Giornale italiano di cardiologia最新文献

Heart failure is a syndrome with a high clinical and healthcare impact. Currently, the incidence in Europe is approximately 5/1000 people/year in the adult population, with a prevalence of 1-2%. The prognosis is burdened by a still high mortality and hospitalization rate. The phase immediately following the hospitalization is defined as the "vulnerable period" because it is characterized by the greatest number of clinical events: 30% risk of rehospitalization and 10% risk of death. Taking care of the patients in this phase is crucial and must be accompanied by a risk stratification process, essential for planning a follow-up that is as personalized as possible, also necessary for resource optimization. In the chronic phase of the disease, risk stratification appears similarly important, as it could represent a support tool in the patient's transition from hospital to the community. The aims of this paper are to review the recommendations for the follow-up of the European and American guidelines, describe the tools available to the clinician to stratify the prognosis and diversify the pathway, and finally hypothesize a follow-up scheme both in the post-acute and chronic phases.

Background: Numerous speculations have been made in recent years about the future of cardiac surgery, seen by some as an "obsolete" discipline and reserved for complex/emerging cases.

Methods: From the central database of the private-affiliated group GVM Care & Research with the National Health System, data from 2014 to 2023 relating to elective cardiac surgery (57 736 patients) were extracted from 12 cardiac surgery centers located throughout the country, with specific reference to isolated coronary and valvular surgery.

Results: The number of elective interventions performed from 2014 to 2023 has progressively increased with a slowdown in 2020 caused by the COVID-19 pandemic. The increase in the number of interventions is mainly linked to an increase in interventions in central-southern Italy which, starting from 2016, has led to equalizing the data in the two geographical areas. Women, throughout the country, have a higher average age at surgery than men and a higher surgical risk than men, especially if operated in northern Italy. Coronary artery bypass grafting has increased especially in southern Italy, and remains more frequent in males throughout the country. As for isolated valve interventions, there has been an increase in the total number, more significant in central and southern Italy, and a significant increase in the use of biological prostheses. Thirty-day mortality has not undergone significant changes in the last 10 years.

Conclusions: Our results demonstrate that cardiac surgery is a specialty that has not reduced its activity over the years in the elective field despite a significant transformation of the branch with a shift towards transcatheter approaches. The observation of a possible diagnostic delay (and consequently of intervention) in the female sex remains, with an increase in the predicted risk in women.

Background: Follow-up management of patients with pulmonary embolism (PE) is crucial to reduce the risk of recurrence and the early identification of those who develop pulmonary hypertension. However, this pathway is poorly defined.

Methods: The ANMCO Working Group on Pulmonary Vascular Diseases together with the ANMCO Study Center addressed a web-based set of 16 questions to ANMCO members to investigate their experience in PE follow-up settings and adherence to guidelines.

Results: Out of 4488 submissions, 294 (6.5%) answered, of which 69% were cardiologists. An outpatient clinic for PE follow-up is not present in 43% of the centers, in 28% it is present in a structured form and in 27% only as an outpatient clinic for anticoagulant therapy (AC). The referring doctor is a cardiologist in 68% of cases. The first visit after PE is usually at 3 months (60%). The bleeding and recurrence risk profiles are assessed in 63% and 36% of cases, respectively. Thrombophilia screening guides AC discontinuation after idiopathic PE (47%), especially in women and young people (55%). Risk factors associated with the index event are decisive for AC extended duration in estrogen-progestin-induced PE (69%) as well as in incidental PE (80%). In the extended phase, direct oral anticoagulants (DOACs) at low dose are used in 45% in accordance with current literature, in 40% due to the risk of bleeding. In patients with active cancer, 47% continue DOACs at full dose indefinitely, 36% at reduced dose. In 93% of cases, exertional dyspnea in the follow-up leads to the request for additional tests: a ventilation-perfusion scan in 44%, a pulmonary computed tomography angiography in 34%.

Conclusions: The data collected show wide heterogeneity in the follow-up management of PE. Dedicated clinics and local pathways are needed in caring for the patient after an episode of PE.

Therapeutic options for the treatment of hypertrophic obstructive cardiomyopathy have recently expanded with the introduction of myosin inhibitors, mavacamten and aficamten, which demonstrated a remarkable effect on functional capacity and symptoms of patients with left ventricular outflow tract obstruction. In recent years, there has also been a change in the approach to physical exercise in patients with hypertrophic cardiomyopathy, which now also includes the possibility of participating in high-intensity and competitive sports for selected patients with a low-risk profile. In this review, we explore the main innovations of the American College of Cardiology/American Heart Association guidelines on hypertrophic cardiomyopathy, we highlight the differences with the guidelines on the management of cardiomyopathies of the European Society of Cardiology, and we highlight some important unresolved issues in the management of the disease.

