Fulltext search in archive

This study aspired to provide comprehensive real-world data on a population with heart failure in the Moravian region of the Czech Republic. The authors compared local clinically relevant data with those from the ground-breaking Paradigm-HF trial and they found that local patients had a more advanced state of heart failure. The high prevalence of implantable cardioverter-defibrillators (ICD) and cardiac resynchronization therapy (CRT) confirms access to advanced and financially demanding treatment options in this region.

An observational study evaluating the safety and efficacy of thoracoscopic ablation of atrial fibrillation in the single-center experience. The cohort consisted of 81 patients suffering from some form of atrial fibrillation, undergoing thoracoscopic ablation either as a single method of treatment or as a part of the hybrid protocol where catheter ablation was suplemented later.

This review provides an updated overview of emerging immune-based therapies for oropharyngeal malignancies, particularly those associated with HPV infection. It summarizes current evidence on checkpoint blockade, engineered T-cell approaches, monoclonal antibodies, and therapeutic vaccination strategies, while discussing their clinical relevance and translational potential. The article further evaluates the influence of viral biology, tumor microenvironment, and predictive biomarkers on therapeutic response. Key limitations, including resistance and immune escape, are also highlighted, together with future opportunities for individualized and combination-based treatment strategies in head and neck oncology.

Background and Aim. Vitamin D deficiency is linked to increased cancer risk and death but the effect of vitamin D substitution on the prognosis of patients with malignant disease is debatable. We aimed to investigate the value of serum vitamin D3 levels in patients with a history of malignancy and confirmed lung metastases. Materials and Method. Serum Vitamin D2 (25-hydroxyergokalciferol) and D3 (25‑hydroxycholekalciferol) levels were measured in 38 patients (28 with and 10 without lung metastases) using high performance liquid chromatography (HPLC). Serum Vitamin D2 + D3 levels of patients with lung metastases were analysed with respect to season, number of metastases, number of malignancies in the history, value according to the ASA (The American Society of Anaesthesiologists) physical status classification, and compared to patients with a history of malignancy without confirmed lung metastasis. Results. Overall, mean serum vitamin D3 levels were significantly higher in summer (summer vs. winter; 85.06 nmol/L vs. 61.01 nmol/L; P=0.013). There was no significant difference in vitamin D3 levels in summer or winter between patients with or without lung metastases. There was also no significant difference in vitamin D3 levels in the summer months between patients with a history of one malignancy versus those with two or more. In winter however, patients with a history of one malignancy had significantly higher vitamin D3 levels (mean, 75.25 nmol/L) than those with two or more malignancies (mean 44.6 nmol/L) (P=0.027). The differences between vitamin D3 levels in patients with ASA 2 and 3 were not statistically significant. Conclusion. Vitamin D supplementation may be advisable for patients with a history of multiple malignancies, particularly during the winter months. However, confirmation in a clinical trial with a larger patient cohort is warranted before firm recommendations can be made.

Amyloidosis represents a clinically and molecularly heterogeneous group of serious, potentially life-threatening disorders characterized by the extracellular deposition of insoluble amyloid fibrils derived from misfolded precursor proteins. These deposits disrupt tissue architecture and function, often affecting vital organs such as the heart and kidneys. Accurate diagnosis and subtyping of amyloidosis are essential for effective clinical management and personalized therapeutic interventions. This review provides an integrated overview of modern approaches to the laboratory diagnosis of amyloidosis, divided into three main areas: (1) histological and immunological methods (including Congo red staining, immunohistochemistry, immunofluorescence, and immunoelectron microscopy) for the initial detection and characterization of amyloid deposition, (2) electrophoretic techniques (capillary electrophoresis, isoelectric focusing, immunofixation electrophoresis) used primarily for the analysis of amyloid-associated proteins in serum and urine, and (3) mass spectrometry-based proteomic analyses that have significantly improved subtype specificity and clinical decision-making. By emphasizing the complementary roles of these techniques, the review aims to support timely, accurate, and subtype-specific diagnosis, ultimately improving clinical outcomes and treatment strategies for patients affected by amyloidosis.

