COVID-19 is a systemic infectious and inflammatory disease primarily transmitted via the respiratory route and associated with significant cardiovascular involvement. SARS-CoV-2 can induce myocardial, pericardial, and endothelial inflammation, thereby increasing the risk of perimyocarditis, vascular inflammation, thrombosis with pulmonary embolism, and cardiac arrhythmias. Emerging evidence indicates persistent cardiovascular abnormalities, including increased arterial stiffness and hemodynamic alterations, even following mild acute infection. Diagnostic evaluation in patients with cardiac symptoms includes laboratory testing, electrocardiography, echocardiography, and cardiac magnetic resonance imaging, as well as Holter monitoring and tilt-table testing for suspected postural orthostatic tachycardia syndrome (POTS). Therapeutic approaches focus on individualized rehabilitation programs and targeted medical therapy, including beta-blockers for tachycardia and thromboprophylaxis in patients increased thrombotic risk.
Homozygous familial hypercholesterolemia (HoFH) is a rare and severe condition associated with extremely high cholesterol levels and significant cardiovascular morbidity and mortality at an early age during adolescence. Despite combination therapy with multiple lipid-lowering drugs, including PCSK9 inhibitors, the majority of affected patients also require lifelong, time-and resource-intensive lipoprotein apheresis. Evinacumab is a new, innovative lipid-lowering agent whose mechanism of action is independent of the LDL receptor. It has been approved in 2021 as an adjuvant therapy for reducing LDL-C in adults and children with HoFH, filling a crucial gap in the treatment landscape for the disease. Data from several randomized controlled trials, as well as real-world observational studies, have confirmed the safety and effectiveness of monthly intravenous evinacumab administration over treatment periods spanning several years. On average, when used alongside established guideline-based lipid-lowering combination therapy (including PCSK9 inhibitors), it results in an LDL-C reduction of about 45-50%. In some cases, this has allowed patients to discontinue lipoprotein apheresis. Evinacumab thus opens up a promising new perspective in the management of HoFH. J Kardiol 2026; 33: (1-2): 11-6.
Heart failure rarely occurs alone. Heart failure (HF) is a common disease associated with high mortality, frequent hospitalizations and reduced quality of life. Coexisting comorbidities arecommon. HI is classified based on LVEF. Measurement of NT-proBNP and echocardiography have key roles in the diagnosis of HF. Diuretics, ACE-I/ARNI, beta-blockers, MRA and SGLT2-inhibitors are recommended as cornerstone therapies in HF. Aetiology and comorbidities should be considered and addressed.
Post-acute infection syndromes (PAIS) are prolonged disease states that can occur after viral infections and manifest through nonspecific neurological, cardiovascular, and immunological symptoms such as fatigue, exhaustion, and cognitive impairments. These symptoms vary in severity and can persist for months or even years, with fatigue playing a central role. PAIS are not a new phenomenon and have already been documented following past pandemics, such as the Spanish flu or COVID-19 pandemic. Various viral pathogens, including SARS-CoV-2, Epstein-Barr virus, and influenza viruses are associated with PAIS. The pathogenesis is multifactorial and involves potential mechanisms such as viral persistence, subacute inflammation, autoimmune reactions, and gut microbiome-dysbiosis. The rehabilitation of affected individuals requires a personalized management approach. While mild fatigue can improve through tailored physical activity, more severe courses, such as myalgic encephalomyelitis/chronicfatigue syndrome (ME/CFS), require specific strategies such as pacing to prevent overexertion and deterioration. Cardiovascular manifestations such as myocarditis, pericarditis, and perimyocarditis may also occur, and their treatment follows established cardiological guidelines. Regular endurance training has a protective effect against infections and supports immune function. However, further research is needed to develop effective treatment strategies for PAIS and to meet the individual needs of patients. J Kardiol 2025; 32
Introduction: The diagnosis of heart failure with preserved ejection fraction (HFpEF) is still challenging, with the gold standard being invasive testing. For noninvasive diagnosis two multiparameter risk scores exist, the HFA-PEFF and the H2FPEF-scor-ing systems. Both integrate morphological evidence of structural heart disease from echocardiography, historical features or laboratory assessment of natriuretic peptides. However, there is still a gap in accuracy when these results are inconclusive. Here, we present a noninvasive test for the diagnosis of HFpEF that is based on cardiopulmonary exercise testing ((PET) parameters. Methods / results: (PET is the gold standard for identifying the cause of unexplained dyspnoea and/ or exercise intolerance, the main symptoms of heart failure. (PET was performed with a total of 100 patients, 50 with HFpEF estimated by the HFA-PEFF score of 6 and 50 patients without a diagnosis of heart failure. For our score we only used parameters with the highest diagnostic accuracy for diagnosing heart failure, which was estimated via an unpaired t-test. Thresholds for the diagnosis of HFpEF were estimated via logistic regression analysis and adjusted by the known threshold, described in the literature. The accuracy of various combinations of parameters for the score was tested via RO(-curve-analysis. By combining five parameters of the (PET (VO2peak indexed by body weight, VE/V(O-2 slope, oxygen uptake efficiency slope [OUES], VO2/WR slope and the increase in PetCO(2) during exercise [PetCO(2) delta]) we obtained a sensitivity of 91% and a specificity of 96% for the diagnosis of HFpEF. By adding the NT proBNP value, the sensitivity improved to 100% and the specificity remained at 96%. Conclusion: The (PET-HFpEF score allows the confirmation of the diagnosis of HFpEF in patients with exercise intolerance and dyspnoea with one comprehensive whole-body testing technique. In combination with the determination of NT-proBNP, the high diagnostic accuracy can be further improved.
