In heart failure, hyperuricemia is common, and higher serum uric acid levels are associated with poorer clinical outcomes. Additionally, hyperuricemia can cause gout, which is difficult to manage and can prolong hospitalization in patients with heart failure. In this context, agents that lower UA have even been investigated as potential treatments for heart failure because of their potential effect on SUA. Among patients with chronic heart failure, our study aimed to determine whether SGLT2 inhibitor empagliflozin influences SUA levels and whether empagliflozin has therapeutic efficacy related to SUA, particularly their effect on reducing mortality, preventing hospitalization, and improving clinical status. In 164 patients, the association between SUA and cardiovascular death or hospitalization for worsening HF and all-cause mortality was investigated. The treatment effect of empagliflozin was studied in relation to SUA as continuous variable, to clinical hyperuricemia (SUA >5.7 mg/dL for women, >7.0 mg/dL for men). Hyperuricemia was prevalent in 61% of patients with no sex differences. Elevated SUA (mean SUA 9.42 ± 1.53 mg/dL) was associated with advanced severity of HF and with worst outcome [composite outcome, hazard ratio (HR) 1.67 (95% confidence interval, CI 1.26–2.14); cardiovascular mortality, HR 1.96 (95% CI 1.32–2.89); all-cause mortality, HR 1.8 (95% CI 1.31–2.44). The reduction of SUA after initiating therapy with empagliflozin was observed rapidly (i.e. at 4 weeks) and was maintained throughout the follow-up period. The beneficial effect of empagliflozin on the primary endpoint was independent of baseline SUA [HR 0.78 (95% CI 0.69–0.90), P < 0.001) and of the change in SUA at 4 weeks [HR 0.84 (95% CI 0.71–0.94), P = 0.014]. Hyperuricemia is common in HF and is a strong indicator of advanced disease severity and increased mortality. The administration of empagliflozin resulted in rapid and sustained reductions in SUA levels and hyperuricemia-related clinical events. The benefit of empagliflozin on the primary outcome was observed independently of SUA. Patients with elevated SUA levels experienced a significant reduction in cardiovascular mortality and all-cause mortality, whereas patients with lower SUA levels did not experience this reduction. Empagliflozin was most effective in lowering SUA levels in patients with the highest SUA levels at baseline who also showed the highest mortality risks.Treatment effect of empagliflozin  Cumulative incidence of hyperur. events

Background: RV dysfunction has been recognized as a powerful independent predictor of poor prognosis. Therefore, accurate evaluation of RV function is helpful for risk stratification in patients with HF, so as to guide clinicians to choose the best treatment and improve the prognosis of patients. Therefore, assessment of RV function is clinically important in almost all patients with heart disease. Objective: The main purpose of this study was to evaluate the prognostic value of right ventricular free wall longitudinal strain in patients with heart failure with reduced ejection fraction (HFrEF). Methods: We evaluated a prospective cohort of 126 patients with known or suspected HFrEF referred for echocardiographic evaluation. All underwent measurement of RV free-wall longitudinal strain (RVFWLS) by 2D transthoracic echocardiography. The primary study endpoint was the occurrence of death for any cause or hospitalization for heart failure. Results: From 126 eligible patients with chronic heart failure, 10 (8%) with RVFWLS not suitable for strain analysis were excluded, leaving a final study population of 116 patients. During the follow-up period of 24 months, 44 patients (38%) reached the composite end point: 18 patients died (15%), and 26 patients (22%) were hospitalized for worsening HF. Compared with patients without events, patients who reached the composite end point were older and prevalently men (P <0.05). Patients with events also showed higher LV volumes, lower LVEF%, increased left atrial volume index (LAVI), increased pulmonary artery systolic pressure, and higher prevalence of severe MR and TR than event-free patients. Diastolic RV diameter was also significantly greater in this group. In this study, we found that a RVFWLS less negative of -19.3% was associated to outcomes with 75% sensitivity and 67% specificity P < 0.001. A value of RVFWLS less than -19.3% was strongly associated to outcome with HR 1.9, 95% CI 1.487–2.7; P < 0.001. Conclusion: RV free wall longitudinal strain seems to be more sensitive and accurate for the diagnosis of RV systolic dysfunction in patients with HFrEF, therefore assessment of RV function should be implemented by analysis of RVFWLS in patients with HFrEF, to improve identification of patients who are at high risk for adverse events.

