Giornale italiano di cardiologia最新文献

We describe the case of a 75-year-old hypertensive patient who comes to the emergency room for an infero-postero-lateral myocardial infarction. The entry echocardiogram showed a rounded formation with mixed echogenicity (maximum transverse diameter 4.5 cm), attached to the free wall of the left atrium and without any hemodynamic impact. Coronary angiography revealed a giant aneurysm of the circumflex artery, followed by an occlusion of the distal tract. After Heart Team evaluation, angioplasty with implantation of a drug-eluting stent was performed in the occluded coronary tract. This is one of the very rare cases in the literature of a giant coronary aneurysm diagnosed within the clinical picture of acute coronary syndrome. There is a lack of guidelines and consensus documents regarding management of this condition. In our case report, we discuss the resulting therapeutic challenges.

Despite the effectiveness of statins in reducing cardiovascular events and slowing the progression of coronary atherosclerosis, significant residual cardiovascular risk persists. In the REDUCE-IT trial, icosapent ethyl (IPE), a highly purified ethyl ester of eicosapentaenoic acid (EPA), has been demonstrated to significantly lower the risk of primary and secondary composite endpoints, including major adverse cardiovascular events and cardiovascular death, when added to a statin compared to placebo. This clinical benefit may partially result from IPE's moderate triglyceride-lowering properties; however, it also significantly reduces levels of atherogenic remnant particle-cholesterol. Previous trials using mixed formulations of omega-3 fatty acids (EPA/docosahexaenoic acid [DHA]) or low-dose IPE have not demonstrated similar benefits, despite achieving comparable triglyceride reductions. These discrepancies have prompted investigations into the mechanistic differences between omega-3 fatty acids, as EPA and DHA exhibit distinct membrane interactions, metabolic products, tissue distributions, and biological effects. Moreover, IPE exerts several beneficial actions on atherosclerosis beyond its triglyceride-lowering properties, improving endothelial function, reducing intra-plaque inflammation and oxidative stress, exhibiting antithrombotic properties, and improving insulin sensitivity. IPE is scientifically plausible as a potential antiatherosclerotic agent based on mechanistic, pathophysiological, outcomes, and plaque-imaging studies. This review aims to synthesize the current evidence regarding IPE and examine its potential applications in light of the European Society of Cardiology guideline recommendations and existing national regulations.

Background: Despite guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF), a residual risk of adverse outcomes persists, particularly after worsening heart failure (WHF). The VICTORIA trial demonstrated the benefit of adding vericiguat in high-risk patients. However, its real-world adoption in Italy remains unclear. The aim of this study was to assess the use, safety, and prescription patterns of vericiguat in Italian patients with recent WHF.

Methods: The multicenter VeriChange survey was conducted across 28 hospitals in Northern Italy. A total of 399 anonymized clinical records of HFrEF patients with recent WHF were collected. The survey included demographic, clinical, therapeutic data and safety outcomes.

Results: Overall, 68% of patients were classified as NYHA III-IV and 77% had a left ventricular ejection fraction ≤35%. Vericiguat was initiated after the first WHF episode in 54% of cases, and during hospitalization in 50%. The target dose of 10 mg/day was reached in 56% of patients. Tolerability was high, with only 3% treatment discontinuation. Prescription occurred in a context of strong adherence to guideline-based therapy.

Conclusions: Vericiguat was introduced early and safely in Italian real-world practice, especially in tertiary and referral centers. Broader implementation and earlier WHF recognition are still needed to reduce residual risk in advanced heart failure patients.

The escalation in demand for digital health services, particularly highlighted by recent global health crises, has emphasized the significance of eHealth literacy (eHL). This concept encompasses the skills necessary to effectively search for, comprehend, evaluate, and apply online health information to solve health-related issues. eHL not only facilitates navigation through the digital health landscape but also broadens the understanding of the digital divide within the context of health information accessibility. In this review, we encompassed individual eHL definitions and tools, focusing on the role of eHL during the COVID-10 outbreak, and with regard to gender, age and social inequalities.

The win ratio is a relatively recent statistical technique introduced with the aim of better managing the analysis of clinical trials involving more than one clinical event as an endpoint in the evaluation of a treatment. The calculation of the win ratio begins by defining a "hierarchy" of clinical events on the basis of their severity, e.g. death, followed, for example, by the number of hospitalizations for heart failure, followed, for example, by softer endpoints including functional or laboratory changes. The analysis begins by comparing each patient in a hypothetical "Group A" with each patient in a hypothetical "Group B" on the hierarchically most important clinical event only. If the patient in Group B dies and the one in Group A does not, or if the one in Group B dies before the one in Group A, then that particular comparison is "won" by Group A. If the patient in Group A dies and the one in Group B does not, or if the one in Group A dies before the one in Group B, then that comparison is "won" by Group B. If nobody dies, or if they die on the same day, then that specific comparison ends in a tie. All comparisons of each patient in Group A with each patient in Group B are then performed. On the comparisons that end in a tie, we move on to the analysis of the endpoint hierarchically in second place, using the same technique. Then we proceed to the analysis of the endpoint hierarchically in third place, and so on down to the event in the lowest position in the hierarchy. The win ratio represents the total sum of comparisons in which, for example, Group A wins, divided by the total sum of comparisons in which Group A "loses". The absolute difference, rather than the ratio, between these two sums indicates the "win difference". Compared to the conventional "time-to-event" statistical techniques including, for example, the Cox model, the win ratio calculation has advantages, but also potential disadvantages. This review aims to offer a summary of the advantages and potential disadvantages of the win ratio, with some practical examples derived from the use of the win ratio in the analysis of important trials in the cardiovascular area.