Exercise and sport have found their way into clinical guidelines for prevention and treatment including rehabilitation of cardiovascular diseases of leading professional societies like the European Society of Cardiology (ESC) with the highest level of evidence IA. Nonetheless, the knowledge required to imple ment these recommendations into clinical practice is only being taught to a very limited extent during medical school and specialist training. The ESC re cognized this imbalance more than ten years ago and created a curriculum for sports cardiology, which has led in Germany to the additional qualification in sports cardiology. Our University Institute for Prevention, Rehabilita tion and Sports Medicine at the University Hospital Salzburg has been accredited by both the European Association of Preventive Cardiology of the ESC and the German Society of Cardiology as a training facility and center for sports cardiology, and one can obtain this additional qualification with us. Such an addi tional qualification could certainly be of interest to us in Austria as well; initial considerations are underway. In fact, patients are-fortunately-asking more and more questions about the benefits and dangers of sport and exercise, and it seems sensible to offer at least more advanced training courses in the field of sports cardiology, or perhaps even additional quali fications to meet these unmet needs. The relevant background and content are presented in this paper.
Cardiopulmonary exercise testing (CPET) is the gold standard for assessing, quantifying and differentiating the origin of dyspnea and exercise intolerance. The aim of this paper is to present the role of CPET in the diagnosis of cardiac and pulmonary exercise in tolerance. It allows a differential diagnosis between heart disease, lung disease, lack oftraining and other causes of impaired performance. The procedure for carrying out the examination is explained, and the most important parameters are discussed based on the evaluation and interpretation of the results. Cardiopulmonary exercise testing allows a differential diagnosis of exercise intolerance, an assessment of performance and a statement on the prognosis to be obtained with one examination. J Kardiol 2025; 32 (7-8): 153-60.
Data from clinical practice reveal a considerable treatment gap in the management ofdyslipidemia. Many patients at high and very high cardiovascular risk are either not receiving any lipid-lowering therapy or are receiving inadequate treatment, despite the potential benefits. This review highlights the current guideline recommendations, obstacles in implementing lipid-lowering therapies and advances in hyperlipidemia research. Despite the potential to achieve the targeted LDL-C levels, several barriers like poor adherence to treatment and limited access to therapy remain. Unwarranted concerns about potential side effects should not prevent maximal LDL-C reduction, as existing evidence indicates no negative impact from extensive reduction (,,the lower, the better"). Concerns regarding muscle pain should not hinder initiation of statin therapy, as current evidence suggests that most complaints of such result from a nocebo effect. Current guidelines generally recommend a stepwise approach starting with a high-potency statin. If the treatment goal is not met within 4to 6weeks, the addition of ezetimibe and subsequently a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor is advised. In contrast, the ,,strike early and strong" (SES) strategy, which advocates for the immediate initiation of an intensive lipid-lowering combination therapy in high-risk patients, is gaining increasing attention and recognition as a promising approach. In summary, current evidence suggests that achieving the desired LDL-C target for individual patients is possible with adequate intensive therapy and individualized treatment plans. This requires a combination of patient education, strategies to improve therapy adherence, immediate initiation of combination therapy, alternative strategies for statin intolerance, as well as advancements in healthcare to remove clinical barriers and enhance therapy access. Among other things, a special "SOP" (Standard Operating Procedure) can be helpful here, as was introduced at our clinic (3rd Medical Department with Cardiology and Internal Intensive Care Medicine, Clinic Ottakring) for patients after acute coronary syndrome in order to help as many patients as possible to achieve LDL-C target values. J Kardiol 2025; 32 (5-6): 97-103.