Heart failure remains one of the most prevalent clinical syndromes associated with significant morbidity and mortality. According to current guidelines MRA are recommended to reduce the risk of HF hospitalization and death in all patients with symptomatic heart failure. The aim of our study was to determine the efficacy of eplerenone vs. spironolactone on left ventricular systolic function (LVEF) in patients with chronic heart failure, especially their effect on preventing hospitalization, reducing mortality, and improving clinical status among patients with chronic HF. From June 2021 to June 2022, the study was a randomized, prospective clinical trial single blind study. A total of 142 patients of chronic heart failure with reduced ejection fraction were selected by random sampling. Each patient was randomly allocated into either of the two groups and was continued receiving treatment with either spironolactone (Spiron-HF group) or eplerenone (Epler-HF group). Patients in Epler-HF group were compared with an arm of the same size. Each patient was evaluated clinically and echocardiographically at the beginning of treatment, after 6 months and at the end of 12th month. After 12 months of treatment, significant improvement of left ventricular ejection fraction was observed in eplerenone treated arm (37.9 ± 3.8 ± 4.6 in Spiron-HF group versus 40.1 ± 5.7 in Epler-HF group; P < 0.05). A significant reduction in left ventricular end-systolic volume (6.3 ± 2.5ml in Spiron-HF versus 17.8± 4.4ml in Epler-HF group; P < 0.05) and left ventricular systolic diameter volume (2.7 ± 0.5ml in Spiron-HF versus 6.7 ± 0.2ml in Epler-HF group; P < 0.05), occurred after 12 months of treatment. The effects of both MRA agents' spironolactone and eplerenone on the primary composite outcome, each of the individual mortality and hospital admission outcomes are shown in Figure 1 and 2. Patients of the Epler-HF group showed statistically significant lower cardiovascular mortality (HR 0.53; 95% CI 0.34–0.82; p= 0.007) and all-cause mortality (HR 0.64; 95% CI 0.44–0.93; p= 0.022) than patients of the Spiron-HF group. The statistical analysis did not show a statistically significant difference between Epler -HF and Spiron-HF study groups regarding the risk of the primary composite outcome; cardiovascular death or hospitalization due to HF (Hazard Ratio (HR) eplerenone vs. spironolactone = 0.95; 95% Confidence Interval (CI) 0.73– 1.27; p= 0.675). Our study has demonstrated favorable effects of eplerenone on cardiac remodeling parameters and reduction of cardiovascular mortality and all-cause mortality compared with spironolactone in the treatment of HFrEF. The ability of eplerenone to effectively block the mineralocorticoid receptor while minimizing side effects and a significant reduction in the risk of hospitalization and cardiovascular death confirms its key role in the treatment of patients with chronic HFrEFCumulative estimates of cardiovascular mCumulative incidence of the primary end-

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The fibrosis of the LA, which is characteristic of AF, causes mechanical dysfunction of the LA and may also be present in patients without LA enlargement. LA strain represents a surrogate marker of this mechanical dysfunction. Early detection of LA dysfunction may be crucial in identifying patients who are more likely to experience AF recurrence following cardioversion and ablation. Before cardioversion and ablation, the probability of AF recurrence might be predicted, which could lead to better patient selection, an individualized therapeutic strategy with reduced risk and focused follow-up. Purpose The aim of this study was to evaluate the additional predictive value of LA function assessed by using strain echocardiography for early AF recurrence after cardioversion and ablation. Methods 94 patients diagnosed with symptomatic persistent atrial fibrillation (EHRA symptom score ≥3 (mean age 59.4 ± 12.2 years, 58% male, 42%female), preserved LV ejection fraction were prospectively analyzed. In 39 (41,5%) patients pharmacological cardioversion was done after saturation with antiarhythmic drugs,in 27 (28,7%) patients planed electrical cardioversion was done after medical saturation with antiarrhythmic drugs and failure of pharmacological cardioversion, and in 28 (29,8%) patients planed RF ablation was performed. Complete echocardiography evaluation including strain and volume index LA was performed before cardioversion and ablation. The rhythm evaluation was done in the first month after cardioversion and RF ablation (35±5 days). The