Kardiologia polska最新文献

Background: Osmolarity is a key indicator of the balance between water and osmotically active molecules. It plays a crucial role in the diuretic response among patients with congestion in acute heart failure (AHF), and therefore, it may provide clinically meaningful information.

Aims: This study investigated the association between urine (pre- and post-diuretic) and serum osmolarity during early diuretic treatment and one-year outcomes in AHF patients.

Methods: It was single-center, prospective, observational study that included AHF. The patients were recruited between March 2021 and November 2023 and underwent one-year follow-up. Serum and urine osmolarity and their contributors (sodium, urea, glucose) were measured before loop diuretic exposure and 3 hours after infusion start. The main endpoints included: 1) all-cause mortality and 2) all-cause unplanned rehospitalizations.

Results: In a one-year follow-up, 59 (23%) patients died (26 [10%] during index hospitalization), and 95 (40%) were rehospitalized. Higher pre-diuretic urine osmolarity was independently associated with a lower probability for mortality (hazard ratio [HR], 0.95; 95% confidence interval [CI], 0.93-0.98; P <0.01) and rehospitalization (HR, 0.98; 95% CI, 0.95-0.99; P = 0.03). Pre-diuretic urine osmolarity was significantly lower in patients with an event during follow-up (359 [272-403] vs. 419 [332-509] mOsm/l; P <0.001 for mortality and 384 [303-463] vs. 430 [342-524] mOsm/l; P = 0.03 for rehospitalization). Moreover, the degree of urine osmolarity drop was lower in patients who died (32 [8-77] vs. 122 [50-208] mOsm/l; P <0.001) and significantly influenced death probability (0.93 [0.89-0.97]; P <0.01), while significance was not proven regarding rehospitalizations (0.98 [0.95-1.00]; P = 0.16). Serum and post-diuretic urine osmolarity had no prognostic significance.

Conclusions: Pre-diuretic urine osmolarity and the degree of its decrease (reflecting the potential for urine dilution) during early decongestion are associated with one-year outcomes in AHF.

Background: Exercise capacity is frequently reduced in patients with hypertrophic cardiomyopathy (HCM), but structured training has historically been limited due to concerns about arrhythmias and sudden cardiac death. Recent data suggest that supervised, individualized exercise may be safe in selected patients; however, evidence for hybrid cardiac telerehabilitation (HCT) in non-obstructive HCM remains lacking.

Aims: To evaluate the efficacy and safety of a 12-week HCT program in patients with non-obstructive HCM and preserved left ventricular ejection fraction.

Methods: In this single-center randomized controlled trial, 60 patients were allocated (1:1) to HCT or usual care. The HCT program consisted of supervised center-based exercise sessions combined with remotely monitored home training. The primary endpoint was the change in peak oxygen uptake (pVO₂) after 3 months. Secondary endpoints included changes in 6-minute walk distance, perceived health status, and safety parameters. Follow-up continued for 12 months after program completion.

Results: Fifty-eight patients completed the 3-month assessment (HCT n = 28; control n = 30). HCT resulted in a significantly greater improvement in pVO₂ compared with usual care (between-group difference: +1.35 ml/kg/min; P <0.01). Additional significant improvements were observed in 6-minute walk test distance. Perceived health status improved in both groups, with a greater increase in the HCT group. No serious adverse events occurred, and adherence to the training program was high.

Conclusions: HCT is feasible, safe, and effective in improving functional capacity and perceived health status in carefully selected patients with non-obstructive HCM. These findings support the use of structured, telemonitored exercise training in low-risk HCM populations, although larger multicenter trials are needed to confirm generalizability.