[Secondary atrial tricuspid regurgitation: an underestimated but increasingly clinically relevant valve disorder].

Atrial secondary tricuspid regurgitation (A-STR) is a complex and increasingly recognized form of valvular heart disease that arises primarily due to right atrial and tricuspid annular dilation in the absence of intrinsic leaflet pathology. Unlike ventricular secondary tricuspid regurgitation, which is driven by right ventricular remodeling, A-STR is predominantly associated with atrial fibrillation, heart failure with preserved ejection fraction, and other conditions that lead to chronic right atrial remodeling. This condition has been underappreciated despite its significant prevalence and impact on patient morbidity and mortality.

Predicting Response to Switching From Phosphodiesterase Type 5 Inhibitor to Riociguat in Patients With Pulmonary Arterial Hypertension: Biomarker and Responder Analysis of the RESPITE and REPLACE Studies.

This exploratory analysis assessed whether plasma biomarkers predict the response to switching from phosphodiesterase type 5 inhibitors (PDE5is) to the soluble guanylate cyclase stimulator riociguat in patients with pulmonary arterial hypertension. Selected biomarkers at baseline and their changes to Week 24 were evaluated in patients with and without a favorable response to riociguat in two trials: RESPITE, in which patients with an inadequate response to PDE5i were switched to riociguat; and REPLACE, in which patients at intermediate risk of 1-year mortality despite a PDE5i were randomized to remain on PDE5i or were switched to riociguat. A response was defined as absence of clinical worsening and at least two of the following criteria: 6-min walk distance increase by 10% or ≥ 30 m, World Health Organization functional class I/II, or -terminal prohormone of brain natriuretic peptide reduction of ≥ 30% at Week 24.

Oral Anticoagulants in Chronic Thromboembolic Pulmonary Hypertension: Tradition or Innovation?

Chronic thromboembolic pulmonary hypertension (CTEPH) can complicate the clinical course of patients with acute pulmonary embolism, with a variable prevalence of 0.5-4%. Beyond specific therapeutic strategies, including pulmonary endarterectomy, balloon pulmonary angioplasty and pulmonary vasodilators, lifelong anticoagulation still represents the mainstay of treatment for this condition.

Long-term clinical impact of sex disparities in patients with ST elevation acute myocardial infarction: a systematic review and meta-analysis of adjusted observational studies.

Objectives: We aimed to address an evidence gap by investigating the clinical impact of sex differences on long-term outcomes after primary percutaneous coronary intervention (pPCI) for acute ST-elevation myocardial infarction.

Design: Systematic review and meta-analysis.

Data Sources: Medline, Scopus and EMBASE were searched through August 2024.

Pentaspline Pulsed Field Ablation Versus High-Power Short-Duration/Very High-Power Short-Duration Radiofrequency Ablation in Atrial Fibrillation: A Meta-Analysis.

Background: Pulsed field energy has been proposed as alternative to radiofrequency energy in atrial fibrillation (AF) ablation.

Objective: To compare data from studies assessing AF ablation with pulsed field ablation (PFA) versus high-power short-duration (HPSD) or very HPSD (vHPSD) radiofrequency ablation (RFA) in terms of AF recurrence, procedure-related complications, fluoroscopy and procedure times.

Methods: A search of online scientific libraries (from inception to October 1, 2024) was performed.

Hypertrophic Cardiomyopathy and Phenocopies: New Therapies for Old Diseases-Current Evidence and Future Perspectives.

The hypertrophic cardiomyopathy (HCM) clinical phenotype includes sarcomeric HCM, which is the most common form of inherited cardiomyopathy with a population prevalence of 1:500, and phenocopies such as cardiac amyloidosis and Anderson-Fabry disease, which are considered rare diseases. Identification of cardiac and non-cardiac red flags in the context of multi-organ syndrome, multimodality imaging, including echocardiography, cardiac magnetic resonance, and genetic testing, has a central role in the diagnostic pathway. Identifying the specific disease underlying the hypertrophic phenotype is very important since many disease-modifying therapies are currently available, and phase 3 trials for new treatments have been completed or are ongoing.

Implications of Oxidative Stress in the Pathophysiological Pathways of Heart Failure.

Heart failure (HF) is a major socioeconomic problem worldwide, associated with high morbidity and mortality due to several underlying diseases. HF is driven by several closely linked mechanisms whose effects are mutually reinforcing. Some of the signalling pathways involved in the progression of HF may initially be compensatory, such as the renin-angiotensin-aldosterone system (RAAS), whose hyperactivation plays a central role in the progression of HF by promoting fluid retention, inflammation, oxidative stress (OS), and myocardial dysfunction.

Early in-hospital use of SGLT2i in heart failure patients with ischemic etiology.

