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Background and Objectives: The fact that men are at a higher risk of cardiovascular disease (CVD) compared to women, regardless of concomitant risk factors, draws attention to the potential role of sex hormones in cardiovascular health. Hormonal therapies undoubtedly play a crucial role in reproductive and endocrine health; however, their cardiovascular implications remain complex and incompletely understood. This review aims at providing an updated overview of recent studies on this topic, highlighting the practical clinical aspects and knowledge gaps. Materials and Methods: This review synthesizes recent clinical studies regarding the cardiovascular impact of female hormone replacement therapy (HRT) and testosterone replacement therapy (TRT). Results: It seems that both hormonal deficiency and excess can exert detrimental effects on the cardiovascular system. While HRT and TRT offer benefits to specific patient populations, their broad biological actions can lead to adverse effects. This creates a sophisticated and delicate relationship between hormonal balance and heart health, complicating the determination of universal safety profiles and use indications. Conclusions: The risk–benefit ratio of hormonal therapies remains a critical concern in clinical practice. Because cardiovascular effects vary significantly based on individual patient profiles, a nuanced approach to prescribing is necessary. Further research is required to bridge knowledge gaps and refine safety guidelines for the use of sex hormones in cardiovascular prevention and treatment.

Despite progress in medical and interventional treatment of acute myocardial infarction (AMI) resulting in low in-hospital mortality, the post-discharge prognosis in MI survivors is still unacceptable. The Managed Care in Acute Myocardial Infarction (MC-AMI, KOS-zawał) is a program introduced by Poland's National Health Fund aiming at comprehensive care for patients with AMI to improve prognosis. It includes acute intervention, complex revascularization, cardiac rehabilitation (CR), scheduled outpatient follow-up, and prevention of sudden cardiac death. The aim of the study was to assess the effect of MC-AMI on major adverse cardiovascular events (MACE) in 3-month follow-up. In this single-center, retrospective observational study we enrolled 1211 patients, and compared them to 1130 subjects in the control group. After 1 : 1 propensity score matching two groups of 529 subjects each were compared. Cox regression was performed to assess the effect of MC-AMI and other variables on MACE. MC-AMI participation is related to reduced MACE rate by 45% in a 3-month observation. Multivariable Cox regression analysis revealed MC-AMI participation to be inversely associated with the occurrence MACE at 3 months (HR = 0.476, 95% CI: 0.283-0.799, < 0.005). Also, older age, male sex (HR = 2.0), history of unstable angina (HR = 3.15), peripheral artery disease (HR = 2.17), peri-MI atrial fibrillation (HR = 1.87) and diabetes (HR = 1.5) were significantly associated with MACE. Participation in MC-AMI - the first comprehensive in-hospital and post-discharge care for AMI patients - improves prognosis and is related to a MACE rate reduction by 45% as soon as in 3 months.

Small vessel disease (SVD) usually refers to atherosclerosis within vessels of diameter of < 2.5 mm. Conflicting data exist regarding the outcomes of its revascularization. To evaluate the outcome of invasive treatment in patients with acute coronary syndromes (ACS) and SVD and the predictors of angina recurrence after percutaneous coronary intervention (PCI). This was an observational, retrospective, single-center study. It covered consecutive 127 patients (26.77% women; median age: 69.74 ±8.97 years) with ACS who underwent PCI in the Upper-Silesian Medical Center in Katowice between 2018 and 2020. The study population was stratified by means of presence of SVD defined by PCI of the culprit artery with a diameter of ≤ 2.5 mm. The major adverse cardiac and cerebrovascular events (MACCE) and angina recurrence were analyzed in a 12-month follow-up period. Overall 99 (77.95%) patients were diagnosed with small-vessel coronary artery disease. MACCE were documented in 14 (11.02%) patients. Univariate analysis revealed the following factors associated with MACCE: left ventricle ejection fraction (LVEF) (OR = 0.95, = 0.0212), left main (LM) stenting (OR = 18.17, = 0.0216), number of former PCIs (OR = 1.48, = 0.0235). According to logistic regression analysis the factors were LM stenting (OR = 20.04, = 0.0216) and number of former PCIs (OR = 1.53, = 0.0203). Patients with SVD had more often refractory or recurrent angina in symptomatic class III/IV on follow-up (52.53% vs. 10.71%, < 0.001). Outcome of invasive treatment in patients with ACS is related to LM stenting and former PCIs but not to SVD occurrence. Patients with SVD have a high rate of recurrent/refractory angina despite successful PCI in this clinical setting.

