Kardiologia polska最新文献

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%.

Background: Patients with osteoporosis (OP) have an increased 10-year cardiovascular death risk. Low bone mineral density (BMD) observed in OP may be associated with arrhythmic presentation of cardiovascular diseases.

Aims: We assessed arrhythmia occurrence in females with osteoporosis.

Methods: One hundred three postmenopausal females, consulted by an endocrinologist, were divided into 2 groups according to BMD (assessed by dual-energy X-ray absorptiometry), expressed as T-score (T-sc; OP ≤-2.5, control >-2.5), taken from the femoral neck (T-sc Neck), the entire total hip (T-sc TH), and/or the spine (T-sc L2-L4, L1-L4). The occurrence of arrhythmia was evaluated using 24-hour Holter electrocardiography monitoring (HM). Major osteoporotic and total hip fracture risks (MOFR and THFR, respectively) were assessed by the FRAX scale.

Results: Arrhythmic burden correlated with BMD: correlations were observed between the number of ventricular ectopic beats (VEB) in HM and the T-sc Neck (r = -0.20; P = 0.04), T-sc TH (r = -0.22; P = 0.03) as well as between the number of supraventricular ectopic beats (SVEB) in HM and the T-sc Neck (r = -0.21; P = 0.03), and T-sc TH (r = -0.23; P = 0.02). Multivariable analysis (linear regression model) showed age and T-sc TH as independently related with ectopy: age (b = 0.07; 95% CI, 0.01-0.13; P = 0.03) and T-sc TH (b = -0.58; 95% CI, -1.07 to -0.08; P = 0.02) were predictors for VEB. Ectopic beats count was also positively correlated with osteoporotic fracture risk: VEB with THFR (r = 0.206; P = 0.04), and SVEB with MOFR (r = 0.21; P = 0.04).

Conclusions: Postmenopausal women diagnosed with osteoporosis are likely to have higher risk of ventricular and supraventricular arrhythmias than women without osteoporosis. Moreover, we documented that the presence of cardiac arrhythmia increases with the risk of osteoporotic fractures.