The concept of heart failure (HF) has undergone significant transformation from ancient times to the present, evolving from rudimentary understandings to a complex clinical syndrome. Early descriptions by Egyptian, Greek and Roman physicians laid the groundwork for understanding cardiac dysfunction. The Renaissance period brought crucial insights with Harvey’s discovery of blood circulation. In the 20th century, the Framingham Heart Study provided a pivotal shift, formally defining HF as a clinical syndrome with diagnostic criteria. Over the decades, definitions of HF have evolved, integrating advancements in pathophysiology, biomarkers and imaging techniques. Initially focused on symptomatic and clinical presentations, modern definitions emphasise underlying structural and functional cardiac abnormalities. This evolution reflects the growing complexity and precision of diagnosing and managing HF. A historical perspective underscores the progressive refinement in HF definitions, which enhances diagnostic precision and therapeutic strategies, ultimately improving patient outcomes. Understanding this evolution is crucial for appreciating contemporary HF management and anticipating future advances.

Chronic heart failure (CHF) carries high morbidity and mortality. Circulating biomarkers of myocardial stretch, injury, and remodelling aids diagnosis and prognosis, but utility varies, especially in HFpEF, where natriuretic peptide (NP) values may be lower or normal in obesity. We systematically searched PubMed, Scopus, and Web of Science (2010–2025) for primary adult chronic-HF studies evaluating blood-based biomarkers: NPs, high-sensitivity troponins (hs-cTn), galectin-3, soluble ST2 (sST2), and microRNAs. Secondary sources (reviews/meta-analyses/guidelines) informed context only. Acute-HF studies were not pooled with chronic-HF analyses. Where appropriate, log hazard ratios were meta-analysed with random effects models. Twenty-nine studies met criteria. NT-proBNP remained the diagnostic/prognostic reference; across five prognostic cohorts, the pooled HR was 1.68 (95% CI 1.54–1.82; I² ≈ 55%). hs-cTn consistently improved risk stratification. Galectin-3 and sST2 were associated with adverse outcomes but typically provided modest incremental value beyond NPs/hs-cTn; galectin-3 is influenced by renal function, and sST2 is commonly interpreted around ~28–35 ng/mL. MicroRNAs (e.g., miR-21, miR-210-3p, miR-22-3p) showed promising yet heterogeneous signals across platforms and preanalytical workflows; therefore, findings were synthesised narratively without pooling. NT-proBNP and hs-cTn form the evidence-based backbone for biomarker-guided assessment in chronic HF. Galectin-3 and sST2 add adjunct prognostic information, while microRNAs remain investigational, pending standardised methods and external validation. Overall, evidence supports a multimarker, phenotype-tailored approach, with core NPs + hs-cTn and selective adjunct use of sST2/galectin-3 in context (HFrEF vs. HFpEF, obesity, renal function) to refine risk stratification and guide clinical decision-making.

Background: The clinical significance of inflammatory phenotypes and their temporal relationship with natriuretic peptide dynamics in acute heart failure (AHF) remain poorly defined. We investigated admission inflammatory phenotypes, in-hospital C-reactive protein (CRP) trajectories, and their relationship with N-terminal pro-B-type natriuretic peptide (NT-proBNP) dynamics. Methods: In this retrospective single-center cohort of 306 patients hospitalized for AHF, patients were stratified according to admission CRP (≤10 vs. >10 mg/L). Among patients with dual biomarker measurements (n = 147), a CRP–procalcitonin (PCT) concordance phenotype was evaluated. Serial CRP measurements were available in 65 patients, and NT-proBNP response (≥30% reduction) was assessed in 42 patients; because these repeat measurements were obtained at the treating physician’s discretion, the corresponding subgroups were older and more severely ill than the full cohort and are treated as exploratory. Results: Elevated admission CRP (>10 mg/L) was associated with higher NT-proBNP levels (3621 vs. 1251 pg/mL, p < 0.001), more severe symptoms (New York Heart Association [NYHA] III–IV: 45.9% vs. 29.8%, p = 0.006), and greater PCT positivity (21.8% vs. 8.7%, p = 0.029), independent of left-ventricular ejection fraction; the association persisted after adjustment for age, sex, and ejection fraction (adjusted odds ratio 2.40, 95% CI 1.27–4.55). The biomarker-defined CRP+/PCT+ phenotype showed the greatest concurrent NT-proBNP burden and the highest prevalence of heart failure with preserved ejection fraction (HFpEF, 70.6%). Despite declining NT-proBNP, CRP increased during hospitalization in 69.2% of patients (median ΔCRP +5.9 mg/L, p < 0.001), and the two changes were uncorrelated, indicating divergent biomarker trajectories. Conclusions: Admission CRP identifies patients with a more severe concurrent inflammatory and hemodynamic profile, while combined CRP–PCT phenotyping further characterizes this profile. Divergent CRP and NT-proBNP trajectories suggest that inflammatory and hemodynamic changes follow distinct time courses during AHF hospitalization. Because no post-discharge outcomes were available, these findings describe concurrent associations rather than prognosis.

