Heart transplantation (HTx) remains the last therapeutic resort for patients with advanced heart failure. The present work is a clinically focused review discussing current issues in heart transplantation. Several factors have been associated with the outcome of HTx, such as ABO and HLA compatibility, graft size, ischemic time, age, infections, and the cause of death, as well as imaging and laboratory tests. In 2018, UNOS changed the organ allocation policy for HTx. The aim of this change was to prioritize patients with a more severe clinical condition resulting in a reduction in mortality of people on the waiting list. Advanced heart failure and resistant angina are among the main indications of HTx, whereas active infection, peripheral vascular disease, malignancies, and increased body mass index (BMI) are important contraindications. The main complications of HTx include graft rejection, graft angiopathy, primary graft failure, infection, neoplasms, and retransplantation. Recent advances in the field of HTx include the first two porcine-to-human xenotransplantations, the inclusion of hepatitis C donors, donation after circulatory death, novel monitoring for acute cellular rejection and antibody-mediated rejection, and advances in donor heart preservation and transportation. Lastly, novel immunosuppression therapies such as daratumumab, belatacept, IL 6 directed therapy, and IgG endopeptidase have shown promising results.

In this paper, the feasibility of myocardial recovery is analyzed through a literature review. First, the phenomena of remodeling and reverse remodeling are analyzed, approached through the physics of elastic bodies, and the terms myocardial depression and myocardial recovery are defined. Continuing, potential biochemical, molecular, and imaging markers of myocardial recovery are reviewed. Then, the work focuses on therapeutic techniques that can facilitate the reverse remodeling of the myocardium. Left ventricular assist device (LVAD) systems are one of the main ways to promote cardiac recovery. The changes that take place in cardiac hypertrophy, extracellular matrix, cell populations and their structural elements, β-receptors, energetics, and several biological processes, are reviewed. The attempt to wean the patients who experienced cardiac recovery from cardiac assist device systems is also discussed. The characteristics of the patients who will benefit from LVAD are presented and the heterogeneity of the studies performed in terms of patient populations included, diagnostic tests performed, and their results are addressed. The experience with cardiac resynchronization therapy (CRT) as another way to promote reverse remodeling is also reviewed. Myocardial recovery is a phenomenon that presents with a continuous spectrum of phenotypes. There is a need for algorithms to screen suitable patients who may benefit and identify specific ways to enhance this phenomenon in order to help combat the heart failure epidemic.

Olive is rich in polyphenols such as hydroxytyrosol (HT) that have antioxidative and anti-inflammatory effects. In this study, we examined the short-term effects of olive oil extract (OE) enriched with HT on left atrial function, left ventricular (LV) function, and arterial elastic properties in patients with chronic coronary artery disease (CAD). Sixty-one patients with chronic CAD were enrolled. This randomized study had a two-period, two-sequence crossover (AB/BA) design. Group AB (n = 32) initially received OE capsules (500 mg) enriched with HT (5 mg) (two capsules/day) for 30 days, and after a wash out of 48 h, placebo for another 30 days. The opposite occurred in Group BA (n = 29). Exclusion criteria included age >70 years, diabetes, anemia, hypertension, liver and thyroid disease, malignancy, autoimmune disease, kidney disease, use of corticosteroids, weight loss, excessive exercise dietary intervention, and use of antioxidant vitamins. Patients underwent echocardiography/Doppler and applanation tonometry applied to radial artery at the beginning and end of the study. No significant change regarding Vmax, Vp, Vmin, E wave, A wave, deceleration time, LV ejection fraction, central aortic systolic and pulse pressure, and augmentation index. However, a trend toward improvement of E/e′ (P = .062) and pulse wave velocity (P = .091) was observed. Use of OE enriched with HT for a limited time period was associated with a trend toward improvement of LV diastolic function and aortic elastic properties in chronic CAD patients. Studies of longer duration are needed to delineate the effect of this promising agent on cardiovascular function and outcomes in chronic CAD.

