The aim of this study was to perform a systematic review on the potential value of saliva biomarkers in the diagnosis, management and prognosis of heart failure (HF). The correlation between saliva and plasma values of these biomarkers was also studied. PubMed was searched to collect relevant literature, i.e., case-control, cross-sectional studies that either compared the values of salivary biomarkers among healthy subjects and HF patients, or investigated their role in risk stratification and prognosis in HF patients. No randomized control trials were included. The search ended on 31st of December 2020. A total of 15 studies met the inclusion criteria. 18 salivary biomarkers were analyzed and the levels of all biomarkers studied were found to be higher in HF patients compared to controls, except for amylase, sodium, and chloride that had smaller saliva concentrations in HF patients. Natriuretic peptides are the most commonly used plasma biomarkers in the management of HF. Their saliva levels show promising results, although the correlation of saliva to plasma values is weakened in higher plasma values. In most of the publications, differences in biomarker levels between HF patients and controls were found to be statistically significant. Due to the small number of patients included, larger studies need to be conducted in order to facilitate the use of saliva biomarkers in clinical practice.

Background/Objectives: Patient care in Cardiac Intensive Care Units (CICU) has evolved but data on patient characteristics and outcomes are sparse. This retrospective observational study aimed to define clinical characteristics and risk factors of CICU patients, their in-hospital and 30-day mortality, and compare it with established risk scores. Methods: Consecutive patients (n = 294, mean age 70 years, 74% males) hospitalized within 15 months were studied; APACHE II, EHMRG, GWTG-HF, and GRACE II were calculated on admission. Results: Most patients were admitted for ACS (48.3%) and acute decompensated heart failure (ADHF) (31.3%). Median duration of hospitalization was 2 days (IQR = 1, 4). In-hospital infection occurred in 20%, 18% needed mechanical ventilation, 10% renal replacement therapy and 4% percutaneous ventricular assist devices (33%, 29%, 20% and 4%, respectively, for ADHF). In-hospital and 30-day mortality was 18% and 11% for all patients (29% and 23%, respectively, for ADHF). Established scores (especially APACHE II) had a good diagnostic accuracy (area under the curve-AUC). In univariate and multivariate analyses in-hospital intubation and infection, history of coronary artery disease, hypotension, uremia and hypoxemia on admission were the most important risk factors. Based on these, a proposed new score showed a diagnostic accuracy of 0.954 (AUC) for in-hospital mortality, outperforming previous scores. Conclusions: Patients are admitted mainly with ACS or ADHF, the latter with worse prognosis. Several patients need advanced support; intubation and infections adversely affect prognosis. Established scores predict mortality satisfactorily, but larger studies are needed to develop CICU-directed scores to identify risk factors, improve prediction, guide treatment and staff training.

Background: Serum natriuretic peptides (NPs) have an established role in heart failure (HF) diagnosis. Saliva NT-proBNP that may be easily acquired has been studied little. Methods: Ninety-nine subjects were enrolled; thirty-six obese or hypertensive with dyspnoea but no echocardiographic HF findings or raised NPs served as controls, thirteen chronic HF (CHF) patients and fifty patients with acute decompensated HF (ADHF) requiring hospital admission. Electrocardiogram, echocardiogram, 6 min walking distance (6MWD), blood and saliva samples, were acquired in all participants. Results: Serum NT-proBNP ranged from 60–9000 pg/mL and saliva NT-proBNP from 0.64–93.32 pg/mL. Serum NT-proBNP was significantly higher in ADHF compared to CHF (p = 0.007) and in CHF compared to controls (p < 0.05). There was no significant difference in saliva values between ADHF and CHF, or between CHF and controls. Saliva and serum levels were positively associated only in ADHF patients (R = 0.352, p = 0.012). Serum NT-proBNP was positively associated with NYHA class (R = 0.506, p < 0.001) and inversely with 6MWD (R = −0.401, p = 0.004) in ADHF. Saliva NT-proBNP only correlated with age in ADHF patients. Conclusions: In the current study, saliva NT-proBNP correlated with serum values in ADHF patients, but could not discriminate between HF and other causes of dyspnoea. Further research is needed to explore the value of saliva NT-proBNP.

Background: Cardiogenic shock (CS) is a life threatening condition marked by inadequate tissue perfusion due to impaired cardiac output. Despite advances in diagnosis and management, mortality remains unacceptably high. Objective: This prospective, single-center observational study aimed to characterize the clinical profile, management strategies, and short- and long-term outcomes of patients with CS. Methods: Seventy patients (SCAI stages B–E) admitted to the Cardiac Intensive Care Unit (CICU) of a tertiary university hospital over a 24-month period were enrolled. Demographic, clinical, hemodynamic, echocardiographic, and biochemical data were collected. The primary outcomes were in-hospital, 1-month, and 1-year mortality. Secondary outcomes included the use of mechanical circulatory support (MCS), mechanical ventilation (MV), and continuous renal replacement therapy (CRRT). Results: Acute myocardial infarction-related CS (AMI-CS) and heart failure-related CS (HF-CS) accounted for 64% of cases. The overall in-hospital mortality was 49%. SCAI stage C was independently associated with higher mortality at all time points compared with stage B. Key predictors of mortality included higher SCAI stage, elevated lactate and creatinine levels, and reduced cardiac output. Intra-aortic balloon pump (IABP) use was more frequent in AMI-CS. Conclusions: CS continues to be associated with poor prognosis, particularly in patients with higher SCAI stages. Standardized clinical pathways and national registries are urgently needed to guide evidence-based and resource-appropriate care.

Transcatheter aortic valve implantation (TAVI) has become the standard of care for patients with severe aortic stenosis. Despite significant procedural refinement, vascular complications (VCs) remain among the most frequent and clinically relevant adverse events associated with TAVI. These complications are closely associated with adverse clinical outcomes and continue to represent one of the most significant limiting factors for the broader expansion of TAVI indications to larger patient populations. Over the past decade, their incidence has declined substantially, largely due to device evolution, improved closure techniques, and the widespread adoption of meticulous pre-procedural imaging and planning. This narrative review provides a comprehensive overview of VCs in TAVI, focusing on contemporary incidence rates, underlying mechanisms, and patient as well as procedural-related risk factors. Additionally, the role of alternative access routes is discussed, alongside emerging technologies and future perspectives aimed at further reducing complication rates.

Cardiogenic shock (CS) is a heterogeneous pathophysiological state with high mortality, despite the development of cardiac intensive care units (CICUs) and the advanced treatments applied. The cornerstones of therapy that have been proposed in many algorithms are intravenous (i.v.) pressors and devices for mechanical circulatory support (MCS), depending on the CS profile (left, right, or biventricular involvement), etiology (acute myocardial infarction, heart failure, or other) and SCAI stage (A to E, with MCS generally recommended for Stages C–E). There are many gaps in the evidence regarding i.v. medications and devices, with the existing data being controversial. Moreover, there are differences in the devices’ availability and, as a result, a lack of experience in many centers. In this review article, an algorithm for the management of CS is proposed, and the gaps in every step are presented. Early clinical suspicion that leads to prompt diagnosis, health system organization, large-scale trials, and the configuration of national or regional shock centers could bridge the current therapeutic gaps and balance disparities in the management of CS in order to improve outcomes.