Sodium-dependent glucose transporter 2 inhibitors: Transforming diabetic cardiomyopathy management

This article addresses the substantial findings of a study on sodium-dependent glucose transporter 2 inhibitors (SGLT2is) and their effects on myocardial function in patients with type 2 diabetes and asymptomatic heart failure. The editorial explores the broader implications of the study findings for clinical practice, thus highlighting the pivotal role of SGLT2is in improving cardiac function, reducing oxidative stress, and attenuating inflammation. It emphasizes the importance of early intervention with SGLT2is in preventing the progression of diabetic cardiomyopathy; hence, these inhibitors have the potential to transform the management of asymptomatic heart failure in patients with diabetes.

Left bundle branch pacing cardiac resynchronization therapy vs biventricular pacing cardiac resynchronization therapy–time to write a requiem for biventricular pacing-cardiac resynchronization therapy

Cardiac resynchronization therapy (CRT) reduces heart failure (HF) hospitalizations and all-cause mortality in patients with HF with reduced ejection fraction with left bundle branch (LBB) block. Biventricular pacing (BVP) is considered the gold standard for achieving CRT; however, approximately 30%–40% of patients do not respond to BVP-CRT. Recent studies have demonstrated that LBB pacing (LBBP) produces remarkable results in CRT. In this meta-analysis, LBBP-CRT showed better outcomes than conventional BVP-CRT, including greater QRS duration reduction and left ventricular ejection fraction improvement, along with consistently lower pacing thresholds on follow-up. Additionally, there was a greater reduction in New York Heart Association class and brain natriuretic peptide levels. This study contributes to the growing body of encouraging data on LBBP-CRT from recent years. With ongoing technological advancements and increasing operator expertise, the day may not be far when LBBP-CRT becomes the standard of care rather than the exception.

High-output heart failure secondary to iatrogenic arteriovenous fistula: A case report

BACKGROUND

Arteriovenous fistula is a rare cause of refractory heart failure, and corrective measures may lead to dramatic improvement; however, the long-term cardiac remodeling outcomes, particularly after delayed closure, remain unclear.

CASE SUMMARY

A 57-year-old man was admitted to the hospital with complaints of exertional dyspnea for more than 10 years. Physical examination revealed wet crackles in the lungs and a continuous machinery murmur in the left lower back and groin area. Asymmetric edema and varicose veins were observed in the lower limbs. Echocardiography revealed a dilated right ventricle with severe pulmonary hypertension. Computed tomography revealed a left common iliac arteriovenous fistula linked to prior lumbar disc surgery. Surgical repair resolved the symptoms, with echocardiography at 4 months showing a reduced right atrium (RA) and ventricular (RV) diameter and tricuspid regurgitation. However, during the 2-year follow-up, gradual RA and RV re-expansion (from 35 mm to 51 mm and from 26 mm to 46 mm, respectively) was observed, despite sustained clinical stability.

CONCLUSION

This case highlights that delayed arteriovenous fistula closure may result in incomplete right heart reverse remodeling, even after symptomatic relief. Potential mechanisms include persistent hemodynamic stress from subclinical residual shunting or functional impairment due to chronic volume overload. Early intervention before irreversible right heart damage is critical for optimal outcomes.

Volatilome and machine learning in ischemic heart disease: Current challenges and future perspectives

Integrating exhaled breath analysis into the diagnosis of cardiovascular diseases holds significant promise as a valuable tool for future clinical use, particularly for ischemic heart disease (IHD). However, current research on the volatilome (exhaled breath composition) in heart disease remains underexplored and lacks sufficient evidence to confirm its clinical validity. Key challenges hindering the application of breath analysis in diagnosing IHD include the scarcity of studies (only three published papers to date), substantial methodological bias in two of these studies, and the absence of standardized protocols for clinical implementation. Additionally, inconsistencies in methodologies-such as sample collection, analytical techniques, machine learning (ML) approaches, and result interpretation-vary widely across studies, further complicating their reproducibility and comparability. To address these gaps, there is an urgent need to establish unified guidelines that define best practices for breath sample collection, data analysis, ML integration, and biomarker annotation. Until these challenges are systematically resolved, the widespread adoption of exhaled breath analysis as a reliable diagnostic tool for IHD remains a distant goal rather than an imminent reality.