Sleep disordered breathing (SDB) is a common co-morbidity in patients with heart failure (HF). Both its forms — central and obstructive sleep apnea — are highly prevalent in this population. SDB fragments sleep, impairs life quality, worsens exercise tolerance, worsens HF and is an independent predictor of poor prognosis. Still, SDB remains largely undiagnosed. Therefore, early detection of SDB seems to be of primary importance, especially in the presence of new diagnostic and therapeutic methods. Treatment with continuous positive airway pressure (CPAP) increases left ventricular ejection fraction and stroke volume in virtually all HF patients with obstructive and in 50% with central sleep apnea. For those in whom central sleep apnea is not suppressed by CPAP, a trial of adaptive servoventilation is recommended. Although no randomized, controlled trials have shown improvement in mortality, several observational studies have shown that effective treatment of both forms of sleep apnea with various positive airway pressure devices improves survival of HF patients. Currently, 2 large trials with newer masked based therapies with adaptive servoventilation are in progress. This article is a brief overview of present knowledge, the pathophysiology, diagnostic approach and therapy of SDB. Sleep disordered breathing (SDB) is a common co-morbidity in patients with heart failure (HF). Both its forms — central and obstructive sleep apnea — are highly prevalent in this population. SDB fragments sleep, impairs life quality, worsens exercise tolerance, worsens HF and is an independent predictor of poor prognosis. Still, SDB remains largely undiagnosed. Therefore, early detection of SDB seems to be of primary importance, especially in the presence of new diagnostic and therapeutic methods. Treatment with continuous positive airway pressure (CPAP) increases left ventricular ejection fraction and stroke volume in virtually all HF patients with obstructive and in 50% with central sleep apnea. For those in whom central sleep apnea is not suppressed by CPAP, a trial of adaptive servoventilation is recommended. Although no randomized, controlled trials have shown improvement in mortality, several observational studies have shown that effective treatment of both forms of sleep apnea with various positive airway pressure devices improves survival of HF patients. Currently, 2 large trials with newer masked based therapies with adaptive servoventilation are in progress. This article is a brief overview of present knowledge, the pathophysiology, diagnostic approach and therapy of SDB.

The rapid evolution of structural heart interventions, particularly transcatheter aortic valve implantation (TAVI), transcatheter edge-to-edge repair (TEER), and hybrid procedures, has significantly expanded treatment options for elderly, frail, and multimorbid patients previously considered high risk or inoperable. However, perioperative risk stratification in this population remains challenging. Traditional risk scores such as EuroSCORE, EuroSCORE II, STS-PROM, CHA₂DS₂-VASc, and HAS-BLED were developed and validated primarily in cohorts undergoing conventional open-heart surgery (CABG and surgical valve replacement) more than 15–25 years ago. This narrative review critically evaluates the performance and limitations of these classical models in contemporary populations undergoing modern structural cardiac interventions. Evidence from registries and meta-analyses indicates only moderate discriminatory ability and systematic calibration errors. EuroSCORE II and STS-PROM frequently overestimate risk in low- and intermediate-risk patients while underestimating it in high-risk and frail individuals, particularly regarding neurological, renal complications, and prolonged hospitalization. Similar limitations apply to CHA₂DS₂-VASc and HAS-BLED when used beyond their original scope in the peri-procedural setting of TAVI/TEER. The review highlights the growing role of frailty assessment, procedure-specific variables, and machine learning algorithms, which demonstrate superior predictive performance compared to conventional scores. Until dedicated, regularly updated risk models based on large TAVI/TEER registries become available, traditional scores should be used only as supportive tools within multidisciplinary Heart Team discussions that incorporate individual frailty, quality of life, and patient preferences.

Adverse effects associated with cancer treatment, including cancer therapy-related cardiovascular toxicity (CTR-CVT), affect patients’ quality of life and overall survival. Severe and potentially life-threatening cardiotoxicity associated with myocardial dysfunction is most likely to occur after treatment with anthracyclines, which are commonly used in cancer therapy. Cardiotoxicity is a significant complication for the patient and may also necessitate interruption of oncological treatment. The mechanism of anthracycline-induced cardiotoxicity is complex, multifactorial and not fully understood. Studies to date suggest a link between the formation of reactive oxygen species, oxidative damage and the subsequent induction of cardiac cell apoptosis. Knowledge of the mechanisms underlying anthracycline cardiotoxicity allows for safe implementation of the best possible oncological treatment in cancer patients by minimising the risk of CTR-CVT, as well as for planning preventive and monitoring interventions for the early detection and treatment of potential cardiovascular complications. Therefore, the search for effective methods to prevent anthracycline-induced cardiotoxicity and its clinical consequences, which have a negative impact on prognosis and quality of life, remains one of the major challenges faced by oncologists and cardiologists caring for cancer patients. This review discusses the main mechanisms underlying anthracycline cardiotoxicity and emphasises the need to identify an increased risk of anthracycline-induced cardiotoxicity in the context of optimising cardio-oncological management.

Background. The complex clinical status of modern day patients hospitalized due to acute heart failure (AHF) results from their advanced age, comorbidities, frailty, heart failure symptoms (including massive swelling of the lower limb), and dramatic reduction of exercise tolerance. Hence, there is a need to implement physiotherapeutic procedures as early as possible, aiming to both accelerate the restoration of clinical stabilization and prevent post-hospital disability. Objectives. We investigated whether assisted lower limb exercises have an impact on perfusion and oxygenation in skeletal muscle and if they are feasible in patients with AHF. Materials and methods. We examined 34 men (age: 66 +/- 11 years; left ventricular ejection fraction (LVEF): 34 +/- 11%; clinical presentation: 31 wet-warm and 3 wet-cold). The intervention (carried out on the 2nd day of hospitalization) included: 1) a 3-minute rest period; 2) an exercise phase (45 repetitions of assisted flexion and extension of the lower limb; and 3) a 10-minute relaxation period. We analyzed blood pressure (BP), heart rate (HR), respiratory rate (RR), tissue oxygenation (reflected by oxygen saturation measured with a pulse oximeter), and changes in peripheral tissue perfusion (reflected by the tissue oxygenation index (TOI) measured with near-infrared spectroscopy (NIRS)). Results. The hemodynamic parameters (both Delta HR and Delta systolic BP) and oxygen saturation did not change (all p > 0.05), whereas the RR declined (p < 0.001). The exercises improved venous outflow (reflected by decreased oxygenated, deoxygenated and total hemoglobin, all p < 0.05) and increased peripheral tissue perfusion, as reflected by the TOI (p < 0.05). The patients reported relief and lack of dyspnea during and after the assisted exercises. Conclusions. The physiotherapeutic intervention improved both venous outflow and muscle oxygenation in men with AHF. The presented protocol was safe, feasible and well-tolerated, and resulted in relief for the patients. We believe that such procedures might be recommended for the initial period of rehabilitation in this challenging subgroup of patients.