, proposed as a potential biomarker. However, conflicting evidence exists regarding its predictive value. This study aimed to assess the association between serum MDA levels and POAF incidence in patients undergoing cardiac surgery. Materials and Methods: This prospective observational study included 99 consecutive patients undergoing elective on-pump cardiac surgery. Patients with preoperative atrial fibrillation, chronic kidney disease requiring dialysis, or emergency surgery were excluded. Blood samples for MDA measurement were collected at six perioperative time points: preoperatively, intraoperatively after aortic clamp release, and at 8, 24, 48, and 72 h postoperatively. Patients were monitored for new-onset POAF during the first three postoperative days. Statistical analyses included independent samples t-tests, Mann–Whitney U-tests, and Fisher’s exact tests, with significance set at p < 0.05. Results: POAF occurred in 33 (33%) patients. Patients who developed POAF were significantly older (p = 0.017) and had higher EuroSCORE II values (p = 0.019). No significant differences were observed in serum MDA concentrations between POAF and non-POAF patients at any measured time point. The incidence of POAF was higher in patients undergoing valvular surgery (p = 0.014). Conclusions: Serum MDA levels were not associated with POAF development, suggesting that lipid peroxidation alone may not play a central role in POAF pathogenesis. These findings challenge the predictive value of MDA for POAF risk stratification. Future research should explore alternative oxidative stress markers and their potential therapeutic implications in POAF prevention.