Esposito A, Macca G, Valli P
… +5 more, Fracchioni I, Ondei A, Martinelli A, Sala S, Di Tano G
G Ital Cardiol (Rome)
· 2026 Jan · PMID 41441836
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Atrial fibrillation is one of the main causes of cardioembolic stroke, frequently associated with thrombus formation in the left atrial appendage (LAA). Surgical LAA closure (LAAC) using the AtriClip® device is an effect...Atrial fibrillation is one of the main causes of cardioembolic stroke, frequently associated with thrombus formation in the left atrial appendage (LAA). Surgical LAA closure (LAAC) using the AtriClip® device is an effective and guideline-recommended strategy in patients undergoing cardiac surgery for other indications, with continuation of oral anticoagulation therapy where indicated. However, thrombus formation on the residual LAA stump, although rare, is a clinically significant complication. We report the case of an 80-year-old woman with permanent atrial fibrillation, heart failure, chronic kidney disease, and poor adherence to home oral anticoagulant therapy, who developed thrombosis on the LAA stump despite a previous AtriClip® occlusion. The diagnosis was established by transthoracic and transesophageal echocardiography, which revealed a thrombotic formation adherent to the wall of the LAA stump. The patient was initially treated with a reduced dose of apixaban, which had been previously discontinued in anticipation of a surgical procedure, and was subsequently switched to warfarin due to lack of efficacy based on imaging findings. Follow-up echocardiography later documented a modest reduction in thrombus size. This case emphasizes the importance of a personalized approach to antithrombotic therapy following LAAC and highlights the need to consider maintaining appropriate echocardiographic surveillance with long-term monitoring of oral anticoagulation therapy, if feasible.
Lucà F, Navazio A, Gulizia MM
… +15 more, Geraci G, Bilato C, Corda M, De Luca L, Di Marco M, Iacovoni A, Milli M, Pascale V, Riccio C, Scicchitano P, Tizzani E, Colivicchi F, Nardi F, Grimaldi M, Oliva F
G Ital Cardiol (Rome)
· 2026 Jan · PMID 41441835
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BACKGROUND: Differently from the structured network for ST-elevation myocardial infarction (STEMI), which is characterized by standardized transfer protocols and well-defined pathways and is well-established in most Ital...BACKGROUND: Differently from the structured network for ST-elevation myocardial infarction (STEMI), which is characterized by standardized transfer protocols and well-defined pathways and is well-established in most Italian regions and provinces, the management of non-STEMI (NSTEMI) still presents organizational gaps, as it lacks a dedicated network in nearly all areas. METHODS: An ANMCO 15-item survey was conducted among hospital cardiologists to assess logistics, decision-making, and timing of invasive coronary angiography (ICA). A total of 539 questionnaires were collected from Hub (65.1%) and Spoke (34.9%) centers. RESULTS: ECG tele-transmission is available in 90.9% of settings; transfers mainly occur via advanced life-support ambulances. ICA timing is primarily driven by hemodynamic instability and ST-T changes, while the GRACE score is not systematically used. Overall, 80.3% of patients are transferred within 24-48 h. Significant regional differences were observed in 24/7 cath lab availability, presence of cardiac surgery, transport models, and early return to Spoke practices. CONCLUSIONS: The survey highlights good technological resources but marked heterogeneity in NSTEMI management. Findings support the need for shared protocols, interoperable telecardiology platforms, and uniform criteria for risk stratification and patient transfers.
