Ferrante MS, Pisano C, Raffa GM
… +7 more, Scarantino A, Lachina C, Nuzzi V, Manca P, Cannata S, Scarlata M, Pilato M
G Ital Cardiol (Rome)
· 2025 Aug · PMID 40718971
·
Publisher ↗
Hypertrophic cardiomyopathy is a heterogeneous and complex disease. It is an autosomal dominant genetic disease caused by a missense mutation in one of at least 12 genes that code for cardiac sarcomere proteins. There ar...Hypertrophic cardiomyopathy is a heterogeneous and complex disease. It is an autosomal dominant genetic disease caused by a missense mutation in one of at least 12 genes that code for cardiac sarcomere proteins. There are various approaches used today for the treatment of this pathology, but the "gold standard" remains the surgical treatment of septal myectomy according to Morrow, in which the hypertrophic septum is surgically excised. However, further less invasive approaches have been proposed, such as alcohol septal ablation and edge-to-edge repair of the systolic anterior motion of the mitral valve in patients who are not candidates for surgery, but the superiority of surgery in resolution of left ventricular outflow tract obstruction and its recurrence has been widely demonstrated. Moreover, the surgical approach is correlated with low mortality and morbidity rates in expert centers for the treatment of this pathology.
Benvenuto M, D'Elia E, Cittar M
… +23 more, Battistoni I, Tagliamonte G, Masarone D, Halasz G, Limonta R, Tinti MD, De Gennaro L, De Maria R, Carigi S, Bianco M, Di Nora C, Manca P, Matassini MV, Rizzello V, Palmieri V, Bilato C, Geraci G, Gori M, Colivicchi F, Grimaldi M, Oliva F, Iacoviello M, a nome dell’Area Cardiorenale e Metabolica ANMCO e dell’Area Scompenso Cardiaco ANMCO
G Ital Cardiol (Rome)
· 2025 Aug · PMID 40718970
·
Publisher ↗
Chronic kidney disease, diabetes mellitus and heart failure represent three chronic conditions closely linked to each other from a pathophysiological and prognostic point of view. This link has led to an ever-increasing...Chronic kidney disease, diabetes mellitus and heart failure represent three chronic conditions closely linked to each other from a pathophysiological and prognostic point of view. This link has led to an ever-increasing emphasis in recent years on the need for a holistic approach to patients who are affected by optimizing the therapeutic management of what has recently been defined as cardio-kidney-metabolic syndrome. The cardiorenal and metabolic approach has gained relevance thanks to recent studies on new drug classes. Initially in diabetic patients and later in those suffering from heart failure and chronic kidney disease, these new drugs have demonstrated their effectiveness in reducing cardiovascular risk, the progression of heart failure and chronic kidney disease. This review aims to address the main pharmacological aspects of two of these new classes, that of sodium-glucose co-transporter 2 inhibitors and the more recent one of non-steroidal mineralocorticoid receptor antagonists.
G Ital Cardiol (Rome)
· 2025 Aug · PMID 40718969
·
Publisher ↗
Despite the effectiveness of statins in reducing cardiovascular events and slowing the progression of coronary atherosclerosis, significant residual cardiovascular risk persists. In the REDUCE-IT trial, icosapent ethyl (...Despite the effectiveness of statins in reducing cardiovascular events and slowing the progression of coronary atherosclerosis, significant residual cardiovascular risk persists. In the REDUCE-IT trial, icosapent ethyl (IPE), a highly purified ethyl ester of eicosapentaenoic acid (EPA), has been demonstrated to significantly lower the risk of primary and secondary composite endpoints, including major adverse cardiovascular events and cardiovascular death, when added to a statin compared to placebo. This clinical benefit may partially result from IPE's moderate triglyceride-lowering properties; however, it also significantly reduces levels of atherogenic remnant particle-cholesterol. Previous trials using mixed formulations of omega-3 fatty acids (EPA/docosahexaenoic acid [DHA]) or low-dose IPE have not demonstrated similar benefits, despite achieving comparable triglyceride reductions. These discrepancies have prompted investigations into the mechanistic differences between omega-3 fatty acids, as EPA and DHA exhibit distinct membrane interactions, metabolic products, tissue distributions, and biological effects. Moreover, IPE exerts several beneficial actions on atherosclerosis beyond its triglyceride-lowering properties, improving endothelial function, reducing intra-plaque inflammation and oxidative stress, exhibiting antithrombotic properties, and improving insulin sensitivity. IPE is scientifically plausible as a potential antiatherosclerotic agent based on mechanistic, pathophysiological, outcomes, and plaque-imaging studies. This review aims to synthesize the current evidence regarding IPE and examine its potential applications in light of the European Society of Cardiology guideline recommendations and existing national regulations.
