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[Recommendations for competitive sports eligibility: what's new in the 2023 COCIS protocols]. [竞技体育资格建议:2023 年 COCIS 协议的新内容]。
IF 0.5 Q4 Medicine Pub Date : 2024-06-01 DOI: 10.1714/4269.42467
Giampiero Patrizi, Lucia Tardini

The benefit of physical exercise is well established, but, at the same time, it is now well known that an intense sports activity can trigger adverse cardiac events and increase sport-related death. Since 1982, Italy has a State law which obliges athletes to undergo a pre-participation evaluation, based on history, physical examination, ECG and stress test. From its introduction, a significant reduction in cardiac sport-related adverse events has been shown. During the pre-participation screening, some cardiological issues or suspects can arise and the sports medicine doctor should deal with them before releasing the certification for participation in competitive sport. In order to give precious advices to these colleagues and help athletes to securely practice sport, the Italian Society of Sports Cardiology, the Italian Federation of Sports Medicine and the other cardiological scientific societies gathered in the COCIS Committee, periodically produce and publish a booklet named "Cardiological Protocols for Competitive Sports Eligibility". The object of this review is to underline the recent 2023 version innovations when compared to previous editions.

体育锻炼的益处已得到公认,但与此同时,众所周知,激烈的体育活动会引发不良心脏事件,增加与运动相关的死亡人数。自 1982 年起,意大利颁布了一项国家法律,规定运动员必须在参赛前进行评估,评估内容包括病史、体格检查、心电图和压力测试。自该法律实施以来,与心脏运动相关的不良事件明显减少。在参赛前的检查过程中,可能会出现一些心脏方面的问题或疑点,运动医学医生应先处理这些问题,然后再发放参加竞技体育的证明。为了给这些同行提供宝贵的建议,帮助运动员安全地从事体育运动,意大利运动心脏病学会、意大利运动医学联合会和 COCIS 委员会中的其他心脏病科学学会定期编制和出版一本名为《竞技体育资格心脏病学协议》的小册子。本次回顾的目的是强调最近的 2023 年版本与之前版本相比的创新之处。
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引用次数: 0
[Surgical treatment of coronary artery to pulmonary artery fistula with a saccular aneurysm]. [伴有囊状动脉瘤的冠状动脉至肺动脉瘘的手术治疗]。
IF 0.7 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS Pub Date : 2024-06-01 DOI: 10.1714/4287.42691
Gerardo Musuraca, Cristiana Giovanelli, Clotilde Terraneo, Nicola Osti, Alessandro Motta, Carlo Angheben, Remo Albiero

A 60-year-old man with hypercholesterolemia and hypertension presented with acute coronary syndrome (SCA). The ECG showed lateral ischemia (T-wave inversion in V4-V6, D1 and aVL) and echocardiography showed normal left ventricular wall motion. Coronary angiography showed critical atherosclerotic lesions in the distal part of the left circumflex artery (LCx, culprit lesion), chronic total occlusion of the right coronary artery (RCA), significant but not critical stenosis in the middle part of left anterior descending artery (LAD), and a coronary artery to pulmonary artery (PA) fistula originating from the proximal part of the LAD and emptying into the PA via a coronary saccular aneurysm (12 x 12 x 10 mm). A multidetector row computed tomography angiography (CTA) confirmed the coronary artery fistula, which was treated with surgical approach. The patient underwent aneurysmorrhaphy with CAF closure and coronary artery bypass grafting on the RCA and LCx. The postoperative course was uneventful and the patient was discharged on postoperative day 14. CTA was useful for understanding the spatial relation of the CAF and the connection with the PA.