Background: Hypertriglyceridemia is a common finding in patients with coronary artery disease (CAD), contributing to the residual cardiovascular risk in this population. In CAD patients with persistently elevated triglyceride levels despite lipid-lowering therapies, treatment with icosapent ethyl (IPE), compared to placebo, significantly lowered the risk of ischemic events. We aimed to quantify the burden of real-world patients with high triglyceride levels despite optimal lipid-lowering therapy, and to provide the potential use of IPE as a therapeutic strategy of secondary prevention.

Methods: We used the data of the multicenter and observational JET-LDL registry, which included 1095 patients with acute coronary syndrome undergoing percutaneous coronary intervention with at least one stent implantation at 35 Italian hospitals. In the present subanalysis, we investigated fasting triglyceride levels at index hospitalization and after 3 months of follow-up, and their relationship with LDL-cholesterol values. We also identified patients potentially eligible for IPE prescription based on inclusion/exclusion criteria of the REDUCE-IT trial and of the Italian Medicines Agency (AIFA).

Results: Triglyceride levels at baseline and at 3-month follow-up were 109 (82.5-147) mg/dl and 98 (75-130) mg/dl, respectively. The reduction of triglycerides was also statistically significant (p<0.01) comparing paired matched patients. At 3 months, 15.6% of patients met the inclusion laboratory criteria of the REDUCE-IT trial, making them eligible for IPE based on these parameters. Additionally, 14.5% of patients were eligible according to AIFA authorized guidelines for the use of IPE, whereas only 0.2% qualified under the criteria for reimbursement.

Conclusions: A non-negligible proportion of patients met the REDUCE-IT triglyceride cut-off levels for IPE prescription at 3-month follow-up post-acute coronary syndromes. However, the prescription of IPE can be very limited by the current restrictive reimbursement criteria.

Chronic kidney disease, diabetes mellitus and heart failure represent three chronic conditions closely linked to each other from a pathophysiological and prognostic point of view. This link has led to an ever-increasing emphasis in recent years on the need for a holistic approach to patients who are affected by optimizing the therapeutic management of what has recently been defined as cardio-kidney-metabolic syndrome. The cardiorenal and metabolic approach has gained relevance thanks to recent studies on new drug classes. Initially in diabetic patients and later in those suffering from heart failure and chronic kidney disease, these new drugs have demonstrated their effectiveness in reducing cardiovascular risk, the progression of heart failure and chronic kidney disease. This review aims to address the main pharmacological aspects of two of these new classes, that of sodium-glucose co-transporter 2 inhibitors and the more recent one of non-steroidal mineralocorticoid receptor antagonists.

A systematic and multidisciplinary approach is needed to manage cancer patients with a cardiac implantable electronic device undergoing radiation therapy. We report a statement from the Italian Association of Hospital Cardiologists (ANMCO) to provide guidance for clinicians involved in the care continuum of this challenging clinical setting. A comprehensive careful assessment of radiotherapy type, treatment plan and cardiac issues is recommended in order to minimize the risk of device malfunction. Risk stratification before radiation therapy as well as the timing of cardiological assessments during treatment and follow-up strategies are thoroughly discussed. An overview of oncological electrophysiology and radiotherapy-induced damage to devices is also provided. The proposed recommendations represent an expert consensus based on available literature data, guidelines and clinical evidence.

The use of polypill, a single pill containing more therapeutic agents, has shown to increase therapeutic adherence and improve cardiovascular prognosis. Among the several polypills currently available, the fixed dose combination of rosuvastatin at different doses and acetylsalicylic acid (ASA) at low dose represents a useful therapeutic option for cardiovascular disease prevention. When the impact of rosuvastatin in association with ASA on cardiovascular disease incidence has been compared with the combination of other statins with ASA, rosuvastatin plus ASA is the combination associated with the lowest incidence of several cardiovascular diseases. As regards the use of ASA in primary prevention, the global clinical benefit may be weakened by the occurrence of bleedings. Therefore, in primary prevention, the combination rosuvastatin/ASA may be considered when the bleeding risk is low and the cardiovascular risk is augmented. In secondary prevention, the need for an early optimal management of cholesterol control may require the use of a fixed dose combination of statin/ezetimibe and ASA in a separate formulation. However, in selected cases in which the distance from the therapeutic low-density lipoprotein cholesterol target does not require the combination of high efficacy statin with ezetimibe, the fixed dose combination rosuvastatin/ASA may be considered even in secondary prevention.

Congenital heart defects (CHDs) are the leading congenital anomalies in humans, with approximately 1.3 million worldwide cases each year. In the past, they were one of the leading causes of infant mortality, and only 15% of patients in the 1940s and 1950s reached adulthood. Today, a profound shift in survival rate has occurred thanks to technological advancements, a deeper understanding of these conditions, early diagnosis capabilities, and neonatal surgery, with 90-95% of newborns with CHD reaching adulthood. The future of CHDs looks promising, with genetic and epigenetic discoveries enabling personalized treatments and improvements in the management of long-term complications. Tissue engineering and regenerative medicine could revolutionize treatment, with the creation of custom-made heart valves and vascular tissues, as well as cellular therapies to improve myocardial function, along with potential solutions for complete heart replacement in cases of myocardial failure. The future challenge remains ensuring that children born with CHDs not only have a long life but also a quality of life comparable to that of all other children.