Background/Objectives: Acute heart failure (AHF) is a leading cause of global morbidity, necessitating the search for reliable biomarkers to guide risk stratification. While hyperuricemia is highly prevalent in heart failure patients and historically considered a potential “cardiotoxin”, contemporary evidence suggests that it may function as a surrogate biomarker for cardiometabolic distress rather than an independent driver of myocardial dysfunction. This study aimed to determine whether serum uric acid acts as an independent predictor of left ventricular ejection fraction (LVEF) in a high-risk cardiometabolic cohort. Methods: This retrospective, cross-sectional study analyzed 306 patients hospitalized for acute heart failure at a tertiary hospital in Timisoara, Romania. Data were analyzed using JASP (v0.96). Statistical methods included Shapiro–Wilk testing, Spearman’s rank-order correlation, and independent samples t-tests. Multivariable ordinary least squares linear regression and maximum likelihood logistic regression were employed to identify predictors of LVEF and diagnostic classification, adjusting for comorbidities and diuretic administration. Results: Hyperuricemia was present in 64.6% of the cohort. Multivariable linear regression demonstrated that while age, sex, and diuretic use significantly predicted LVEF variance, serum uric acid did not (p = 0.356). Furthermore, logistic regression confirmed uric acid possessed no diagnostic utility in differentiating heart failure phenotypes (OR = 0.995; p = 0.973). Conclusions: Serum uric acid is not an independent predictor of reduced ejection fraction in acute heart failure patients. Elevated uric acid appears to be a biochemical shadow of generalized metabolic distress, systemic congestion, and the pharmacokinetic effects of diuretic therapy rather than a pathological driver of contractile dysfunction.

Background and Objectives: Suspected bacterial infection is one of the leading presentations to the Emergency Department (ED) and is still associated with considerable morbidity and mortality. There is increasing evidence that biological sex may influence host immune responses, disease manifestations, therapeutic requirements, and clinical outcomes in infectious diseases. However, sex-specific differences among patients who present to the ED with suspected infection remain incompletely defined. This study, therefore, aimed to assess demographic characteristics, clinical presentation, and clinical management as well as short-term outcomes related to sex among these patients. Materials and Methods: Our single-center retrospective observational study included consecutive adults patients (n= 213) presented with suspected acute bacterial infection to the Emergency Department between June 2025 and August 2025. Results: Female patients were significantly older than male patients (72.13 ± 15.26 vs. 64.25 ± 13.66 years, p < 0.001). Cardiovascular disease and urinary tract infections were more frequently observed among women, whereas men presented significantly higher diastolic blood pressure values at admission (p = 0.004). Vasopressor therapy was more commonly required in female patients compared to males (26.0% vs. 13.3%, p = 0.019). No significant sex-related differences were identified regarding ICU admission or in-hospital mortality. Conclusions: ED patients with suspected bacterial infection demonstrate sex-related differences in age, comorbidities, infection source, and treatment requirements. Female patients were older and more frequently required vasopressor therapy. On the other hand, male patients had higher diastolic blood pressure and presented more frequently with respiratory infections. Short-term outcomes, including ICU admission and in-hospital mortality, were similar for both sexes. These findings highlight the importance of considering sex-specific characteristics in the early assessment and management of suspected infection in the Emergency Department.

Background and Objectives: Suspected bacterial infection is one of the leading presentations to the Emergency Department (ED) and is still associated with considerable morbidity and mortality. There is increasing evidence that biological sex may influence host immune responses, disease manifestations, therapeutic requirements, and clinical outcomes in infectious diseases. However, sex-specific differences among patients clinically managed for suspected bacterial infection in ED remain incompletely defined. This study, therefore, aimed to assess demographic characteristics, clinical presentation, and clinical management as well as short-term outcomes related to sex among these patients. Materials and Methods: This retrospective single-center observational study included consecutive adults presenting with suspected bacterial infection to the ED between 1 June and 31 August 2025. Demographic, clinical, laboratory, treatment, infection-source, and outcome data were extracted from medical records. Between-group comparisons were followed by planned age-adjusted analyses and multivariable logistic regression. Results: A total of 213 patients were included, comprising 100 women (46.9%) and 113 men (53.1%). Women were older than men (median 77.0 vs. 67.0 years, p < 0.001), had lower diastolic blood pressure (70 vs. 75 mmHg, p = 0.004), and lower hemoglobin concentrations (11.79 vs. 12.45 g/dL, p = 0.004). Cardiovascular disease was more frequent among women than men (72.0% vs. 52.2%, p = 0.003), although this difference was attenuated and no longer significant after adjustment for age. A documented urinary source of infection was more frequent among women (51.0% vs. 34.5%, p = 0.015) and remained significantly associated with female sex after age adjustment (OR 2.14, 95% CI 1.20–3.81, p = 0.010; Benjamini–Hochberg-adjusted p = 0.039). No significant difference was detected in Emergency Department treatment: supplemental oxygen, vasopressors and broad-spectrum antibiotics were given with similar frequency to women and men (all p ≥ 0.139). Direct intensive care unit (ICU) admission from the ED occurred in 14 of 100 women (14.0%) and 21 of 113 men (18.6%; OR 0.71, 95% CI 0.34–1.49), and in-hospital mortality in 7 women (7.0%) and 9 men (8.0%; OR 0.87, 95% CI 0.31–2.43). After adjustment, female sex was not independently associated with direct ICU admission (OR 0.64, 95% CI 0.29–1.39; p = 0.257) or in-hospital mortality (OR 0.80, 95% CI 0.27–2.35; p = 0.690). Conclusions: In this single-center retrospective cohort of adults clinically managed for suspected bacterial infection in the emergency department, women were older and more frequently had a documented urinary source of infection. After adjustment for age, female sex remained associated with a documented urinary source of infection. The study did not provide precise evidence that sex was independently associated with direct ICU admission or in-hospital mortality; however, the confidence intervals were wide and clinically relevant differences cannot be excluded. Larger prospective multicenter studies with standardized diagnostic criteria, microbiological confirmation, and adequate outcome-event numbers are needed.