Giornale italiano di cardiologia最新文献

Hospital discharge is a crucial moment in the continuity of care, acting as a bridge between the acute phase and the treatment pathway that follows. Far from being a simple administrative act, it is a complex process requiring careful planning, effective communication, and the active involvement of all the stakeholders of the healthcare system, including the patient. Poor discharge management can have a negative impact on clinical outcomes, resulting in a higher risk of hospital readmission and inefficient use of healthcare resources. Taking into account the increasingly old, fragile population showing a high prevalence of comorbidities and complex care needs, it is essential to consider discharge as a comprehensive and integrated approach to the care continuum. This document arises from the necessity to share an updated and practical model for the management of hospital discharge, based on the latest scientific evidence and multidisciplinary experience, its aim being to promote continuity of care and personalized treatment as well as to improve health outcomes. The authors intend to provide clinical cardiologists with a unified tool for the management of patient discharge, offering concrete proposals to improve communication between physicians and patients, optimize therapies, and positively impact health outcomes.

Cardiovascular risk stratification represents a cornerstone in preventing and managing atherosclerotic diseases. There has been a profound transformation in risk assessment models in recent years, shifting from static and uniform approaches to dynamic, integrated, and increasingly personalized paradigms. The SCORE2, SCORE2-OP, SCORE2-Diabetes and SMART2 tools allow for a more accurate and context-specific estimation of absolute cardiovascular risk by incorporating clinical and demographic variables such as age, comorbidities, metabolic profile, and geographic context. In parallel, the use of advanced non-invasive imaging techniques, parameters such as coronary artery calcium scoring and carotid intima-media thickness, as well as biomarkers, has enabled the early identification of apparently healthy individuals who are at hidden risk. This shift also challenges the traditional dichotomy of primary and secondary prevention, favoring a more continuous and nuanced concept of risk stratification. The integration of clinical, instrumental, and biological data now allows for more refined and timely risk assessment, paving the way for earlier, more targeted, and intensive preventive strategies aimed at reducing the incidence of cardiovascular events and significantly improving long-term outcomes.

The Impella 5.5® (Abiomed Inc., Danvers, MA, USA) is a temporary mechanical circulatory support device utilized for the management of cardiogenic shock. In this review, we outline the device's key features, paying particular attention to its indications and contraindications, the surgical technique for implantation, and potential complications. Additionally, we emphasize the potential benefits of using the Impella as a bridge to left ventricular assistance device implantation, a safe strategy to mitigate the risk of right heart failure.

Maternal mortality represents a crucial indicator of the quality of care, as stated by the World Health Organization. Non-obstetric mortality in Italy is equally derived from cardiovascular and hypertensive problems with an upward trend. The increased incidence of cardiovascular risk factors, the rise in maternal age, and the use of assisted reproduction suggest a growing impact of arrhythmias on maternal morbidity and mortality. This review article outlines the management of the most common arrhythmias during pregnancy, following the Heart Rhythm Society consensus document. The general principle is that any treatment should not be delayed in urgent situations due to concerns about fetal risk, as restoring sinus rhythm and adequate maternal hemodynamics is the primary objective of therapy. Despite limitations associated with data from non-randomized studies, key antiarrhythmic drugs are relatively safe. Electrical cardioversion is risk-free with certain management peculiarities. When required, ablation therapy or the implantation of intracardiac devices with zero or minimal fluoroscopy can be considered. Clinically significant arrhythmias and the management of patients with structural heart disease or channelopathies require multidisciplinary care in a cardio-obstetric team, with particular attention to delivery setting and timing.

Genetic tests are useful in the, even early, diagnosis and management of various hereditary pathologies with cardiovascular involvement such as cardiomyopathies, arrhythmic diseases, and aortic diseases. The diagnosis of these diseases can be challenging in athletes where the ECG and echocardiogram show physiological alterations due to intense physical activity. However, if performed inappropriately and if not interpreted by a team of professionals with multidisciplinary skills, genetic tests can lead to unnecessary disqualifications from sports activity with important psychological repercussions as well as on the athlete's career. This review analyzes the potential role of genetic tests in the presence of clinical/instrumental findings (ECG, imaging) that require a precise distinction between adaptive changes in the athlete's heart and hereditary pathologies. Furthermore, the impact of test results in prognostic stratification in athletes with a defined diagnosis is discussed. The objective is to provide clinicians, who in their work find dubious clinical pictures or previous diagnoses of dubious prognostic significance, with the basic tools to decide when to recommend genetic testing. The review examines the role of genetic tests in athletes in three specific cardiological contexts: cardiomyopathies, channelopathies, and aortic diseases.

The long QT syndrome (LQTS) is a cardiac disease of genetic origin which, unless properly diagnosed and managed, carries a high risk for sudden cardiac death, especially among youngsters. At the same time, the available therapies are quite effective. Most lethal episodes occur as the sentinel event, stressing the fact that most of the time there is no room for error in diagnosis or management. Here, we endeavored to share the 50-year specific experience of our group, by critically discussing both the approach and management of LQTS. Following an analysis of the clinical impact of the genetic findings, essential for personalized management, we focused on diagnosis and especially on management by analyzing the therapies currently available (beta-blockers, left cardiac sympathetic denervation, mexiletine and the implantable cardioverter-defibrillator) and those which are still experimental. We thought it appropriate to show examples of major clinical errors which unfortunately keep recurring. LQTS is a moving target, because the arrhythmic risk can decrease in response to therapy or increase for still unknown reasons: this forces the need for a constant reassessment of the arrhythmic risk of these patients. This regular reassessment, which we deem essential to protect the patients' life, represents an integral part of our management strategy because it allows yearly therapeutic optimization, key to our patients' survival. Practically, almost all patients with LQTS could have an essentially normal life, if they are correctly managed.

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 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 about 1 year ago, symptomatic patients despite maximal therapy with beta-blockers or calcium channel blockers, with or without disopyramide, had only basal septal reduction therapy via myectomy or alcohol septal ablation 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.