Giornale italiano di cardiologia最新文献

Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide, exerting a substantial burden on healthcare systems. Their management requires multidisciplinary approaches, continuity of care, and advanced monitoring tools. Artificial intelligence (AI) has recently emerged as a transformative resource, owing to its ability to analyze large, heterogeneous datasets and generate accurate predictive models. Techniques such as machine learning, deep learning, and natural language processing, combined with multimodal data (electronic health records, imaging, wearable devices, sensors), can enable earlier diagnosis, dynamic risk stratification, and personalized therapies. Furthermore, the integration of AI with telemedicine and digital therapeutics provides new opportunities for remote monitoring, clinical decision support, and patient empowerment, with significant potential to improve clinical outcomes, optimize healthcare resources, and reduce hospitalizations. However, challenges remain, including algorithmic bias, lack of interpretability, ethical and legal concerns, and the need for adequate training of healthcare professionals. The recent adoption of the European AI Act establishes stricter regulatory standards to ensure safety and transparency, though it may slow down large-scale implementation. In conclusion, AI represents a pivotal innovation in cardiovascular medicine, provided it is embedded into validated clinical pathways, supported by scientific evidence, and embraced by clinicians. The future of digital cardiology will rely on the ability to develop predictive, personalized, and patient-centered healthcare models.

Artificial intelligence (AI) is assuming an increasingly prominent role in the diagnosis and management of acute myocardial infarction. Its main objective is to enable earlier and more accurate diagnosis, enhance the interpretation of the ECG, accelerate reperfusion times, and ultimately improve patient outcomes. The ECG represents an ideal substrate for the application of deep learning, owing to the vast availability of digital tracings, the association with confirmed diagnoses, and the inclusion of numerous clinical variables. Several systems even allow the automated analysis of photographs of paper-based ECGs, processed through deep learning algorithms. Current evidence indicates that: (i) in ST-elevation myocardial infarction, AI achieves sensitivity and specificity superior to those of experienced cardiologists, with an accuracy approaching clinical applicability; (ii) in non-ST-elevation myocardial infarction, clinical heterogeneity reduces diagnostic precision, yet AI still demonstrates significant discriminative power, serving as a valuable support tool for clinicians; (iii) emerging applications include the prediction of complete vessel occlusion and identification of the culprit coronary artery; and (iv) advanced algorithms may also estimate functional parameters such as ejection fraction and global longitudinal strain, thereby enriching prognostic stratification. In conclusion, AI applied to the ECG represents an innovative tool for the timely diagnosis of acute coronary syndromes. Its integration into clinical practice has the potential to support cardiologists both in confirming uncertain diagnoses and in rapidly selecting patients who should undergo revascularization.

Chronic coronary syndromes require an integrated diagnostic-therapeutic approach that combines anatomical, functional, and morphological assessments. The 2024 ESC guidelines assign a key role to intravascular imaging and invasive coronary functional testing to guide percutaneous coronary revascularization and to reduce major adverse cardiovascular events, including cardiac death, myocardial infarction, and repeat revascularization - particularly in patients with complex anatomy - or to reduce angina class/improve quality of life in cases of epicardial and/or microvascular vascular dysfunction. However, the implementation of these strategies in Italy remains limited, characterized by significant geographical disparities and lower utilization rates compared to other European and international countries. Cultural, educational, managerial, and economic barriers continue to hinder the large-scale adoption of these technologies, despite their proven effectiveness in reducing major cardiovascular events. The aim of this GISE/ANMCO/SIC consensus document is to promote a more appropriate and systematic use of functional evaluation and intracoronary imaging in Italian clinical practice, through shared pathways for cultural awareness, training in catheterization laboratories, adjustment of reimbursement systems, and quality monitoring, in order to improve the appropriateness and personalization of care as well as long-term outcomes for patients with chronic coronary syndromes.

