Imagenomics and Ventricular Arrhythmia: The Scar, The Channel, The Variant.

Background: Imagenomics is an emerging clinical framework that combines advanced imaging and genetic profiling to refine risk stratification and advance precision medicine in the management of ventricular arrhythmias.

Case Summary: A 43-year-old woman presented with palpitations and presyncope. Ambulatory electrocardiogram revealed frequent premature ventricular contractions and nonsustained ventricular tachycardia, consistently initiated by a premature ventricular contraction with distinct morphology.

[Artificial intelligence-enhanced ECG interpretation: a new era for electrocardiography?].

Artificial intelligence (AI) is redefining ECG interpretation, transforming it from a static diagnostic tool into a dynamic, predictive, and integrative instrument. Although widespread, traditional rule-based ECG analysis has limitations in accuracy and adaptability, especially in complex clinical settings. In contrast, AI-driven models, particularly those employing machine learning and deep learning architectures, have demonstrated improved diagnostic performance across a broad spectrum of cardiovascular diseases, including atrial fibrillation, acute myocardial infarction, hypertrophic cardiomyopathy, and valvular heart disease.

Revisiting type 2 myocardial infarction: Unmet clinical needs.

Cardiovascular disease is the most common cause of mortality and morbidity worldwide and acute coronary syndrome (ACS) is often the first clinical manifestation. Currently, the diagnosis of acute myocardial infarction (AMI) is based on the fourth universal definition of myocardial infarction (MI), with different subtypes based on their pathophysiological background. While type 1 myocardial infarction (T1MI) is defined by an acute coronary event with plaque disruption and consequent athero-thrombosis, type 2 myocardial infarction (T2MI) is defined as an event due to oxygen demand and supply imbalance, unrelated to acute coronary athero-thrombosis.

Preeclampsia: Insights into pathophysiological mechanisms and preventive strategies.

Preeclampsia is a hypertensive disorder of pregnancy associated with significant maternal and fetal complications. Its pathogenesis involves endothelial dysfunction, abnormal placentation, and coagulation abnormalities, leading to increased thrombotic and hemorrhagic risks. This narrative review provides an in-depth overview of the pathophysiological mechanisms underlying preeclampsia, with a particular focus on its thrombotic and hemorrhagic complications.

Gender and Sex-related differences in Type 2 Myocardial Infarction: the undervalued side of a neglected disease.

Type 2 myocardial infarction (T2MI) occurs due to an imbalance between coronary blood supply and myocardial oxygen demand, leading to ischemia without the rupture of an atherosclerotic plaque, distinguishing it from Type 1 myocardial infarction (T1MI). Although T2MI is frequently diagnosed in clinical practice and associated with a poor prognosis, there is limited understanding of the sex differences in this condition, despite women representing a higher proportion of T2MI cases compared to T1MI. This review explores the definitions, epidemiological aspects, and clinical scenarios that reveal significant differences in T2MI between men and women that contribute to disparities in outcomes.

Aortic valve and coronary artery calcium scoring: impact of half- versus standard-dose protocols.

Aims: CT acquisition parameters and reconstruction techniques may affect the accuracy of calcium scoring measurements with a potential impact on clinical decision making. We evaluated the agreement of half- versus standard-dose protocols for assessment of aortic valve (AVCS HD and AVCS SD protocols) and coronary artery calcium scoring (CACS HD and CACS SD protocols) with and without the application of iterative reconstruction.

Methods: We enrolled 144 consecutive patients (mean age 83 ± 9 years) with known aortic stenosis undergoing 128-row prospective sequential CT with standard (120 kVp/20 mAs) and half-dose (120 kVp/10 mAs) protocols for both AVCS and CACS evaluation.

Early prescription of SGLT2i for acute patient care: from current evidence to future directions.

Sodium-glucose cotransporter 2 inhibitors (SGLT2i) have emerged as transformative therapies in the management of chronic heart failure (HF), offering substantial reductions in mortality and hospitalizations. Beyond their initial classification as diuretics, SGLT2i exert a spectrum of cardioprotective effects that extend far beyond renal modulation. By activating autophagic pathways and mimicking a starvation-like state, SGLT2i enhance cellular bioenergetics and mitigate acute injury, potentially underpinning both their immediate and sustained cardiometabolic benefits when administered early in acute care settings.

