Two main types of cardiac amyloidosis (CA) exist, as a result of either aberrant plasma cell production of misfolded monoclonal light chains, known as immunoglobulin light chain amyloidosis (AL), or production of disintegrated and misfolded transthyretin (TTR) proteins by the liver, also called transthyretin amyloidosis (ATTR). Non-invasive diagnostics (cardiac uptake on diphosphonate scintigraphy, Perugini score 2 or 3) have gained prominence in modern cardiology in correlation with the negative findings of free light chains in serum and the results of negative immunofixation in serum and urine. Additionally, criteria related to echocardiography or cardiac magnetic resonance are necessary for establishing a diagnosis. A total of 3.063 99mTc-MDP bone scintigrams were analyzed between August 2018 and March 2023, of which Perugini score 1 was validated in 13 patients, Perugini score 2 in 10 patients and Perugini score 3 in 1 patient. From our experience, we could observe that cardiac uptake can be verified in daily clinical practice and that is meaningful for monitoring patients with ATTR-cardiomyopathy (ATTR-CM). Although the sample size is not large, the importance of the study lies in the fact that it involves patients whose findings have been incidentally verified. If patients are selected according to clinical characteristics, the number of positive findings may potentially increase. Our study aimes to raise awareness among physicians of various specialties about the significance of the diagnostic algorithm for infiltrative cardiomyopathies. This is to ensure early diagnosis of this problem and initiation of treatment in the earliest stages when the therapeutic effect is most optimal. Such an approach would yield benefits for both patients and the entire healthcare system. A meticulous diagnostic and therapeutic approach is therefore fundamental for improving clinical outcomes in patients with ATTR-CM, including careful attention to specific TTR genetic variants and long-term follow-up.

Abstract Objectives Prenatal cardiology is a part of preventive cardiology based on fetal echocardiography and fetal interventional cardiology, which facilitates treatment of congenital heart defects (CHD) in pediatric patients and consequently in adults. Timely prenatal detection of CHD plays a pivotal role in facilitating the appropriate referral of pregnant women to facilities equipped to provide thorough perinatal care within the framework of a well-structured healthcare system. The aim of this paper is to highlight the role of left atrial strain (LAS) in prenatal evaluation of fetal heart and prediction of structural and functional disorders. Methods We conducted a comprehensive literature review searching PubMed for articles published from inception up until August 2023, including the search terms “left atrial strain”, “fetal echocardiography”, and “prenatal cardiology” combined through Boolean operators. In addition, references lists of identified articles were further reviewed for inclusion. Results Our review underscores the significance of LAS parameters in fetal echocardiography as a screening tool during specific gestational windows (starting from 11 to 14 weeks of gestation, followed by better visualization between 18 and 22 weeks of gestation). The left atrial strain technique and its parameters serve as valuable indicators, not only for identifying cardiac complications but also for predicting and guiding therapeutic interventions in cases of both cardiac and noncardiac pregnancy complications in fetuses. Evidence suggests establishment of second-trimester reference strain and strain rate values by speckle-tracking echocardiography in the healthy fetal cohort is essential for the evaluation of myocardial pathologies during pregnancy. Conclusions Finding of LAS of fetal heart is feasible and probably can have potential for clinical and prognostic implications.

BACKGROUND: Left atrial (LA) strain analysis has emerged as a noninvasive technique for assessing LA function and early detection of myocardial deformation. Recently, its application has also shown promise in the pediatric population, spanning diverse cardiac conditions that demand accurate and sensitive diagnostic measures. OBJECTIVE: This research article endeavors to explore the role of LA strain parameters and contribute to the growing body of knowledge in pediatric cardiology, paving the way for more effective and tailored approaches to patient care. METHODS: A comprehensive literature review was conducted to gather evidence from studies using echocardiographic strain imaging techniques across pediatric populations. RESULTS: LA strain parameters exhibited greater sensitivity than conventional atrial function indicators, with early detection of diastolic dysfunction and LA remodeling in pediatric cardiomyopathy, children with multisystem inflammatory syndrome, rheumatic heart disease, as well as childhood renal insufficiency and obesity offering prognostic relevance as potential markers in these pediatric subpopulations. However, there remains a paucity of evidence concerning pediatric mitral valve pathology, justifying further exploration. CONCLUSION: LA strain analysis carries crucial clinical and prognostic implications in pediatric cardiac conditions, with reliable accuracy and sensitivity to early functional changes.

