Introduction: The co-prevalence of cerebrovascular and cardiovascular diseases is not uncommon among patients. In most cases, the symptoms can be clearly differentiated; however, in certain situations, establishing the correct diagnosis and selecting the appropriate therapy can be particularly challenging. Case report: A 74-year-old diabetic patient was admitted to the Emergency Department with limb numbness and blurred vision. During observation, he experienced two episodes of staring blankly ahead with unresponsiveness and transient impairment of consciousness. Simultaneous ECG recordings showed significant ST-segment elevation in inferior leads, which nearly resolved by the end of each episode. Neurological evaluation considered absence seizures unlikely, and native brain CT excluded intracranial tumor or hemorrhage; therefore, the patient was admitted to the cardiology department. Echocardiography revealed a reduced left ventricular ejection fraction (37%) with diffuse hypokinesis. Carotid ultrasound, followed by contrast-enhanced CT, demonstrated a significant occlusion of the left internal carotid artery and a marked stenosis of the right internal carotid artery. Although no further seizure-like episodes were observed during cardiology hospitalization, an urgent coronary angiography was performed due to non-sustained ventricular tachycardia (NSVT). Coronarography revealed significant stenosis of the left main coronary artery and chronic total occlusion of the right coronary artery; thus, urgent coronary artery bypass graft (CABG) surgery was recommended. Based on these findings, we concluded that the transient ischemic episodes were caused by angina-induced severe reductions in cardiac output, leading to critically decreased cerebral perfusion. Prior to triple bypass surgery, right carotid artery stenting was successfully performed. Follow-up echocardiography showed an improved ejection fraction (47%). The patient was discharged in good general condition to cardiac rehabilitation, with only mild residual neurological symptoms. Conclusion: This case illustrates that severe concomitant cardiovascular and cerebrovascular diseases can be effectively managed through timely diagnosis and close interdisciplinary collaboration.

Bevezetés: A cerebro- és kardiovaszkuláris betegségek együttes előfordulása nem ritka betegeink körében. Az esetek többségében a két tünetegyüttes jól elkülöníthető, bizonyos helyzetekben azonban a helyes diagnózis felállítása kihívást jelenthet. Esetismertetés: A 74 éves, diabéteszes férfi beteg végtagzsibbadás és szemkáprázás miatt kereste fel a Sürgősségi Betegellátó Osztályt (SBO). Két ízben „elrévedéssel” járó rosszulléte jelentkezett, amely során a beteg érdemi kontaktusba nem volt vonható. A rosszulléti EKG-n az inferior elvezetésekben szignifikáns ST-eleváció volt látható, amely a rosszullét terminálódásával szinte teljesen megszűnt. A tünetek hátterében felmerült Jackson-roham kóroki szerepét a neurológiai konzílium elvetette. Az akut natív koponya-CT vérzést, illetve térfoglalást nem igazolt, így a beteget a kardiológiai osztályra vettük fel. Echokardiográfia során csökkent szisztolés balkamra-funkciót (EF: 37%) és kiterjedt hipokinézist írtunk le. A carotisultrahang, majd a kontrasztanyagos koponya-CT a bal oldali carotis interna okklúzióját és a jobb oldali carotis interna szűkületét igazolta. Osztályunkon ismételt rosszullét nem jelentkezett, EKG-eltérések és monitorozása során észlelt, nem tartós kamrai tachycardia miatt sürgető koronarográfia történt, amely szignifikáns szűkülettel eredő főtörzset, illetve krónikusan elzárt RCA-t írt le, így sürgető koronária-bypass- (CABG-) műtétet javasoltak. Mindezen eredmények alapján a beteg panaszainak hátterében az anginás rosszullétek alatti csökkent pumpafunkció, illetve a súlyos carotisbetegség következtében fellépő agyi perfúziós zavar kóroki szerepe állhatott. A hármas CABG-műtét előtt megtörtént a jobb oldali carotis sztentelése. A kontrollszívultrahangon jelentősen javult, 47%-os ejekciós frakció írtunk le. A beteget kardiológiai rehabilitáció után otthonába emittáltuk jó állapotban, enyhe neurológiai maradványtünetekkel. Következtetés: Esetünk megmutatja, hogy súlyos cerebro- és kardiovaszkuláris betegségek együttállása esetén is a korai diagnózis és az interdiszciplináris együttműködés sikeres kimenetelhez vezethet.