一名患有高胆固醇血症和高血压的 60 岁男子出现急性冠状动脉综合征(SCA)。心电图显示侧壁缺血(V4-V6、D1和aVL出现T波倒置),超声心动图显示左心室壁运动正常。冠状动脉造影显示左侧环状动脉(LCx,罪魁祸首)远端存在严重的动脉粥样硬化病变,右侧冠状动脉(RCA)慢性全闭塞、左前降支动脉(LAD)中段有明显但非严重狭窄,冠状动脉至肺动脉(PA)瘘源于左前降支动脉近端,通过冠状动脉囊状动脉瘤(12 x 12 x 10 毫米)流入肺动脉。多切面行计算机断层扫描血管造影术(CTA)证实了冠状动脉瘘,并采用手术方法进行了治疗。患者接受了动脉瘤夹闭术,并在 RCA 和 LCx 上进行了冠状动脉搭桥术。术后过程顺利,患者于术后第14天出院。CTA 有助于了解 CAF 的空间关系以及与 PA 的连接。
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引用次数: 0
[Drug-eluting stents in contemporary interventional practice: the STENT PANORAMA project (Part I)]. [当代介入治疗中的药物洗脱支架:STENT PANORAMA 项目(第一部分)]。
IF 0.7 Q4 Medicine Pub Date : 2024-06-01 DOI: 10.1714/4287.42690
Giulia Masiero, Alberto Barioli, Marco Borghesi, Luca Donazzan, Enrico Fabris, Tommaso Fabris, Chiara Fraccaro, Andrea Gratta, Daniele Giacoppo, Davide Lanzellotti, Mattia Lunardi, Concetta Mammone, Giuseppe Marchese, Marco Mojoli, Luca Nai Fovino, Andrea Pascotto, Filippo Zilio, Gabriele Pesarini

STENT PANORAMA is a project carried out by the Young Interventional Cardiologists of Triveneto coordinated by the Italian Society of Interventional Cardiology (GISE) Veneto delegation. The project includes two parts: the first, here reported, is aimed at describing in a standardized and easily usable way the main technological characteristics of the latest generation of the drug eluting stents (DES) that are most widely used in the Italian cath-labs. The second, to follow, will aim to summarize the main scientific evidence regarding the performance of individual devices with particular reference to subgroups of clinical interest. The ambitious goal of the STENT PANORAMA working group is to provide the interventional cardiologist with a thorough, practical, and functional knowledge of the DES currently available in the modern therapeutic armamentarium to promote a therapeutic strategy tailored to the patient.

STENT PANORAMA 是由意大利介入心脏病学会威尼托代表处协调的 Triveneto 青年介入心脏病专家开展的一个项目。该项目包括两个部分:第一部分在此报道,旨在以标准化和易于使用的方式描述意大利阴式实验室最广泛使用的最新一代药物洗脱支架(DES)的主要技术特点。接下来的第二部分将总结有关单个设备性能的主要科学证据,特别是与临床相关的亚组。STENT PANORAMA 工作组的宏伟目标是为介入心脏病专家提供有关现代治疗设备中现有 DES 的全面、实用和功能性知识,以促进为患者量身定制治疗策略。
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引用次数: 0
["Extreme sports" in patients with heart disease: an informative approach to patient counseling]. [心脏病患者的 "极限运动":为患者提供信息咨询的方法]。
IF 0.5 Q4 Medicine Pub Date : 2024-06-01 DOI: 10.1714/4269.42468
Francesco Feletti, Stefano Savonitto

The term "extreme sports" includes a range of sporting activities, predominantly individual, practised outdoors in a wild and non-competitive environment, which have in common the critical role of environmental variables, the importance of qualitative parameters in evaluating performance, the centrality of technological elements and the high perceived risk which, together with the spectacularity, attracts the attention of the media, favoring its popularity. Despite their diversity, these disciplines share specific risks and physiological and pathophysiological aspects. The average age of participants is generally higher than that of traditional and competitive sports, and the prevalence of male subjects implies a higher likelihood of cardiological evaluation whose path has yet to be codified like that of traditional sports. The risk of severe injuries in these sports is not higher than that of traditional sports and non-sporting activities. In contrast, the risk of cardiovascular events is documented only for some sports practised in the mountains, such as mountaineering, skiing and mountain biking, and it does not appear to be higher than that of equivalent physical activities performed at low altitudes. The diagnostic and prognostic criteria for cardiological counseling of enthusiasts are not defined. Environmental exposure to extremes of temperature, altitude, wind and humidity, and dehydration are typical characteristics of these activities, which should be addressed with adequate experience, preparation and equipment to minimize the potential impact on health. Finally, many of these activities are often conducted in "remote areas" compared to the possibility of emergency response, which should be considered in the risk assessment of an acute cardiovascular event. The definition of cardiovascular risk constitutes an open area of research to allow the practice of these sports to an increasing number of participants.

