Background: Systemic venous congestion is a key driver of organ dysfunction in heart failure (HF), yet accurate non-invasive quantification remains challenging. Recognizing residual congestion is critical, since it predicts HF readmissions and mortality. Traditional assessments (physical exam, jugular venous pressure, inferior vena cava [IVC] size) are imprecise. The Venous Excess Ultrasound Score (VExUS) is a semi-quantitative point-of-care ultrasound (POCUS) protocol that integrates IVC diameter with Doppler flow patterns in the hepatic, portal and intrarenal veins to grade systemic venous overload. Methods: We conducted a narrative review of literature (2018–2025) regarding the usefulness of VExUS in HF, covering congestion pathophysiology, clinical evidence (hemodynamic correlations, organ dysfunction, outcomes), potential applications, integration with lung ultrasound, echocardiography and biomarkers, limitations of its assessment and future directions. Results and Discussions: In HF, elevated right atrial pressure causes venous congestion. VExUS integrates IVC diameter with Doppler waveforms of hepatic, portal, and intrarenal veins to grade congestion. Emerging evidence shows higher VExUS grades correlate with elevated filling pressures, renal dysfunction, and worse outcomes. Its use may guide diuretic therapy, aid discharge planning, and monitor outpatient congestion, especially when combined with lung ultrasound and biomarkers. However, VExUS has limitations: it is technical and operator-dependent. Importantly, large trials validating VExUS-guided management are lacking. Future directions include AI-driven automation of Doppler analysis and integration with multimodal congestion monitoring to provide a comprehensive congestion assessment. Conclusions: VExUS is a promising noninvasive tool for quantifying congestion in HF. Higher grades are associated with organ dysfunction and poor prognosis. Incorporating this technique into HF care may improve congestion-guided therapy, but large-scale validation is required before routine use.

Pulmonary thromboembolism (PE) is a life-threatening condition that often leads to right ventricular (RV) dysfunction, a key determinant of prognosis and clinical management. Biomarkers play a crucial role in the early detection and risk stratification of RV dysfunction in PE, complementing imaging and hemodynamic assessments. Cardiac troponins, B-type natriuretic peptides, and novel biomarkers, such as heart-type fatty acid-binding protein (H-FABP) and growth differentiation factor-15 (GDF-15), provide valuable insights into myocardial injury, overload, and stress. This article explores the clinical possible significance of these biomarkers, their predictive value, and their potential to guide therapeutic strategies in patients with PE. Understanding the role of biomarkers in RV dysfunction assessment may improve patient outcomes focusing on early intervention and personalized treatment approaches.

Because the number of elderly people is increasing worldwide, and the prevalence of cardiovascular risk factors and cardiovascular diseases increase with age, in current clinical practice we are faced with a large number of geriatric patients requiring oral anticoagulant treatment. Our review highlights some of the particularities of using direct oral anticoagulants (DOACs) in the geriatric population. We focused on the difficulties of managing DOAC treatment in the presence of geriatric syndromes. We highlighted the practical steps needed to overcome the challenges related to the risk of falling, cognitive impairment, swallowing disorders, and polypragmasy to improve patient care. We provided data to help guide the choice of anticoagulant and dose.

Type 2 diabetes mellitus is associated with major cardiovascular complications, including cardiac autonomic neuropathy, which contributes to sympathetic–parasympathetic imbalance and increases susceptibility to arrhythmias and sudden cardiac death. Heart rate variability, assessed through R–R intervals on electrocardiography and 24 h Holter monitoring, represents a sensitive, non-invasive marker of autonomic dysfunction and arrhythmogenic risk. In patients with type 2 diabetes mellitus, chronic hyperglycaemia, oxidative stress, and metabolic inflammation lead to early impairment of the autonomic nervous system, manifested by consistent reductions in SDNN, RMSSD, pNN50, total power, and the high-frequency component, indicating diminished parasympathetic tone and sympathetic predominance. Nonlinear HRV indices demonstrate a loss of complexity and fractal organisation, providing additional prognostic value beyond conventional time- and frequency-domain analyses. Reduced HRV correlates with the severity of cardiac autonomic neuropathy, duration of diabetes, and poor glycaemic control, identifying patients with increased arrhythmogenic vulnerability. HRV analysis enables prediction of arrhythmic risk, facilitating the identification of high-risk individuals and guiding personalised interventions. The integration of HRV assessment into routine clinical practice may improve the early detection of subclinical autonomic neuropathy and optimise cardiovascular risk stratification and management in patients with type 2 diabetes mellitus.

Cardiovascular disease and diabetes mellitus have now reached pandemic proportions, and their association has become very common. Some patients with coronary artery disease and diabetes remain symptomatic, with chest pain present despite the implementation of evidence-based medical treatment and maximal therapy. A hypothesis increasingly confirmed in clinical practice is that epicardial or microvascular spasm, or both, are frequently responsible for the lack of symptom control or for the occurrence of major adverse cardiovascular events. Our review provides the most up-to-date and in-depth analysis of the available literature to provide solid knowledge about coronary spasm in diabetes patients. We have deepened the substrate of coronary spasm in relation to the multiple and complex structural and functional abnormalities produced by chronic hyperglycemia, with the ultimate goal of allowing optimization of treatment and improving patient outcomes.

Acute heart failure (AHF) is a leading cause of hospitalization and mortality worldwide. Despite advances in biomarker-based evaluation, accurate diagnostic and prognostic stratification remains challenging in everyday clinical practice. Growth differentiation factor-15 (GDF-15) has emerged as a biomarker associated with advanced disease profiles, poor outcomes and complex underlying pathophysiological processes in heart failure (HF). This study aimed to investigate the diagnostic and prognostic value of GDF-15 in the acute setting and to evaluate its incremental role within multimarker assessment strategies. In this prospective cohort study, 60 patients hospitalized with AHF and 42 control subjects were enrolled. Circulating levels of GDF-15, N-terminal pro–B-type natriuretic peptide (NT-proBNP), and high-sensitivity cardiac troponin I (hs-cTnI) were measured at admission. Diagnostic performance was assessed using receiver operating characteristic (ROC) analysis and multivariable logistic regression. Prognostic value was evaluated for in-hospital, short-term, and one-year mortality, including multimarker models. GDF-15 levels were significantly elevated in AHF and demonstrated a favorable diagnostic profile, with high specificity and acceptable sensitivity. When integrated into multivariable diagnostic models, GDF-15 added significant value beyond established cardiac biomarkers. For prognosis, standalone biomarkers showed limited long-term discrimination, whereas multimarker approaches incorporating GDF-15 improved short-term mortality prediction and enhanced one-year risk stratification in patients with markedly elevated NT-proBNP levels. GDF-15 provides independent diagnostic and prognostic information in AHF and enhances multimarker strategies for comprehensive patient assessment, supporting its integration as a complementary biomarker in contemporary AHF evaluation.