Background: After an acute COVID-19 infection, many patients suffered from various complaints called as post-COVID syndrome. Methods: Our post-COVID outpatient department was operational for 19 months, where patients (n = 252) underwent a detailed cardiopulmonary examination within a 3-month-long follow-up period. Results: Most patients (69.9%) had mild acute symptoms with a higher hospitalization risk with preexisting hypertension (p < 0.05) and diabetes (p < 0.001). Most common post-COVID symptoms were fatigue (29.4%) and dyspnea (19.1%). Echocardiographic parameters showed no abnormalities and did not change during the follow-up period. Exercise capacity was also generally normal with no change over time; however, 9.9% of patients showed significant desaturation during a 6 min walk test. This finding showed correlation (p < 0.01) with decreased diffusion capacity (DLCO). Generally, DLCO improved slightly but significantly (p < 0.05) by the end of the follow-up period (from 72.4% to 74.1%). Our key finding was a 10× higher prevalence (24.6%) of lupus anticoagulant positivity among post-COVID patients compared to the normal population (estimated at 2–4%). Conclusions: In conclusion, post-COVID syndrome is a common consequence even after a mild infection. Severe infections tend to lead to worse cardiopulmonary outcomes. Higher prevalence of lupus anticoagulant positivity may underline the importance of autoimmunity in the pathomechanism of post-COVID syndrome.

A 61 éves, ismert hipertóniás nőbeteg a Sürgősségi Betegellátó Osztályon (SBO) jelentkezett két napja kezdődő, enyhe, jobb oldali végtaggyengeség, beszéd-, illetve látászavar miatt.

Background: The actin-binding protein Flightless-I (Flii) has not been quantified in the human serum yet. We aimed to determine serum Flii levels in healthy individuals and to investigate Flii as a potential marker in patients with sepsis focusing on diagnosis, organ failures, and short-term mortality. Methods: A total of 30 controls and 64 septic and 22 non-septic patients were enrolled in this follow-up study. Serum Flii levels were quantified by using the capillary electrophoresis-based Simple Western™ system with chemiluminescent detection. The assay was calibrated by applying dilution series of a purified recombinant human Flii standard and a parallel internal standard. Results: Flii levels of healthy controls were found between 3.5 and 8.8 mg/L, while septic and non-septic patients showed significantly lower values (p < 0.001). First-day Flii could differentiate sepsis from the non-septic inflammatory state (AUC: 0.667; p < 0.05) and indicated acute respiratory distress syndrome (ARDS) among septic patients (AUC: 0.686; p < 0.05). Furthermore, a combination of Flii and other sepsis markers seemed to offer an improved diagnostic performance (sepsis vs. non-sepsis, AUC of Flii + gelsolin (GSN) + Gc-globulin + procalcitonin: 0.974; p < 0.001 and ARDS vs. non-ARDS, AUC of Flii + GSN + presepsin: 0.776; p < 0.001) compared with single markers even in the prediction of 14-day mortality (AUC of Flii + GSN + Gc-globulin: 0.76; p < 0.001). Conclusions: We adapted a properly precise and reproducible automated Western blot method to determine concentrations of Flii in human serum. Our results revealed the relationship between Flii and sepsis; however, Flii alone did not appear to be a prominent sepsis marker. When combined with other biomarkers, measurement of serum Flightless-I may provide additional value supporting patient care.

