European Heart Journal Supplements最新文献

[This retracts the article DOI: 10.1093/eurheartjsupp/suaf043.].

[This corrects the article DOI: 10.1093/eurheartjsupp/suaf003.].

Recently, intensive cardiac care units (ICCUs) have undergone a significant transformation related to the evolution in management of acute coronary syndrome and influenced by other factors such as the epidemiological transition, the increasing complexity of clinical cases, the technological advancement, and the growth of clinical and scientific expertise of cardiologists. In the context of this evolution, a functional reorganization of ICCUs in Italy has to be implemented in order to meet the changing needs of the population with cardiovascular disease requiring critical care. Therefore, the Italian Association of Hospital Cardiologists (ANMCO) proposes this position paper for the reorganization of CICUs into three levels with increasing functional complexity, based on the hospital characteristics, the available technology, and the clinical cases treated. The system would be functionally integrated into a regional ICCU organization modelled on a time-dependent care network. This proposed network aims to standardize diagnostic and therapeutic protocols and establish unified data collection registries to facilitate self-assessment and support clinical research. The document delineates specific requirements for each ICCU level, including the management of clinical cases, the expertise of intensive care cardiologists, the technological facilities, and the medical and nursing staff needed to ensure optimal care delivery.

Semaglutide, a glucagon-like peptide-1 receptor agonist, has emerged as a pivotal therapeutic agent in the management of the cardio-renal-metabolic continuum. Initially developed for glycaemic control in Type 2 diabetes mellitus, its benefits extend far beyond glucose regulation. Clinical trials have demonstrated semaglutide's potential to reduce major adverse cardiovascular events, particularly in overweight/obese patients with high cardiovascular risk, as well as improving functional capacity in patients suffering from heart failure with preserved left ventricular function. Additionally, it has shown promise in improving renal outcomes, such as slowing the progression of albuminuria and reducing the risk of chronic kidney disease in diabetic populations. These effects are likely due to its multifaceted mechanisms, including anti-inflammatory properties, weight reduction, blood pressure lowering, and direct renal protection. This review synthesizes current evidence on semaglutide's role in the interrelated domains of cardiovascular, renal, and metabolic health.

Hypertrophic cardiomyopathy (HCM) is a non-rare genetic cardiomyopathy, with an estimated prevalence of 1:500, characterized by an increase in the left ventricular wall thickness in the absence of increased loading conditions. The hypertrophy is mostly asymmetric and predominantly affects the basal septum and anterior wall. Left ventricular outflow tract obstruction, at rest or after provocative tests, is detected in many patients and represents the primary cause of reduced functional capacity, as well as an independent predictor of sudden cardiac death and advanced heart failure. Until ∼1 year ago, symptomatic patients despite maximal therapy with β-blockers or calcium channel blockers plus disopyramide had only basal septal reduction therapy through myectomy or septal alcoholization as additional therapeutic options. Today, a new class of drugs that inhibit cardiac myosin activity is available for patients with obstructive HCM. In light of the new treatment perspectives, the correct clinical-therapeutic classification of affected patients becomes of fundamental importance for the cardiologist. The aim of this position paper is to increase the knowledge of cardiologists in the field of HCM, defining its epidemiological, genetic, and pathological characteristics, identifying the diagnostic criteria and instrumental methods capable of stratifying the risk profile, with the aim of an optimal therapy tailored on the single patient.

Heart failure is the leading cardiovascular cause of hospitalization with an increasing prevalence, especially in older patients. About 50% of patients with heart failure have preserved ventricular function, a form of heart failure that, until a few years ago, was orphaned by pharmacological treatments effective in reducing hospitalization and mortality. New trials, which have tested the use of gliflozins in patients with heart failure with preserved ejection fraction (HFpEF), have for the first time demonstrated their effectiveness in changing the natural history of this insidious and frequent form of heart failure. Therefore, diagnosing those patients early is crucial to provide the best treatment. Moreover, the diagnosis is influenced by the patient's comorbidities, and some HFpEF patients have symptoms common to other rare diseases that, if unrecognized, develop an unfavourable prognosis. This position paper aims to provide the clinician with a useful tool for diagnosing and treating patients with HFpEF, guiding the clinician towards the most appropriate diagnostic and therapeutic pathway.

Heart transplantation (HTx) is a definitive treatment for selected patients with advanced heart failure. However, primary graft dysfunction (PGD), a severe early complication, is a major cause of post-HTx morbidity and mortality. This paper explores the pathophysiology, diagnostic approaches, and management strategies for PGD, with a particular focus on temporary mechanical circulatory support (MCS) devices such as venoarterial extracorporeal membrane oxygenation and Impella. It also highlights the essential role of the multidisciplinary Heart Team in optimizing outcomes through patient-tailored MCS selection and timely intervention.

A cerebral stroke is a heterogeneous entity and-in the context of this heterogeneity-a cryptogenic stroke, that is, of unknown origin at the time of diagnosis, finds a worthy position. Cryptogenic strokes are ∼25% of ischaemic strokes and in hindsight, they often appear to be of obvious or highly presumptive origin. Knowledge of the causes of a cerebral stroke that are not immediately evident is, therefore, fundamental for the purposes of correct secondary and, hopefully, primary prevention. Certainly, in fact, a cryptogenic stroke may require appropriate treatment, which is similar to a stroke whose origin is immediately evident. Equally certainly, however, cryptogenic stroke can benefit from specific treatments, which the lack of diagnosis of origin is destined to nullify. Therefore, it must unfortunately be accepted that a minority of cryptogenic strokes remain without a culprit and, therefore, without a specific corrective treatment. However, the insistent deepening of the diagnostic process in 'obscure' cases must also be pursued. Only the unyielding examination of these cases, in fact, is destined to identify a covert vasculitis, Fabry disease, occult atrial fibrillation, or one of the many pathologies, often far from rare, which require a therapy as specific as it is life-saving. In this brief review, therefore, we will try to fully expand on the identifiable causes of cryptogenic stroke.

Acute myocarditis (AM) is an inflammatory condition of the myocardium that may lead to severe complications, including acute heart failure and life-threatening ventricular arrhythmias (VAs). In-hospital VAs are estimated to affect 2.5% of adult patients with AM. Recent insights suggest a genetic predisposition to develop VA in a subset of patients with AM. This review will focus on arrhythmogenic manifestations of AM, highlighting risk stratification for VA after an acute episode and the contribution of genetic factors, emphasizing the need to integrate clinical, imaging, and genetic findings. In addition, prognostic information derived from cardiac magnetic resonance imaging will be discussed, pointing out the association between VA and the presence, extension, and septal localization of late gadolinium enhancement. The overlap between inherited arrhythmogenic and inflammatory cardiomyopathies will be explored, with specific attention to the identification of desmosomal gene variants, which are associated with recurrent myocarditis-like episodes and a higher risk of VA. Cardiac sarcoidosis, giant cell myocarditis, and immune checkpoint inhibitors-related myocarditis will be discussed as a paradigm of inflammatory cardiomyopathies with increased arrhythmic burden. Finally, the clinical challenges of managing patients with AM and arrhythmogenic presentation will be tackled, looking at indications for implantable cardioverter defibrillators after the acute phase.