Loverre E, Doimo S, Mojoli M
… +12 more, Cappannelli S, Zuin M, Gori M, Carigi S, Dalla Valle C, Pavan D, Di Lenarda A, Scalvini S, Temporelli PL, a nome dell’Area Cronicità, Area Nursing, Area Scompenso Cardiaco dell’Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO)
G Ital Cardiol (Rome)
· 2026 Jan · PMID 41441834
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Through the use of teleassistance, nurses play a fundamental role in the management of chronic cardiovascular diseases, contributing to improving patients' perceived quality of life and promoting self-care practices. Thi...Through the use of teleassistance, nurses play a fundamental role in the management of chronic cardiovascular diseases, contributing to improving patients' perceived quality of life and promoting self-care practices. This model of care actively supports the development of mindful and proactive behaviors by patients in managing their own lifestyle habits. Furthermore, teleassistance is an effective tool in promoting therapeutic adherence, particularly in the post-hospital discharge phase. The literature review carried out in this study confirms these benefits. However, there is a need to explore the effectiveness of nursing teleassistance in relation to other relevant clinical outcomes, such as the reduction of new hospitalizations, post-discharge complications, mortality and healthcare-related costs.
Giamundo DM, Rebecchi M, Crescenzi C
… +8 more, Romeo F, Panattoni G, Sgueglia M, Politano A, Jacomelli I, Parisi C, De Ruvo E, Calò L
G Ital Cardiol (Rome)
· 2026 Jan · PMID 41441833
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During a cardiological evaluation, premature ventricular contractions (PVCs) may be found, which require careful evaluation using diagnostic methods to discern in which patients there is a high risk of structural heart d...During a cardiological evaluation, premature ventricular contractions (PVCs) may be found, which require careful evaluation using diagnostic methods to discern in which patients there is a high risk of structural heart disease and sudden cardiac death. Epidemiological data show that PVCs occur in about 75% of healthy (or apparently healthy) individuals, without evidence of underlying structural heart disease. PVCs are generally asymptomatic, but can also manifest as palpitations, dyspnea, syncope and fatigue. The first clinical management includes a clinical evaluation, anamnesis and a 12-lead ECG; the latter is fundamental to describe the characteristics of the PVC (morphology, origin, complexity, behavior in relation to physical exercise or meals) that can suggest the benignity or malignancy of the arrhythmia. Echocardiography is important for evaluating left ventricular ejection fraction. Moreover, cardiac magnetic resonance is useful for identifying the presence of myocardial scar indicative of an associated structural heart disease. Therefore, the purpose of this review is to critically analyze the process of evaluating PVCs, which is fundamental for accurate risk stratification and a correct therapeutic approach (pharmacological or ablative).
Guido V, Di Fusco SA, Morviducci L
… +2 more, Ammirati F, Colivicchi F
G Ital Cardiol (Rome)
· 2026 Jan · PMID 41441832
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Type 2 diabetes mellitus (T2DM) is a common risk factor for atherosclerotic cardiovascular disease. Although in patients with coronary artery disease T2DM has a non-negligible prevalence, it is often overlooked. Due to i...Type 2 diabetes mellitus (T2DM) is a common risk factor for atherosclerotic cardiovascular disease. Although in patients with coronary artery disease T2DM has a non-negligible prevalence, it is often overlooked. Due to its prognostic impact and the availability of pharmacological intervention, as sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA), able to improve the prognosis, an early diagnosis is crucial. T2DM diagnosis is based on three evaluations: fasting serum glucose levels; glycate hemoglobin levels; and oral glucose tolerance test. In addition, it is important to know the clinical significance of stress-induced hyperglycemia, commonly found in patients with an acute cardiovascular event. As regards T2DM therapy, SGLT2i and GLP1-RA represent two pillars to reduce cardiovascular disease risk but, despite international guidelines, their use remains rather low in routine cardiovascular care. This review reports indications for an appropriate use of these treatments with an analysis of benefits and precautions to consider in clinical practice.