As the indication for transcatheter aortic valve implantation has been expanded and the devices have steadily improved, there is an increasing number ofTAVI procedures worldwide in high as well as in low-risk patients. In the following article the current indication for TAVI, the limitations, procedural aspects and followup including the medical therapy will be discussed. J Kardiol 2025; 32 (5-6): 108-12.
Heart failure is a common and life-threatening condition which is often not treated optimally with medication and device therapy. Challenges for establishing optimal therapy exist in hospitals but play an important role at primary care physicians and office-based cardiologists as well. Various health system-related, patient-related, and therapy-associated factors, such as clinical inertia, medication compliance, and side effects, contribute to this problem. Additionally, the initial diagnosis of heart failure is often made only during hospital admissions due to cardiac decompensation, which delays treatment and worsens the prognosis. Improved coordination between hospitals, primary care providers, and office-based cardiologists, as well as continuous medical education, are essential to enhance patient care. Approaches, such as rollout of nation-wide multiprofessional disease management programs and telemedicine, along with the integration of artificial intelligence, seamlessly embedded in hospital electronic health records and practice-based patient management software, could significantly improve the treatment outcomes and care of heart failure patients.
Contemporary drug-eluting stents (DES) improved in all three of their components (i.e. the metallic backbone, the polymer and the released antiproliferative substance). Consequently, DES now provide an outstanding efficacy and safety profile, that is challenging to further advance. To improve the prognosis of patients undergoing percutaneous coronary intervention, three main therapeutic avenues are at our disposal: Optimal secondary prevention, modern antithrombotic strategies, and intracoronary imaging guided interventions. In the light of recent data, this review offers a clinical overview of intracoronary imaging modalities, directed towards a target audience of non-invasive cardiologists.
Introduction: The wearable cardioverter defibrillator (WCD) is an alternative to conventional implantable cardioverter defibrillator (ICD) therapy to reduce the risk of sudden cardiac death in patients with cardiac disease temporary contraindication to ICD. While the WCD is indicated in certain situations according to current guidelines, its use in daily clinical practice is unclear. Methods: We performed an analysis of all first WCD prescriptions in Austria and compared indica tions, outcome and definite treatments at three timepoints: 2010-2015, 2016-2020 and 2021-2024. Results: Between July 2010 and July 2024 the WCD was prescribed in 4258 patients in 78 cen tres, with an increasing number of prescriptions within the last years (n = 1.982 in 2021-2024 vs. 419 in 2010-2015). Ischemic cardiomyopathy was the indication in about one third of patients (31.7-34.0%, p = 0.331) and the rate of appropri ate shock (1.2-2.1%, p = 0.264) and inappropriate shock (0.0-0.7%, p = 0.224) was similar throughout all timepoints. In the last years, the rate of definite ICD implantations after WCD prescription decreased (2010-2015: 38.9% vs. 2021-2024: 26.9%, < 0.001) and the proportion of patients with recovery of left ventricular dysfunction increased (23.2% vs. 34.3%, p < 0.001). Discussion: For 25 years, the WCD is an established option for bringing therapy in patients with increased risk of ventricular arrhythmias. A reduced rate of ICD implantations and increased rate of re covered left ventricular dysfunction after WCD use in the last years may be a result of advances in neuro humoral therapy in patients with heart failure and reduced left ventricular ejection fraction.
E-health interventions offer innovative solutions to improve the quality of cardiovascular care by enabling early diagnosis, continuous monitoring, and personalised treatments. These applications can help close caregaps, offer cost efficiency, flexibility, personalisation, anonymity, and improved treatment adherence. E-mental health, a specific area of e-health, uses these technologies in the sense of a psychocardiological approach in which the interactions between mental illness and cardiovascular disease are considered. Accordingly, there are several studies that use digital interventions to address depressive and anxiety disorders in particular, which are often significant as a consequence of, but also as predisposing factors for cardiovascular diseases. Studies show that e-mental health applications are comparable to traditional interventions in terms of their effectiveness and represent a valuable addition, particularly in structurally weak regions.
