Kardiologia polska最新文献

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.

Diabetic cardiomyopathy (DCM) has emerged as a major health challenge, further intensified by the rising global prevalence of type 2 diabetes mellitus. It plays a key role in the morbidity and mortality linked to diabetes, mainly through myocardial dysfunction that develops independently of coronary artery disease or hypertensive heart disease, and it is a major contributor to heart failure. Despite the significance of DCM, there is no gold standard diagnostic test; rather, a multimodal approach is required that includes clinical evaluation (risk factors, and symptoms and signs), cardiac imaging techniques, and biomarkers. The integration of all evaluations may ultimately allow for earlier identification and improved outcomes through timely intervention. In addition, there is scarce evidence on treatment of DCM. The conventional treatment approach is primarily focused on achieving glycemic control, managing cardiac dysfunction, and reducing cardiovascular events using therapies extrapolated from diabetes and heart failure guidelines, rather than targeting the underlying pathophysiological mechanisms. On the other hand, beyond pharmacological approaches, lifestyle modifications, particularly exercise and dietary interventions, could play an important role in the management of DCM due to the associated cardiometabolic benefits in patients with diabetes. In this review, due to the urgent need of clarification for the specific management of DCM and the lack of consistent evidence, we provide a practical updated overview from the pathophysiology to current and future treatment strategies. By integrating this knowledge, we aim to summarize the diagnosis and therapeutic approach that could effectively mitigate or prevent the progression of DCM.

Background: Treatments for heart failure with preserved ejection fraction (HFpEF) remain inconclusive.

Aims: We aim to explore in this prospective and observational cohort study how combined therapy with sodium-dependent glucose transporter 2 inhibitor (SGLT2i), glucagon-like peptide 1 receptor agonists (GLP-1RA), angiotensin receptor-neprilysin inhibitor (ARNI), or mineralocorticoid receptor antagonists (MRA) impact clinical outcomes in HFpEF patients with type 2 diabetes mellitus (T2DM).

Methods: We enrolled 1445 HFpEF patients with T2DM from a prospective cohort between October 2018 and October 2022. The patients were divided into five groups based on their medications at 3 months after discharge: defined as a combination of SGLT2i, GLP-1RA, ARNI, and MRA. The primary outcome is major adverse cardiovascular (CV) events (MACEs), corresponding to the CV mortality and/or HF rehospitalization. The secondary outcome is CV mortality as well as left ventricular ejection fraction (LVEF) change or HF category transition.

Results: During a median follow-up period of 54 (27-75) months, participants with quadruple combination showed the most benefits, corresponding to MACEs (79/174; P <0.001), CV mortality (46/174; P = 0.03), LVEF change, or HF transitions. Quadruple combination was a protective factor for MACEs, while higher N-terminal pro-B-type natriuretic peptide level was an independent risk factor. For participants with LVEF less than 60%, quadruple combination reduced the incidence of composite endpoint events compared to those with LVEF over 60%.

Conclusions: Quadruple combination therapy with SGLT2i, GLP-1RA, ARNI, and MRA in HFpEF patients with T2DM was associated with favorable clinical outcomes, especially in participants with LVEF less than 60%.