primary endpoint was persistent AF recurrence. Results 29 (30,8%) patients had AF recurrence in the overall study population, independently of duration of AF or method of rhythm control. Peak atrial longitudinal strain (PALS) ≤15% had the highest incremental predictive value for AF recurrence (HR =8.42, 95% CI: 3.17–25.12, p < 0.001). In patients with non-dilated LA, PALS≤15% remained an independent predictor of AF recurrence (HR = 5.32, 95% CI: 1.77–17.42, p = 0.005). Conclusion This study shown that, in addition to LA dilatation, LA function as determined by PALS can provide a prognostic value for early AF recurrence after cardioversion or ablation. PALS also predicted AF recurrence in patients with nondilated LA. These findings highlight the additional prognostic usefulness of LA strain and recommend its implementation in the systematic assessment of AF patients prior to the choice of rhythm/rate control.

Background: Heart failure remains one of the most prevalent clinical syndromes associated with significant morbidity and mortality. According to current guidelines, the prescription of a MRA is recommended to reduce the risk of HF hospitalization and death in all patients with symptomatic heart failure and no contraindications for this therapy. Objective: The aim of our study was to determine the efficacy of eplerenone vs. spironolactone on left ventricular systolic function by measuring left ventricle ejection fraction (LVEF) in patients with chronic heart failure, especially their effect on preventing hospitalization, reducing mortality, and improving clinical status among patients with chronic HF. Methods: From June 2021 to June 2022, the study was a randomized, prospective clinical trial single blind study. A total of 142 patients of chronic heart failure with reduced ejection fraction were selected by random sampling. Each patient was randomly allocated into either of the two groups and was continued receiving treatment with either spironolactone (Spiron-HF group) or eplerenone (Epler-HF group). Patients in Epler-HF group were compared with an arm of the same size and matched by age and gender patients in Spiron-HF group for management of chronic HFrEF. Each patient was evaluated clinically, biochemically, and echocardiographically at the beginning of treatment (baseline) after 6 months and at the end of 12th month. Echocardiography was performed to find out change in left ventricular systolic function. Results: After 12 months of treatment, significant improvement of left ventricular ejection fraction was observed in eplerenone treated arm (37.9 ± 3.8 ± 4.6 in Spiron-HF group versus 40.1 ± 5.7 in Epler-HF group; P < 0.05). A significant reduction in left ventricular end-systolic volume (6.3 ± 2.5ml in Spiron-HF versus 17.8± 4.4ml in Epler-HF group; P < 0.05) and left ventricular systolic diameter volume (2.7 ± 0.5ml in Spiron-HF versus 6.7 ± 0.2ml in Epler-HF group; P < 0.05), occurred after 12 months of treatment. Left ventricular global longitudinal strain (LV GLS) was significantly improved in Epler-HF group compared with Spiron-HF group (0.6 ± 0.4 versus 3.4 ± 0.9; P < 0.05). There were no significant differences observed in reduction of left ventricular end-diastolic volume (2.2 ± 0.5 ml versus 4.7 ± 1.1ml; P =0.103) and left ventricular diastolic diameter (1.2 ± 0.6 versus 1.7 ± 0.3; P=0.082) in both arms. The effects of both MRA agents spironolactone and eplerenone on the primary composite outcome, each of the individual mortality and hospital admission outcomes are shown in Figure 1 and 2. Patients of the Epler-HF group showed statistically significant lower cardiovascular mortality (HR 0.53; 95% CI 0.34–0.82; p= 0.007) and all-cause mortality (HR 0.64; 95% CI 0.44–0.93; p= 0.022) than patients of the Spiron-HF group. The statistical analysis did not show a statistically significant difference between Epler -HF and Spiron-HF study groups regarding the risk of the primary composite outcome; cardiovascular death or hospitalization due to HF (Hazard Ratio (HR) eplerenone vs. spironolactone = 0.95; 95% Confidence Interval (CI) 0.73– 1.27; p= 0.675). Conclusion: Our study has demonstrated favorable effects of eplerenone on cardiac remodeling parameters and reduction of cardiovascular mortality and all-cause mortality compared with spironolactone in the treatment of HFrEF. The ability of eplerenone to effectively block the mineralocorticoid receptor while minimizing side effects and a significant reduction in the risk of hospitalization and cardiovascular death confirms its key role in the treatment of patients with chronic HFrEF.