The intricate relationship between sports participation and cardiac arrhythmias is a key focus of cardiovascular research. Physical activity, integral to preventing atherosclerotic cardiovascular disease, induces structural, functional, and electrical changes in the heart, potentially triggering arrhythmias, particularly atrial fibrillation (AF). Despite the cardiovascular benefits, the optimal exercise amount remains unclear, revealing a J-shaped association between AF and exercise. Endurance athletes, particularly males, face elevated AF risks, influenced by age. Risk factors vary among sports modalities, with unique physiological responses in swim training potentially elevating AF risk. Clinical management of AF in athletes necessitates a delicate balance between rhythm control, rate control, and anticoagulation therapy. Sport-induced bradyarrhythmias, including sinus bradycardia and conduction disturbances, are prevalent among athletes. Managing bradycardia in athletes proves challenging due to its complex and not fully understood pathophysiology. Careful consideration is required, particularly in symptomatic cases, where pacemaker implantation may be necessary for sinus node dysfunction. Although pacing is recommended for specific atrioventricular (AV) blocks, milder forms often prevail without restricting sports participation. This review explores the nuanced relationship between exercise and tachy- and bradyarrhythmia in athletes, addressing the challenges clinicians face when optimizing patient care in this distinctive population.

Chronic lymphocytic leukemia (CLL) is the most common type of leukemia in adults. Despite improvements in treatment, CLL is still considered an incurable disease. The aim of the present study was to evaluate galectin-1, −3 and −9 (Gal-1, −3 and −9) and Gal-3 binding protein (Gal-3BP) as prognostic and predictive factors in patients with CLL. Serum concentrations of Gal-1, −3 and −9 and Gal-3BP were measured in 48 patients with CLL and 30 control patients, using multiplex bead arrays. In patients with CLL, galectin concentrations were assessed prior to, during and following treatment. In patients with CLL who were untreated, galectin concentrations were measured twice with a 6-month interval. The serum level of Gal-9 was significantly increased (P<0.0001) in patients with CLL compared with the control group, and was associated with the clinical stage according to Binet classification, as well as poor cytogenetic and serum CLL prognostic factors. In addition, patients with CLL, who exhibited treatment failure, exhibited higher concentrations of Gal-9 (P=0.06) and Gal-3BP (P=0.009) at the end of the treatment when compared with patients under complete remission or stabilization of the disease. The serum level of Gal-3 was significantly decreased (P=0.012) in patients with CLL compared with the control group. These results suggest that Gal-9 is a potential prognostic factor in patients with CLL. The predictive value of Gal-9 requires further study in larger cohorts of patients.