Background: To evaluate atherosclerotic changes in carotid arteries (CCA) in uremic patients before and after 18 months of continuous ambulatory peritoneal dialysis (CAPD) treatment, and to evaluate the impact of dyslipidemia and CAPD treatment on vascular remodeling. Materials and Methods: We conducted a longitudinal, prospective study during 2020 and 2021 at the Clinic for Nephrology, Clinical Center University of Sarajevo. Patients with end-stage renal disease were included and were followed during 18 months of CAPD treatment. All patients were treated using commercially prepared biocompatible balanced dialysis solutions. Carotid intima-media thickness (IMT) and atherosclerotic plaques on the common carotid artery (CCA) were measured by echotomography. Results: A total of 50 patients were included and were followed during 18 months of CAPD treatment. Lipid values in the serum of patients with CAPD were significantly lower after 18 months of CAPD treatment compared to the values before treatment, while the value of high-density lipoprotein (HDL) was significantly increased after 18 months of CAPD treatment. The values of IMT and the diameter of the CCA compared to the basal values were significantly lower (P < 0.001). Conclusion: We demonstrated significantly lower lipid values and higher HDL levels following CAPD treatment. Correct selection of the targeted pharmacological intervention can substantially impact the regression of vascular changes in patients on peritoneal dialysis.

INTRODUCTION Sodium-glucose cotransporter-2 (SGLT2) inhibitors are integral in treating patients with heart failure, regardless of the existence of diabetes mellitus. In light of their benefits on the heart muscle, the question of their effect on acute coronary syndrome is raised, and a hypothesis as to whether they can be implemented in its treatment is proposed. The aim of the article was to indicate the potential of using SGLT2 inhibitors in the treatment of myocardial infarction (MI). EVIDENCE ACQUISITION A PubMed search for articles published between October 2017 and May 2022 was conducted using the following keywords: "SGLT2 inhibitors," "Acute Coronary Syndrome," "Treatment," "Prognosis." Reference lists of identified articles were searched for further articles. EVIDENCE SYNTHESIS Reports from clinical trials and animal studies thus far investigating mechanistic pathways of SGLT2 inhibitors' effect in relation to acute myocardial infarction were interplayed to extract relevant findings and analyze the safety of this therapy in acute coronary syndrome (ACS) patients. CONCLUSIONS SGLT2 inhibitors indicate beneficial effects in acute cardiovascular incident by various mechanisms, and early initiation of therapy may improve outcomes for AMI survivors.

In modern cardiology, sodium‐glucose cotransporter 2 (SGLT2) inhibitors are critical components of heart failure (HF) treatment algorithms and exert their effects primarily by preventing glucose reabsorption and facilitating its urinary excretion. The objective was to systematically review randomized controlled trials (RCTs) assessing the effects of SGLT2 inhibitors, particularly canagliflozin, empagliflozin, dapagliflozin, ertugliflozin, sotagliflozin (dual SGLT inhibitor), and their use in HF. Systematic searches of PubMed/Medline, The Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases were performed. There were no restrictions imposed on the date and status of publication; however, there were restrictions on language for the searched studies. A total of 1139 records were identified in the bibliographic searches from both databases and the register of choice for this systematic review. Following duplicate removal, screening for titles and abstracts, and thorough assessment of full‐text articles, 12 RCTs met the inclusion criteria. Altogether, 83 878 patients were included in this review. Among the included studies, two RCTs, with six respective reports, investigated canagliflozin, four RCTs with 13 derived reports investigated dapagliflozin, three RCTs with 12 separate reports studied the effects of empagliflozin, one RCT and its three respective reports assessed ertugliflozin's effects, and two RCTs with one added report investigated the dual inhibitor sotagliflozin. Pooled meta‐analytic effects of SGLT2 inhibitors were as follows: on atrial fibrillation odds ratio (OR) = 0.83, 95% confidence interval (CI): 0.68–1.01, prediction interval (PI): 0.57–1.19; on HF hospitalization OR = 0.69, 95% CI: 0.60–0.78, PI: 0.60–0.78; on cardiovascular death OR = 0.82, 95% CI: 0.58–1.15, PI: 0.42–1.60; and on major adverse cardiovascular events OR = 0.90, 95% CI: 0.77–1.06, PI: 0.71–1.15. SGLT2 inhibitors significantly improve the quality of life in HF patients. Their beneficial effects on HF, especially in left ventricular dysfunction, have made their use possible irrespective of diabetes mellitus or atrial fibrillation status.

