Giubilato S, Di Fusco SA, Cappannelli S
… +26 more, Gil Ad V, Rossini R, Doimo S, Della Bona R, Sorini-Dini C, Di Monaco A, Zilio F, Gasparetto N, Gatto L, Amico F, Abrignani MG, Iacovoni A, Riccio C, Bilato C, Lucà F, Scicchitano P, Di Lenarda A, Picano E, Geraci G, De Luca L, Gulizia MM, Colivicchi F, Gabrielli D, Oliva F, Nardi F, Grimaldi M
Environmental sustainability represents an emerging priority for cardiology, owing to the close interconnection between planetary health and human health, with cardiovascular diseases constituting the main clinical outco...Environmental sustainability represents an emerging priority for cardiology, owing to the close interconnection between planetary health and human health, with cardiovascular diseases constituting the main clinical outcome. The global healthcare sector accounts for approximately 4-5% of total greenhouse gas emissions, and cardiology contributes substantially to this burden because of its high resource intensity in diagnostic testing, interventional procedures, and energy consumption. At the same time, environmental factors such as air pollution, extreme temperatures, defined as values significantly above or below the regional average caused by climate change, and exposure to emerging contaminants, including heavy metals (lead, cadmium, arsenic) and micro- and nanoplastics are increasingly recognized as major determinants of cardiovascular risk. Chronic exposure to these pollutants is associated with oxidative stress, systemic inflammation, and accelerated progression of atherosclerosis. Strategies for sustainable cardiology primarily aim to reduce emissions related to energy use and supply chains. Priority actions include adopting circular economy principles (reduce, reuse, recycle), improving the appropriateness and optimization of diagnostic testing favoring lower environmental impact modalities, such as echocardiography, over carbon-intensive techniques and implementing telemedicine to reduce patient and provider travel. Furthermore, primary cardiovascular prevention can be considered an effective "double-benefit strategy", capable of simultaneously reducing disease burden and the demand for emission-intensive healthcare. In this context, healthcare professionals and scientific societies, including ANMCO, are called upon to lead a cultural shift by integrating environmental sustainability as a core ethical principle of contemporary cardiology practice.
Giammanco A, Gambacurta R, Gouni-Berthold I
… +14 more, Jukema JW, Roeters van Lennep JE, Ray K, Koskinas K, Stulnig T, Vanassche T, Lamparter M, Wenz-Pöschl K, Chhabra R, De Muniategui Climente M, Pintó X, Parhofer KG, Averna M, a nome del Gruppo di Studio MILOS
BACKGROUND: Bempedoic acid (BA), an adenosine triphosphate-citrate lyase inhibitor, effectively reduces LDL cholesterol (LDL-C) and cardiovascular (CV) risk, as demonstrated in randomized clinical trials. However, real-w...BACKGROUND: Bempedoic acid (BA), an adenosine triphosphate-citrate lyase inhibitor, effectively reduces LDL cholesterol (LDL-C) and cardiovascular (CV) risk, as demonstrated in randomized clinical trials. However, real-world data on its use in clinical practice remain limited. METHODS: MILOS (NCT04579367) is a European prospective observational study evaluating the effectiveness and safety of BA, either as monotherapy or in fixed-dose combination with ezetimibe (BA+EZE FDC), in adult patients with primary hypercholesterolemia or mixed dyslipidemia. This article presents interim 8-week follow-up data for Italian patients enrolled between March and December 2023. RESULTS: Of the 1310 patients enrolled, 855 (BA, n = 445; BA+EZE FDC, n = 410) had available LDL-C data at both pre-treatment and 8-week follow-up. The overall mean age was 66.0 ± 10.7 years; heterozygous familial hypercholesterolemia was present in 11.1%, and 15.1% had diabetes. A larger proportion of patients (57.7%) were in secondary prevention, and 82.4% were at high or very high CV risk. Before starting BA or BA+EZE FDC, 33.1% of patients were not receiving lipid-lowering therapy. After an average of 59.3 ± 19.3 days of treatment, a mean LDL-C reduction of 22.6 ± 32.3% was observed, with a median reduction of 25.4% (interquartile range 8.1-43.2), from 2.9 ± 1.2 mmol/l (110.7 ± 44.8 mg/dl) to 2.1 ± 0.8 mmol/l (79.2 ± 32.2 mg/dl), following BA/BA+EZE FDC treatment, with or without background lipid-lowering therapy. The overall proportion of patients achieving LDL-C targets increased from 7.1% (61/855) before treatment to 37.2% (318/855) at 8-week follow-up with a 29.4% increase among patients at very high CV risk. During follow-up, 56 of 1310 patients (4.3%) reported at least one adverse drug reaction, with no unexpected adverse drug reactions observed; this rate is consistent with data reported in the literature. CONCLUSIONS: In the Italian cohort of the MILOS study, BA, alone or in BA+EZE FDC, proved to be an effective therapeutic option for managing patients at CV risk, supporting its role in achieving guideline-recommended lipid-lowering goals in real-world clinical practice.