Background. To investigate the association between atopic dermatitis (AD) and keratoconus (KC) in atopic dermatitis patients with no prior ophthalmologic diagnosis. Methods. Thirty eyes of 30 patients with moderate to severe AD were included in this pilot study and compared to healthy controls (n=20) and patients with forme fruste KC (n=28). In the AD group, diagnosis of KC was based on clinical signs and corneal topography criteria such as inferior steepening (inferior-superior difference>1.45 D) and elevated maximum keratometry values (>47 D). Subclinical KC was defined by the presence of specific sensitive indices from corneal topography, tomography, or biomechanical assessments. Risk factors analyzed for ectasia development were the onset and severity of AD, sensitization to aeroallergens, systemic therapy, concomitant atopic diseases, eyelid eczema, and total IgE. Results. We identified two manifest KC (6.7%), and six subclinical KC (20%) cases in patients with AD but with no previous diagnosis of KC. No overall differences were found in corneal tomography and biomechanics indices between control and AD patients. However, eye rubbing was not identified as a risk factor for developing ectasia in the AD group. Conclusion. Dermatologists should be aware that patients with moderate or severe AD may have a higher risk for developing corneal ectasia, particularly when eyelid eczema is present. The estimated prevalence of KC in patients with AD appears to be higher than that in the general population but more studies are needed.

In this review, the authors comprehensively evaluate the unique challenges associated with assessing stroke risk and determining the need for anticoagulation therapy in patients with device-detected atrial fibrillation. This condition poses diagnostic and therapeutic dilemmas, given its often subclinical nature and variability in atrial fibrillation burden. The analysis places particular emphasis on findings from recently published clinical trials, which provide valuable insights into the management strategies for this patient population. Additionally, the authors explore the emerging evidence on the interplay between device-detected atrial fibrillation and heart failure.

A prosthetic arteriovenous graft (AVG) represents a type of vascular access for haemodialysis (HD), employing a synthetic conduit that replaces a native vessel and permits repeated cannulation. Due to their associated complications, particularly thrombosis and infection, arteriovenous grafts (AVGs) have long been regarded as a secondary option. Current recommendations advocate an individualized approach to vascular access planning based on patient´s anatomy, life expectancy, anticipated dialysis duration, and personal preferences, leading to a broader and more flexible use of AVGs. Their key advantage is the potential for early initiation of HD, while minimizing the need for central venous catheters. However, a major disadvantage of AVGs is their tendency to develop stenotic lesions, predominantly at the venous anastomosis, which adversely affects graft patency. If left untreated, this may lead to graft thrombosis. Regular evaluation of AVG function is essential for early detection of stenosis and maintenance of graft patency. Despite its widespread use in clinical practice, the role of AVG surveillance in vascular access management remains a subject of considerable debate, as current evidence regarding its effectiveness in preventing thrombosis and prolonging graft patency is inconclusive.

Ceramides are a heterogeneous group of bioactive membrane sphingolipids. Evidence suggests that specific ceramide species are potential biomarkers and mediators of cardiovascular disease. The aim of the study was to develop two prediction models for carotid intima-media thickness (CIMT) using readily available variables. One model included conventional biomarkers (total cholesterol, triglycerides, hypolipidemics) in addition to gender and age, while the other included blood concentrations of selected ceramides. Cer(d18:1/18:0) was inversely related to CIMT, while Cer(d18:1/24:1) was positively correlated. Given that the study is cross-sectional, the findings should be interpreted as associations and do not support any causal inference.

Motor imagery techniques, such as motor imagery, mirror therapy, and graded motor imagery, have the capacity to activate brain regions that overlap with those involved in actual movement execution. In individuals with chronic pain, these areas may undergo structural and functional changes due to persistent nociceptive input. Engaging in motor imagery can stimulate brain activity and potentially contribute to the restoration of more typical neural patterns. This scoping review of randomized controlled trials demonstrates that patients with chronic musculoskeletal pain may benefit from these techniques. Compared to control groups, participants receiving MI-based interventions experienced reductions in pain both immediately after therapeutic sessions and during follow-up assessments conducted up to several months post-intervention.

Integrin alpha-6 (α6ITG, CD49f) has long been considered one of the most reliable markers of stemness, yet emerging evidence challenges this view by revealing its broader role in niche accessibility and survival. As a laminin receptor, α6ITG mediates cellular interactions and participates in signal transduction pathways that help maintain cellular phenotype. Its expression allows for the identification and purification of stem cells from heterogeneous populations. Because α6ITG expression is highly sensitive to environmental cues, it also serves as a sensor of culture conditions and cryopreservation stress, with potential use in biobanking and regenerative medicine. This marker holds significant potential; it may be one of the few markers consistently expressed in all stem cells, potentially qualifying it as a common "stemness" marker. Additionally, the therapeutic implications of α6ITG knockdown using antibodies may greatly influence future cancer treatments. Elevated expression in cancer correlates with growth, invasion, and poor prognosis. The aim of this review is to explore the biological and translational importance of α6ITG in stem cell and cancer biology.