Senni M, Oliva F, Grimaldi M
… +8 more, Zito GB, Anelli F, Gesualdo L, Montano N, Dentali F, Sinagra G, Indolfi C, Perrone Filardi P
G Ital Cardiol (Rome)
· 2026 Jan · PMID 41441830
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Cardio-kidney-metabolic syndrome and heart failure remain complex clinical conditions with significant healthcare implications. While therapeutic plans were intended to ensure appropriate prescribing, they often represen...Cardio-kidney-metabolic syndrome and heart failure remain complex clinical conditions with significant healthcare implications. While therapeutic plans were intended to ensure appropriate prescribing, they often represent bureaucratic barriers. Facilitating or removing such plans could enhance treatment timeliness, therapeutic continuity, and equitable access. This work also includes other widely used cardiovascular drugs such as direct oral anticoagulants, which remain under therapeutic plan requirements despite robust clinical experience and safety data. In light of the recent AIFA resolution of July 4, 2025, abolishing the therapeutic plan for sodium-glucose cotransporter 2 inhibitors, this paper considers such a decision as a major normative and operational breakthrough. The removal of this prescribing barrier reflects both the safety and manageability of these drugs and represents a potential model for broader regulatory simplifications. It is therefore believed that overcoming the prescribing barriers imposed by therapeutic plans is not only a clinical necessity but also an organizational and ethical imperative, in order to avoid delaying or limiting access to care.
G Ital Cardiol (Rome)
· 2026 Jan · PMID 41441829
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Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide, exerting a substantial burden on healthcare systems. Their management requires multidisciplinary approaches, continuity of care, and...Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide, exerting a substantial burden on healthcare systems. Their management requires multidisciplinary approaches, continuity of care, and advanced monitoring tools. Artificial intelligence (AI) has recently emerged as a transformative resource, owing to its ability to analyze large, heterogeneous datasets and generate accurate predictive models. Techniques such as machine learning, deep learning, and natural language processing, combined with multimodal data (electronic health records, imaging, wearable devices, sensors), can enable earlier diagnosis, dynamic risk stratification, and personalized therapies. Furthermore, the integration of AI with telemedicine and digital therapeutics provides new opportunities for remote monitoring, clinical decision support, and patient empowerment, with significant potential to improve clinical outcomes, optimize healthcare resources, and reduce hospitalizations. However, challenges remain, including algorithmic bias, lack of interpretability, ethical and legal concerns, and the need for adequate training of healthcare professionals. The recent adoption of the European AI Act establishes stricter regulatory standards to ensure safety and transparency, though it may slow down large-scale implementation. In conclusion, AI represents a pivotal innovation in cardiovascular medicine, provided it is embedded into validated clinical pathways, supported by scientific evidence, and embraced by clinicians. The future of digital cardiology will rely on the ability to develop predictive, personalized, and patient-centered healthcare models.
Carigi S, Barisone M, Rizzello V
… +16 more, De Maria R, Bartolotti M, Marchesi M, Caples N, Ameri P, Baldasseroni S, Di Lenarda A, Marini M, Municinò A, Pini D, Radini D, Raineri C, Verde A, D'Elia E, Senni M, Gori M
G Ital Cardiol (Rome)
· 2026 Jan · PMID 41441828
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Masiero G, Aurigemma C, Biscaglia S
… +21 more, Bruno F, Burzotta F, Campo G, Cangemi S, Chieffo A, Di Mario C, Esposito G, Perrone Filardi P, Giubilato S, Iannaccone M, Marchese A, Leone AM, Moscarella E, Oliva F, Polimeni A, Porto I, Saia F, Tarantini G, Scotto di Uccio F, Vergallo R, Indolfi C
G Ital Cardiol (Rome)
· 2025 Dec · PMID 41287615
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Chronic coronary syndromes require an integrated diagnostic-therapeutic approach that combines anatomical, functional, and morphological assessments. The 2024 ESC guidelines assign a key role to intravascular imaging and...Chronic coronary syndromes require an integrated diagnostic-therapeutic approach that combines anatomical, functional, and morphological assessments. The 2024 ESC guidelines assign a key role to intravascular imaging and invasive coronary functional testing to guide percutaneous coronary revascularization and to reduce major adverse cardiovascular events, including cardiac death, myocardial infarction, and repeat revascularization - particularly in patients with complex anatomy - or to reduce angina class/improve quality of life in cases of epicardial and/or microvascular vascular dysfunction. However, the implementation of these strategies in Italy remains limited, characterized by significant geographical disparities and lower utilization rates compared to other European and international countries. Cultural, educational, managerial, and economic barriers continue to hinder the large-scale adoption of these technologies, despite their proven effectiveness in reducing major cardiovascular events. The aim of this GISE/ANMCO/SIC consensus document is to promote a more appropriate and systematic use of functional evaluation and intracoronary imaging in Italian clinical practice, through shared pathways for cultural awareness, training in catheterization laboratories, adjustment of reimbursement systems, and quality monitoring, in order to improve the appropriateness and personalization of care as well as long-term outcomes for patients with chronic coronary syndromes.
