Geraci G, Iacovoni A, Lucà F
… +15 more, Bilato C, Corda M, De Luca L, Di Marco M, Milli M, Navazio A, Pascale V, Riccio C, Scicchitano P, Tizzani E, Nardi F, Gabrielli D, Colivicchi F, Grimaldi M, Oliva F
Cardiovascular diseases continue to be the leading cause of death worldwide, with ischemic heart disease remaining the primary cause among cardiovascular conditions; as is well known, it is closely linked to LDL choleste...Cardiovascular diseases continue to be the leading cause of death worldwide, with ischemic heart disease remaining the primary cause among cardiovascular conditions; as is well known, it is closely linked to LDL cholesterol levels, now identified as the "cause" of atherosclerotic plaque development and not just a risk factor. The recent introduction of increasingly powerful lipid-lowering drugs makes it more realistic today to achieve the desired LDL targets, and the evolution of therapeutic strategies allows for more personalized care by tailoring treatments to the specific profile of each patient. There are also high expectations for therapies, currently under evaluation, aimed at other potential targets contributing to atherosclerotic disease, such as lipoprotein(a) and interleukin-6. However, these new and potent therapies also have a significant economic impact, making it essential for scientific societies to thoughtfully consider how to manage resources to ensure equitable care. Likely, the use of digital tools can support a balanced and cost-effective management approach.
Di Fusco SA, Orso F, Maggioni AP
… +17 more, Bilato C, Corda M, De Luca L, Di Marco M, Geraci G, Iacovoni A, Milli M, Navazio A, Pascale V, Riccio C, Scicchitano P, Tizzani E, Nardi F, Gabrielli D, Colivicchi F, Grimaldi M, Oliva F
Since 2021, the Research Center of the Italian Association of Hospital Cardiologists (ANMCO)/Heart Care Foundation, which boasts a long tradition of research with significant impact on clinical practice, has implemented...Since 2021, the Research Center of the Italian Association of Hospital Cardiologists (ANMCO)/Heart Care Foundation, which boasts a long tradition of research with significant impact on clinical practice, has implemented a training project to promote knowledge of the basic methodologies for clinical research and the creation of a network of young researchers currently active in numerous research studies coordinated by the same Study Center and illustrated during the ANMCO General States 2024. Among these, the EYESHOT-2 study, together with the first phase of the BRING-UP Prevention and BRING-UP3 Heart Failure studies, enrolled almost 13 000 patients with, for the last two, 97% completeness of data at the 6-month follow-up, which is expression of the high quality of observational research work. Furthermore, in collaboration with international scientific societies and research centers, the same Study Center coordinates the activities in Italy of several international multicenter studies including EuroHeart, COLT-HF, and AFFIRMO. The States General was also an opportunity to discuss the main challenges that clinical research must face in the near future, from new research methodologies, such as the use of machine learning and registry-based randomized clinical trials, to new lines of research, such as mechanistic and pathophysiological clinical studies and decentralized clinical trials for rare diseases.
Noncompaction myocardium (NCM) is a rare cardiac condition characterized by prominent trabeculation, associated with an increased risk of heart failure, arrhythmias, and embolism. We report the case of a 46-year-old man,...Noncompaction myocardium (NCM) is a rare cardiac condition characterized by prominent trabeculation, associated with an increased risk of heart failure, arrhythmias, and embolism. We report the case of a 46-year-old man, smoker, with a family history of sudden cardiac death, who presented to the emergency department with progressive dyspnea. Echocardiography revealed dilated cardiomyopathy with severe biventricular dysfunction and marked apical trabeculation of the left ventricle. Coronary angiography showed a single coronary artery with anomalous origin of the right coronary artery from the mid-segment of the left anterior descending artery, without significant stenosis. Cardiac magnetic resonance imaging confirmed the NCM phenotype with a noncompacted-to-compacted myocardial ratio of 2.4. The simultaneous presence of NCM and single coronary artery is extremely rare in the literature. This phenotypic combination may suggest a common genetic predisposition and warrants targeted diagnostic investigations for optimal cardiovascular risk management.
