Giornale italiano di cardiologia最新文献

In the past few years, computed tomography coronary angiography (CTCA) has rapidly become a widely used diagnostic tool in several clinical settings and is recommended by the European guidelines with a high degree of recommendation in patients with suspected coronary artery disease. The rapid accumulation of evidence is tumultuous and clinical use has grown in parallel with the possibility of offering significant advantages in many areas. Today, CTCA is used both in the diagnosis of low-risk chest pain in emergency departments and in the recognition and prognostic assessment of stable coronary artery disease. By identifying the presence, extent, and quality of atherosclerotic disease, CTCA today offers an important tool for the identification of the disease, promoting the best therapeutic choices with significant prognostic implications, a high safety profile and potentially significant savings in resources. New applications and evidence are accumulating thanks to the marriage of CTCA with artificial intelligence. Alongside increasing accuracy, new risk markers have been identified that enrich the informative content of this method. This review reports the most significant studies that have marked this path so far.

Patients with heart failure (HF) frequently experience iron deficiency, with an estimated prevalence of sideropenia around 50%. In HF patients, iron deficiency is associated with reduced functional capacity, lower quality of life, and an increased risk of hospitalizations and mortality. Therefore, timely diagnosis and treatment of sideropenia are essential to improve clinical outcomes in HF patients with reduced or mildly reduced ejection fraction, while data on the benefits of iron supplementation in HF patients with preserved ejection fraction remain limited. This review aims to provide an overview of the prevalence, diagnostic criteria, available evidence, indications, iron formulations, and recommended protocols for identifying and treating iron deficiency in HF patients.

Artificial intelligence (AI) is revolutionizing cardiology, offering new opportunities to improve diagnosis, therapy, and prevention of cardiovascular diseases. By analyzing large amounts of data and supporting clinical decisions, AI can simplify modern medical complexities. However, its development is limited by methodological, ethical, and organizational obstacles. This review aims to present the potential applications of AI in cardiology in a practical and accessible manner, exploring key algorithms, opportunities, and limitations. It is crucial to address the challenges associated with AI to ensure its ethical and responsible use in support of clinical expertise while actively promoting collaboration between clinicians and information technology specialists to fully realize the potential of AI in daily cardiological practice.

Background: The national survey of the SIC-ANMCO Amyloidosis Centers was designed to create a geographical mapping of the centers that identify and follow patients with cardiac amyloidosis in Italy and to describe their diagnostic capabilities and multidisciplinary organization.

Methods: The survey was administered to 212 centers in Italy. Among them, 153 centers responded (72%), 31/35 (89%) of which were academic medical centers and 122/177 (69%) hospitals.

Results: The results revealed a prevalence of centers in the North and Center of Italy compared to the South and the Islands, highlighting a greater number of patients in heart failure/cardiomyopathy clinics in hospitals (53%) and in clinics dedicated to amyloidosis in academic medical centers (71%). Most centers have an internal multidisciplinary collaboration network with the neurologist (82% in total, 97% in academic medical centers and 78% in hospitals) and the hematologist (69% in total, in 94% and 63%, respectively) and have the possibility of performing on-site cardiac magnetic resonance imaging (74%, in 94% and 68%, respectively) and scintigraphy with bone tracers (52%, in 91% and 44%, respectively), or alternatively to refer patients to other centers thanks to well-structured or occasional collaborations. Conversely, only a minority of centers perform endomyocardial biopsy (31%, in 71% of academic medical centers and in 20% of hospitals) and a smaller number of academic medical centers perform sophisticated amyloid tissue typing techniques such as immunogold labeling (11%) and mass spectrometry (4%).

Conclusions: The survey provided important information on the current Italian situation, underlining the importance of collaboration between the various levels of the network, to guarantee the best possible pathways and treatments for all patients with amyloidosis.

This review highlights the epidemiological and clinical challenge associated with managing patients who have cerebral amyloid angiopathy (CAA) and atrial fibrillation. As the population ages, clinicians are increasingly required to devise appropriate management strategies for this specific patient subgroup. These patients face not only the risk of intracerebral hemorrhage associated with oral anticoagulant therapy but also complications due to CAA. CAA is an age-related small vessel disease characterized by the deposition of β-amyloid in the walls of cortical and leptomeningeal arteries, arterioles, and capillaries. This condition progressively weakens the vascular integrity, thereby increasing the risk of major bleeding events. The lack of randomized clinical trials necessitates a multiparametric and multidisciplinary approach to assess the extent of vasculopathy and balance thromboembolic and hemorrhagic risks, aiming to tailor the most effective management strategy for each patient. In managing such cases, it is crucial to address concomitant risk factors and consider both pharmacological and non-pharmacological interventions, such as left atrial appendage occlusion, to mitigate the risk of stroke.

Heart failure is the leading cardiovascular cause of hospitalization with an increasing prevalence, especially in older patients. About 50% of patients with heart failure have preserved ventricular function, a form of heart failure that, until a few years ago, was orphaned by pharmacological treatments effective in reducing hospitalization and mortality. New trials, which have tested the use of gliflozins in patients with heart failure with preserved ejection fraction (HFpEF), have for the first time demonstrated their effectiveness in changing the natural history of this insidious and frequent form of heart failure. Therefore, diagnosing those patients early is crucial to provide the best treatment. Moreover, the diagnosis is influenced by the patient's comorbidities, and some HFpEF patients have symptoms common to other rare diseases that, if unrecognized, develop an unfavourable prognosis. This position paper aims to provide the clinician with a useful tool for diagnosing and treating patients with HFpEF, guiding the clinician towards the most appropriate diagnostic and therapeutic pathway.

Heart failure with preserved ejection fraction (HFpEF) is a complex clinical entity frequently associated with chronic kidney disease (CKD). Recent studies indicate that 50-60% of HFpEF patients also have CKD, and the prevalence of HFpEF among CKD patients is similarly high. Chronic low-grade systemic inflammation is common to both conditions and is linked to risk factors such as obesity, insulin resistance, and diabetes. The hyperactivation of the mineralocorticoid receptor plays a central role in this process, contributing to interstitial fibrosis and inflammation. Additional factors, including metabolic acidosis, gut dysbiosis, and reduced expression of the α-Klotho protein, amplify the inflammatory response. This systemic inflammation reduces nitric oxide production, impairing cardiac diastolic function and, together with metabolic syndrome and aging, further exacerbates the already complex cardiac pathology. Therapeutic strategies aimed at reducing inflammation, such as renin-angiotensin-aldosterone system inhibitors and sodium-glucose cotransporter 2 inhibitors, show promising potential. Additionally, the use of anti-inflammatory drugs and novel interventions to restore gut microbiota balance may offer new opportunities to improve prognosis in patients with HFpEF and CKD. Further studies are needed to clarify the clinical efficacy of these approaches and their role in optimizing the management of this complex patient population.