极限运动 "一词包括一系列体育活动,主要是在野外和非竞技环境中进行的个人户外运动,其共同点是环境变量的关键作用、质量参数在评价成绩中的重要性、技术要素的中心地位以及高风险感,这些因素加上壮观的场面吸引了媒体的关注,使其大受欢迎。尽管竞赛项目多种多样,但它们都有共同的风险以及生理和病理生理方面的问题。参与者的平均年龄普遍高于传统运动和竞技运动的参与者,而且男性参与者居多,这意味着更有可能进行心脏病学评估,而心脏病学评估的路径尚未像传统运动那样形成规范。在这些运动中,严重受伤的风险并不比传统运动和非体育活动高。相比之下,只有登山、滑雪和山地自行车等一些在山区进行的运动才有发生心血管事件的风险记录,而且似乎并不比在低海拔地区进行的同等体育活动的风险高。对爱好者进行心脏病咨询的诊断和预后标准尚未确定。暴露于极端温度、海拔、风力和湿度环境以及脱水是这些活动的典型特征,应通过充分的经验、准备和装备来应对,以最大限度地减少对健康的潜在影响。最后,与应急响应的可能性相比,许多这类活动往往是在 "偏远地区 "进行的,在对急性心血管事件进行风险评估时应考虑到这一点。心血管风险的定义是一个开放的研究领域,以便让越来越多的参与者参与这些运动。
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引用次数: 0
[Optical coherence tomography imaging for the evaluation and treatment of calcified coronary artery disease]. [用于评估和治疗钙化冠状动脉疾病的光学相干断层成像]。
IF 0.7 Q4 Medicine Pub Date : 2024-06-01 DOI: 10.1714/4287.42688
Marco Busco, Alfredo Ricchiuto, Francesco Bianchini, Gianluca Anastasia, Fabio Pescetelli, Matteo Vercellino, Enrico Romagnoli, Francesco Burzotta, Carlo Trani, Italo Porto, Cristina Aurigemma, Rocco Vergallo

Coronary calcific disease represents one of the main challenges for the interventional cardiologist, for whom optimal lesion preparation and percutaneous coronary intervention optimization are paramount for correct management. In this perspective, intravascular imaging using optical coherence tomography (OCT) is becoming an increasingly indispensable tool. This work aims to provide a detailed overview of the complexity of calcified lesions, first analyzing their various morphologies and their clinical impact: spotty calcium seems to be more present in plaques at higher risk of destabilization, while diffuse calcification is typical of stable coronary stenosis; the eruptive calcific nodule is one of the three culprit lesion phenotypes responsible for acute coronary syndromes.In the second part of this review, the available technologies for the treatment of calcified lesions are described, with the aid of illustrative OCT images. Intravascular lithotripsy causes fractures at various levels of the calcified plaque, both circumferentially and longitudinally, with an improvement in vessel compliance; atherectomy acts by modifying the composition of the plaque with selective action on the hard calcific component. OCT, providing a comprehensive overview of lesion characteristics, can guide in the selection of the most appropriate therapeutic strategy, while also offering important information on the effectiveness of the chosen treatment.