Aim To examine a relation of thyroid function, neutrophil-lymphocyte ratio (NLR) with left ventricular function measured through the left ventricular ejection fraction (LVEF) in patients with acute myocardial infarction treated with percutaneous coronary intervention (PCI). Methods This prospective research involved 160 consecutive patients with acute myocardial infarction. Patients were divided into those with normal thyroid hormone status (n=80) and those with hypothyroidism (newly diagnosed) (n=80). Inflammatory parameters and parameters of hormonal status were taken for analysis: thyroid-stimulating hormone (TSH), thyroxine (T4), triiodothyronine (T3), free thyroxine (FT4), and free triiodothyronine (FT3). All patients underwent transthoracic echocardiographic examination (TTE) five days upon admission, and left ventricular ejection fraction (LVEF) was analysed. Results Significant difference between the two groups was verified in values of T3, T4, erythrocytes, haemoglobin, haematocrit, neutrophil, lymphocytes, NLR, C-reactive protein (CRP) and sedimentation rate. Patients with euthyroidism had a higher frequency of coronary single-vessel disease (p=0.035) and a significantly lower frequency of triple vessel disease (p=0.046), as well as a higher median value of LVEF (p=0.003). There was a significant correlation between LVEF with haemoglobin values (p=0.002), NLR (p=0.001), and CRP (p=001). Conclusion The altered status of the thyroid gland in acute myocardial infarction is associated with the severity of the coronary blood vessel lesion, LVEF and correlates with inflammatory response.

BACKGROUND: Heat-not-burn (HNB) technology by the U.S. Food and Drug Administration has been classified as a modified risk tobacco product, which can be a better option for those populations who cannot give up the habit of smoking. The outlook on the effects of these products is quite controversial in the scientific world. OBJECTIVE: To present the effect of HNB tobacco products on the cardiovascular system, with reference to the existence of possible benefits of the technology. METHODS: The literature search was conducted in PubMed/Medline, the Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov databases, with reliance on a well-defined guiding research statement. Quality appraisal was performed using the CASP checklist for randomized controlled trials. RESULTS: The search of three databases identified 167 records, and after selection process, 25 randomized controlled trials were eligible for our study’s criteria. Twenty studies investigated the effects of HNB products on biomarkers of clinical relevance. Five studies evaluated other functional heart parameters rather than biomarkers. CONCLUSION: With HNB tobacco products, significant reductions were found in biomarkers of exposure and biological effect related to pathways involved in cardiovascular disease, including inflammation, oxidative stress, lipid metabolism, platelet function, and endothelial dysfunction.

Sodium-glucose co-transporter 2 inhibitors (SGLT2 inhibitors) represent a therapeutic modality option for type 2 diabetes mellitus. This group of drugs includes dapagliflozin, empagliflozin, canagliflozin, ertugliflozin and sotagliflozin. Given their proven benefit in the scope of heart failure through clinical studies, they have also gained their place in patients with reduced, moderately reduced, or preserved systolic function of the left ventricle. Due to the effect on both the systolic and diastolic function of the left ventricle, and the neurohumoral activity itself, their range of use has been expanded in patients without a history of diabetes mellitus, and empagliflozin in a dose of 10 mg, as well as dapagliflozin in a dose of 10 mg, have been implemented in patients without diabetes mellitus. New directions for the expansion of the use of SGLT2 inhibitors have pointed towards their applicability in acute heart failure (sotagliflozin) and type 1 diabetes (sotagliflozin). Recently, clinical studies concerning the use of empagliflozin and dapagliflozin in acute coronary syndrome (ACS), appeared. The aim of this paper was to highlight the possible benefit of including SGLT2 inhibitors in patients with ACS.

Cardiotoxicity is one of the most important side effects of first-line chemotherapy medications. It is influenced by genetic variation, whereby the relationship between the chemotherapeutic dose and the risk of cardiotoxicity can be altered. The incidence of cardiotoxicity depends on the substance used in the therapeutic modality of cancer and can reach an incidence of 30% during a three-year follow-up. The main element of the clinical picture is systolic dysfunction of the left ventricle, with symptoms of heart failure, which can change or stop oncological therapy, along with pharmacological treatment of heart failure. These symptoms can occur during prolonged use of cancer therapies, monitoring the patient is advisable. Considering the increasing success of oncology therapy and the extension of life, as well as the improvement of the quality of life, a multidisciplinary approach, as well as the symbiosis of the work of cardiologists and oncologists, is imperative. Patient stratification concerning oncological treatment modality is imposed as part of a cardiologist's daily work from the beginning of cancer treatment.

Cardiomyopathies are diseases of the heart muscle, and present a heterogeneous group of myocardial diseases with mechanical or electrical dysfunction, characterized by ventricular hypertrophy or dilatation. They can be strictly related to the heart muscle (primary), or as part of a systemic disease (secondary), and represent a factor that leads to a reduced quality of life, the occurrence of heart failure and mortality. The primary ones are those that are genetic conditioning, the mixed ones include dilated and restrictive cardiomyopathy, and the acquired ones are caused by myocarditis, stress-induced, peripartum, tachycardia-induced and those caused by endocrine pathology (primarily in newborns of mothers with a diagnosis of diabetes mellitus). Etiologically, they can arise as a result of a genetic mutation, an inflammatory process, and they are also divided into metabolic, toxic and those caused by some other cause. The aim of the article was to present the characteristics of cardiomyopathies themselves in relation to the etiological factor, with review of the diagnostic and therapeutic modality.