Background: Heart attack, or cardiac arrest, became a leading cause of death after the turn of the century. Defibrillation is one of the most important medical advances of the twentieth century. Defibrillation is a critical step in the treatment of cardiac arrest as it can be the only way to restore a normal heart rhythm and save the life of the individual. However, it is important to note that defibrillation is only effective if it is performed quickly and in conjunction with other life-saving measures such as cardiopulmonary resuscitation (CPR). The history of cardiac defibrillation therapy is long and fascinating, spanning several centuries, many countries and continents. Objective: The aim of this article was to provide historical information about technical and scientific advances in cardiac devices and the development of today defibrillators. Methods: Review of the available literature, historical data, personal contacts, others and personal experience in this field. Discussion: In 1947, Beck published the first paper describing open chest defibrillation of the human heart. Ten years later, Kouwenhoven demonstrated that the heart could be defibrillated through a closed chest. The first external defibrillator weighed 120 kg and delivered 500 v of alternating current (AC) potential. The mere size of the defibrillator restricted its use to surgical suites or other areas hospital locations. In many cases, cardiac arrhythmias recurred. This was thought to be related to the amount of energy used to defibrillate the heart which it was believed caused myocardial damage. These factors limited the practical application of defibrillators. By 1956, a unit was built that could be wheeled into the emergency room, plugged into a wall outlet, and deliver 1000 volts. By 1962, Lown realized that AC current resulted in a high frequency of cardiac arrhythmias and cardiac damage. A direct current (DC) defibrillator, consisting of a battery, a capacitor to store energy, and a transformer was developed. The therapy spread from operating rooms to coronary care units and emergency departments and in the late 1960s left the hospital and started appearing on mobile intensive care units. The first portable EMS defibrillators (used by paramedics) emerged in the early 1970s. In 1980 the automatic implantable cardioverter-defibrillator was invented. Automated external defibrillators began appearing in the late 1980s allowing the therapy to be delivered by EMTs and lay people. The ‘father’ of the modern automated external defibrillator (AED), Professor James Francis (1916-2004) was a physician and cardiologist from Northern Ireland who transformed emergency medicine and paramedic services with the invention of the portable defibrillator. Conclusion: Defibrillators are critical resuscitation devices. The use of reliable defibrillators has led to more effective treatments and improved patient safety through better control and management of complications during Cardiopulmonary Resuscitation (CPR). The 75th anniversary of the world’s first successful human cardiac defibrillation represents the landmark event that defined the future of cardiovascular medicine and ushered in a new era of advanced cardiac life support.