BACKGROUND: Heart failure (HF) significantly impacts on morbidity, mortality, and healthcare use, particularly in elderly populations and underserved areas. Remote monitoring can anticipate clinical deterioration and imp...BACKGROUND: Heart failure (HF) significantly impacts on morbidity, mortality, and healthcare use, particularly in elderly populations and underserved areas. Remote monitoring can anticipate clinical deterioration and improve care. The aim of this study was to describe the ASL Nuoro's integrated model for proactive HF management via telemonitoring. METHODS: A prospective observational study enrolled HF patients stratified by the 3C-HF score and monitored using non-invasive home devices linked to the CARE MAP platform. RESULTS: From April 2023 to March 2025, 499 patients were enrolled; 354 were active at follow-up (mean age 80 ± 11 years, 61% men). Therapeutic adherence was high (sodium-glucose cotransporter 2 inhibitors 85%, angiotensin receptor-neprilysin inhibitors 56%). Monthly clinical alerts averaged 1740 (60% clinical relevant), leading to 413 contacts/month. HF hospitalizations dropped by 71% (June-December 2023 vs. 2022). CONCLUSIONS: The integrated model proves to be feasible, effective, and sustainable, even in settings characterized by high organizational complexity. From a social perspective, it ensures equitable access to care and is applicable in geographically disadvantaged areas. The inherent limitations of the 3C-HF score highlight the need for more advanced and dynamic prognostic tools. The intervention also demonstrates economic advantage through the reduction of hospitalizations and the optimization of resource utilization.
De Carlini CC, Castelli MG, Vecchio CR
… +33 more, Turco A, Iorio A, Russo F, Frisinghelli A, Grieco NB, Bonfanti P, Caramma IC, Corticelli A, Rendina E, Cecchini M, Farina E, Borriello D, D'Amata D, Ferri L, Barbieri L, Pierini S, De Marco F, Bandera A, Seminari E, Bichi S, Marchetto G, Martino A, Tolva VS, Froio A, Loffreno A, Uccello G, Mascioli G, Rovaris G, Rordorf R, Piconi S, Di Tano G, Oliva F, Achilli F
Infective endocarditis is a pathology that still presents a high burden of morbidity and mortality. Several observational studies and national and international registries showed that patients undergoing invasive cardiov...Infective endocarditis is a pathology that still presents a high burden of morbidity and mortality. Several observational studies and national and international registries showed that patients undergoing invasive cardiovascular procedures (surgical or percutaneous) are at higher risk of developing infective endocarditis, resulting in increased morbidity, length of hospital stay and mortality related to these procedures. The role of antibiotic prophylaxis is therefore crucial in the prevention of postoperative infections. This is accompanied by new emerging strategies in the pre- and postoperative nursing management of patients.
Biagini E, Limongelli G, Parisi V
… +13 more, Cappelli F, Graziani F, Monda E, Olivotto I, Pieroni M, Rubino M, Ditaranto R, Serratore S, Schiavo MA, Sinagra G, Indolfi C, Perrone Filardi P, a nome del Registro Italiano della Malattia di Anderson-Fabry della Società Italiana di Cardiologia (SIC)
Anderson-Fabry disease is a panethnic, rare disease caused by α-galactosidase A deficiency, with subsequent systemic intracellular accumulation of glycosphingolipids. Confined as a nephrological disease for many decades,...Anderson-Fabry disease is a panethnic, rare disease caused by α-galactosidase A deficiency, with subsequent systemic intracellular accumulation of glycosphingolipids. Confined as a nephrological disease for many decades, the widespread use of multimodality imaging techniques over the last 20 years (like cardiac magnetic resonance) has allowed to highlight the frequent and heterogeneous cardiovascular involvement, with important impact on therapeutic strategies and prognosis. However, many grey zones and knowledge gaps remain, both in diagnostic and management approaches. Recently, the Italian Society of Cardiology has promoted the constitution of the Italian Fabry Disease Cardiovascular Registry, aiming to expand our understanding of the disease focusing on cardiovascular manifestations and complications, to improve quality of care and outcomes of these patients.
