Abstract Background: Studies on Sodium–Glucose cotransporter-2 inhibitors (SGLT2i) in the treatment of heart failure (HF) investigate their potential as a therapeutic alternative for managing congestion and their influence on diuretic efficacy in acute decompensated HF. Objectives: To analyze the impact of introducing SGLT2i in patients with HF, with emphasis on the hypothesis of a potential reduction in outpatient furosemide use over time, as well as concomitant changes in renal function and clinical signs of congestion. Methods: Retrospective study of 85 […]

Abstract Background In heart failure with reduced ejection fraction (HFrEF), optimized medical therapy (OMT) with beta-blockers, angiotensin-converting enzyme inhibitors (ACEIs), angiotensin II receptor blockers (ARBs) (or sacubitril/valsartan), spironolactone, and sodium-glucose cotransporter-2 inhibitors (SGLT2i), at target or maximally tolerated doses, reduces morbidity and mortality. However, real-world data show its underuse. Objective To estimate the prevalence and clinical associations that influence the use of OMT in clinical practice. Methods Cross-sectional observational study including outpatients with HFrEF treated at a tertiary hospital. Clinical […]

Abstract Cardiac remodeling, present in heart failure (HF), is a compensatory biological process following an initial myocardial injury that gradually becomes maladaptive, leading to clinical deterioration and chronic HF. Reverse remodeling (RR), which has been increasingly addressed, occurs when the geometry and/or function of the left ventricle recover in response to treatment, approaching normal cardiac structure. RR is associated with a better prognosis. Factors associated with RR include female sex, non-ischemic etiology, mild to moderate HF, lower fibrotic burden, elevated […]

Abstract Heart failure (HF) with preserved ejection fraction (HFpEF) is currently the most prevalent subtype of HF, particularly among older women with multiple metabolic comorbidities. Despite recent therapeutic advances, its pathophysiology remains incompletely understood and markedly heterogeneous. In 2025, Milton Packer proposed a new conceptual framework: the adipokine hypothesis. According to this hypothesis, HFpEF is a condition primarily driven by the expansion and dysfunction of visceral adipose tissue. This remodeling of adipose tissue results in altered secretion of adipokines, which […]

Abstract Heart failure with preserved ejection fraction (HFpEF) is a prevalent clinical syndrome with a complex diagnosis, associated with various comorbidities and high rates of cardiovascular events. Cardiopulmonary exercise testing (CPET) plays an essential role in understanding the mechanisms of exercise limitation and in complementing the diagnosis of HFpEF, but it presents several gaps to be explored in risk prediction. This article reviews the literature on current pathophysiological, diagnostic, and prognostic aspects of HFpEF. Subsequently, the role of CPET in […]

Introduction According to current guidelines (class I recommendation), the treatment of heart failure with reduced ejection fraction (HFrEF) – defined as left ventricular ejection fraction (LVEF) ≤40% – should be based on the quadruple therapy scheme aimed at reducing cardiovascular outcomes. This regimen consists of beta-blockers (BB), mineralocorticoid receptor antagonists (MRA), renin–angiotensin–aldosterone system blockers (including angiotensin-converting enzyme inhibitors [ACEIs], Angiotensin II Receptor Blockers [ARBs], or Angiotensin Receptor–Neprilysin Inhibitors [ARNIs]), and Sodium–Glucose Cotransporter-2 Inhibitors (SGLT2i)., In recent decades, with the therapeutic […]

Introduction: the paradox of digitalis therapy Digoxin holds a unique position in the history of cardiovascular medicine. Although it is the oldest drug in continuous use for heart failure (HF) treatment, there has been a sharp decline in prescriptions over the past two decades. Overshadowed by the advent of disease-modifying therapies and stigmatized due to concerns regarding toxicity, digoxin was relegated to a Class IIa recommendation in the Brazilian guideline and a third-line recommendation (Class IIb) in the major international […]

Abstract Background Long COVID syndrome (LCS) refers to persistent sequelae following acute SARS-CoV-2 infection and affects approximately 5%-20% of individuals. Objective This study evaluated functional capacity limitations in patients with LCS using cardiopulmonary exercise testing (CPET) and quantified the effects of a structured cardiorespiratory rehabilitation (CR) program. Methods In this prospective observational study, 67 outpatients with LCS completed CPET before and after participation in a supervised CR program. At baseline, patients demonstrated reduced functional capacity, including decreased VO2peak (19.47 ± […]

Introduction Heart failure with reduced ejection fraction (HFrEF), especially of ischemic etiology, is a challenging condition associated with high morbidity and mortality.¹ Patients with HFrEF frequently present with ventricular remodeling and progressive systolic dysfunction, making early identification of significant coronary artery disease (CAD) essential for defining therapy and optimizing prognosis. Triple-vessel CAD involving the left main coronary artery (LMCA) constitutes a high-risk scenario. Guidelines recommend surgical revascularization in most cases, particularly in the presence of pronounced left ventricular dysfunction.² Evidence […]

Abstract Background Heart failure with reduced ejection fraction (HFrEF) accounts for approximately half of all heart failure hospitalizations, negatively impacts patients’ functional capacity and quality of life, and is associated with high financial costs in health care. Objectives To analyze the clinical and epidemiological profile of patients with heart failure with HFrEF in a hospital in southern Santa Catarina in the year 2023. Methods 147 patients with HFrEF were evaluated in a reference hospital in southern Santa Catarina. The data […]