The impact of hormone replacement therapy (HRT) on the cardiovascular (CV) system in menopausal women has been the subject of significant debate for many years. After a phase marked by restrictive use following the outcomes of the first randomized trials in the 2000s, the last decade has witnessed a significant reassessment of the risks and benefits of therapy, especially CV risk. Thanks to new studies conducted in more selected populations and sub-analyses of earlier trials, there is now ample evidence regarding the high safety profile of HRT, and even protection on the CV system, for young women with a low CV risk profile in the early menopausal phase. This evidence has been incorporated into all national and international menopausal guidelines and, recently, also in a consensus document by the European Society of Cardiology. Therefore, the cardiologist assumes a central role in the risk assessment and treatment of modifiable CV risk factors during the menopausal transition, a critical period for women as it is associated with significant changes in the glycometabolic balance. This article summarises current knowledge on the subject and provides practical guidance for the cardiological management of such patients.

Background: The growing experience in minimally invasive techniques, supported by outstanding outcomes and excellent surgical exposure of the entire proximal thoracic aorta via ministernotomy, has motivated surgeons to apply this approach to more challenging procedures such as aortic root and arch treatment.

Methods: From September 2016 to April 2024, 243 consecutive patients underwent proximal aortic surgical treatment through the ministernotomy approach at the Cardiac Surgery Unit of the Lancisi Cardiovascular Center of Ancona - Polytechnic University of Marche, Italy. In all cases, a preoperative computed tomography scan was performed.

Results: The mean age of the population was 65 ± 12 years, and 176 patients (72%) were male. Aortic valve disease occurred in 66.9% of cases (n=85) with significant aortic valve regurgitation or stenosis in 127 (52%) and 44 (18%) patients, respectively. Bicuspid aortic valve was found in 29% of patients (n=70). Surgical procedures included aortic root operations (n=88) using Bentall (n=64) or David (n=24) technique, isolated replacement of the ascending aorta (n=73), and combined treatment: replacement of the ascending aorta and the aortic valve (n=82). The 30-day mortality and stroke rate was 0.4%. In 132 patients (54%), extubation occurred within the first 6 h after surgical treatment. The median hospital stay was 7 days with 48% (n=107) of patients discharged home without need for any cardiac rehabilitation.

Conclusions: Minimally invasive thoracic aortic surgery can be performed successfully at specialized cardiac surgery centers. Preoperative careful and accurate analysis of patient's computed tomography scan is essential to promote patient-tailored planning and promote optimal surgical exposure.

Out-of-hospital cardiac arrest is one of the leading causes of death in developed countries and is a real challenge because survival rates are still very low, often less than 10%. Cardiac arrest registries have proven to be an essential tool in improving the survival of cardiac arrest victims, as they allow us to measure the phenomenon and consequently improve treatment. Ten years ago, we have started collecting data in the province of Pavia, then extended to the provinces of Brescia, Como, Cremona, Lodi, Mantua and Varese, with the aim of achieving regional coverage. The systematic and automatic collection of data has allowed us to monitor numerically and geographically many aspects of cardiac arrest, thus answering many questions and providing evidence that can lead to improvements in the system and care. The purpose of this review is to share the potential of a regional registry to bring the cardiology community closer to this topic, so that other registries can be created and grow in the hope of merging them into a national registry in the future.

Heart failure (HF) is a clinical syndrome with high morbidity and mortality, characterized by periods of relative clinical stability and exacerbations of HF, known as worsening heart failure (WHF). WHF is currently defined as a deterioration of HF signs and symptoms, necessitating an intensification of medical therapy, often identified by an increase in diuretic therapy. Episodes of WHF, whether they result in patient hospitalization or outpatient management, suggest clinical progression of HF with significant worsening of the prognosis. Although the prognostic impact of WHF is well documented in the literature, its current definition has limitations, and its management remains suboptimal and non-standardized, particularly in outpatient settings. Additionally, early detection of WHF episodes, preventing possible patient hospitalization, is crucial for improving prognosis and is still underemphasized in major HF clinical trials. This review aims to report the prevalence of WHF and the limitations of its current definition, and to provide suggestions for the appropriate management of WHF episodes, with a special focus on early and outpatient recognition.

Takotsubo syndrome is an acquired pathological condition that occurs mainly in postmenopausal women in response to stressful events of a variety of psychophysical nature and, especially in the acute phase, may be indistinguishable from acute coronary syndrome. The clinical presentation of Takotsubo syndrome is characterized by chest pain, an increase in biomarkers of myocardial necrosis, wall motion abnormalities and ECG changes that may completely overlap with cardiac ischemia. It is therefore of paramount importance to make a correct differential diagnosis between these two conditions, which have different therapeutic and prognostic implications. As evidence of this, we report the case of a Takotsubo syndrome with an atypical ECG presentation, known as the de Winter pattern, suggestive of acute coronary syndrome. This case report further highlights the need for urgent coronary angiography combined with ventriculography to allow for a proper differential diagnosis.