Purpose: SGLT2i role in the treatment of heart failure (HF) regardless of clinical presentation and left ventricular ejection fraction (LVEF) has been widely proven and real-world data regarding patients with HF and ischemic heart disease (IHD) and, in particular with recent acute coronary syndrome (ACS) and de novo HF, are lacking. We aim to evaluate the occurrence of the composite of cardiovascular death (CV)/ HF hospitalization (HFH), all-cause death, CV death and HFH at 6 months follow up, in patients with HF due to IHD as well as in recent ACS who introduced SGLT2i during the index hospitalization.

Methods: The present is an observational, prospective, single center study, enrolling patients with a diagnosis of HF due to IHD as primary etiology.

Expert consensus document on artificial intelligence of the Italian Society of Cardiology.

Artificial intelligence (AI), a branch of computer science focused on developing algorithms that replicate intelligent behaviour, has recently been used in patients management by enhancing diagnostic and prognostic capabilities of various resources such as hospital datasets, electrocardiograms and echocardiographic acquisitions. Machine learning (ML) and deep learning (DL) models, both key subsets of AI, have demonstrated robust applications across several cardiovascular diseases, from the most diffuse like hypertension and ischemic heart disease to the rare infiltrative cardiomyopathies, as well as to estimation of LDL cholesterol which can be achieved with better accuracy through AI. Additional emerging applications are encountered when unsupervised ML methodology shows promising results in identifying distinct clusters or phenotypes of patients with atrial fibrillation that may have different risks of stroke and response to therapy.

Coronary microcirculation in myocardial ischemia: A genetic perspective.

Coronary microvascular dysfunction (CMD) is a major contributor to ischemic heart disease (IHD), acting both independently and together with atherosclerosis. CMD encompasses structural and functional microcirculatory changes that result in dysregulated coronary blood flow. Structural abnormalities include microvascular remodeling, resulting in arteriolar and capillary narrowing, perivascular fibrosis and capillary rarefaction.

Sotatercept in Patients with Pulmonary Arterial Hypertension at High Risk for Death.

Background: Sotatercept improves exercise capacity and delays the time to clinical worsening in patients with World Health Organization (WHO) functional class II or III pulmonary arterial hypertension. The effects of add-on sotatercept in patients with advanced pulmonary arterial hypertension and a high risk of death are unclear.

Methods: In this phase 3 trial, we randomly assigned patients with pulmonary arterial hypertension (WHO functional class III or IV) and a high 1-year risk of death (Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management Lite 2 risk score, ≥9) who were receiving the maximum tolerated dose of background therapy to receive add-on sotatercept (starting dose, 0.

The right ventricle: the co-star in the complex history of heart failure.

The natural history of patients with heart failure (HF), mainly affecting the left ventricle in the initial stages, is marked by the progressive involvement of the right ventricle (RV), which in the advanced stages of the disease becomes dilated and dysfunctional. The geometrical, functional, and pathological interdependence binding the two ventricles underlies this progressive path. Researchers' and clinicians' efforts must be aimed at interrupting the inevitable trajectory of HF, by preventing the development of pulmonary hypertension (PH) and RV dysfunction or the transition from isolated post-capillary PH to combined pre- and post-capillary PH.

Myocarditis and pericarditis during COVID-19 pandemic: a study of the Italian Society of Cardiology.

Aims: Some studies about myocarditis and pericarditis following COVID-19 vaccination raised concerns worldwide. However, the heterogeneous diagnostic criteria for postvaccination inflammatory heart diseases may result in overestimating incidence rates. The aim of this multicentre Italian registry is to evaluate the impact of COVID-19 vaccines on the incidence of myocarditis and pericarditis in the Italian population.

SGLT2i reduce arrhythmic events in heart failure patients with cardiac implantable electronic devices.

Background: Sodium glucose cotransporter 2 inhibitors (SGLT2i) represent one of the four pillars of heart failure (HF) pharmacological therapy.

Objective: The study aims to clarify SGLT2i antiarrhythmic effect on patients with HF with reduced ejection fraction (HFrEF) in terms of atrial and ventricular arrhythmias (AAs and VAs) reduction.

Methods: HFrEF carriers of implantable cardioverter defibrillator (ICD) or cardiac resynchronization therapy defibrillator (CRT-D) followed by remote monitoring of Policlinico Umberto I of Rome for 1 year before and after SGLT2i therapy initiation were enrolled in the study.

Right heart reverse remodeling: .

Pulmonary arterial hypertension (PAH) is characterized by pulmonary vascular remodeling and arterial narrowing, leading to a progressive rise in right ventricular (RV) afterload and poor survival outcomes. PAH prognosis largely depends on RV remodeling and function: when the increased afterload exceeds the RV's adaptive capacity, ventricular-arterial uncoupling occurs, ultimately causing right heart failure and death. In this clinical setting the primary treatment goal is to achieve low mortality risk and right heart reverse remodeling (RHRR).