Background and Aims. Suicide represents a major public health issue influenced by a complex interplay of individual, social, and environmental factors. While suicidological research traditionally focuses on psychological and clinical aspects, spatial dimensions of suicidal behavior remain less explored, particularly in Central Europe. This study presents a geospatial analysis of completed suicides in the Olomouc and Zlín Regions of the Czech Republic between 2018 and 2022, using a unique dataset derived from forensic autopsy records. The primary goal was to demonstrate the potential of spatial processing and interdisciplinary collaboration between forensic medicine and geoinformatics in identifying contextual patterns of suicidal behavior. Methods. A dataset of 585 completed suicides was compiled from forensic autopsy reports, including detailed individual-level characteristics and geolocation data. Spatial analyses were conducted using GIS software, integrating additional layers such as land use, demographic and socioeconomic indicators, and quality of life indices. Both point-level and aggregated data (municipality and administrative district levels) were used to explore correlations and spatial variability. Results. The study confirmed known trends - such as male predominance and the role of alcohol - and identified new spatial relationships, including a negative correlation between blood alcohol concentration and latitude, and between age and distance from residence to suicide location. Spatial analyses were conducted at multiple levels of aggregation and combined with selected socioeconomic and environmental indicators, including quality of life, urban-rural context, and foreclosure (enforcement) rates. The results demonstrate that spatial patterns and correlations between suicide rates and area-based characteristics vary depending on the spatial scale of analysis. Conclusion. The findings illustrate the potential of interdisciplinary collaboration between forensic medicine and geoinformatics and provide an exploratory basis for further research and more context-sensitive suicide prevention approaches.

This randomized controlled multicentric pilot study evaluated a home-based telerehabilitation system aimed at improving balance and cognitive function in older adults. The results show it is safe, user-friendly, and effective as traditional therapy, with added benefits from cognitive stimulation.

Aim. The recurrence rate of colorectal cancer remains high even after radical surgery. Existing criteria for administering adjuvant treatment lack sufficient precision, often leading to undertreatment or overtreatment. This study investigates circulating tumour cells (CTCs) as a potential prognostic biomarker to improve the accuracy of patient selection. Methods. Forty-six colorectal cancer patients without distant metastases who underwent radical surgery were enrolled in this prospective study conducted at Tomas Bata Hospital in Zlín. The study protocol was approved by the hospital's Ethics Committee. Circulating tumour cells (CTCs) were measured in peripheral blood samples collected preoperatively, on the second postoperative day, and one month after surgery. CTCs were detected and characterized using semiautomated microscopy. Comprehensive clinicopathological data were recorded as part of standardized perioperative care. The prognostic significance of CTCs was evaluated based on the time to recurrence (TTR) parameter. Results and Conclusion. Growing evidence from circulating tumour cell (CTC) research supports their potential role as a valuable biomarker in cancer management. In this study involving stage I-III colorectal cancer patients, a recurrence rate of 20% was observed among individuals with detectable CTCs, whereas no recurrence occurred in patients with a sustained absence of CTCs. Despite this apparent difference, the time to recurrence (TTR) did not differ significantly between the groups (log-rank test, P=0.175). Although the result was not statistically significant, the observed trend suggests a possible prognostic value of CTCs that merits investigation in a larger cohort. Furthermore, neither individual time-point measurements nor dynamic changes in CTC levels demonstrated a significant correlation with TTR.

This is an overview and case series on smell testing in Parkinson's disease as olfactory dysfunction is viewed as an early indicator of this disease. The authors tested olfaction both subjectively and objectively: psychophysical tests are commonly used but these tests may be inaccurate and difficult in patients with Parkinson's disease with cognitive deficits in addition to motor symptoms. Objective electrophysiological olfactory tests are important. These are the olfactory/trigeminal event-related potentials (OERPs/TERPs). In this overview, the authors also describe a series of cases that demonstrate the importance of complex smell tests.