Background: Cerebrovascular accidents (CVI) are considered the second most serious complication in cardiac surgery patients with a frequency of 10%. By preventing complications of surgical treatment, using a Color Doppler ultrasound (CDU) device, in the population of cardiac surgery patients, the unplanned costs of prolonged postoperative treatment would be reduced. Objective: To prove that the acquisition and use of the newly developed CDU device “Affinit 30” is completely economical, profitable and medically justified. Methods: Numerical parameters of the treatment of cardiovascular patients were analyzed (number of procedures, number of days in the intensive care unit, cost of additional consultative services of the clinic for radiology and neurology), and the calculated economic value of the potential investment, as well as the cost of preventing surgical complications, by purchasing and installing a new modern CDU device. Results: The profitability of the investment was assessed using the economic parameters Net Present Value (NPV) of the investment, Internal rate of return (IRR) and Profitability Index (PI). A mathematical calculation with the given parameters yields NPV = 948,850 KM and IRR of 273% when applied to the given parameters. The PI value is 12.6, which matches the previously calculated NPV and IRR values. Conclusion: The acquisition and use of the newly developed CDU device “Affinit 30” is economically profitable and medically justified. This is shown by the calculated values of the economic parameters Net Present Value of the investment (NPV), Internal rate of return (IRR) and the Profitability Index (PI).

Background: Consuming a diet rich in natural foods that include oilseed products containing bioactive compounds and a diverse array of fatty acids is not just a dietary choice; it is a critical element of maintaining human health. Objective: This paper aims to review the current state of knowledge on minor bioactive compounds in vegetable cold pressed oils, these are substances that are found in small amounts in vegetable cold pressed oils. Methods: Intended as an indispensable resource, this review is designed to empower medical professionals in the fields of integrative medicine, nutrition, and dietetics. Results and Discussion: Cold-pressed oils extracted from various plant sources have emerged as vital allies in the battle against inflammation-related diseases, offering a versatile range of valuable compounds. These compounds contribute to the oils' multifaceted properties, which encompass potent anti-inflammatory, antioxidant, and anticancer effects, greatly enhancing their nutritional significance. This brief review delves deep into the intricate composition of cold-pressed oils, with a specific focus on the often overlooked but highly influential minor bioactive compounds, including phytosterols, phospholipids, tocols, phenols, squalene and pigments. Intended as an indispensable resource, this review is designed to empower medical professionals in the fields of integrative medicine, nutrition, and dietetics. It equips them with a wealth of knowledge to guide consumers in making informed choices when incorporating cold-pressed oils into their dietary plans, tailored to their individual health needs.. Conclusion: This paper highlights the importance of cold-pressed oils as a source of various minor bioactive compounds that have the potential to promote human health and prevent or manage a range of diseases. The findings presented in this paper serve as a valuable resource for medical professionals in the field of integrative medicine, nutrition, and dietetics, as well as for consumers looking to make informed choices about their dietary and health needs.

Background: Endocrine-disrupting chemicals (EDCs) represent a group of chemicals which are related to the disturbances in the human hormonal system. Due to the newest research, it was discovered that their actions did not exclusively point to the hormonal system but rather to all organs of the human body. EDCs are metabolized and may excrete the influence on human metabolism. That influence can be related to the activity of different enzymes included in human metabolism. Those effects can be classified as epigenetic effects. Objective: The aim of the study was to make analysis, evaluation, examination and determination of the possible mechanisms through which EDCs may interact with different metabolically-driven diseases. Methods: This paper represents a review article that includes original and review articles that were used being published in the following databases: Medline/PubMed, ScienceDirect, Oxford Academic, and Google Scholar. Results: EDCs interact through nuclear or steroid receptors excreting their influence onto diseases such as obesity, metabolic syndrome (MetS) and non-alcoholic fatty liver disease (NAFLD). Those mechanisms are mediated through metabolic or immunological pathways. It encompasses different types of hormones, such as vistafin or inflammatory cytokines. Conclusion: It has been noticed that EDCs may influence the appearance of specifically related diseases in offspring excreting epigenetic effects. Further research must be oriented towards potential consequences and ideal pathways for prevention and treatment options.