Improving organization and patient care quality in intensive care units is increasingly important as intensive care unit diagnostic and therapeutic procedures account for a growing proportion of hospital services. We identified the lack of comprehensive national and international registries available in the contemporary literature. This paper aims to describe and analyze cardiac intensive care unit (CICU) network at the national level in Croatia and its comparison with more developed countries. Thirty-four representatives from all Croatian acute hospitals (response rate of 100%) filled in a web based questionnaire on CICU organization and competence during September and October 2016. Organization and available technical procedures for health care in general, and especially in very expensive CICU treatment, highly depends on gross domestic product (GDP) per capita. That is why one could expect that Croatia, with the second lowest GDP among European Union countries and 4.7 CICU per million inhabitants will have worse results in this field in comparison with most of these countries. Results such as one nurse responsible for a mean of 2.7 CICU patients, 52% of cardiologists among physicians during working hours but 37% during night shifts, 24/7 transesophageal echocardiography in only 26.5% of CICUs, one-third without therapeutic hypothermia, and 23.5% without extracorporeal membrane oxygenation treatment are some of these results, revealing much room for improvement. This representative, nationwide sample of Croatian CICUs also demonstrated considerable variation of key elements of structures with respect to hospital size, academic status and financial issues, as well as a trend towards current guidelines. This kind of investigation is very important for proposing standards, reimbursement master plan, or quality assessment of the national health system.

Epicardial adipose tissue (EAT) is an active form of visceral adipose tissue that can affect myocardial function due to shared circulation with the myocardium. Given its rapid metabolic activity, EAT is considered a potential therapeutic target for medications that modulate fat and is a potent marker of metabolic changes including those observed in diabetic cardiomyopathy. Recent investigations propose an association between EAT accumulation and chronic diseases such as type 2 diabetes mellitus (T2DM), atrial fibrillation, and heart failure with preserved ejection fraction. According to the method first described by Iacobellis et al , EAT thickness is identified as the echo-free space between the outer wall of the myocardium and the visceral layer of the pericardium, measured in the parasternal short- and long-axis views at end-systole using ultrasound. Ultrasound of EAT is a safe, cost-effective, and readily available tool for cardiometabolic risk assessment. This minireview investigates the current role of echocardiography in the assessment of EAT thickness in patients with T2DM, regardless of the presence of overt heart failure. We also discuss whether changes in EAT thickness may be used as a significant marker of disease progression and if delta EAT thickness could serve as a surrogate of effective therapy.

Sleep-disordered breathing (SDB)—including obstructive sleep apnea (OSA) and central sleep apnea (CSA)—is highly prevalent among individuals with heart failure (HF), yet frequently underdiagnosed. Increasing evidence shows that SDB and HF interact in a vicious cycle: recurrent hypoxic episodes, fluctuations in intrathoracic pressure, and autonomic dysregulation further strain cardiac function, while HF itself predisposes to the development of apnea. This interplay worsens arrhythmia burden, symptom severity, and long-term prognosis. This review will explore how OSA and CSA influence HF progression and outcomes, elucidate the underlying mechanisms linking these conditions, and discuss diagnostic challenges—from simple screening questionnaires to advanced telemonitoring approaches. We will critically evaluate current therapeutic options, including continuous positive airway pressure (CPAP), adaptive servo-ventilation (ASV), and emerging technologies, in light of major clinical trials and guideline recommendations. Finally, we will highlight the importance of a multidisciplinary, patient-centered approach to improve outcomes in this complex patient population.

Background: The apnea–hypopnea index (AHI) is the conventional metric for grading obstructive sleep apnea (OSA) severity; however, it poorly reflects the true physiological impact of the disorder. The recently introduced hypoxic burden (HB) quantifies total exposure to intermittent hypoxia by integrating the duration and depth of oxygen desaturations associated with respiratory events. HB has emerged as a more biologically relevant and prognostically powerful biomarker than AHI. Methods: This narrative review summarizes the concept, methodology, and clinical significance of HB. Theoretical foundations, algorithmic approaches, and standardization challenges are discussed, along with evidence from major cohort studies evaluating the relationship between HB, cardiovascular outcomes, and treatment response. Results: HB integrates frequency, duration, and amplitude of desaturations into a continuous measure of nocturnal hypoxemia. Multiple independent cohorts (e.g., MrOS, Sleep Heart Health Study) have demonstrated that HB predicts cardiovascular morbidity and mortality more strongly than AHI. Elevated HB is associated with oxidative stress, endothelial dysfunction, sympathetic activation, and systemic inflammation. Reductions in HB during therapy with continuous positive airway pressure (CPAP), noninvasive ventilation (NIV), or oxygen supplementation correlate with improvements in hemodynamic and inflammatory markers, suggesting its potential as a dynamic therapeutic target. Conclusions: HB represents a major advance in the physiological assessment of OSA, linking sleep-related hypoxemia to biological stress and clinical outcomes. Its clinical integration—through standardized computation and incorporation into digital and AI-driven platforms—may enable personalized, physiology-based sleep medicine and establish HB as a key prognostic and therapeutic biomarker comparable to HbA1c in diabetes.

Epicardial adipose tissue (EAT) is a distinct form of visceral adipose tissue that lies within the pericardium and directly adjacent to the myocardium. Individuals with type 2 diabetes mellitus (T2DM) exhibit excessive and metabolically active EAT, which contributes to the development of early diabetic myocardial disease, formerly referred to as diabetic cardiomyopathy. Recent studies have demonstrated that excess EAT is characterized by a proinflammatory profile that may adversely affect the underlying myocardium, leading to impaired diastolic and systolic function. In this review, we discuss the role of excessive EAT as a source of proinflammatory and profibrotic cytokines that influence adjacent ventricular and atrial myocardium through local tissue crosstalk. In addition to metabolic alterations, enlarged EAT induces hemodynamic changes that result in pericardial constraint and enhanced ventricular interdependence, both of which are hallmarks of diabetic pericardial disease. We further analyze the interplay among T2DM, inflammation, obesity, and increased EAT on the one hand, and myocardial dysfunction characterized by myocardial stiffness, elevated filling pressures, and diastolic and systolic dysfunction on the other. We emphasize that the distinct immunometabolic activity of perivascular adipose tissue may lead to a paradigm shift in the understanding of coronary artery disease, moving from a predominantly endoluminal to an exoluminal perspective. A wide range of dietary, lifestyle, and pharmacological interventions are available within this emerging diabeto-cardiometabolic continuum, each with a potential role; however, the timing of intervention is crucial. This review also explores the potential effects of antidiabetic and other pharmacological agents that modulate EAT thickness, volume, and/or activity, and discusses directions for future mechanistic and clinical research.