Purpose. To report the approach, technical success, safety, and short-term outcomes of thoracic duct stenting for treating chylothorax and chylous ascites in a patient with Yellow Nail Syndrome. Case report. A 57-year-old male with Yellow Nail Syndrome, characterized by yellow thickened nails, lymphedema, and respiratory abnormalities, required repeated thoracocenteses for chylothorax. A thoracic duct intervention involving percutaneous transluminal angioplasty and balloon-expandable stent implantation via retrograde access was performed. Procedure characteristics, clinical success, complications, and follow-up were recorded. Conclusions. Thoracic duct stenting was a safe and technically successful procedure. After the procedure, the patient was relieved of symptoms. This technique could be considered for patients with recurrent chylothorax and chylous ascites, including those with Yellow Nail Syndrome. Further research is required to validate these findings.

Introduction. Human skin is constantly exposed to various agents causing oxidative stress. In response, skin cells can activate transcriptional nuclear factor erythroid 2-related factor 2 (Nrf2), which influences the expression of several protective genes. However, accumulating evidence suggests severe adverse effects of chronic Nrf2 activation. Phytochemicals are popular for supporting skin health. Some are potent Nrf2 inducers and their long-term use may be hazardous. Silymarin (SM), an extract from Silybum marianum fruits, and its major flavonolignan silybin (SB) are used in cosmetic formulations for their protective and regenerative activities. However, knowledge about their potential to modulate Nrf2-driven pathway in skin cells or tissue is lacking. Methods. Here we evaluated effects of SM, SB, silychristin (SC), silydianin (SD), isosilybin (ISB) and 2,3-dehydrosilybin (DHSB) and taxifolin (TA) on Nrf2 nuclear translocation, the level of Nrf2-control proteins (Keap1 and Bach1) and selected Nrf2-driven genes (NAD(P)H:quinone oxidoreductase 1 and heme oxygenase 1) in human primary fibroblasts and keratinocytes. Results. SM and its components significantly stimulated Nrf2 nuclear translocation; SM and SB were most potent on both cell types. The effect of SM and compounds was more pronounced in fibroblasts than on keratinocytes. Regardless, effects of SM and studied compounds on the Nrf2 regulating and Nrf2-controled proteins were non-significant. Conclusion. SM and its components do not have a significant effect on the studied proteins, and seem to be safe with respect to possible negative effects associated with the Nrf2 signalling pathway activation during dermal application. However, we cannot give a definitive answer on their effect after repeated long-term application to the whole skin. Further experiments on human skin ex vivo or clinical studies on volunteers are necessary.

The aim of the study was to evaluate the association of cardiac biomarkers levels with the parameters of cardiac structure and function in the patients with arterial hypertension. Patients with arterial hypertension, normal left ventricular ejection fraction and absence of signs of heart failure were included in the study. Biomarker of cardiac remodeling (NT-proBNP) correlated with the parameters of left ventricular diastolic function and biomarkers involved in myocardial fibrosis (sST2) correlated with parameters of cardiac structure and were associated with left ventricular hypertrophy (sST2 and TIMP-1).

The prevalence of multimorbidity, defined as the presence of at least two chronic diseases, is increasing in both the general population and among patients with rheumatic conditions. This study provides insight into the prevalence of multimorbidity in one of the most frequent systemic autoimmune disorders, systemic lupus erythematosus (SLE). This chronic inflammatory autoimmune disease is characterised by the involvement of multiple organs due to both the disorder itself and the frequent comorbidities that are associated with the underlying disease process. These factors have the potential to affect the quality of life, treatment options, healthcare utilisation and overall patient prognosis.

Aims. Angiogenesis is activated in the retina of diabetic patients with retinopathy complications. Vascular endothelial growth factor (VEGF) plays an essential role as a mediator of the retinal induced neovascularization. VEGF levels are increased significantly in the vitreous and aqueous ocular fluids in the patients with proliferative diabetic retinopathy. The aim of this study is to investigate whether VEGF promoter/5'UTR polymorphisms are associated with diabetic retinopathy (DR) development and/or severity. Methods. In this case-control study, Type 2 diabetic patients with or without DR, and normal controls were recruited. DR was classified based on the presence or absence of proliferative changes. The genotyping was analysed by polymerase chain reaction followed by restriction fragment length polymorphism. Results. A total of 259 subjects (172 with diabetes+DR, 87 healthy controls; male:female, 125:134) were recruited. The average age was 59.5+9.6 years, diabetes duration was 8.5+4.5 years, body mass index was 30.6+6.0 kg/m2, and HbA1c was 7.37+1.2% (57 mmol/mol). Significant differences in the distribution of genotypes in T(-1,498)C, G(-1,190)A and G(-1,154)A polymorphism in diabetic patients versus controls, and DR patients versus DM without DR patients were shown. No association between DR severity and polymorphisms was detected. Non-significant differences in allele frequency were found. The haplotypes TGAGC, TGACT and CAGCT were significantly increased in DM patients, whereas CGGCC was the most common haplotype in DR patients. Conclusions. Multiple VEGF polymorphisms and CGGCC haplotype are significantly correlated with a higher DR risk in Type 2 diabetic patients.