冠状动脉钙化病是介入心脏病专家面临的主要挑战之一,对他们来说,最佳的病变准备和经皮冠状动脉介入治疗优化是正确治疗的关键。从这个角度来看,使用光学相干断层扫描(OCT)进行血管内成像正日益成为一种不可或缺的工具。本文旨在详细概述钙化病变的复杂性,首先分析钙化病变的各种形态及其临床影响:斑点状钙似乎更多出现在失稳风险较高的斑块中,而弥漫性钙化则是稳定型冠状动脉狭窄的典型表现;爆发性钙化结节是导致急性冠状动脉综合征的三种罪魁祸首病变表型之一。血管内碎石术可在钙化斑块的不同层面造成周向和纵向断裂,并改善血管顺应性;动脉粥样硬化切除术通过改变斑块的组成,选择性地作用于坚硬的钙化成分。OCT 能全面显示病变特征,为选择最合适的治疗策略提供指导,同时还能提供有关所选治疗方法有效性的重要信息。
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引用次数: 0
In questo numero. 本期内容
IF 0.5 Q4 Medicine Pub Date : 2024-05-01 DOI: 10.1714/4252.42290
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引用次数: 0
[Management of patent foramen ovale in non-cardiac surgery]. [非心脏手术中卵圆孔未闭的处理]。
IF 0.7 Q4 Medicine Pub Date : 2024-05-01 DOI: 10.1714/4252.42291
Marco B Ancona, Domitilla Gentile, Luca A Ferri, Fabrizio Monaco, Filippo Russo, Barbara Bellini, Ciro Vella, Giulia Ghizzoni, Greca Zanda, Eustachio Agricola, Giulio Truci, Luigi Beretta, Stefano Turi, Giovanni Landoni, Matteo Montorfano

Patent foramen ovale (PFO) is a remnant of normal fetal anatomy which may persist into adulthood, mostly asymptomatic. In some adults, PFO may result in a potential for shunting venous thromboembolism to the arterial circulation; less frequently it can cause interatrial, right-to-left shunting of deoxygenated blood. The pathogenesis of several medical conditions is related to the presence of PFO. Some randomized clinical trials have shown evidence of benefit for device closure as compared with medical therapy in patients with cryptogenic stroke. The literature reported several cases of carbon dioxide embolism during general laparoscopic surgery and sometimes stroke after laparoscopic or neurosurgery but there are neither prospective studies addressing these issues, nor randomized clinical trials assessing the effectiveness of pharmacotherapy or interventional procedures at decreasing risk. The European position paper suggests routine monitoring in non-cardiac surgery of patients with a PFO and no actual indications for closure. This article aims to further stratify the risk of periprocedural stroke and paradoxical embolism in this category of patients.

卵圆孔未闭(PFO)是正常胎儿解剖结构的残留物,可能会持续到成年,大多无症状。在一些成年人中,PFO 可能导致静脉血栓栓塞向动脉循环分流;较少见的情况是,它可能导致心房间脱氧血液从右向左分流。一些疾病的发病机制与 PFO 的存在有关。一些随机临床试验显示,在隐源性卒中患者中,与药物治疗相比,装置闭合的效果更佳。文献报道了数例普通腹腔镜手术中的二氧化碳栓塞病例,有时也报道了腹腔镜或神经外科手术后的卒中病例,但既没有针对这些问题的前瞻性研究,也没有随机临床试验评估药物治疗或介入手术在降低风险方面的效果。欧洲立场文件建议在非心脏手术中对有 PFO 的患者进行常规监测,但没有实际的关闭指征。本文旨在进一步对此类患者围手术期中风和矛盾性栓塞的风险进行分层。
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引用次数: 0
[The IN-HF Registry: the history and the scientific production for the Italian cardiology community]. [IN-HF 登记:意大利心脏病学界的历史和科研成果]。
IF 0.5 Q4 Medicine Pub Date : 2024-05-01 DOI: 10.1714/4252.42293
Vittoria Rizzello, Maria Denitza Tinti, Mauro Gori, Marco Marini, Vittorio Palmieri, Luisa De Gennaro, Paolo Manca, Maria Vittoria Matassini, Concetta Di Nora, Matteo Bianco, Samuela Carigi, Piero Gentile, Giuseppe Leonardi, Francesco Orso, Marco Gorini, Lucio Gonzini, Donata Lucci, Aldo Pietro Maggioni, Renata De Maria, Luigi Tavazzi

The Italian Network on Congestive Heart Failure (IN-CHF) project, later known as IN-HF Online, was launched in 1995 to provide the Italian cardiology community with a digital tool, standardized across the country, for managing outpatients with heart failure (HF), that enabled the creation of a database for clinical, educational and scientific purposes. During its almost three decades of activity, this observational research program has achieved highly positive scientific results. Indeed, IN-HF fostered professional relationships among individuals working in different centers, established a cultural network for the care of HF patients, periodically updated on the scientific advances, and allowed the assessment of several clinical, epidemiological, and prognostic features. These findings have been published in numerous national and international journals, as summarized in the present overview.