Di Fusco SA, Pollarolo L, Spinelli A
… +13 more, Alonzo A, Marino G, Castello L, Matteucci A, Geraci G, Riccio C, Gulizia MM, Gabrielli D, Oliva F, Nardi F, Grimaldi M, Colivicchi F, a nome dell’Area Prevenzione dell’Associazione Nazionale Medici Cardiologi Ospedalieri
Ranolazine, approved for the symptomatic treatment of chronic stable angina, is currently indicated as an additional treatment when angina symptoms are not controlled with traditional drugs such as beta-blockers and calc...Ranolazine, approved for the symptomatic treatment of chronic stable angina, is currently indicated as an additional treatment when angina symptoms are not controlled with traditional drugs such as beta-blockers and calcium channel blockers. This review summarizes clinical studies that support current established recommendations for its use and discusses emerging evidence in clinical settings other than ischemic heart disease. A growing number of studies have shown a significant antiarrhythmic effect of this molecule, at both atrial and ventricular levels. Treatment with ranolazine has been associated with a reduced risk of atrial fibrillation and a greater likelihood of restoring sinus rhythm. Additionally, ranolazine is associated with a reduced risk of ventricular arrhythmias in various clinical settings. Ranolazine also plays a modest but clinically significant role in controlling glucose metabolism and is mentioned in the 2023 European Society of Cardiology guidelines on diabetes as a treatment capable of reducing glycated hemoglobin, especially in diabetic patients with poor metabolic control. In cardio-oncology, preclinical and clinical studies have shown a potential cardioprotective effect of ranolazine during certain chemotherapy treatments. In vitro and in vivo studies also suggest a favorable impact of ranolazine on the nervous system, with potential therapeutic effects, for example, in the treatment of neuropathic pain. Although the aforementioned contexts require further evaluation in targeted clinical trials, in all these areas ranolazine's pharmacodynamic profile suggests clinical benefits. Overall, a review that integrates current recommendations with a critical analysis of emerging therapeutic frontiers lays the foundation for an increasingly personalized therapeutic approach.
The recent document from the American Heart Association updates the guidelines on the diagnosis and management of Kawasaki disease (KD), a severe acute systemic inflammatory and febrile illness with mucocutaneous manifes...The recent document from the American Heart Association updates the guidelines on the diagnosis and management of Kawasaki disease (KD), a severe acute systemic inflammatory and febrile illness with mucocutaneous manifestations and lymph node involvement primarily affecting children under 5 years of age. Coronary artery involvement, with dilation and aneurysms in approximately 25% of patients, and cardiovascular system involvement make KD the most common systemic vasculitides and the leading cause of acquired heart disease in pre-school children living in developed countries. Classic KD is diagnosed based on established clinical and laboratory criteria, which exclude other similar conditions. The etiology and pathogenesis of KD remain unknown, with the disease affecting genetically susceptible children through an immune-mediated mechanism. The leading theory is that an unidentified trigger initiates a multi-organ inflammatory pathological cascade, sometimes resulting in incomplete or atypical forms in younger patients. For this reason, the American guidelines review KD diagnostic criteria, cardiac imaging techniques (echocardiography, coronary computed tomography, magnetic resonance imaging), specific therapies (intravenous immunoglobulin, aspirin, and additional treatments for resistant cases), management of myocardial infarctions, and the transition of care from pediatric to adult age. This review article also highlights future research areas, the role of inflammation, the development of differential diagnostic algorithms for multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection, and the use of new oral anticoagulants. Lastly, the most recent data on the long-term course of the disease and the regression of coronary aneurysms are revisited.