The epidemiological transition has led to an increase in life expectancy and to a growing population of chronic patients, often with heart failure. These patients are frequently affected by comorbidities and frailty, which in turn increase the risk of disability and worsening quality of life, requiring an accurate multidimensional assessment (MDA). In this context, MDA is crucial for integrated and holistic management of elderly patients, considering not only the pathology but the patient in his complexity. MDA requires a multidisciplinary team to ensure a comprehensive and integrated assessment of the elderly patient. MDA tools assess various domains of health, using scales and validated tools to explore physical, functional, mental and socio-economic status. MDA is applied in two phases: an initial screening procedure and an in-depth analysis of individual problems for targeted interventions. MDA can be performed in various care settings, including outpatient clinics, hospitals, nursing homes, home care, and rehabilitation centers. Several studies show that MDA improves survival as well as functional and mental status, reducing hospitalization times and the frequency of institutionalization. This ANMCO position paper discusses MDA tools of older adults with chronic heart disease, highlighting the need for a holistic approach to address comorbidities and frailty in a growing population.

Cardiovascular diseases remain the leading cause of mortality globally and in Italy, with a growing burden exacerbated by aging populations and underdeveloped strategies for managing chronic cardiovascular conditions. This position paper, resulting from the 2024 ANMCO General Assembly, addresses the current state of cardiovascular chronicity management in Italy, highlighting critical gaps and proposing sustainable, integrative solutions. Despite improvements in acute cardiovascular care, the lack of structured post-acute management, insufficient adoption of secondary prevention protocols, limited access to innovative therapies, and a slow digital transition continue to hinder effective chronic care. The document stresses the pivotal role of cardiologists, not only in acute intervention but also in long-term care and secondary prevention, emphasizing the need for a multidisciplinary, multichannel healthcare model. The paper explores the potential of e-Health and artificial intelligence to revolutionize chronic disease management. It advocates for the widespread implementation of integrated care pathways, digital tools like electronic health records and telemedicine platforms, which together could enhance early detection, patient monitoring, and therapeutic adherence while reducing unnecessary hospitalizations. It also underscores the necessity of updating national and regional pharmaceutical policies to improve equitable access to disease-modifying therapies. Furthermore, the integration of palliative care in end-stage cardiovascular disease and the enhancement of post-acute care networks are deemed essential. Ultimately, the document advocates for a comprehensive systemic and cultural transformation - spearheaded by scientific societies such as ANMCO - where technological innovation, organizational reform, and patient-centered care align to ensure a sustainable and universally accessible healthcare system. This vision is consistent with the objectives of the PNRR, the 2030 Agenda, and, most importantly, the foundational principles of the Italian Constitution.

Background: Pulmonary arterial hypertension (PAH) is a rare syndrome characterized by remodeling of the small pulmonary arterial vessels and increased pulmonary vascular resistance, which in the later stages can lead to right-sided heart failure and death. The therapeutic approach is evolving, but differences remain between countries.

Methods: An Italian survey was designed to evaluate differences in the diagnosis, management and treatment of PAH patients across Italian centers. The survey was administered to 32 PAH Centers in Italy via an online questionnaire. A panel of 9 PAH experts analyzed and discussed the results.

Results: Thirty Centers from 15 regions responded, thus representing the entire Italian reality. The results showed that all participating Centers perform right heart catheterization at PAH diagnosis (100%), while genetic testing is available in 73% of cases. Centers with a high patient volume have 10.4% of patients on oral monotherapy, while Centers with a low patient volume have a low percentage of patients on triple oral therapy (15%) or parenteral prostanoids (11.3%). Many Centers (70%) use parenteral prostanoids in up-front approach in incident high-risk PAH patients. Nine Centers (30%) achieve the low risk profile in more than 60% of the population followed. In line with the literature, an upfront strategy including parenteral prostanoids was associated with a high likelihood of achieving a low-risk profile. Overall, 70% of Centers have patients on the list for lung transplant.

Conclusions: Italian PAH Centers have excellent adherence to the diagnostic standards recommended by European guidelines and good uniformity in therapeutic management, with some divergences related to differences in the phenotype of PAH patients. The survey also revealed a good awareness of the efficacy of parenteral prostanoids, especially if started early. Collaboration and referral of selected PAH patients to Centers with greater experience in the management of complex infusion therapies is the key to success.

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.