G Ital Cardiol (Rome)
· 2025 Aug · PMID 40718968
·
Publisher ↗
The ISCHEMIA study enrolled patients with chronic coronary syndrome, moderate-to-severe myocardial ischemia, and critical coronary stenosis, demonstrating that coronary revascularization is not superior to optimized medi...The ISCHEMIA study enrolled patients with chronic coronary syndrome, moderate-to-severe myocardial ischemia, and critical coronary stenosis, demonstrating that coronary revascularization is not superior to optimized medical therapy in a population with LDL cholesterol <70 mg/dl in both treatment groups. Despite its bias, ISCHEMIA was able to demonstrate the limitations of a strategy based on coronary revascularization in this clinical setting. Five years after its publication, after even studies based on coronary anatomy have failed to identify a population that benefits from an interventional strategy, coronary revascularization remains the first choice in unstable or worsening angina, in individuals with left main stem disease, complex three-vessel disease, and two-vessel disease with involvement of the proximal anterior interventricular branch or in subjects in whom the objective is to control angina symptoms. In all other cases, medical therapy aimed at achieving lesion stabilization should be preferred. The time has come to promote a critical reflection and question the still dominant practice of performing coronary revascularization directly during coronary angiography based solely on anatomical considerations.
Basile C, Villaschi A, Orso F
… +1 more, Maggioni AP
G Ital Cardiol (Rome)
· 2025 Aug · PMID 40718967
·
Publisher ↗
Integrating artificial intelligence (AI) into cardiovascular clinical trials is emerging as a key factor in streamlining patient selection, data collection, endpoint monitoring, and outcome analysis. On the one hand, mac...Integrating artificial intelligence (AI) into cardiovascular clinical trials is emerging as a key factor in streamlining patient selection, data collection, endpoint monitoring, and outcome analysis. On the one hand, machine learning and deep learning algorithms facilitate the management and review of ever-increasing volumes of clinical, imaging, and telemonitoring data, identifying predictive patterns and automating repetitive tasks. On the other hand, the high cost and long duration of traditional trials, coupled with the need for adequate population diversity, underscore the urgency of re-engineering trial design. AI can contribute to more adaptive study protocols, minimize interobserver variability, and improve endpoint accuracy. However, technical and ethical challenges remain, including algorithmic bias, privacy, model interpretability, and legal accountability for errors. Looking ahead, the introduction of digital biomarkers, synthetic control arms, and increasingly decentralized trials may redefine experimental paradigms and make cardiovascular trials faster, more inclusive, and more targeted. The aim of this review is to describe the use of AI in randomized controlled trials in cardiology.
G Ital Cardiol (Rome)
· 2025 Aug · PMID 40718960
·
Publisher ↗
BACKGROUND: Despite guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF), a residual risk of adverse outcomes persists, particularly after worsening heart failure (WHF). The VICTORI...BACKGROUND: Despite guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF), a residual risk of adverse outcomes persists, particularly after worsening heart failure (WHF). The VICTORIA trial demonstrated the benefit of adding vericiguat in high-risk patients. However, its real-world adoption in Italy remains unclear. The aim of this study was to assess the use, safety, and prescription patterns of vericiguat in Italian patients with recent WHF. METHODS: The multicenter VeriChange survey was conducted across 28 hospitals in Northern Italy. A total of 399 anonymized clinical records of HFrEF patients with recent WHF were collected. The survey included demographic, clinical, therapeutic data and safety outcomes. RESULTS: Overall, 68% of patients were classified as NYHA III-IV and 77% had a left ventricular ejection fraction ≤35%. Vericiguat was initiated after the first WHF episode in 54% of cases, and during hospitalization in 50%. The target dose of 10 mg/day was reached in 56% of patients. Tolerability was high, with only 3% treatment discontinuation. Prescription occurred in a context of strong adherence to guideline-based therapy. CONCLUSIONS: Vericiguat was introduced early and safely in Italian real-world practice, especially in tertiary and referral centers. Broader implementation and earlier WHF recognition are still needed to reduce residual risk in advanced heart failure patients.
