Coronary flow reserve increase after 4-year dapagliflozin treatment in patients with type 2 diabetes: the DAPAHEART follow-up study.

Background: Cardiovascular (CV) outcome trials have shown that sodium-glucose cotransporter-2 inhibitors (SGLT2i) reduce CV mortality in type 2 diabetes (T2DM). We previously found that 4 weeks of SGLT2i treatment increased coronary flow reserve (CFR) by 30% and reduced epicardial adipose tissue (EAT) thickness by 19% in T2DM patients with stable coronary artery disease (CAD). However, long-term effects remain unclear.

Strain-derived myocardial work indices in adult cancer survivors: results from an observational study and comparison with available reference ranges.

Aims: Adult survivors of haematological malignancies are at increased risk of long-term cardiovascular sequelae. Several echocardiographic metrics have been tested to detect subclinical myocardial dysfunction before it progresses toward cardiac events. Myocardial work (MW) is a load-independent echocardiographic index that conjugates non-invasive arterial blood pressure and global longitudinal strain (GLS).

Atrioventricular Node Dysfunction in Heart Failure: New Horizons from Pathophysiology to Therapeutic Perspectives.

Heart failure (HF) is characterized by adverse myocardial remodeling involving both the contractile cardiomyocytes and the conduction tissue. HF is often associated with atrioventricular (AV) node dysfunction, which frequently leads to conduction delays and subsequent dyssynchrony ultimately related to adverse clinical outcomes. Despite its clinical relevance, AV node pathology in HF remains poorly explored.

Adverse cardiovascular events in coronary Plaques not undeRgoing pErcutaneous coronary intervention evaluateD with optIcal Coherence Tomography. The PREDICT-AI risk model.

Introduction: Most acute coronary syndromes (ACS) originate from coronary plaques that are angiographically mild and not flow limiting. These lesions, often characterised by thin-cap fibroatheroma, large lipid cores and macrophage infiltration, are termed 'vulnerable plaques' and are associated with a heightened risk of future major adverse cardiovascular events (MACE). However, current imaging modalities lack robust predictive power, and treatment strategies for such plaques remain controversial.

Clinical outcomes in women and men with raphe-type bicuspid aortic valve stenosis undergoing transcatheter aortic valve replacement.

Background: There is paucity of data regarding sex-related differences among patients with bicuspid aortic valve (BAV) undergoing transcatheter aortic valve replacement (TAVR).

Methods: The AD-HOC was an observational, retrospective, investigator-initiated registry enrolling consecutive patients with Sievers type 1 BAV stenosis who underwent TAVR at 24 international centers from 2016 to 2023. The primary endpoint was major adverse events (MAEs), including death, neurologic events and heart failure hospitalization.

Transcatheter Aortic Valve Replacement With Balloon- Versus Self-Expandable Bioprostheses for the Treatment of Bicuspid Aortic Valve Stenosis.

Background: Differences between balloon- and self-expandable transcatheter heart valves (BE-THVs and SE-THVs, respectively) may influence the outcomes of transcatheter aortic valve replacement for bicuspid aortic valve (BAV) stenosis.

Methods: Consecutive patients undergoing transcatheter aortic valve replacement with BE-THV or SE-THV for computed tomography-diagnosed bicuspid aortic valve stenosis at 29 centers were included. The primary outcome was death or stroke.

Généreux staging classification in predicting left ventricular reverse remodeling after intervention for severe aortic valve regurgitation.

Aims: Severe native aortic regurgitation (AR) is characterized by a progressive left ventricular (LV) dysfunction and remodeling which, up to a certain degree, can be reversed by surgical aortic valve replacement (SAVR) or transcatheter aortic valve implantation (TAVI). We aimed to investigate how Généreux staging classification could predict left ventricular reverse remodeling (LVRR).

Methods: This monocentric retrospective study analyzes data from 103 patients (29 % female) treated for pure chronic AR in whom echocardiographic examinations had been made before the procedure, in the early postoperative period (48-72 h), and at mid-term follow-up (6 months).

Uncovering Plaque Erosion: A Distinct Pathway in Acute Coronary Syndromes and a Gateway to Personalized Therapy.

Plaque erosion (PE) is now recognized as a common and clinically significant cause of acute coronary syndromes (ACSs), accounting for up to 40% of cases. Unlike plaque rupture (PR), PE involves superficial endothelial loss over an intact fibrous cap and occurs in a low-inflammatory setting, typically affecting younger patients, women, and smokers with fewer traditional risk factors. The growing recognition of PE has been driven by high-resolution intracoronary imaging, particularly optical coherence tomography (OCT), which enables in vivo differentiation from PR.

From Vision to Illumination: The Promethean Journey of Optical Coherence Tomography in Cardiology.

Optical Coherence Tomography (OCT) has evolved from a breakthrough ophthalmologic imaging tool into a cornerstone technology in interventional cardiology. After its initial applications in retinal imaging in the early 1990s, OCT was subsequently envisioned for cardiovascular use. In 1995, its ability to visualize atherosclerotic plaques was demonstrated in an in vitro study, and the following year marked the acquisition of the first in vivo OCT image of a human coronary artery.