In recent decades, clinical practice has been founded on the principles of evidence-based medicine, where therapeutic decisions arise from the integration of clinical expertise, patient preferences, and scientific eviden...In recent decades, clinical practice has been founded on the principles of evidence-based medicine, where therapeutic decisions arise from the integration of clinical expertise, patient preferences, and scientific evidence derived from controlled studies and meta-analyses. The advent of artificial intelligence (AI) in health care, however, is driving a significant evolution in clinical research, owing to its ability to analyze large volumes of heterogeneous data and overcome the limitations of traditional statistical approaches. The availability of large-scale datasets, increasing computational capability, and reduced storage costs have supported the transition towards a "data-intensive" research model, progressively integrated with conventional methods. Within cardiology, arrhythmology represents one of the fields in which AI finds extensive application. The analysis of complex electrophysiological signals, data from implantable devices, advanced cardiac imaging, and clinical parameters enables the development of algorithms capable of identifying patterns not detectable by human interpretation. These tools have already demonstrated practical utility in the early diagnosis of arrhythmias, risk stratification, procedural planning and guidance for catheter ablation, prediction of response to cardiac stimulation therapies, and optimization of remote device monitoring. Among the key emerging benefits, AI promises increasingly personalized care, enabling more targeted interventions while reducing overtreatment. Furthermore, the development of "digital twins" opens the possibility of simulating patient-specific therapeutic scenarios to support complex clinical decision-making. This manuscript provides an overview of current evidence, emerging applications, and remaining challenges related to the integration of AI in arrhythmology, highlighting its potential to drive a transition towards predictive, preventive, and personalized cardiovascular medicine.
Recurrent pericarditis represents the most challenging complication of acute pericarditis and has a significant impact on patients' quality of life. It is defined by the occurrence of a new episode after complete remissi...Recurrent pericarditis represents the most challenging complication of acute pericarditis and has a significant impact on patients' quality of life. It is defined by the occurrence of a new episode after complete remission and should be distinguished from incessant pericarditis, in which symptoms persist without clinical remission. The causes are often idiopathic, likely post-viral or related to autoimmune/autoinflammatory mechanisms, but also include forms secondary to systemic diseases, interventional procedures, or, more rarely, malignancies. The diagnosis is based on the criteria for acute pericarditis applied to a recurrent episode, supported by biomarkers and multimodality imaging. First-line treatment consists of non-steroidal anti-inflammatory drugs or high-dose aspirin combined with colchicine and restriction of physical activity. Corticosteroids are reserved for selected cases and should be used at low doses with very gradual tapering. In refractory or corticosteroid-dependent patients, interleukin-1 inhibitors have revolutionized management, significantly reducing recurrences in forms with an inflammatory phenotype. Prognosis is generally favorable in idiopathic forms but requires structured follow-up and personalized therapeutic strategies. In this article, we address the most common clinical questions regarding recurrent pericarditis, aiming to translate current guideline recommendations into everyday clinical practice.