意大利充血性心力衰竭网络(IN-CHF)项目(后称为 IN-HF Online)于 1995 年启动,旨在为意大利心脏病学界提供一种全国统一的数字化工具,用于管理门诊心力衰竭(HF)患者,从而建立一个用于临床、教育和科研目的的数据库。在近三十年的活动中,这项观察研究计划取得了非常积极的科学成果。事实上,IN-HF 促进了在不同中心工作的人员之间的专业关系,建立了心力衰竭患者护理的文化网络,定期更新科学进展,并允许对一些临床、流行病学和预后特征进行评估。这些研究成果已发表在众多国内外期刊上,本综述将对其进行总结。
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引用次数: 0
[STEP-RCV Project - A scientific expert panel for patients at high and very high cardiovascular risk: how to streamline lipid-lowering therapy]. [STEP-RCV项目--心血管高风险和极高风险患者科学专家小组:如何简化降脂治疗]。
IF 0.5 Q4 Medicine Pub Date : 2024-05-01 DOI: 10.1714/4252.42295
Furio Colivicchi, Marcello Arca, Stefania Angela Di Fusco, Angela Pirillo, Alberico L Catapano

Over the last decade, several innovative therapeutic options have been developed and marketed for the management of hypercholesterolemia. However, the impossibility of a contextual update of international guidelines and the limits imposed by national regulatory authorities do not allow the use of these treatments in many patients, in particular in those at higher cardiovascular risk. Real-world studies show that the use of lipid-lowering therapies is inadequate even among patients at higher cardiovascular risk, with only 20% achieving recommended low-density lipoprotein cholesterol (LDL-C) levels and the use of combination therapies implemented in only 24% of patients. This review aims to highlight the benefits of an approach based on combination therapy and to propose a therapeutic algorithm that includes oral combination therapy, where necessary also in triple association (statin, ezetimibe and bempedoic acid), as an initial approach based on the most favorable cost-effectiveness ratio for patients at higher cardiovascular risk and the use of injectable anti-proprotein convertase subtilisin/kexin 9 therapies if the recommended LDL-C goal is not achieved.

在过去的十年中,针对高胆固醇血症的治疗开发并上市了多种创新疗法。然而,由于无法根据具体情况更新国际指南,以及国家监管机构的限制,许多患者,尤其是心血管风险较高的患者无法使用这些疗法。现实世界的研究表明,即使在心血管风险较高的患者中,降脂疗法的使用也不充分,只有 20% 的患者能达到推荐的低密度脂蛋白胆固醇(LDL-C)水平,只有 24% 的患者使用了联合疗法。本综述旨在强调以联合疗法为基础的方法的益处,并提出一种治疗算法,其中包括口服联合疗法,必要时还包括三联疗法(他汀类药物、依折麦布和贝美多酸),作为心血管风险较高患者最有利的成本效益比基础上的初始方法,如果不能达到推荐的低密度脂蛋白胆固醇目标,则使用注射抗蛋白转换酶亚基酶/kexin 9疗法。
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引用次数: 0
[Management and treatment of atrial fibrillation in cancer patients: an important decision-making hub in cardio-oncology]. [癌症患者心房颤动的管理和治疗:心脏病肿瘤学的重要决策枢纽]。
IF 0.5 Q4 Medicine Pub Date : 2024-05-01 DOI: 10.1714/4252.42298
Giuseppe Boriani, Marta Mantovani, Benedetta Cherubini, Enrico Tartaglia, Niccolò Bonini
{"title":"[Management and treatment of atrial fibrillation in cancer patients: an important decision-making hub in cardio-oncology].","authors":"Giuseppe Boriani, Marta Mantovani, Benedetta Cherubini, Enrico Tartaglia, Niccolò Bonini","doi":"10.1714/4252.42298","DOIUrl":"https://doi.org/10.1714/4252.42298","url":null,"abstract":"","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2024-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140855824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Giornale italiano di cardiologia
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