Badano LP, Tomaselli M, Fraccaro C
… +15 more, Sannino A, Fortuni F, Adamo M, Ancona F, Sticchi A, Camalleri V, Pasquini A, Cannata F, Masiero G, Golino P, Perrone Filardi P, Indolfi C, Vizza CD, Muraru D, a nome dei componenti del Gruppo di Studio Cardiopatie Valvolari della Società Italiana di Cardiologia
Atrial secondary tricuspid regurgitation (A-STR) is a complex and increasingly recognized form of valvular heart disease that arises primarily due to right atrial and tricuspid annular dilation in the absence of intrinsi...Atrial secondary tricuspid regurgitation (A-STR) is a complex and increasingly recognized form of valvular heart disease that arises primarily due to right atrial and tricuspid annular dilation in the absence of intrinsic leaflet pathology. Unlike ventricular secondary tricuspid regurgitation, which is driven by right ventricular remodeling, A-STR is predominantly associated with atrial fibrillation, heart failure with preserved ejection fraction, and other conditions that lead to chronic right atrial remodeling. This condition has been underappreciated despite its significant prevalence and impact on patient morbidity and mortality. Echocardiography is the primary diagnostic tool for diagnosing and assessing patients with A-STR. The natural history of A-STR is unfavorable, with potential worsening over time, particularly if the underlying conditions are not properly treated. Treatment options include cardioversion of atrial fibrillation and medical treatment of heart failure with preserved ejection fraction, which may promote reverse remodeling of the right heart structures and reduce STR severity in some cases. Surgical tricuspid valve annuloplasty remains the gold standard for severe cases, but transcatheter interventions are emerging as potential alternatives. This review provides a comprehensive overview of A-STR, encompassing its epidemiology, pathophysiology, diagnostic approaches, and treatment strategies. By synthesizing current evidence and highlighting gaps in knowledge, this paper aims to guide clinicians in the management of this challenging condition and to inspire future research.
This review article describes two controversial aspects of secondary tricuspid regurgitation: the still poorly understood anatomy of the tricuspid valve and the advantages and limitations of color Doppler echocardiograph...This review article describes two controversial aspects of secondary tricuspid regurgitation: the still poorly understood anatomy of the tricuspid valve and the advantages and limitations of color Doppler echocardiography in evaluating tricuspid regurgitation. The tricuspid apparatus is characterized by a complex anatomical structure that includes a saddle-shaped ring, three leaflets (or more), and a subvalvular apparatus. An in-depth knowledge of the anatomy is essential for understanding the various pathophysiological mechanisms of secondary (atriogenic and ventriculogenic) tricuspid regurgitation. Two-dimensional and three-dimensional echocardiography and color Doppler analysis play a key role in correct morphological and functional evaluation and in defining the etiology and extent of tricuspid regurgitation. A multiparametric approach that considers qualitative, semiquantitative, and quantitative parameters is recommended.
Artificial intelligence (AI) is redefining ECG interpretation, transforming it from a static diagnostic tool into a dynamic, predictive, and integrative instrument. Although widespread, traditional rule-based ECG analysi...Artificial intelligence (AI) is redefining ECG interpretation, transforming it from a static diagnostic tool into a dynamic, predictive, and integrative instrument. Although widespread, traditional rule-based ECG analysis has limitations in accuracy and adaptability, especially in complex clinical settings. In contrast, AI-driven models, particularly those employing machine learning and deep learning architectures, have demonstrated improved diagnostic performance across a broad spectrum of cardiovascular diseases, including atrial fibrillation, acute myocardial infarction, hypertrophic cardiomyopathy, and valvular heart disease. Notably, AI-ECG is now able to detect subclinical ventricular dysfunction, stratify long-term risk, and anticipate major adverse events before overt clinical manifestations occur. In addition to diagnosis, AI-ECG is emerging as a decision support tool in scenarios characterized by diagnostic uncertainty, such as syncope and cardio-oncology, and may significantly optimize triage and resource allocation. Multiparametric approaches further extend its utility, enabling simultaneous prediction of structural, functional, and electrical cardiac parameters. Wearable devices integrated with AI improve continuous monitoring and may decentralize arrhythmia detection and sudden cardiac death prevention. Despite these advances, critical challenges remain. Poorly explainable AI models, algorithmic bias, overfitting, data governance, and regulatory uncertainty demand rigorous methodological scrutiny. In this framework, federated learning architectures may enable continuous multicenter model refinement and enhance methodological robustness while safeguarding data privacy. The European AI Act and methodological checklists promoted by scientific societies offer a framework to address these issues, fostering transparency, equity, and clinical validity. If validated and implemented responsibly, AI-enhanced ECG has the potential to enhance - not replace - clinical reasoning, advancing a precision medicine paradigm based on both technological innovation and human expertise.
