Giornale italiano di cardiologia最新文献

Bempedoic acid is a lipid-lowering drug recently introduced into clinical practice. The CLEAR Outcomes randomized controlled clinical trial has confirmed the efficacy of bempedoic acid in reducing low-density lipoprotein cholesterol (LDL-C) levels and has shown that this reduction translates into a significant decrease in major adverse cardiovascular events (MACE). The clinical benefits were consistent with the benefits obtained with other lipid-lowering drugs that have the same efficacy in reducing LDL-C levels. Furthermore, the CLEAR Outcomes trial confirmed the safety of bempedoic acid. This study reported the same frequency of adverse events as observed in previous phase 3 trials. Pre-specified and post-hoc analyses of the CLEAR Outcomes trial showed that treatment with bempedoic acid confers a clinical benefit both in primary prevention and in patients with recurrent events, independent of gender and comorbidities such as diabetes, obesity and metabolic syndrome, and confirmed a potential additive benefit due to the favorable effects on the glycemic profile and high-sensitivity C-reactive protein. In patients with peripheral artery disease, bempedoic acid reduces both MACE and major adverse limb events. Based on the available evidence, the European Medicines Agency has updated the summary of product characteristics to include cardiovascular disease as a therapeutic indication in addition to hypercholesterolemia. Bempedoic acid is now approved in adults with established atherosclerotic cardiovascular disease or at high risk of a first cardiovascular event, to reduce cardiovascular risk by lowering LDL-C levels, in patients treated with the maximum tolerated statin dose (with or without ezetimibe), or in statin-intolerant patients who are not adequately controlled with ezetimibe alone.

Spontaneous coronary artery dissection (SCAD) is a rare but increasingly recognized cause of acute coronary syndrome, primarily affecting young women without traditional cardiovascular risk factors. We report the case of a 57-year-old woman with obesity and a history of smoking, admitted for acute respiratory failure due to pneumonia, complicated by cardiac arrest. Elevated troponin levels, along with subsequent ECG and echocardiographic findings suggestive of previous myocardial ischemia, led to the indication for coronary angiography. The angiogram revealed severe three-vessel coronary disease with three distinct SCADs involving the left anterior descending, right coronary, and circumflex arteries. Advanced imaging, including whole-body positron emission tomography, revealed active systemic vasculitis. A multidisciplinary approach led to initiation of immunosuppressive therapy with corticosteroids and tocilizumab, alongside conservative cardiac management with dual antiplatelet therapy. At 1-year follow-up, the patient showed significant improvement in left ventricular function and normalization of inflammatory markers. This case highlights the diagnostic and therapeutic complexity of multiple SCADs, particularly in the context of underlying systemic inflammatory diseases, and underscores the importance of individualized treatment strategies and multidisciplinary collaboration.

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.

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.

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.