Arrhythmogenic cardiomyopathy diagnosis and management: a systematic review of clinical practice guidelines and recommendations with insights for future research.

Arrhythmogenic cardiomyopathy (ACM) is addressed in international guidelines and expert consensus statements. To assist clinicians in their routine practice and support decision-making, we performed a systematic review of the most relevant guidelines and recommendations for ACM diagnosis and management. Our search, covering MEDLINE, EMBASE, and resources from scientific societies over the last 10 years, identified two guidelines and three consensus statements that met rigorous inclusion criteria for detailed analysis.

Comparison of mortality trends in patients with rheumatic mitral valve disease and nonrheumatic mitral valve disease: A retrospective study in US from 1999 to 2020.

Background: Mitral valve disease (MVD) can have both rheumatic and nonrheumatic etiologies. However, differences in mortality remain unknown.

Methods: We extracted age-adjusted mortality rates (AAMRs) per 100,000 persons from the CDC WONDER database and stratified them by sex, region, and race.

Current trends and challenges in the clinical use of cardiovascular magnetic resonance: a survey from the Italian Society of Cardiology.

Aims: Challenges related to the use of cardiovascular magnetic resonance (CMR) remain a key issue to secure its full clinical impact. This survey aimed to assess the awareness of CMR clinical utility and to collect data on its local usage levels, operational barriers, and report efficacy, with the goal of identifying key obstacles to its effective implementation across Italy.

Methods And Results: The CMR Working Group of the Italian Society of Cardiology promoted an online survey targeting Italian physicians involved in direct care of patients with cardiovascular disease.

Four-dimensional flow provides incremental diagnostic value over echocardiography in aortic stenosis.

Aims: Four-dimensional flow cardiovascular MRI (4D flow CMR) has emerged as a promising technique for assessing aortic stenosis (AS). This study aimed to evaluate the agreement between 4D flow CMR and transthoracic echocardiography (TTE) in estimating peak aortic valve (AV) velocities (V), grading AS severity and predicting AV intervention in a real-world setting.

Methods: Participants from the PREFER-CMR registry who had consecutive TTE and 4D flow CMR were included.

Dilated cardiomyopathy evaluation with Imagenomics: combining multimodal cardiovascular imaging and genetics.

Dilated cardiomyopathy (DCM) is a clinical diagnosis characterized by the presence of left ventricular dilatation and systolic dysfunction unexplained by abnormal loading conditions or coronary artery disease. However, a broad range of phenotypic manifestations, encompassing isolated scar, DCM with preserved ejection fraction, and overt DCM, should be regarded as a diagnostic classification representing a broad spectrum of underlying aetiologies, including both inherited and acquired heart muscle disorders. A multimodal non-invasive imaging approach is essential for accurate morpho-functional assessment of cardiac chambers and is key to establish the cardiac phenotype and to rule out an underlying ischaemic aetiology.

Tracing Visual Expertise in ECG Interpretation: An Eye-Tracking Pilot Study.

Background: Visual expertise is pivotal for accurate ECG interpretation. We aimed to identify and measure expertise-based differences in visual search patterns, cognitive load, and diagnostic accuracy during ECG analysis using eye-tracking technology.

Methods: First- to third-year residents and board-certified expert cardiologists interpreted ECGs of patients with suspected acute coronary syndrome, while eye-tracking glasses recorded fixation count, duration, and pupil dilation.

Design of lipid-based formulations for oral delivery of a BASP1 peptide targeting MYC-dependent gastrointestinal cancer cells.

Hypothesis: Oral delivery of the proliferation-inhibiting brain acid-soluble protein 1 effector domain peptide (Myr-NT) towards MYC-dependent gastrointestinal tumors can be achieved by forming hydrophobic ion pairs (HIPs) and incorporating them into lipid-based formulations.

Experiments: Hydrophobic ion pairing of fluorescently-labelled Myr-NT (Myr-NT-TAMRA) was performed, increase in lipophilicity was assessed, and the most promising HIP was subsequently incorporated into a nanoemulsion. Stability of the peptide towards degradation by trypsin was evaluated.

Mixed dry reverse micelles: potential carriers for oral protein delivery via SEDDS.