Colivicchi F, Di Fusco SA, Matteucci A
… +15 more, Gulizia MM, Riccio C, Caldarola P, Bilato C, De Luca L, Geraci G, Navazio A, Murrone A, Roncon L, Urbinati S, Di Lenarda A, Gabrielli D, Nardi F, Grimaldi M, Oliva F
G Ital Cardiol (Rome)
· 2025 Dec · PMID 41287614
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The application of the clinical audit methodology in the healthcare setting is a strategy aimed at improving the quality, safety, effectiveness, efficiency and appropriateness of care. Clinical audit is structured as a c...The application of the clinical audit methodology in the healthcare setting is a strategy aimed at improving the quality, safety, effectiveness, efficiency and appropriateness of care. Clinical audit is structured as a circular and cyclical process that involves the succession of a series of phases whose repetition aims at a progressive improvement in the quality of care. In an audit process, several data are collected from routine clinical activity and compared with reference standards. Following, the existing gap with respect to benchmarks are analyzed, and interventions aimed at reducing this gap are defined. Recognizing the potential of this strategy to improve the quality of care, ANMCO has created the "ANMCO National Audit Initiative". The project starts from the recognition of specific clinical areas in which an intervention to improve the quality of care is potentially indicated and is developed with the involvement of professionals from numerous hospital centers, located throughout the country. To date, four national projects have been carried out and completed, on topics such as oral anticoagulation in patients with atrial fibrillation, the use of the polypill for cardiovascular prevention, lipid-lowering therapy in patients at high cardiovascular risk, and pharmacological therapy after acute coronary syndrome. Two additional projects, on the management of heart failure with preserved ejection fraction and on the use of wearable defibrillators, are currently underway. The strength of the ANMCO initiative lies in the ability to transform critical analysis into concrete and shared interventions, involving a large number of professionals.
Esposito A, Valli P, Macca G
… +5 more, Fracchioni I, Ferrari FFE, Martinelli A, Sala S, Di Tano G
G Ital Cardiol (Rome)
· 2025 Dec · PMID 41287613
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Stage IV lung cancers are often characterized by widespread systemic metastases, including pleural and cardiac sites. We report the case of a 67-year-old man admitted for suspected advanced lung cancer with bilateral ple...Stage IV lung cancers are often characterized by widespread systemic metastases, including pleural and cardiac sites. We report the case of a 67-year-old man admitted for suspected advanced lung cancer with bilateral pleural and pericardial effusion. Echocardiography revealed an intracardiac mass with heterogeneous echogenicity (hypo/isoechoic) adherent to the anterior wall of the right ventricle, associated with mild impairment of right ventricular systolic function and a mild-to-moderate pericardial effusion without clinical signs of tamponade. Whole-body positron emission tomography (PET) confirmed hypermetabolic pulmonary nodules and widespread secondary lesions, including myocardial involvement. This case highlights the crucial role of integrated imaging techniques, particularly the combination of echocardiography and PET, in the early detection of cardiac metastases. A multidisciplinary approach, involving oncologists, cardiologists, and radiologists, was fundamental to define an accurate clinical framework and the appropriate therapeutic strategy. Unfortunately, the premature death limited the possibility of targeted therapy. Advanced imaging modalities are confirmed to be essential for the personalized management of complex oncologic patients.