Stochastics is a science that studies mathematical models trying to predict how a given phenomenon may evolve over time because of chance. It is necessary to abandon the binary thinking of "it works or it doesn't work" a...Stochastics is a science that studies mathematical models trying to predict how a given phenomenon may evolve over time because of chance. It is necessary to abandon the binary thinking of "it works or it doesn't work" and rely on the logic of probability and randomness, which represent the measures of uncertainty people are destined to confront in their life and health choices. In making decisions shared with the patient, the physician must consider the baseline risk, the risk ratio, the variation in absolute risk, the competing risk within the patient, but also the number of patients needed to treat to determine the benefit (NNT) or harm (NNH) in the "theoretical" patient of clinical research, the "average" patient of guidelines, and the "imagined" patient of administered medicine. The NNT indicates the magnitude of the random benefit in the "real" patient, while the NNH indicates the harm. These two elements can represent the interface between statistical and stochastic medicine for simplified shared decision-making in "real" patients.
G Ital Cardiol (Rome)
· 2026 Jun · PMID 42200269
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Cor triatriatum sinister (CTS) is a rare congenital heart defect, with an estimated incidence of 0.1-0.4% of all congenital heart defects, characterized by the presence of a fibromuscular septum that divides the left atr...Cor triatriatum sinister (CTS) is a rare congenital heart defect, with an estimated incidence of 0.1-0.4% of all congenital heart defects, characterized by the presence of a fibromuscular septum that divides the left atrium into two chambers. We report the case of a 37-year-old woman with an incidental diagnosis of CTS during hospitalization for chest pain. Transthoracic echocardiography revealed a left intra-atrial membrane without hemodynamic significance, subsequently better characterized by transesophageal echocardiography, which ruled out the presence of a significant gradient and associated cardiac anomalies, including atrial septal defects. The patient was classified in Loeffler group III due to the presence of extensive patency of the membrane associated with a non-significant transmembrane gradient. In the absence of hemodynamically significant obstruction and associated congenital heart disease, the natural history is generally favorable. In asymptomatic patients, a conservative approach is adopted, involving clinical and instrumental follow-up and control of risk factors. However, in light of the risk of atrial fibrillation and cardioembolic events, long-term arrhythmia monitoring is indicated. This case highlights the role of echocardiographic imaging in the diagnosis and risk stratification of CTS in adults.
Bugani G, Pergolini F, Rizza C
… +5 more, Carinci V, Nobile G, Colletta M, Barbato G, Casella G
G Ital Cardiol (Rome)
· 2026 Jun · PMID 42200268
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New-onset left bundle branch block (LBBB) following transcatheter aortic valve implantation (TAVI) is a common conduction disorder, sometimes transient. Conversely, the development of sustained ventricular tachycardia (V...New-onset left bundle branch block (LBBB) following transcatheter aortic valve implantation (TAVI) is a common conduction disorder, sometimes transient. Conversely, the development of sustained ventricular tachycardia (VT) after TAVI is rare and its management is challenging. We report the case of a female patient with aortic stenosis treated with transcatheter self-expandable aortic valve implantation, who developed new-onset LBBB post-procedure. Several days later, the patient experienced hemodynamically tolerated slow VT with a right bundle branch morphology. She underwent an electrophysiological study, but slow VT was only transiently interrupted. Due to the persistence of slow VT, the patient was discharged with an external loop recorder, which revealed spontaneous resolution of VT and regression of LBBB after a few days.
Di Belardino N, Di Nuzzo R, Scorza A
… +1 more, Pafi M
G Ital Cardiol (Rome)
· 2026 Jun · PMID 42200267
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Brugada syndrome is an inherited cardiac channelopathy associated with sudden cardiac death, typically diagnosed in middle-aged individuals. Fever is a well-known trigger for malignant ventricular arrhythmias in predispo...Brugada syndrome is an inherited cardiac channelopathy associated with sudden cardiac death, typically diagnosed in middle-aged individuals. Fever is a well-known trigger for malignant ventricular arrhythmias in predisposed patients. We report the case of a 73-year-old man without cardiovascular risk factors or previous syncope who experienced ventricular fibrillation-related cardiac arrest triggered by fever as the first clinical manifestation of Brugada syndrome. This case highlights the pivotal role of fever in unmasking high-risk ECG patterns and challenges the assumption of age-related protection.