Aims. This study evaluates the feasibility of an artificial intelligence (AI)-assisted software tool for early identification and classification of chronic wounds and for supporting decisions on whether professional clinical review is needed. Methods. A pilot assistive software solution was developed by integrating wound image analysis with patient-reported metadata. The system combines You Only Look Once (YOLO) for wound localization and U-Net for tissue segmentation. A standardized wound imaging and annotation protocol was designed in collaboration with the University Hospital Bulovka. Diagnostic performance will be evaluated using sensitivity, specificity, positive predictive value and negative predictive value. Results. A Python-based prototype and a multimodal software architecture were developed. More than 500 standardized wound images have been collected to date, and the dataset is being expanded iteratively according to model performance, class balance, annotation quality and validation requirements. A regulatory certification strategy was outlined under the Medical Device Regulation and the AI Act. Conclusion. The study establishes a technical and regulatory foundation for future AI-based wound care tools intended to support earlier triage and professional assessment of chronic wounds.

A rapid LAMP-LFD method was developed by combining the loop-mediated isothermal amplification technique and lateral flow device for the detection of Vibrio parahaemolyticus. By improving the specificity and sensitivity of Vibrio parahaemolyticus detection, it provides a rapid and convenient detection method for field and grass-roots units. To provide a new method for the diversity of Vibrio parahaemolyticus detection methods. It has promising  applications  in the detection of Vibrio parahaemolyticus at the basic level.

There is a current need to better stratify patient prognosis following histological evaluation for prostate cancer in order to optimise therapy decisions. In this article, the authors provide an overview of some recently discussed putative prognostic markers. These include the immunohistochemical stains PSA, PSMA, Ki67, PD-L1, CDK19, PTPN12, EZH2 and E-cadherin and the genes TMPRSS2:ERG, SPOP, IDH-1, PTEN, TP53, RB1, CHD1 and SPINK1, the androgen receptor, BRCA1 and BRCA2, ATM, MYC and CCND1. The results are not easy to interpret due to wide variations in a number of key variables. Overall, the Gleason score is still the most widely used and most validated of the prognostic markers. Ki67 and PTEN are the most promising.

Given the constant need to improve primary prevention and prediction of stroke, the aim of this mini review was to introduce the glycopeptide copeptin, which, according to available studies, shows significant potential in the diagnosis and prognosis of various diseases, including cerebrovascular events. In this regard, copeptin could become a valuable biomarker in clinical practice. It could be used as one of the prognostic and predictive biomarkers in the course of cerebrovascular events, their clinical outcome, and predicting their recurrence. This mini review includes a brief overview of the physiology of copeptin, its role in emergency care for selected cerebrovascular events with a focus on ischemic strokes, and its influence through vascular risk factors.

Background. Obstructive sleep apnea (OSA) is a known risk factor for cardiovascular (CV) morbidity and mortality. Chronic low-grade inflammation has been identified as a pathophysiological link. Continuous positive airway pressure (CPAP) therapy successfully treats OSA and has positive effects beyond improving breathing patterns during sleep. However, its potential impact on CV morbidity and mortality remains unclear. Objectives. To determine the association between CV risk, the risk of incident malignancies, and the probability of patient death based on inflammatory parameters, anthropometry and OSA severity parameters, as well as the effectiveness of CPAP therapy. Methods. We retrospectively analyzed data from 245 patients diagnosed with moderate-to-severe OSA, identified as having an apnea-hypopnea index ≥ 15/h. Adherence was defined as CPAP use ≥ 4 h/night for ≥ 70% of days. We assessed CV history, mortality, polysomnographic data and inflammatory parameters (C-reactive protein, leukocyte count, neutrophil-to-lymphocyte ratio [NLR], monocyte-to-lymphocyte ratio, and platelet-to-white blood cell ratio). Univariate and multivariate logistic regressions were used to identify independent predictors of CV outcomes, malignancy incidence and death within 10 years. Results. Patients poorly adhering to CPAP therapy (39.2%) had significantly higher rates of CV complications (32.8% vs. 15.1%, P = 0.003), malignancies (19.7% vs. 8.3%, P = 0.018), and mortality (14.6% vs. 4.0%, P = 0.003). Non-adherence was a strong independent predictor of CV complications (odds ratio [OR] = 2.75, P = 0.004) and death (OR = 4.07, P = 0.006). In univariate analysis, age, non-adherence, and NLR were significantly associated with the risk of incident malignancy (P = 0.022-0.008); NLR was also significant in multivariate analysis (P = 0.008). The t90 index (time spent below 90% oxygen saturation) was an independent predictor of mortality (OR = 1.03, P = 0.003). Conclusions. Non-adherence to CPAP therapy is associated with an increased risk of CV complications, malignancies and death in OSA patients. Inflammatory markers and desaturation parameters (particularly t90) are valuable predictors that should be monitored in routine practice to identify high-risk patients. Implementing strategies to improve CPAP adherence may reduce long-term systemic inflammation and clinical risks.