The use of polypill, a single pill containing more therapeutic agents, has shown to increase therapeutic adherence and improve cardiovascular prognosis. Among the several polypills currently available, the fixed dose com...The use of polypill, a single pill containing more therapeutic agents, has shown to increase therapeutic adherence and improve cardiovascular prognosis. Among the several polypills currently available, the fixed dose combination of rosuvastatin at different doses and acetylsalicylic acid (ASA) at low dose represents a useful therapeutic option for cardiovascular disease prevention. When the impact of rosuvastatin in association with ASA on cardiovascular disease incidence has been compared with the combination of other statins with ASA, rosuvastatin plus ASA is the combination associated with the lowest incidence of several cardiovascular diseases. As regards the use of ASA in primary prevention, the global clinical benefit may be weakened by the occurrence of bleedings. Therefore, in primary prevention, the combination rosuvastatin/ASA may be considered when the bleeding risk is low and the cardiovascular risk is augmented. In secondary prevention, the need for an early optimal management of cholesterol control may require the use of a fixed dose combination of statin/ezetimibe and ASA in a separate formulation. However, in selected cases in which the distance from the therapeutic low-density lipoprotein cholesterol target does not require the combination of high efficacy statin with ezetimibe, the fixed dose combination rosuvastatin/ASA may be considered even in secondary prevention.
Cardiovascular risk stratification represents a cornerstone in preventing and managing atherosclerotic diseases. There has been a profound transformation in risk assessment models in recent years, shifting from static an...Cardiovascular risk stratification represents a cornerstone in preventing and managing atherosclerotic diseases. There has been a profound transformation in risk assessment models in recent years, shifting from static and uniform approaches to dynamic, integrated, and increasingly personalized paradigms. The SCORE2, SCORE2-OP, SCORE2-Diabetes and SMART2 tools allow for a more accurate and context-specific estimation of absolute cardiovascular risk by incorporating clinical and demographic variables such as age, comorbidities, metabolic profile, and geographic context. In parallel, the use of advanced non-invasive imaging techniques, parameters such as coronary artery calcium scoring and carotid intima-media thickness, as well as biomarkers, has enabled the early identification of apparently healthy individuals who are at hidden risk. This shift also challenges the traditional dichotomy of primary and secondary prevention, favoring a more continuous and nuanced concept of risk stratification. The integration of clinical, instrumental, and biological data now allows for more refined and timely risk assessment, paving the way for earlier, more targeted, and intensive preventive strategies aimed at reducing the incidence of cardiovascular events and significantly improving long-term outcomes.