Az akut szívelégtelenség egy súlyos, magas mortalitású kórkép, amelyet az idős populációban a nem tervezett hospitalizációk leggyakoribb okaként tartanak számon. Az esetek kb. 90%-ában pangásos tünettannal jelentkezik, amelynek kezelésében elsősorban kacsdiuretikumokat alkalmazunk. Komoly problémát jelent azonban, hogy az esetek egy részében a kacsdiuretikumokkal szemben rezisztencia alakul ki. Ezen esetekben az alkalmazott vízhajtókezelés ellenére nem megfelelő az ürülő vizelet mennyisége. A diuretikumrezisztencia amellett, hogy hosszabb hospitalizációs időt és nem megfelelő ütemben javuló, pangásos tünettant eredményez, bizonyítottan rosszabb prognózist jelent, mint a megfelelően kialakuló diuretikus válasz. Így a rezisztencia áttörése fontos probléma, amelyre egyéb támadásponton ható vízhajtók hozzáadása jelenthet megoldást. Közülük a legszélesebb körben vizsgáltak a tiazid típusú és tiazidszerű diuretikumok. Ezek, bár korábbi kutatási eredmények alapján hatékonyak lehetnek a rezisztencia kezelésében, korai mellékhatásprofi ljuk jelentősen befolyásolhatja a betegek túlélését, így ez idáig kombinált alkalmazásuk nem terjedt el széles körben. A témában nemrégiben megjelent CLOROTIC trial azonban új, ígéretes eredményeket szolgáltatott a kérdéskörben, így összefoglaló közleményünkben ezek tükrében vizsgáljuk a tiazidok lehetséges alkalmazását az akut szívelégtelen populációban kacsdiuretikumrezisztencia fennállása esetén.

Abstract Introduction Pulmonary arterial hypertension (PAH) is a cardiovascular disease that is characterized by severe structural and functional damages, resulting from the obstructive remodeling of the pulmonary vasculature and consequent right ventricular pressure overload. The current therapy mainly focuses on the pulmonary vascular system, with uncertain efficacy. Therefore, it is crucial to explore new therapeutic approaches. The mechanism of colchicine is complex and not-fully understood, but it has been proven to exert cardiopulmonary protective effects. Methods PAH induction was carried out in 8-week-old male WKY rats with a single subcutaneous injection of 60 mg/kg monocrotaline. Monocrotaline, a pyrrolizidine alkaloid, is metabolized in liver and induces inflammatory processes, which can cause PAH in rats. Starting from day 14 after MCT injection, the animals received three times a week intraperitoneal colchicine treatment at a dose of 0.5 mg/kg for two weeks. Echocardiographic examinations were performed during the study. At the end of the study, besides histological examination of the right ventricles and lungs [arterial wall thickness (WT%) and area (WA%)], the expression and phosphorylation levels of the proteins involved in cardiac remodeling were evaluated using Western blot. We assessed the pyruvate dehydrogenase (PDH) enzyme activity in the heart, which plays an important role in energy metabolism. We also examined the production of cytokines and chemokines in the right ventricle. Results The VW/BW ratio in the colchicine-treated group was significantly reduced compared to the MCT group (p<0.01). Echocardiographic parameters, EF% and E/e' ratio – characterizing the left ventricular function – did not differ considerably between the groups during the treatment. The TAPSE and PAT values characterizing right ventricular function improved in the MCT+C group (p<0.05). Collagen deposition and TGFβ level were significantly reduced by colchicine (p<0.05) in PAH animals. In the MCT+C group, the vascular remodeling (WT% and WA%) significantly decreased compared to the MCT group (p<0.01). The expression of α-SMA in vessel walls was most pronounced in the MCT group (p<0.01), which was significantly reduced by colchicine treatment. The phosphorylation of prosurvival signaling factors (ERK1/2, Akt1, GSK3β) was significantly increased in the MCT+C group (p<0.01) compared to the MCT group. In the right ventricle, PDH enzyme activity increased in the MCT+C group compared to the MCT group (p<0.01). According to cytokine array, cytokines involved in mediating fibrosis and inflammatory processes (TIMP-1, VEGF, L-selectin, CXCL7) showed increased secretion in the MCT group, which was moderately attenuated by colchicine treatment. Conclusion Colchicine treatment reduced the extent of fibrosis and inflammation, improved the structure of the pulmonary vasculature, and enhanced right ventricular function and energy supply.