Bonfanti P, Di Martino SE, Mantovani A
… +5 more, Berlinghieri N, Pozzi A, Pini C, Corrado G, De Ponti R
G Ital Cardiol (Rome)
· 2026 Jun · PMID 42200266
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We report the case of a 47-year-old male patient with a history of tetralogy of Fallot surgically corrected in childhood using the Waterston-Cooley and Cooley techniques. In adulthood, he developed severe pulmonary insuf...We report the case of a 47-year-old male patient with a history of tetralogy of Fallot surgically corrected in childhood using the Waterston-Cooley and Cooley techniques. In adulthood, he developed severe pulmonary insufficiency, treated percutaneously with the implantation of a bioprosthetic valve. The patient was admitted for an elective surgery procedure. Following the administration of spinal anesthesia, ECG monitoring revealed the onset of atrioventricular block progressing to asystole, requiring immediate external cardiac massage. During the subsequent period, the patient also experienced a 5 s third-degree atrioventricular block associated with dizziness following carotid sinus massage. After multidisciplinary evaluation, the decision was made to implant a leadless pacemaker (Abbott Aveir VR). The procedure presented technical challenges, primarily due to the altered cardiac anatomy resulting from the underlying congenital heart disease and previous surgical corrections. Despite these difficulties, successful implantation was achieved. To our knowledge, this represents one of the few reported cases in the literature of leadless pacemaker implantation in a patient with corrected congenital heart disease. Given the absence of standardized procedural guidelines for such complex cases, we present our experience and discuss the associated technical considerations.
De Michele M, Saia F, Esposito G
… +27 more, Argenziano L, Marchese A, Nardi S, Attisano T, Marino V, Fineschi M, Tedeschi C, Addeo L, Sidiropulos M, Musto C, Giordano S, Campana P, De Marco F, Silverio A, Tuccillo V, Contarini M, Severino S, Pierini S, Pedretti RFE, Di Lascio A, Regazzoli D, Mariani S, Leone S, Castriota F, Stabile E, Guarini P, Dalla Vecchia LA
G Ital Cardiol (Rome)
· 2026 Jun · PMID 42200237
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Carotid atherosclerotic disease represents one of the leading causes of ischemic stroke. It should be considered as a pathological continuum that includes increased intima-media thickness, development of atherosclerotic...Carotid atherosclerotic disease represents one of the leading causes of ischemic stroke. It should be considered as a pathological continuum that includes increased intima-media thickness, development of atherosclerotic plaque and progression to clinically significant carotid stenosis. Non-invasive imaging techniques currently allow accurate characterization of carotid plaque in terms of composition, echogenicity, echostructure, presence of intraplaque hemorrhage, ulceration and vascular remodeling, all factors closely associated with plaque instability and the risk of ischemic events. At the same time, advances in medical therapy and revascularization techniques have improved clinical outcomes but have also increased the complexity of therapeutic decision-making in individual patients, requiring the integration of clinical, anatomical, hemodynamic and imaging data. Despite the availability of international guidelines, areas of uncertainty and significant heterogeneity remain in clinical practice, terminology, risk stratification criteria and indications for revascularization, particularly in asymptomatic patients or those with intermediate-grade stenosis. The aim of the present SICOA-GISE consensus document is to harmonize terminology between the different disciplines involved (cardiology, neurology, radiology and vascular surgery), promote a multidisciplinary approach and provide practical guidance on the appropriate use of imaging techniques, identification of high-risk carotid plaque and integration of medical and interventional therapy.