Riccio C, Fattirolli F, Ambrosetti M
… +35 more, Geraci G, Milli M, Abrignani MG, Angelino ME, Barisone M, Biffi B, Cesaro A, de Giovanni M, Di Fusco SA, Di Lenarda A, Mazza A, Parretti D, Radini D, Ruzzolini M, Scalvini S, Scicchitano P, Venturini E, Bilato C, Calisi P, Corda M, De Luca L, Di Marco M, Iacovoni A, Maranta F, Navazio A, Pascale V, Pistono M, Tizzani E, Werren M, Gulizia MM, Nardi F, Gabrielli D, Colivicchi F, Grimaldi M, Oliva F
Hospital discharge is a crucial moment in the continuity of care, acting as a bridge between the acute phase and the treatment pathway that follows. Far from being a simple administrative act, it is a complex process req...Hospital discharge is a crucial moment in the continuity of care, acting as a bridge between the acute phase and the treatment pathway that follows. Far from being a simple administrative act, it is a complex process requiring careful planning, effective communication, and the active involvement of all the stakeholders of the healthcare system, including the patient. Poor discharge management can have a negative impact on clinical outcomes, resulting in a higher risk of hospital readmission and inefficient use of healthcare resources. Taking into account the increasingly old, fragile population showing a high prevalence of comorbidities and complex care needs, it is essential to consider discharge as a comprehensive and integrated approach to the care continuum. This document arises from the necessity to share an updated and practical model for the management of hospital discharge, based on the latest scientific evidence and multidisciplinary experience, its aim being to promote continuity of care and personalized treatment as well as to improve health outcomes. The authors intend to provide clinical cardiologists with a unified tool for the management of patient discharge, offering concrete proposals to improve communication between physicians and patients, optimize therapies, and positively impact health outcomes.
BACKGROUND: Telemedicine is an innovative and impactful resource in the management of heart failure. At the Cardiology Department of the Piacenza Hospital, a pilot telemedicine project called "TeleCuore" has been launche...BACKGROUND: Telemedicine is an innovative and impactful resource in the management of heart failure. At the Cardiology Department of the Piacenza Hospital, a pilot telemedicine project called "TeleCuore" has been launched, aimed at patients with heart failure. This article describes the organizational model adopted and the initial results of TeleCuore regarding its clinical impact and patient satisfaction. METHODS: The project involved patients with de novo heart failure or those in outpatient follow-up with recent episodes of clinical instability and adequate digital skills. A multidisciplinary team, coordinated by a case manager nurse, managed patient monitoring and education. Using the AdiLife platform and multiparametric devices, vital and clinical parameters were monitored over time, with alert analysis by nurses and technicians in cardiocirculatory pathophysiology and cardiovascular perfusion, with continuous support from the cardiology medical staff. In addition to being monitored to detect potential instabilities early and optimize therapies, patients were subjected to questionnaires to measure the project's impact on satisfaction, disease awareness, and difficulties in using the equipment. RESULTS: Overall, 257 patients completed at least 6 months of follow-up. Of these, 32 (12.5%) showed signs of heart failure. In 18 cases (56.2%), TeleCuore allowed for the early detection of instability, enabling outpatient management. A total of 14 patients (43.8%) were sent to the emergency department, 10 of whom were referred following parametric anomalies associated with symptoms identified during telephone interviews. Only 5 patients (15.6%) required hospitalization. During the follow-up, an increase in the use of guideline-recommended therapies was observed. The questionnaires highlighted a positive impact of TeleCuore on monitoring, therapy management, and the doctor-patient relationship. CONCLUSIONS: TeleCuore has demonstrated the feasibility, appreciation, and effectiveness of managing heart failure through telemedicine, with benefits in reducing hospitalizations, optimizing therapies, and increasing disease awareness.
Congenital heart defects (CHDs) are the leading congenital anomalies in humans, with approximately 1.3 million worldwide cases each year. In the past, they were one of the leading causes of infant mortality, and only 15%...Congenital heart defects (CHDs) are the leading congenital anomalies in humans, with approximately 1.3 million worldwide cases each year. In the past, they were one of the leading causes of infant mortality, and only 15% of patients in the 1940s and 1950s reached adulthood. Today, a profound shift in survival rate has occurred thanks to technological advancements, a deeper understanding of these conditions, early diagnosis capabilities, and neonatal surgery, with 90-95% of newborns with CHD reaching adulthood. The future of CHDs looks promising, with genetic and epigenetic discoveries enabling personalized treatments and improvements in the management of long-term complications. Tissue engineering and regenerative medicine could revolutionize treatment, with the creation of custom-made heart valves and vascular tissues, as well as cellular therapies to improve myocardial function, along with potential solutions for complete heart replacement in cases of myocardial failure. The future challenge remains ensuring that children born with CHDs not only have a long life but also a quality of life comparable to that of all other children.