The year 2023 proved to be a productive period with many remarkable scientific papers published from Hungary in the field of heart failure (HF). Our aim with this brief review is to highlight the results of the most prominent landmark randomized clinical trials as well as other relevant influential publications with significant contribution from Hungarian authors. Several clinical trials were published in 2023 with the primary focus on optimizing medical management. Papers described the use of sodium-glucose cotransporter-2 inhibitors (SGLT2i) in HF in association with renal dysfunction, COVID-19 infection, and evaluating their economic impact. A comprehensive manuscript analysed the geographic differences in patient characteristics, treatments, and outcomes in the PARADISE-MI trial population. With regards to glucagon-like peptide-1 (GLP-1) receptor agonists, the STEP-HFpEF landmark clinical trial reported a favourable effect for semaglutide in patients with HFpEF and obesity. The intermittent administration of levosimendan did not improve post-hospitalization clinical stability in a population with advanced HF. In the field of cardiac resynchronization therapy (CRT), results of the BUDAPEST-CRT Upgrade trial was published in the European Heart Journal. This was the first prospective, randomized controlled trial to demonstrate that CRT upgrade in patients with intermittent or permanent RV pacing and HFrEF reduces morbidity and mortality. Several papers focused on the greater field of cardiomyopathies, including medical therapies, diuretic use, and cardiotoxicity. Finally, it is important to mention that an issue of Cardiologia Hungarica was published that was entirely dedicated to HF.

A bal kamrai nonkompaktáció (LVNC) az új európai cardiomyopathia-irányelvben leírtak szerint a továbbiakban már nem sorolható a cardiomyopathiák közé. Jelen írás egy LVNC-vel diagnosztizált betegpopuláció adatait felhasználva a myocardium ezen jellegzetes morfológiai eltérésének fizikai és klinikai hátterét kíséreli meg körbejárni, emellett – tekintettel a válaszok hiányára – kérdéseket fogalmaz meg az érintett betegek jövőbeni ellátásával kapcsolatban.

Acute heart failure (AHF) is a serious condition with a high mortality rate. It is considered as the most common cause of unplanned hospitalizations in the elderly population. In 90% of all cases AHF presents with congestive symptoms, thus mostly treated with loop diuretics. However, in some cases resistance to loop diuretics develops, causing a major problem. In these cases, despite diuretic treatment, urinary output remains inadequate. Resistance, apart from leading to longer hospitalization and inadequate improvement of congestion, has been shown to be responsible for a worse prognosis compared to properly established diuretic response. Thus, managing resistance is important for which the addition of other diuretics (acting at other targets) may be a solution. The most widely studied of these are thiazide diuretics. Although, previous research suggests that thiazides may be effective in treating diuretic resistance, their early side effects can significantly affect patient survival, therefore their use in combination has not yet been widely adopted. However, the recent CLOROTIC trial has provided promising results on this issue. In our review, we are investigating the use of thiazides in the acute heart failure population in the presence of loop diuretic resistance in the light of these new results.

Mitochondria form a dynamic network in cells, regulated by the balance between mitochondrial fusion and fission. The inhibition of mitochondrial fission can have positive effects in acute ischemic/reperfusion injury models by preventing the fall in mitochondrial membrane potential associated with fission processes. However, inhibition of fission in chronic models is disadvantageous because it obstructs the elimination of damaged mitochondrial fragments. OPA1, in view of previous results, is a possible therapeutic target as a fusion promoter and structure stabilizer protein. We used transgenic mice in which the OMA1 cleavage sites of OPA1 were deleted. This resulted in a higher representation of L-OPA1 compared to S-OPA1. After genotyping and model validation, all animals were examined by echocardiograph on two occasions, at weeks 11 and 36. Histological samples were taken from hearts to examine mitochondrial morphology and structure remodeling. The signaling pathways related to mitochondrial dynamic processes were evaluated. Cardiomyocytes were isolated from neonatal mice to determine the efficiency of mitochondrial respiration using the SeaHorse assay method. OPA1 protein promotion has a negative effect on systolic function during aging. We confirmed that volume overload and ventricular remodeling did not manifest. The reason behind the loss of pump function might be, at least partly, due to the energy deficit caused by mitochondrial respiratory failure and damage in mitochondrial quality control pathways.

Cardiovascular diseases (CVDs) are among the leading causes of morbidity and mortality worldwide. Unhealthy dietary habits have clearly been shown to contribute to the development of CVDs. Beyond the primary nutrients, a healthy diet is also rich in plant-derived compounds. Natural polyphenols, found in fruits, vegetables, and red wine, have a clear role in improving cardiovascular health. In this review, we strive to summarize the results of the relevant pre-clinical and clinical trials that focused on some of the most important natural polyphenols, such as resveratrol and relevant flavonoids. In addition, we aim to identify their common sources, biosynthesis, and describe their mechanism of action including their regulatory effect on signal transduction pathways. Finally, we provide scientific evidence regarding the cardiovascular benefits of moderate, long-term red wine consumption.