The aim of this study was to evaluate the potential of mixed dry reverse micelles (dRMs) to increase the lipophilicity of therapeutic proteins and allow their incorporation into self-emulsifying drug delivery systems (SEDDS). Horseradish peroxidase (HRP) was incorporated in mixed dRMs, forming HRP-dRMs, using soybean phosphatidylcholine (SPC) and sodium docusate (SD) as surfactants. HRP-dRMs were characterized with respect to their distribution coefficient and stability in simulated physiological fluids.

Practical guidance for management of atrial fibrillation in sports cardiology.

Importance: Atrial fibrillation (AF), the most prevalent sustained arrhythmia, portends higher risk of cardiovascular morbidity and mortality, and is associated with quantifiable impairment in quality of life. While physical activity is widely recognized for its cardiovascular benefits, recent evidence challenges its role in the development of AF.

Observations: Emerging data suggest a U-shaped relationship between physical activity and AF risk.

Optimizing hydrophilic drug incorporation into SEDDS using dry reverse micelles: a comparative study of preparation methods.

Aim: It was the aim of this study to compare two different dry reverse micelle (RM) preparation methods for the incorporation of hydrophilic drugs into oral self-emulsifying drug delivery systems (SEDDS).

Methods: Cationic ethacridine lactate, anionic fluorescein sodium salt and the antibiotic peptide bacitracin were solubilized in RM containing sodium docusate, soy phosphatidylcholine and sorbitan monooleate in highly lipophilic oils such as squalane. In the dry addition (DA) method, drugs were directly added to empty RM in their powder form.

ECG Patterns of Occlusion Myocardial Infarction: A Narrative Review.

The traditional management of acute coronary syndrome has relied on the identification of ST-segment elevation myocardial infarction (STEMI) as a proxy of acute coronary occlusion. This conflation of STEMI with acute coronary occlusion has historically overshadowed non-ST-segment elevation myocardial infarction (NSTEMI), despite evidence suggesting 25% to 34% of NSTEMI cases may also include acute coronary occlusion. Current limitations in the STEMI/NSTEMI binary framework underscore the need for a revised approach to chest pain and acute coronary syndrome management.

Hypertrophic cardiomyopathy management: a systematic review of the clinical practice guidelines and recommendations.

Aims: In light of recent advances in imaging techniques, molecular understanding and therapeutic options in hypertrophic cardiomyopathy (HCM), we performed a systematic review of current guidelines for the diagnosis and management of HCM in order to identify consensus and discrepant areas in the clinical practice guidelines.

Methods And Results: We systematically reviewed the English language guidelines and recommendations for the management of HCM in adults. MEDLINE and EMBASE databases were searched for guidelines published in the last 10 years.

Hydrophobic ion pairing: lipophilicity improvement of anionic macromolecules by divalent cation mediated complex formation.

The aim of this study was to develop an alternative strategy to sufficiently increase the lipophilicity of anionic model macromolecules (MM) without the use of cationic counterions. Enoxaparin (ENO), insulin (INS) and poly-L-glutamic acid (PLG) were ion paired with anionic surfactants (sodium decanoate (DEC), sodium dodecyl sulfate (SDS), sodium stearate (SS) and sodium octadecyl sulfate (SOS)), mediated by divalent cations such as magnesium, calcium and zinc. Complexes were evaluated regarding their precipitation efficiency and logD.

Diagnosis and management of dilated cardiomyopathy: a systematic review of clinical practice guidelines and recommendations.

Dilated cardiomyopathy (DCM) is extensively discussed in numerous expert consensus documents and international guidelines, with differing recommendations. To support clinicians in daily practice and decision-making, we conducted a systematic review of key guidelines and recommendations concerning the diagnosis and clinical management of DCM. Our research encompassed MEDLINE and EMBASE databases for relevant articles published, as well as the websites of relevant scientific societies.

Clot-in-transit and pulmonary embolism: an urgent call for awareness and action.

Patients with acute pulmonary embolism (PE) have a wide spectrum of clinical presentations, from incidental findings to sudden cardiac death. Management and treatment recommendations in currently available guidelines vary according to patient risk and haemodynamic profile. A clot-in-transit (CiT) in the right heart chambers may be occasionally identified and is, therefore, an under-recognised but challenging condition, often preceding an abrupt clinical deterioration, and associated with increased mortality.