The post-cardiac arrest syndrome is a delicate, critical and complex condition that involves most patients resuscitated by a cardiac arrest. The main pathophysiological mechanism of this syndrome is a widespread ischemia...The post-cardiac arrest syndrome is a delicate, critical and complex condition that involves most patients resuscitated by a cardiac arrest. The main pathophysiological mechanism of this syndrome is a widespread ischemia-reperfusion damage, then there are other pathological alterations involving various organs which, if untreated, can evolve into multiorgan dysfunction. For this reason, a series of diagnostic-therapeutic actions (bundles) are necessary to ensure a correct management of the post-cardiac arrest syndrome: adequate oxygenation and ventilation, hemodynamic stabilization, temperature control, early prediction of neurological outcome, optimization of metabolic aspects, indication and timing of coronary angiography. The management of the post-cardiac arrest syndrome, the fifth link in the chain of survival, consists of a set of early, complex and multidisciplinary interventions, which must be promptly started, immediately after a return of spontaneous circulation, regardless of the location of cardiac arrest presentation, and it aims to obtain a good hemodynamic and neurological recovery. In this review, we will address the most recent scientific recommendations in the various areas of management of post-cardiac arrest syndrome that have led in recent years to a change in the practical approach to the comatose patient after cardiac arrest.
Zilio F, Giubilato S, Caldarola P
… +29 more, Ciliberti G, Di Monaco A, Sorini Dini C, Iannopollo G, Cornara S, Franchin L, Vitale E, Falsini G, Magnesa M, Fortuni F, Della Bona R, Gatto L, Gasparetto N, Spinelli A, Roncon L, Cangemi S, Borrello F, Geraci G, Riccio C, Bilato C, Nardi F, Valente S, Rossini R, Gulizia MM, Gabrielli D, Colivicchi F, Grimaldi M, Oliva F, a nome dell’Area Management e Qualità, dell’Area Giovani e del Gruppo di Studio Responsabilità Professionale e Sicurezza delle Cure, ANMCO
In applied sciences, including medicine, simulation refers to a model of reality that employs a variety of techniques and technologies, along with diverse professional expertise, to facilitate the dynamic analysis and pr...In applied sciences, including medicine, simulation refers to a model of reality that employs a variety of techniques and technologies, along with diverse professional expertise, to facilitate the dynamic analysis and prediction of events or processes based on specific predefined conditions. Simulation is of paramount importance to improve the skills of medical staff, to speed up learning and to optimize clinical practice in different settings, including cardiology. Literature shows that simulation is more effective than other learning strategies, supporting both upgrading of staff's clinical skills and patients' safety, reducing the risk of medical error. Moreover, andragogical principles highlight the need for personalized training programs, in order to meet healthcare professionals' needs, while practicing in a safe environment, improving technical skills, clinical decision making, stress management, cooperation, and teamwork. This review written by the Management and Quality Working Group, by the Young Cardiologists Working Group, and by the Professional Responsibility and Safety of Care Study Group of the the Italian Association of Hospital Cardiologists (ANMCO) highlights the crucial role of simulation in managing high-risk situations commonly encountered in cardiology, emphasizing the importance of continuous high-quality training. It also describes how ANMCO is promoting simulation as a strategy for implementing quality in the field of cardiology.
Patent foramen ovale (PFO) is a normal fetal communication between the right and left atrium that persists after birth. It is a common finding, occurring in 20-25% of the population, although its prevalence decreases wit...Patent foramen ovale (PFO) is a normal fetal communication between the right and left atrium that persists after birth. It is a common finding, occurring in 20-25% of the population, although its prevalence decreases with age. In most cases, PFO remains asymptomatic throughout life. However, it has been linked to conditions such as cryptogenic stroke, migraine with aura, decompression illness, and systemic arterial embolism. The evidence supporting PFO closure for these conditions primarily comes from non-randomized cohort studies, which often yielded conflicting results. This focused review aims to address the most common questions regarding the diagnosis, management, and treatment of PFO based on the latest available guidelines.