Ciliberti G, Navazio A, Cappannelli S
… +22 more, Doimo S, Giubilato S, Zilio F, Vitale E, Rossini R, Bilato C, Corda M, De Luca L, Di Marco M, Geraci G, Iacovoni A, Milli M, Pascale V, Riccio C, Scicchitano P, Tizzani E, Gulizia MM, Nardi F, Gabrielli D, Colivicchi F, Grimaldi M, Oliva F
G Ital Cardiol (Rome)
· 2025 Oct · PMID 41037418
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Waiting lists in cardiology are one of the most significant problems of the Italian Health Service (SSN). This phenomenon is perceived with significant delays in accessing specialist visits, diagnostic tests and surgical...Waiting lists in cardiology are one of the most significant problems of the Italian Health Service (SSN). This phenomenon is perceived with significant delays in accessing specialist visits, diagnostic tests and surgical interventions, negatively affecting the health of patients and the overall quality of the SSN. Structural, organizational and demographic factors can be identified among the main causes of waiting lists in cardiology. On the one hand, the number of cardiologists and specialized healthcare workers is often insufficient compared to the growing demand for care. In fact, the distribution of medical personnel is uneven across the country and there are also real problems regarding the number of doctors and nurses within the SSN, workloads and salary aspects. Furthermore, the Italian population is rapidly aging, with a significant increase in age-related cardiovascular diseases, such as heart failure, arrhythmias and coronary heart disease. These factors lead to an ever-increasing demand for cardiology services, putting pressure on the SSN. The aim of this document is to provide an updated overview of the problem of waiting lists in cardiology, to analyze the causes and to provide possible solutions.
Casella G, Tizzani E, Musumeci G
… +17 more, Valente S, Bilato C, Corda M, De Luca L, Di Marco M, Geraci G, Iacovoni A, Milli M, Navazio A, Pascale V, Riccio C, Scicchitano P, Nardi F, Gabrielli D, Colivicchi F, Grimaldi M, Oliva F
G Ital Cardiol (Rome)
· 2025 Oct · PMID 41037417
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In recent years, there has been a constant reduction in mortality and morbidity in numerous cardiovascular diseases. The advent of hospital networks has allowed for a reduction in the timing of reperfusion treatment in p...In recent years, there has been a constant reduction in mortality and morbidity in numerous cardiovascular diseases. The advent of hospital networks has allowed for a reduction in the timing of reperfusion treatment in patients with acute coronary syndromes (ACS). However, to date, only the network for ST-elevation myocardial infarction, according to the latest Cardiological Census, is widely spread in Italy. Instead, there are several other acute heart diseases for which there is no equally widespread network, and there is still great heterogeneity among regions. The data from the National Outcome Plan of AGENAS confirms these gaps, particularly for non-ST-elevation ACS and for cardiogenic shock. This observation is further complemented by the profound transformation that the intensive cardiac care units (ICCUs) have undergone in recent years. Today's ICCUs are no longer just places for treating ACS, but should also care for and monitor other acute heart diseases, in particular heart failure, cardiogenic shock, intermediate-to-high-risk pulmonary embolism, and multiple cardiac complication of non-cardiac organ damage as well. This evolution requires significant developments in clinical skills, technological resources, and healthcare organization. The purpose of this work is therefore to describe this clinical and organizational evolution and identify the necessary pathways, interactions with the territory and system indicators to implement them with the aim to improve the prognosis of patients with acute heart diseases as well.