Background/Objectives: The aim of this study was to examine the association between in-hospital initiation of sodium glucose co-transporter 2 inhibitors (SGLT2is) and outcomes in hospitalized heart failure (HHF) patients utilizing data from a Greek center. Methods: The present work was a single-center, retrospective, observational study of consecutive HF patients hospitalized in a tertiary center. The study endpoint was all-cause mortality or HF rehospitalization. Univariate and multivariate Cox proportional-hazard models were conducted to investigate the association between SGLT2i administration at discharge and the study endpoint. Results: Sample consisted of 171 patients, 55 of whom (32.2%) received SGLT2is at discharge. Overall, mean follow-up period was 6.1 months (SD = 4.8 months). Patients who received SGLT2is at discharge had a 43% lower probability of the study endpoint compared to those who did not receive SGLT2is at discharge (HR = 0.57; 95% CI: 0.36–0.91; p = 0.018). After adjusting for age, gender, smoking, hemoglobin (Hgb), use of SGLT2is at admission, use of Angiotensin-Converting Enzyme Inhibitors (ACEI-Is)/Angiotensin Receptor Blockers (ARBs) at discharge and Sacubitril/Valsartan at discharge, the aforementioned result remained significant (HR = 0.38; 95% CI: 0.19–0.73; p = 0.004). The 55 patients who received SGLT2is at discharge were propensity score matched with the 116 patients who did not receive SGLT2is at discharge. Receiving SGLT2is at discharge continued to be significantly associated with a lower probability of the study endpoint (HR= 0.43; 95% CI: 0.20–0.89; p = 0.024). Conclusions: Initiation of SGLT2is in HHF patients may be associated with better outcomes.

(1) Introduction: Early identification of patients at high risk of recurrent events after hospitalization for acute decompensated heart failure (ADHF) remains challenging. The Larissa Heart Failure Risk Score (LHFRS) is a simple prognostic tool based on hypertension, coronary artery disease, and red blood cell distribution width. Urinary sodium has recently emerged as an objective marker of natriuretic response and decongestion. We prospectively evaluated whether incorporation of urinary sodium improves the prognostic performance of the LHFRS. (2) Methods: This prospective single-center observational study enrolled 130 consecutive adults hospitalized with ADHF. Clinical, laboratory, electrocardiographic, and echocardiographic data were collected at admission. Spot urinary sodium and chloride were measured at admission and 2 h after intravenous loop diuretic administration according to a standardized decongestion protocol. The primary endpoint was heart failure rehospitalization within 3 months. Secondary endpoints included all-cause mortality and the composite of death or heart failure rehospitalization. Multivariable logistic regression with bootstrap internal validation (1000 resamples) was used to identify independent predictors of outcomes. (3) Results: The study population included patients across the spectrum of heart failure phenotypes (HFrEF 58%, HFmrEF 7%, HFpEF 35%). During follow-up, 48 patients (36.9%) experienced heart failure rehospitalization and 23 (17.7%) died. The LHFRS independently predicted 3-month rehospitalization (B = 0.490, p = 0.041). Admission urinary sodium and 2-h urinary sodium provided incremental prognostic information beyond the LHFRS and remained independently associated with rehospitalization after multivariable adjustment (p = 0.008 and p = 0.001, respectively). Urinary chloride demonstrated similar prognostic associations, whereas conventional renal biomarkers, including serum creatinine, urea, estimated glomerular filtration rate, serum sodium, and NT-proBNP, did not consistently retain independent prognostic significance. The LHFRS was also significantly associated with the composite endpoint of death or rehospitalization (B = 1.173, p = 0.002), while its association with mortality alone was not statistically significant (B = −5.551, p = 0.256). (4) Conclusions: Lower admission and 2-h urinary sodium concentrations were associated with 3-month HF rehospitalization after adjustment for the LHFRS. These findings are hypothesis-generating and require confirmation in larger, externally validated multicenter cohorts.