Canale ML, Pignalberi C, Oliva S
… +10 more, Giubilato S, Nesti M, Troccoli R, Di Monaco A, Bisceglia I, Turazza F, Bilato C, Colivicchi F, Grimaldi M, Oliva F
G Ital Cardiol (Rome)
· 2025 Aug · PMID 40718977
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A systematic and multidisciplinary approach is needed to manage cancer patients with a cardiac implantable electronic device undergoing radiation therapy. We report a statement from the Italian Association of Hospital Ca...A systematic and multidisciplinary approach is needed to manage cancer patients with a cardiac implantable electronic device undergoing radiation therapy. We report a statement from the Italian Association of Hospital Cardiologists (ANMCO) to provide guidance for clinicians involved in the care continuum of this challenging clinical setting. A comprehensive careful assessment of radiotherapy type, treatment plan and cardiac issues is recommended in order to minimize the risk of device malfunction. Risk stratification before radiation therapy as well as the timing of cardiological assessments during treatment and follow-up strategies are thoroughly discussed. An overview of oncological electrophysiology and radiotherapy-induced damage to devices is also provided. The proposed recommendations represent an expert consensus based on available literature data, guidelines and clinical evidence.
Bava A, Giuffrè MR, Postorino S
… +4 more, Stelitano M, Zema D, Rao CM, Benedetto FA
G Ital Cardiol (Rome)
· 2025 Aug · PMID 40718976
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We describe the case of a 75-year-old hypertensive patient who comes to the emergency room for an infero-postero-lateral myocardial infarction. The entry echocardiogram showed a rounded formation with mixed echogenicity...We describe the case of a 75-year-old hypertensive patient who comes to the emergency room for an infero-postero-lateral myocardial infarction. The entry echocardiogram showed a rounded formation with mixed echogenicity (maximum transverse diameter 4.5 cm), attached to the free wall of the left atrium and without any hemodynamic impact. Coronary angiography revealed a giant aneurysm of the circumflex artery, followed by an occlusion of the distal tract. After Heart Team evaluation, angioplasty with implantation of a drug-eluting stent was performed in the occluded coronary tract. This is one of the very rare cases in the literature of a giant coronary aneurysm diagnosed within the clinical picture of acute coronary syndrome. There is a lack of guidelines and consensus documents regarding management of this condition. In our case report, we discuss the resulting therapeutic challenges.
Sparasci FM, Raone L, Currao A
… +4 more, Munafò AR, Visconti LO, Musumeci G, Ferlini M
G Ital Cardiol (Rome)
· 2025 Aug · PMID 40718975
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BACKGROUND: Hypertriglyceridemia is a common finding in patients with coronary artery disease (CAD), contributing to the residual cardiovascular risk in this population. In CAD patients with persistently elevated triglyc...BACKGROUND: Hypertriglyceridemia is a common finding in patients with coronary artery disease (CAD), contributing to the residual cardiovascular risk in this population. In CAD patients with persistently elevated triglyceride levels despite lipid-lowering therapies, treatment with icosapent ethyl (IPE), compared to placebo, significantly lowered the risk of ischemic events. We aimed to quantify the burden of real-world patients with high triglyceride levels despite optimal lipid-lowering therapy, and to provide the potential use of IPE as a therapeutic strategy of secondary prevention. METHODS: We used the data of the multicenter and observational JET-LDL registry, which included 1095 patients with acute coronary syndrome undergoing percutaneous coronary intervention with at least one stent implantation at 35 Italian hospitals. In the present subanalysis, we investigated fasting triglyceride levels at index hospitalization and after 3 months of follow-up, and their relationship with LDL-cholesterol values. We also identified patients potentially eligible for IPE prescription based on inclusion/exclusion criteria of the REDUCE-IT trial and of the Italian Medicines Agency (AIFA). RESULTS: Triglyceride levels at baseline and at 3-month follow-up were 109 (82.5-147) mg/dl and 98 (75-130) mg/dl, respectively. The reduction of triglycerides was also statistically significant (p<0.01) comparing paired matched patients. At 3 months, 15.6% of patients met the inclusion laboratory criteria of the REDUCE-IT trial, making them eligible for IPE based on these parameters. Additionally, 14.5% of patients were eligible according to AIFA authorized guidelines for the use of IPE, whereas only 0.2% qualified under the criteria for reimbursement. CONCLUSIONS: A non-negligible proportion of patients met the REDUCE-IT triglyceride cut-off levels for IPE prescription at 3-month follow-up post-acute coronary syndromes. However, the prescription of IPE can be very limited by the current restrictive reimbursement criteria.