The manuscript describes the protocol for a prospective study evaluating the relationship between carotid stenosis and retinal oxygen metabolism. Carotid stenosis is a major cause of ischaemic stroke worldwide. Retinal oximetry imaging of retinal blood vessels is noninvasive and capable of direct examination of the post-stenotic blood flow. It may be useful in differentiating high and low risk stenosis of the same severity. The results will yield more information about adaptive changes in the post-stenotic basin and may reveal mechanisms behind larger ischaemic deficits in some stroke patients. Previous studies have demonstrated that retinal blood flow is affected in a variety of eye and systemic diseases, including diabetic retinopathy, age-related macular degeneration, and glaucoma.

This study explores the use of uterine artery embolization (UAE) in patients with postpartum hemorrhage caused by placenta accreta spectrum (PAS) disorders. The procedure was performed after conservative treatments failed, aiming to control bleeding and reduce the need for more invasive surgeries. UAE successfully improved symptoms in the majority of patients, with no major complications during or after the procedure. Follow-up showed no recurrence of bleeding. The results suggest that UAE is a safe and effective treatment option for managing PAS-related hemorrhage, offering a less invasive alternative to surgical interventions.

Objective. This study aimed to explore the independent causal relationship between three types of crystallin proteins (α, β, and γ) and risk of cataract, using single nucleotide polymorphisms (SNPs) as instrumental variables for α, β, γ crystallin through Mendelian randomization (MR) analysis. Methods. Genetic instruments associated with α, β, γ crystallin levels and cataract were obtained from the IEU Open GWAS Project (GWAS IDs: prot-a-673, prot-a-674, prot-a-675, and ukb-d-20002_1278). Two-sample MR analyses were conducted using five different MR algorithms containing MR-Egger, inverse variance weighted (IVW), Weighted median, Simple mode, and MR-PRESSO. Results. The MR analysis revealed a significant causal relationship between α crystallin level and the risk of cataract [odds ratio (OR)_IVW = 0.9989, 95% CI 0.9978~0.9999; OR_MR-PRESSO= 0.9988, 95% CI 0.9978~0.9999]. Conversely, no significant causal relationship was found between β or γ crystallin and the risk of cataract. Conclusion. The occurrence of cataract may be potentially linked to abnormal levels of α crystallin, suggesting that monitoring and managing these levels could be crucial in understanding and potentially mitigating the risk of cataract.

This bioinformatics study aimed to determine differentially expressed genes (DEGs) patterns of knee osteoarthritis chondrocytes versus human bone marrow stem cells towards chondrogenic commitment. We identified 43 DEGs (15 downregulated and 28 upregulated) and enriched pathways, which revealed the enrichment of complement and coagulation cascades and arrhythmogenic right ventricular cardiomyopathy pathways for upregulated and downregulated DEGs, respectively. Hub networks identified the top 5 hub genes, including CLU, PLAT, CP, TIMP3, and SERPINA1.

This article provides a synthesis of key clinical trials on device-based therapy in heart failure within the context of the current trend toward personalized medicine. Its main contribution is the proposal of a novel decision-making algorithm that integrates risk stratification based on underlying etiology, electrophysiological and functional parameters, as well as prognostic indicators including current non-invasive methods. The review also reflects current developments in clinical practice, including the growing role of physiological pacing, and supports an individualized approach to improving patient prognosis and quality of life.