Background/Objectives: SGLT2 inhibitors (SGLT2i) became a cornerstone of heart failure with preserved ejection fraction (HFpEF) pharmacotherapy in the recent years However, their actual influence on pulmonary veins isolation (PVI) efficacy in this population remains unclear. The aim of the study was to evaluate an impact of SGLT2i on one-year first-time PVI efficacy and clinical course of patients with HFpEF and atrial fibrillation (AF). Methods: This is a single-center retrospective study including 105 HFpEF and AF individuals, who underwent the first-time PVI (51 (48.6%) males; mean age at PVI: 65.2 ± 9.5 years). 53 patients treated with SGLT2i (hospitalized for PVI since 2023) and 52 patients without such a treatment (2020-mid-2023) were assessed according to the clinical presentation and hard endpoints. The primary endpoint was arrhythmia recurrence rate. The secondary endpoint was a composite of major adverse cardiovascular and cerebrovascular events (MACCE). Results: SGLT2i therapy was associated with greater symptom reduction after PVI (90.6% vs. 62.7%; p < 0.001). There was a statistical trend toward reduced all-cause mortality in SGLT2i (0% vs. 5.8%; p = 0.076). Although overall AF recurrence rates were similar between subgroups, Kaplan–Meier analysis showed a non-significant trend toward lower recurrence in the SGLT2i group (p = 0.096). The analysis did not reveal significant differences in terms of cardiovascular hospitalizations, stroke/transient ischemic attack (TIA) and MACCE incidence between the subgroups. Non-vitamin K antagonist oral anticoagulants (NOACs) administration was associated with a lower risk of AF recurrence (OR 0.27; 95% CI 0.096 to 0.77; p = 0.014). MACCE occurrence was predicted by higher CHA2DS2-VA (Congestive heart failure, Hypertension, Age ≥ 75, Diabetes, Stroke, Vascular disease, Age 65–74) (OR 5.63; 95% CI 1.57–20.12; p = 0.008), lower left ventricular ejection fraction (LVEF) (OR 0.74; 95% CI 0.57–0.99; p = 0.028) and (vitamin K antagonists) VKA use (OR 97.44; 95% CI 3.2–2962.57; p = 0.009). Conclusions: SGLT2i pharmacotherapy in the study population was linked to higher efficacy in symptom reduction, with a probability of AF recurrence and all-cause mortality reduction, which may suggest a potential beneficial role of SGLT2i in this cohort.

The aim of the study was to assess the predictors of major adverse cardiovascular events (MACE) in patients with systemic sclerosis (SSc) without pulmonary arterial hypertension. The study comprised 68 patients with SSc who were followed up for the median time of 99 (96; 107) months. The main exclusion criteria involved tricuspid regurgitation maximal velocity > 2.8 m/s and structural heart disease. At baseline the patients underwent clinical assessment of cardiovascular risk factors, 6-min walk test, transthoracic echocardiography and biomarker testing, including growth differentiation factor 15 (GDF-15). The primary composite endpoint was onset of MACE defined as death, myocardial infarction, myocardial revascularization and hospitalization for heart failure. The follow-up consisted of outpatient visits at 1 year intervals and telephone interview every 6 months. The baseline analysis revealed that chronic kidney disease (HR 28.13, 95%CI 4.84–163.38), lung fibrosis on high resolution computed tomography (HR 4.36, 95%CI 1.04–18.26) and GDF-15 concentration (unit HR 1.0006, 95%CI 1.0002–1.0010) were independent predictors of MACE occurrence. CHLD (Chronic kidney disease, Hypertension, hyperLipidaemia, Diabetes mellitus) score was formulated which assigned 1 point for the presence of arterial hypertension, hyperlipidaemia, diabetes mellitus and chronic kidney disease. After inclusion of CHLD score in Cox proportional model, it remained the only independent predictor of MACE onset (unit HR per 1 point 3.46; 95%CI 2.06–5.82, p < 0.0001). Joint assessment of traditional risk factors in the form of CHLD score may serve as a reliable predictor of long-term outcome in patients with SSc without pulmonary arterial hypertension.

The issue of small coronary artery atherosclerosis represents an intriguing aspect of coronary artery disease, which is related with higher rates of peri- and post-procedural complications and impaired long-term outcome. This problem is further complicated by the unclear definition of small coronary vessel. Recent randomized controlled trials have provided new data on possible novel interventional treatment of small coronary vessels with drug-coated balloons instead of traditional new-generation drug-eluting stent implantation. Also, the conservative management represents a therapeutic option in light of the results of the recent ISCHEMIA trial. The current article provides an overview of the most appropriate definition, interventional management, and prognosis of small coronary artery atherosclerosis.

