Ischaemic cardiomyopathy (ICM) represents an important cardiovascular condition associated with substantially increased morbidity and mortality. It is characterised from a broad spectrum of clinical manifestations and pathophysiological substrates and its diagnosis is based on the demonstration of significant left ventricular dysfunction in the context of significant epicardial coronary artery disease. Contemporary management aims at improving prognosis through evidence-based pharmacotherapy and device therapy, where indicated. Whilst the beneficial role of revascularisation remains clear in patients with strong indications such as those with symptoms and/or acute coronary syndromes, for those patients that are asymptomatic and suffer from stable ischaemic heart disease the impact of revascularisation on hard outcomes remains less well defined and currently its adoption is hampered by the lack of robust randomised data. The aim of this review is therefore to provide a constructive appraisal on the pathophysiology of ICM, the role of the various non-invasive imaging techniques in the diagnosis of ICM and the differentiation between viable and non-viable myocardium and finally discourse the potential role of revascularisation and contemporary device therapy in the management of patients with ICM.

Aims We assessed the outcome of hospitalized coronavirus disease 2019 (COVID‐19) patients with heart failure (HF) compared with patients with other cardiovascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia). We further wanted to determine the incidence of HF events and its consequences in these patient populations. Methods and results International retrospective Postgraduate Course in Heart Failure registry for patients hospitalized with COVID‐19 and CArdioVascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia) was performed in 28 centres from 15 countries (PCHF‐COVICAV). The primary endpoint was in‐hospital mortality. Of 1974 patients hospitalized with COVID‐19, 1282 had cardiovascular disease and/or risk factors (median age: 72 [interquartile range: 62–81] years, 58% male), with HF being present in 256 [20%] patients. Overall in‐hospital mortality was 25% ( n = 323/1282 deaths). In‐hospital mortality was higher in patients with a history of HF (36%, n = 92) compared with non‐HF patients (23%, n = 231, odds ratio [OR] 1.93 [95% confidence interval: 1.44–2.59], P < 0.001). After adjusting, HF remained associated with in‐hospital mortality (OR 1.45 [95% confidence interval: 1.01–2.06], P = 0.041). Importantly, 186 of 1282 [15%] patients had an acute HF event during hospitalization (76 [40%] with de novo HF), which was associated with higher in‐hospital mortality (89 [48%] vs. 220 [23%]) than in patients without HF event (OR 3.10 [2.24–4.29], P < 0.001). Conclusions Hospitalized COVID‐19 patients with HF are at increased risk for in‐hospital death. In‐hospital worsening of HF or acute HF de novo are common and associated with a further increase in in‐hospital mortality.

Hyponatraemia is very common in heart failure (HF), especially in decompensated patients. It is associated with increased mortality and morbidity and considered a marker of advanced disease. Recognition of hyponatraemia and its causes may help guide treatment strategy. Historically, therapy has primarily focused on water restriction, decongestion with loop diuretics in case of volume overload (dilutional hyponatraemia) and sodium repletion in case of depletion. In this review, we summarise the potential benefits of established and emerging HF therapies on sodium homeostasis, with a focus on dual vasopressin antagonists, angiotensin receptor-neprilysin inhibitors, sodium-glucose cotransporter 2 inhibitors and hypertonic saline, and propose a potential therapeutic approach for hyponatraemia in HF.

Sleep-disordered breathing (SDB) is a complex syndrome with a high prevalence and a significant impact on the general well-being of the overall population. Heart failure (HF) is a major health issue with an increasing incidence, a high rate of hospitalizations, and high mortality in developing countries. Focusing on early recognition and management of HF comorbidities may have an important role in reducing the economic burden and public health impact of HF. The close interconnection between HF, heart rhythm disturbances, and sleep apnea is supported by the mutual risk factors such as age, smoking, obesity, and male sex. Central sleep apnea (CSA) may be considered a marker of advanced HF, often being associated with elevated pulmonary capillary wedge pressure, brain natriuretic peptide (BNP), and noradrenaline levels and with low left ventricular ejection fraction. In the same way, there is an important correlation between CSA and different types of arrhythmias. The large intraindividual rhythm variability reported in patients with SDB who underwent continuous monitoring by implantable loop recorder (ILR) demonstrated the incapacity of 24-hour and 48-hour Holter monitoring to accurately determine the incidence of cardiac arrhythmias. In patients with HF and CSA, the extended cardiac monitoring by ILR becomes compulsory because in-time interventions could be life saving, but with the absolute lack of solid evidence in this field, there is an acute need for extensive randomized trials to further highlight the potential beneficial effect of ILR monitoring in patients with CSA and HF.

Purpose In arterial hypertension (HTN), vascular structural changes develop as a consequence of haemodynamic as well as neurohumoral factors. Indeed, in the peripheral vessels a decrease in arterial compliance and, in the heart remodelling occurs respectively. The significant impact of HTN on left heart remodelling and its interconnection with intrarenal hemodynamics (IRH) has been widely studied. In the same time, there is lack of data concerning the affinity of HTN, IRH and right heart remodelling, as another important cluster of factors for prediction of mortality and morbidity in this group of patients. Methods The study included 104 patients (50 females and 54 males, mean age 48,26±11,2 years) with grade I-III arterial hypertension. All subjects underwent careful clinical history and physical examination to reveal risk factors, cardiovascular history and treatments. Blood test, echocardiography focused on right heart evaluation, intrarenal Doppler measurements were repeated in three parts of both kidneys (superior, median, and lower) untill three reproducible waveforms were obtained. The following IRH parameters were obtained: renal resistive index (RRI), renal pulsatile index (RPI), acceleration time (AT), renal volume (RV) and RV/RRI ratio. Results The mean RRI was 0,6672±0,0452, mean RPI 1,2533±0,178, mean AT 66,68±2,324 ms, mean RV 129,67±23,79 ml and mean RV/IRR ratio 195,52±41,587 ml. Mean 24 hours SBP was 146,12±13,96 mmHg, mean 24 hours DBP 86,59±6,78 mmHg. The mean pulse pressure (PP) was 59,10±22,90 mmHg. The mean 24 hours heart rate (HR) was 75,14±26,86 beats/minute. Mean value for the right ventricular (RV) basal diameter (4Ch) was 29,5±3,71 mm, right atrium (RA) diameter 39,71±3,38 mm, RA area 16,98±2,89 mm2, Sm RV 0,11±0,05 mm/sec, TAPSE 19,2±1,66 mm, SPAP 28,3±5,321 mmHg. We found an important positive correlation between RA diameter and RA area with RRI (r=0,364, p<0,01), (r=0,371, p<0,01), RPI (r=0,296, p<0,01), (r=0,320, p<0,01) and AT (r=0,155, p<0,05), (r=0,148, p<0,05), and negative correlation of RV Sm with RRI (r=−0,259, p<0,01), RPI (r=−0,232, p<0,01), AT (r=−0,162, p<0,05), meanwhile PASP showed an important positive connection with RRI (r=0,354, p<0,01), RPI (r=0,330, p<0,01) and AT (r=0,218, p<0,01). Conclusions The assumption that cardiac structural changes are progressing in parallel with extracardiac target damage could have an important scientific substrate, emphasizing the potential connection of IRH and the heart remodelling, including the right heart in HTN, and the eventual strengthening the IRH positions as a predictor of cardiovascular outcomes in this subset of population.

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