Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed as antihyperglycemic agents, have revolutionized heart failure (HF) management, offering substantial benefits across all stages and phenotypes of the disease. Regardless of left ventricular ejection fraction (LVEF), these agents have proven efficacy in both chronic and acute HF presentations. This review explores SGLT2i applications spanning the HF continuum, from early stages (Stage A) in at-risk individuals to the mitigation of progression in advanced HF (Stage D). Evidence from numerous trials has shown that SGLT2i significantly lower rates of HF hospitalization, improve renal function, and decreases cardiovascular mortality, highlighting their multifaced mechanisms of action in HF care. This review also highlights the potential mechanisms by which SGLT2i exert their beneficial effects on the cardiovascular and renal systems, each contributing to early and sustained clinical improvements. However, the integration of SGLT2i into guideline-directed medical therapy poses practical challenges, including initiation timing, dosing, and monitoring, which are addressed to support effective treatment adaptation across patient populations. Ultimately, this review provides a comprehensive assessment of SGLT2i as a foundational therapy in HF, emphasizing their role as an intervention across multiple stages aimed at improving outcomes across the entire HF spectrum.

Heart failure (HF) affects many patients worldwide every year. It represents a leading cause of hospitalization and still, today, mortality remains high, albeit the progress in treatment strategies. Several factors contribute to the development and progression of HF. Among these, sleep apnea syndrome represents a common but still underestimated factor because its prevalence is substantially higher in patients with HF than in the general population and is related to a worse prognosis. This review summarizes the current knowledge about sleep apnea syndrome coexisting with HF in terms of morbidity and mortality to provide actual and future perspectives about the diagnosis, evaluation, and treatment of this association.

Environmental factors such as extreme temperatures, humidity, wind, pollution, altitude, and diving can significantly impact athletes’ cardiovascular systems, potentially hindering their performance, particularly in outdoor sports. The urgency of this issue is heightened by the increasing prevalence of climate change and its associated conditions, including fluctuating pollution levels, temperature variations, and the spread of infectious diseases. Despite its critical importance, this topic is often overlooked in sports medicine. This narrative review seeks to address this gap by providing a comprehensive, evidence-based evaluation of how athletes respond to environmental stresses. A thorough assessment of current knowledge is essential to better prepare athletes for competition under environmental stress and to minimize the harmful effects of these factors. Specifically, adaptative strategies and preventative measures are vital to mitigating these environmental influences and ensuring athletes’ safety.

Article: Athlete’s heart or heart disease in the athlete? Evaluation by cardiopulmonary exercise testing - The Journal of Sports Medicine and Physical Fitness 2023 Mar 23 - Minerva Medica - Journals

Electrocardiogram modifications in athletes are common and usually reflect structural and electrical heart adaptations to regular physical training, known as the athlete’s heart. However, these electrical modifications sometimes overlap with electrocardiogram findings that are characteristic of various heart diseases. A missed or incorrect diagnosis can significantly impact a young athlete’s life and potentially have fatal consequences during exercise, such as sudden cardiac death, which is the leading cause of death in athletes. Therefore, it is crucial to correctly distinguish between expected exercise-related electrocardiogram changes in an athlete and several electrocardiogram abnormalities that may indicate underlying heart disease. This review aims to serve as a practical guide for cardiologists and sports clinicians, helping to define normal and physiology-induced electrocardiogram findings from those borderlines or pathological, and indicating when further investigations are necessary. Therefore, the possible athlete’s electrocardiogram findings, including rhythm or myocardial adaptation, will be analyzed here, focusing mainly on the differentiation from pathological findings.

Positive airway pressure (PAP) therapy is widely used to manage both acute and chronic respiratory failure and plays an increasingly important role in cardiology, particularly in treating patients with respiratory comorbidities. PAP, including continuous positive airway pressure and noninvasive ventilation, significantly impacts hemodynamics by altering intrathoracic pressure, affecting preload, afterload, and stroke volume. These changes are crucial in conditions such as acute cardiogenic pulmonary edema, where PAP can enhance gas exchange, reduce the work of breathing, and improve cardiac output. PAP reduces the left ventricular afterload, which in turn increases stroke volume and myocardial contractility in patients with left-sided heart failure. However, the role of PAP in right ventricular function and its effects on venous return and cardiac output are critical in the cardiac intensive care setting. While PAP provides respiratory benefits, it must be used cautiously in patients with right heart failure or preload-dependent conditions to avoid adverse outcomes. Additionally, in recent years, the use of PAP has expanded in the treatment of severe obstructive sleep apnea and obesity hypoventilation syndrome, both of which significantly influence cardiovascular events and heart failure. This review provides an in-depth analysis of the hemodynamic effects of PAP in cardiovascular disease, focusing on its impact on ventricular function in both acute and chronic conditions. Evaluating clinical studies, guidelines, and recent advancements offers practical insights into the physiological mechanisms and key clinical considerations. Furthermore, this review aims to serve as a helpful guide for clinicians, assisting in decision-making processes where PAP therapy is applied.