The Early Pharmacological Strategy with Inodilator, bEta-blockers, Mineralocorticoid Receptor Antagonists, Sodium-glucose coTransporter-2 Inhibitors and Angiotensin Receptor-neprylisin Inhibitors in Acute Heart Failure (PENTA-HF).

Purpose: The management of acute heart failure (AHF) is crucial and challenging. Regarding the use of inotropes, correct patient selection and time of administration are of the essence. We hypothesize that the early use of Levosimendan favouring hemodynamic stabilization and enables rapid optimization of guideline-directed medical therapy (GDMT) in patients with HF, eventually impacting the patient's prognosis during the vulnerable phase.

Echocardiography of the right heart in pulmonary arterial hypertension: insights from the ULTRA RIGHT VALUE study.

Aims: Outcome in pulmonary arterial hypertension (PAH) is determined by right ventricular (RV) function adaptation to increased afterload. Echocardiography is easily available to assist bedside evaluation of the RV. However, no agreement exists about the feasibility and most relevant measurements.

Prognostic Value of Advanced Echocardiographic Analysis for Transcatheter Aortic Valve Replacement: A Systematic Review.

Transcatheter aortic valve implantation (TAVI) is the main treatment option for patients with severe aortic stenosis (AS) and older age. Improved imaging techniques have enabled better patient selection, and the main role is played by echocardiography. Methods more sensitive than LVEF in assessing cardiac function, such as global longitudinal strain (GLS) and myocardial work (MW), have become widespread, and other methods, like hemodynamic forces (HDFs), might be promising.

MicroRNA and Heart Failure: A Novel Promising Diagnostic and Therapeutic Tool.

Heart failure (HF) has a multifaceted and complex pathophysiology. Beyond neurohormonal, renin-angiotensin-aldosterone system, and adrenergic hyperactivation, a role for other pathophysiological determinants is emerging. Genetic and epigenetic factors are involved in this syndrome.

The impact of vaccination status on post-acute sequelae in hospitalized COVID-19 survivors using a multi-disciplinary approach: An observational single center study.

Background: COVID-19 vaccines reduced mortality, hospitalizations and ICUs admissions. Conversely, the impact of vaccination on Long COVID-19 syndrome is still unclear. This study compared the prevalence of post-acute sequelae at short and long-term follow-up among hospitalized unvaccinated and vaccinated COVID-19 survivors through a multidisciplinary approach.

Treatment With Oral or Inhaled Treprostinil in Patients With Pulmonary Arterial Hypertension and Cardiovascular Comorbidities.

Background: An increasing number of patients with pulmonary arterial hypertension (PAH) have cardiovascular comorbidities. However, the effects of comorbidities on responses to PAH treatment are not well understood.

Research Question: Do cardiovascular comorbidities in patients with PAH influence the efficacy and tolerability of inhaled or oral treprostinil?

Study Design And Methods: All patients from phase 3 studies Clinical Investigation Into Inhaled Treprostinil Sodium in Patients With Severe Pulmonary Arterial Hypertension (TRIUMPH) (N = 235) and Phase III Clinical Worsening Study of UT-15C in Subjects With PAH Receiving Background Oral Monotherapy (FREEDOM-EV) (N  =  690) were included in this post hoc analysis and were classified as having 0, ≥ 1, or ≥ 2 cardiovascular comorbidities of interest based on patient medical history.

Celiac Disease and Inflammatory Cardiomyopathies: Exploring the Heart-Gut Axis.

: Celiac disease (CD) is associated with an increased risk of cardiovascular (CV) events, especially inflammatory heart diseases. We aimed to gather evidence on the association between CD and inflammatory CV diseases, including pericarditis and myocarditis, and the underlying pathophysiological mechanisms. : The PubMed, Scopus, and Google Scholar databases were searched for studies assessing the prevalence and the long-term outcomes of patients with CD and inflammatory CV diseases.

Sodium-Glucose Cotransporter 2 Inhibitor Therapy in Different Scenarios of Heart Failure: An Overview of the Current Literature.

Heart failure (HF) is a complex syndrome that requires tailored and patient-centered treatment. Sodium-glucose cotransporter 2 inhibitors (SGLT2is) constitute one of the four pillars of the medical treatment of HF. However, the 2023 ESC guidelines treat HF as a single entity without making clear distinctions in phenotypes according to etiology.

The in-hospital administration of sacubitril/valsartan in acute myocardial infarction: A meta-analysis.

There is a need to address the evidence gap regarding the in-hospital administration of sacubitril/valsartan in acute myocardial infarction patients. After searching MEDLINE, Google Scholars and Scopus, a random-effects meta-analysis of randomized controlled trials comparing the in-hospital administration of the angiotensin receptor-neprilysin inhibitors (ARNis) versus the standard therapy in patients with reduced heart failure due to myocardial infarction was performed. The primary outcome was major adverse cardiovascular events.