Pagnoni G, Maini A, Marconi I
… +4 more, Aschieri D, Sgura FA, Boriani G, Coppi F
G Ital Cardiol (Rome)
· 2025 Oct · PMID 41037416
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Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome, primarily affecting young women without traditional cardiovascular risk factors. We report the case of...Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome, primarily affecting young women without traditional cardiovascular risk factors. We report the case of a 57-year-old woman with obesity and a history of smoking, admitted for acute respiratory failure due to pneumonia, complicated by cardiac arrest. Elevated troponin levels, along with subsequent ECG and echocardiographic findings suggestive of previous myocardial ischemia, led to the indication for coronary angiography. The angiogram revealed severe three-vessel coronary disease with three distinct SCADs involving the left anterior descending, right coronary, and circumflex arteries. Advanced imaging, including whole-body positron emission tomography, revealed active systemic vasculitis. A multidisciplinary approach led to initiation of immunosuppressive therapy with corticosteroids and tocilizumab, alongside conservative cardiac management with dual antiplatelet therapy. At 1-year follow-up, the patient showed significant improvement in left ventricular function and normalization of inflammatory markers. This case highlights the diagnostic and therapeutic complexity of multiple SCADs, particularly in the context of underlying systemic inflammatory diseases, and underscores the importance of individualized treatment strategies and multidisciplinary collaboration.
Savastano S, Baldi E, Currao A
… +4 more, Sanzo A, Compagnoni S, De Luca L, Rordorf R
G Ital Cardiol (Rome)
· 2025 Oct · PMID 41037415
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Electrical storm represents a significant challenge in the management of cardiological emergencies, with a high mortality rate. The therapeutic armamentarium is limited, and the efficacy of available drugs is not always...Electrical storm represents a significant challenge in the management of cardiological emergencies, with a high mortality rate. The therapeutic armamentarium is limited, and the efficacy of available drugs is not always consistent. Furthermore, non-pharmacological strategies are restricted in their application and not universally accessible in medical facilities. There is a close link between the autonomic nervous system and ventricular arrhythmias, as the activation of the sympathetic nervous system can modify the electrophysiological characteristics of the substrate and increase triggered activity and automaticity. This combination is crucial for the initiation and maintenance of ventricular arrhythmias. In recent years, percutaneous stellate ganglion block has emerged as an option in the management of electrical storm, a development largely informed by the findings of multicenter studies that have substantiated its efficacy and safety, along with its expeditious learning curve, thereby paving the way for its widespread adoption. Nevertheless, the role of stellate ganglion block within clinical guidelines remains circumscribed, primarily due to the paucity of data from randomized studies. Its indication is reserved for when alternative therapeutic strategies, both pharmacological and non-pharmacological, have failed to yield the desired outcomes. In the future, it may well be used earlier in the treatment of arrhythmic storm, helping to avoid arrhythmia refractoriness and an unfavorable outcome.
Nasso G, Loizzo T, Bonifazi R
… +2 more, Vignaroli W, Speziale G
G Ital Cardiol (Rome)
· 2025 Oct · PMID 41037414
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The surgical treatment of atrial fibrillation (AF) has evolved significantly over years and even more so in the last 10 years. Eliminating AF and AF-related stroke are the current objectives, more than just heart rate co...The surgical treatment of atrial fibrillation (AF) has evolved significantly over years and even more so in the last 10 years. Eliminating AF and AF-related stroke are the current objectives, more than just heart rate control, and there are now many successful surgical procedures focused on and with excellent results. We reviewed the current types of surgical AF procedures, discussing minimally invasive and hybrid ones, and this may be helpful to clinicians in understanding the different surgical AF options available and to help them in the management of this patient population.