Di Marco L, Cappuccilli M, Piperata A
… +4 more, Ghigi V, Calabria S, Veronesi C, Degli Esposti L
G Ital Cardiol (Rome)
· 2026 Jun · PMID 42200235
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BACKGROUND: Acute type A aortic dissection (AADA) is a life-threatening cardiovascular emergency whose prognosis is closely linked to the timeliness of diagnosis and treatment. However, its low incidence and highly varia...BACKGROUND: Acute type A aortic dissection (AADA) is a life-threatening cardiovascular emergency whose prognosis is closely linked to the timeliness of diagnosis and treatment. However, its low incidence and highly variable clinical presentation make early recognition challenging. In addition, poor therapeutic adherence and inadequate surveillance of predisposing factors, including hypertension and aortic aneurysm, contribute to diagnostic delays and worse clinical outcomes. METHODS: A retrospective observational analysis was conducted using real-world administrative data from Italian healthcare facilities covering over 12 million individuals (2010-2024). Adult patients urgently hospitalized for AADA (ICD-9-CM 441.01) were identified. Clinical profile, comorbidities, pharmacological treatments, diagnostic procedures, and the presence of hypertension - defined as the number of annual prescriptions ≥ 9 (a proxy for diagnosis) of antihypertensive drugs - were evaluated. RESULTS: A total of 1625 patients were included (mean age 67.3 ± 13.4 years; 65.6% male). Diabetes was reported in 8.5% of cases, cardiovascular disease in 21.2%, and ascending aortic aneurysm or ectasia in 6%. In the year preceding hospitalization, 65.8% of patients had at least one antihypertensive prescription, but only 35% showed evidence of continuous treatment. Diagnostic procedures were infrequent: echocardiography was performed in 12.3% of patients, cardiac computed tomography/magnetic resonance angiography in 1.8%, and 24-h ambulatory blood pressure monitoring in 2.4%. CONCLUSIONS: This real-world analysis highlights major gaps in the pre-hospital management of AADA in Italy, characterized by suboptimal blood pressure control, poor therapeutic adherence, and limited use of diagnostic imaging in at-risk patients. These findings underscore the need for structured prevention and surveillance strategies aimed at the early recognition of predisposing conditions and the optimization of integrated care for patients at risk of acute aortic dissection.
Giroletti L, Graniero A, Gerometta P
… +1 more, Agnino A
G Ital Cardiol (Rome)
· 2026 Jun · PMID 42200234
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In recent decades, there has been a growing interest in applying robotic technology to cardiac surgery. The advantages of robotic technology, such as magnified vision, precise robotic instruments and 360° movement of rob...In recent decades, there has been a growing interest in applying robotic technology to cardiac surgery. The advantages of robotic technology, such as magnified vision, precise robotic instruments and 360° movement of robotic arms, have attracted the cardiac community to reduce the invasiveness of the procedure, postoperative risks, and improve clinical outcomes. While in the United States the adoption of robotic assistance immediately gained widespread acceptance (approximately 1900 cases per year), in Europe the beginning has been slower with a significant growth in the last 10 years. The robotic platform has been used for various procedures, including mitral valve repair and replacement, coronary artery bypass grafting, arrhythmia ablation, aortic valve surgery, and tricuspid valve surgery. Intraoperative and postoperative results are encouraging showing good safety, a low mortality rate, a low conversion rate to larger incisions, shorter hospital stays compared to other techniques, and low postoperative complication rates. The procedure has also been effective, yielding good surgical quality and patient satisfaction. In this review, we analyze the current state of robotic cardiac surgery in the ever-evolving field of personalized cardiac surgery for each patient.
Visconti LO, Landi A, Ferlini M
… +1 more, De Servi S
G Ital Cardiol (Rome)
· 2026 Jun · PMID 42200233
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Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is considered the cornerstone of pharmacological treatment after acute coronary syndrome in order to avoid recurrent ischemic episodes. Since 2002, guidelines...Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is considered the cornerstone of pharmacological treatment after acute coronary syndrome in order to avoid recurrent ischemic episodes. Since 2002, guidelines from scientific societies strongly recommend maintenance of two drugs for 12 months. Given that bleeding events have a similar or even worse impact on mortality than recurrent myocardial infarction, in the last years several trials have challenged guideline-recommended dual antiplatelet therapy duration after percutaneous coronary intervention by testing the clinical effect of P2Y12 inhibitor reduction and de-escalation or, in particular, maintenance of only P2Y12 inhibitor monotherapy. We provide a literature overview on aspirin-free antiplatelet strategies in light of the results of recent studies in patients with acute coronary syndrome undergoing percutaneous coronary intervention.