Background and Objectives: Understanding the underlying causes of implantable cardioverter-defibrillator (ICD) discharges is vital for effective management. This study aimed to evaluate the characteristics of patients admitted following ICD discharge, focusing on myocardial ischemia as a potential exacerbating factor and potential risk factors for VT recurrence. Materials and Methods: This retrospective, single-center study included 81 patients with high energy discharge from cardiac implantable electronic device admitted urgently to the cardiology department from 2015 to 2022. The exclusion criterion was ST-segment elevation acute coronary syndrome. Data were collected anonymously from electronic medical records. Patients were categorized based on coronary angiography, percutaneous angioplasty, presence of significant stenosis, recurrent ventricular tachycardia (VT), and catheter ablation. Clinical variables, including demographic data, echocardiographic parameters, and pharmacotherapy, were analyzed. The primary endpoint was the recurrence of VT during in-hospital stay. Results: Among 81 patients, predominantly male (86.4%), with a mean age of 63.6 years, 55 (67.9%) had coronary artery disease (CAD) as the primary etiology for ICD implantation. Coronary angiography was performed in 34 patients (42.0%) and showed significant stenosis (>50%) in 18 (41.8%) patients, while 8 (26.0%) individuals underwent percutaneous coronary intervention (PCI). Recurrent VT occurred in 21 subjects (26.3%), while ventricular catheter ablation was performed in 36 patients (44.0%). Referral for urgent coronary angiography was associated with presence of diabetes (p = 0.028) and hyperlipidemia (p = 0.022). Logistic regression analysis confirmed NYHA symptomatic class (OR 4.63, p = 0.04) and LVH (OR 10.59, p = 0.049) were independently associated with relapse of VT. CAD patients underwent catheter ablation more frequently (p = 0.001) than those with dilated cardiomyopathy. Conclusions: The study showed a low referral rate for coronary angiography among patients with ICD discharge. Presence of LVH and preexisting symptomatic class influence arrhythmia recurrence. Understanding these associations can guide personalized management strategies for ICD recipients.

Background The study aimed to evaluate the application of intra-renal Doppler flow indices for the prediction of major adverse cardiac and cerebrovascular events (MACCE) during 24-month follow-up in patients with coronary artery disease (CAD) subject to coronary angiography (CA). Methods This prospective study comprised 111 consecutive patients with stable and unstable CAD (68.5% men; median age 65 years), referred for CA. Ultrasonographic parameters of intra-renal blood flow in arcuate/interlobular arteries, including renal resistive index (RRI) and pulsatility index (RPI), were acquired directly before and 1 h after the procedure. Endpoint of MACCE (cardiovascular death, myocardial infarction, myocardial revascularization or stroke) were recorded during 24-month follow-up. Results MACCE occurred in 14 patients (12.6%). Patients with MACCE had more diffuse CAD reflected by Syntax score (23.6 vs.14.4 pts., p  = 0.02), higher platelet level (242.4 vs. 207.2 × 1000/μl, p  = 0.01), higher rate of left main CAD (42.9% vs.5.2%, p  < 0.001) and left ventricular ejection fraction < 50% (50% vs.23.7%, p  = 0.045). Patients with MACCE had higher pre-procedural (0.68 ± 0.06 vs. 0.62 ± 0.06, p  < 0.001) and post-procedural RRI (0.72 ± 0.06 vs.0.66 ± 0.06, p  = 0.01), but comparable RPI ( p  = 0.63 and p  = 0.36, respectively). Cox proportional hazards model revealed that pre-procedural RRI (OR = 1.11 per 0.01; p  = 0.02) and left main CAD (OR = 5.75, p  = 0.002) were the only independent predictors of MACCE occurrence. Receiver operator characteristic curve analysis revealed that preprocedural RRI > 0.645 accurately predicted the composite endpoint (AUC = 0.78, p  = 0.001) and identified patients with impaired 24-month prognosis according to Kaplan-Meier curve (log-rank p  < 0.001). Conclusions Increased pre-procedural RRI, together with left main CAD, are associated with worse 24-month prognosis in patients with CAD referred for CA.