The prevalence of heart failure (HF) continues to rise in developed nations. Symptomatic congestion is the most common reason for patients to seek medical attention, and management often requires intravenous (IV) diuretic administration in the hospital setting. Typically, the number of admissions increases as the disease progresses, not only impacting patient survival and quality of life but also driving up healthcare expenditures. pH-neutral furosemide delivered subcutaneously using a proprietary, single-use infusor system (Furoscix) has a tremendous potential to transition in-hospital decongestive therapy to the outpatient setting or to the patient’s home. This review is aimed at providing an overview of the pharmacodynamic and pharmacokinetic profile of the novel pH-neutral furosemide in addition to the most recent clinical trials demonstrating its benefit when used in the home setting. Given the newest data and approval by the Food and Drug Administration in the US, it has the potential to revolutionize the care of patients with decompensated HF. Undoubtedly, it will lead to improved quality of life as well as significantly reduced healthcare costs related to hospital admissions.

In the year 2022 a large number of remarkable scientific papers were published in the field of heart failure and heart muscle disease, to which the Hungarian Heart Failure community contributed with influential scientific activity. Results of landmark randomized clinical trials were published, and in recognition of the clinical and scientific activity of the Hungarian centers, notable activity was also demonstrated publishing these studies. In the field of cardiomyopathies several novel results were published in 2022. In connection with hypertrophic cardiomyopathy (HCM) a landmark paper described the genetic architecture of the affected Hungarian population. An editorial comment was published in a highly ranked journal describing the myosin motor inhibition concept. An interesting paper about a retrospective analysis of cardiac amyloidosis patients, and MR specific differences between left ventricular noncompaction and dilated cardiomyopathy was published. Severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) was an ongoing pandemic in 2022 resulting in millions of deaths worldwide, affecting the heart of as much as 20–25% of those infected and causing several cardiac complications. Studies were published about the screening for myocardial injury and about the immunological response on disease itself and the vaccination against the virus. A joint scientific statement by the ESC also dealt with this topic. An impressive study was published about the prognostic value of anemia in patients with preserved, and mildly reduced and recovered ejection fraction and about the feasibility of baroreflex sensitivity measurements in heart failure subjects. In relation to drug therapy, a study is also worth mentioning about the cardiac efficacy and overall safety of SGLT2 inhibitors in patients treated with anthracyclines, and a network meta-analysis of randomized trials, analyzing the cardiovascular outcomes in patients treated with gliflozins. Finally, a focused issue of Cardiologia Hungarica on heart failure and myocardial diseases should be highlighted.

INTRODUCTION:The COVID-19 pandemic and consequent social isolation prompted a surge in mental health disorders and substance use in the general population and, therefore, in potential organ donors. We aimed to evaluate if this led to a change in donor characteristics, including the mechanism and circumstance of death, and how this may have affected clinical outcomes following heart transplantation.METHODS:We identified all heart donors from the SRTR database between 18 October 2018 and 31 December 2021, excluding those who donated immediately after the US national emergency declaration. Donors were stratified into pre-COVID-19 (Pre-Cov; through 12 March 2020) and post-COVID-19 national emergency declaration cohorts (Post-Cov; 1 August 2020 through 31 December 2021) based on the heart procurement date. Relevant demographics, cause of death, and substance use history were collected in addition to graft cold ischemic time, the incidence of primary graft dysfunction (PGD), and recipient survival at 30 days post-transplant.RESULTS:A total of 10,314 heart donors were identified; 4941 were stratified into the Pre-Cov and 5373 into the Post-Cov cohorts. There was no difference in demographics, but illicit drug use was significantly higher in the Post-Cov group, leading to an increased incidence of death from drug intoxication. Fatal gunshot wounds were also more common. Despite these changes, the incidence of PGD remained similar (p = 0.371), and there was no difference in 30 days recipient survival (p = 0.545).CONCLUSION:Our findings confirm that COVID-19 had a major impact on mental health and psychosocial life with an associated increase in illicit substance use and fatal intoxication rates in heart transplant donors. These changes did not alter peri-operative mortality following heart transplantation. Future studies are needed to ensure that long-term outcomes remain unaffected.