Manes MT, Giubilato S, Francese M
… +16 more, Mannarini A, Ciliberti G, Pavan D, Di Fusco SA, Rossini R, Khoury G, Aschieri D, Scardovi B, Bruno N, Cocozza S, Gulizia MM, Geraci G, Gabrielli D, Colivicchi F, Grimaldi M, Oliva F
G Ital Cardiol (Rome)
· 2025 Aug · PMID 40718973
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The escalation in demand for digital health services, particularly highlighted by recent global health crises, has emphasized the significance of eHealth literacy (eHL). This concept encompasses the skills necessary to e...The escalation in demand for digital health services, particularly highlighted by recent global health crises, has emphasized the significance of eHealth literacy (eHL). This concept encompasses the skills necessary to effectively search for, comprehend, evaluate, and apply online health information to solve health-related issues. eHL not only facilitates navigation through the digital health landscape but also broadens the understanding of the digital divide within the context of health information accessibility. In this review, we encompassed individual eHL definitions and tools, focusing on the role of eHL during the COVID-10 outbreak, and with regard to gender, age and social inequalities.
G Ital Cardiol (Rome)
· 2025 Aug · PMID 40718972
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The win ratio is a relatively recent statistical technique introduced with the aim of better managing the analysis of clinical trials involving more than one clinical event as an endpoint in the evaluation of a treatment...The win ratio is a relatively recent statistical technique introduced with the aim of better managing the analysis of clinical trials involving more than one clinical event as an endpoint in the evaluation of a treatment. The calculation of the win ratio begins by defining a "hierarchy" of clinical events on the basis of their severity, e.g. death, followed, for example, by the number of hospitalizations for heart failure, followed, for example, by softer endpoints including functional or laboratory changes. The analysis begins by comparing each patient in a hypothetical "Group A" with each patient in a hypothetical "Group B" on the hierarchically most important clinical event only. If the patient in Group B dies and the one in Group A does not, or if the one in Group B dies before the one in Group A, then that particular comparison is "won" by Group A. If the patient in Group A dies and the one in Group B does not, or if the one in Group A dies before the one in Group B, then that comparison is "won" by Group B. If nobody dies, or if they die on the same day, then that specific comparison ends in a tie. All comparisons of each patient in Group A with each patient in Group B are then performed. On the comparisons that end in a tie, we move on to the analysis of the endpoint hierarchically in second place, using the same technique. Then we proceed to the analysis of the endpoint hierarchically in third place, and so on down to the event in the lowest position in the hierarchy. The win ratio represents the total sum of comparisons in which, for example, Group A wins, divided by the total sum of comparisons in which Group A "loses". The absolute difference, rather than the ratio, between these two sums indicates the "win difference". Compared to the conventional "time-to-event" statistical techniques including, for example, the Cox model, the win ratio calculation has advantages, but also potential disadvantages. This review aims to offer a summary of the advantages and potential disadvantages of the win ratio, with some practical examples derived from the use of the win ratio in the analysis of important trials in the cardiovascular area.