Colivicchi F, Arca M, Di Fusco SA
… +4 more, Pirillo A, Alonzo A, Nardi F, Catapano AL
G Ital Cardiol (Rome)
· 2025 Oct · PMID 41037413
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Bempedoic acid is a lipid-lowering drug recently introduced into clinical practice. The CLEAR Outcomes randomized controlled clinical trial has confirmed the efficacy of bempedoic acid in reducing low-density lipoprotein...Bempedoic acid is a lipid-lowering drug recently introduced into clinical practice. The CLEAR Outcomes randomized controlled clinical trial has confirmed the efficacy of bempedoic acid in reducing low-density lipoprotein cholesterol (LDL-C) levels and has shown that this reduction translates into a significant decrease in major adverse cardiovascular events (MACE). The clinical benefits were consistent with the benefits obtained with other lipid-lowering drugs that have the same efficacy in reducing LDL-C levels. Furthermore, the CLEAR Outcomes trial confirmed the safety of bempedoic acid. This study reported the same frequency of adverse events as observed in previous phase 3 trials. Pre-specified and post-hoc analyses of the CLEAR Outcomes trial showed that treatment with bempedoic acid confers a clinical benefit both in primary prevention and in patients with recurrent events, independent of gender and comorbidities such as diabetes, obesity and metabolic syndrome, and confirmed a potential additive benefit due to the favorable effects on the glycemic profile and high-sensitivity C-reactive protein. In patients with peripheral artery disease, bempedoic acid reduces both MACE and major adverse limb events. Based on the available evidence, the European Medicines Agency has updated the summary of product characteristics to include cardiovascular disease as a therapeutic indication in addition to hypercholesterolemia. Bempedoic acid is now approved in adults with established atherosclerotic cardiovascular disease or at high risk of a first cardiovascular event, to reduce cardiovascular risk by lowering LDL-C levels, in patients treated with the maximum tolerated statin dose (with or without ezetimibe), or in statin-intolerant patients who are not adequately controlled with ezetimibe alone.
Tedeschi A, Canale ML, Greco A
… +15 more, Inno A, De Biasio M, Oliva S, Bisceglia I, Maurea N, Tarantini L, Aschieri D, Riccio C, Bilato C, Geraci G, Navazio A, Colivicchi F, Grimaldi M, Oliva F, a nome dell’Area Cardioncologia ANMCO
G Ital Cardiol (Rome)
· 2025 Oct · PMID 41037411
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The enormous progress made in recent decades in the diagnosis and treatment of oncological and hematological diseases has resulted in a significant increase in patient survival and a substantial growth in the population...The enormous progress made in recent decades in the diagnosis and treatment of oncological and hematological diseases has resulted in a significant increase in patient survival and a substantial growth in the population of cancer survivors. These include both living patients with active disease and those who are free of cancer after treatment. There is strong evidence that cancer survivors are at an increased risk of developing cardiovascular diseases and that this risk may outweigh the prognostic impact that is imposed by the disease itself for certain types of cancer. The pathophysiological bases of the interaction between cardiovascular disease and cancer are complex and involve the sharing of both modifiable and non-modifiable risk factors, the effects on the cardiovascular system of certain treatments, as well as the pathogenic changes imposed by cancer, in which inflammation appears to play a key role. In this context, it is therefore essential to increase the attention of the cardiology community to this issue and to enhance cardiological follow-up programs for this high cardiovascular risk population.
Musella F, Ciliberti G, Fortuni F
… +14 more, Finocchiaro G, Piroli F, Guasti S, Zabbia D, Franchin L, Cornara S, Cangemi S, Corda M, Riccio C, Iacovoni A, Colivicchi F, Grimaldi M, Oliva F, De Chiara B
G Ital Cardiol (Rome)
· 2025 Oct · PMID 41037410
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The athlete's heart is a complex physiological adaptation to sustained physical training, necessitating a specialized approach to diagnosis and management. Advanced cardiac imaging plays a pivotal role in differentiating...The athlete's heart is a complex physiological adaptation to sustained physical training, necessitating a specialized approach to diagnosis and management. Advanced cardiac imaging plays a pivotal role in differentiating physiological remodeling from pathological conditions such as cardiomyopathies. In particular, cardiac magnetic resonance is essential for detecting subclinical myocardial fibrosis and other structural abnormalities that may indicate underlying disease. Serial imaging during follow-up is valuable for monitoring the progression or regression of cardiac remodeling, especially during periods of detraining, and is key to confirming the physiological nature of observed changes. Early identification of high-risk features, including complex arrhythmias or structural abnormalities, is critical for preventing adverse outcomes such as sudden cardiac death.