Artificial Intelligence-based Approaches for Characterizing Plaque Components From Intravascular Optical Coherence Tomography Imaging: Integration Into Clinical Decision Support Systems.

Intravascular optical coherence tomography (IVOCT) is emerging as an effective imaging technique for accurately characterizing coronary atherosclerotic plaques. This technique provides detailed information on plaque morphology and composition, enabling the identification of high-risk features associated with coronary artery disease and adverse cardiovascular events. However, despite advancements in imaging technology and image assessment, the adoption of IVOCT in clinical practice remains limited.

High residual gradients after transcatheter aortic valve implantation in raphe-type bicuspid aortic valve stenosis: insights from the AD-HOC registry.

Background: Bicuspid aortic valve (BAV) stenosis poses several challenges when transcatheter aortic valve implantation (TAVI) is performed, including the risk of high residual gradients (HRG).

Objective: To identify incidence, predictors and outcomes of HRG after TAVI in Sievers type 1 BAV stenosis.

Methods: Consecutive patients with Sievers type 1 BAV stenosis undergoing TAVI at 24 international centers from 2016 to 2023 were enrolled.

Advanced Analyses of Coronary Computed Tomography Angiography to Predict Future Cardiac Events: A Meta-Analysis.

Background: Although coronary computed tomographic angiography (CTA) is widely used for anatomical evaluation, its advanced analyses, including plaque characterization, computed tomography-derived fractional flow reserve (CT-FFR), and radiomics signature extraction, hold promise for improved prediction of major adverse cardiovascular events (MACE).

Objectives: The aim of this meta-analysis was to assess the added prognostic value of advanced coronary CTA-based analyses in predicting MACE.

Methods: A systematic search of PubMed, Embase, and CENTRAL identified studies reporting coronary CTA-based advanced analyses predicting MACE.

The Impact of THV Platforms on Transfemoral TAVR in Complex Vascular Access: Insights From the Hostile Registry.

Background: The choice of transcatheter heart valve (THV) platform, including self-expanding valves (SEVs) and balloon-expandable valves (BEVs), may influence outcomes in patients with peripheral artery disease (PAD) undergoing transfemoral transcatheter aortic valve replacement (TAVR). This relationship remains underexplored in high-risk populations with challenging vascular access.

Aims: This study assessed the impact of SEVs and BEVs on clinical outcomes in PAD patients, considering hostile score severity.

Unveiling the Causes of Acute and Non-Acute Myocardial Ischemic Syndromes: The Role of Optical Coherence Tomography.

Despite significant advances in understanding and management, cardiovascular diseases remain the leading cause of mortality worldwide. Historically, diagnostic and therapeutic strategies have typically targeted obstructive coronary arteries. However, growing evidence supports the pivotal role of non-obstructive mechanisms in myocardial ischemia, prompting a new classification that distinguishes Acute Myocardial Ischemic Syndromes from Non-Acute Myocardial Ischemic Syndromes.

Validation of machine learning angiography-derived physiological pattern of coronary artery disease.

Aims: The classification of physiological patterns of coronary artery disease (CAD) is crucial for clinical decision-making, significantly affecting the planning and success of percutaneous coronary interventions (PCIs). This study aimed to develop a novel index to reliably interpret and classify physiological CAD patterns based on virtual pullbacks from single-view Murray's law-based quantitative flow ratio (μFR) analysis.

Methods And Results: The pullback pressure gradient index (PPGi) was used to classify CAD patterns, with a cut-off value of PPGi = 0.

Admission reasons, procedures, and mortality of elderly patients in CICU: the SAGE-CICU study (study on acute gaps in the elderly - cardiac intensive care unit).

Background: The growing proportion of elderly patients admitted to cardiac intensive care units (CICUs) presents specific challenges, including complex comorbidity profiles, divergent diagnostic patterns, and reduced access to invasive therapies. Current guidelines, derived predominantly from younger cohorts, offer limited guidance for managing these high-risk patients. A better understanding of their acute cardiovascular care needs is crucial to support tailored clinical decision-making and effective resource allocation.

Single versus Dual Antiplatelet Therapy in Patients with Severe Peripheral Arterial Disease Undergoing TAVI: Insights from The Hostile Registry.

Aims: Single antiplatelet therapy (SAPT) has been shown to be a safer alternative to dual antiplatelet therapy (DAPT) in patients without atrial fibrillation undergoing transcatheter aortic valve implantation (TAVI). However, antithrombotic therapy for TAVI patients with severe peripheral artery disease (PAD) remains an underexplored area. This study aimed to evaluate and compare the outcomes of SAPT and DAPT in this high-risk patient population.

Iatrogenic coronary artery dissections: direct visualization and mechanistic insights from the visible heart laboratories.

Objective: Percutaneous coronary intervention (PCI) frequently causes limited coronary artery dissections, but angiography is imprecise in assessing the presence or hazard of induced dissections. Bloodless angioscopy during instructional PCI, which is possible in the Visible Heart Laboratories (VHL), can provide valuable insights into dissection morphology and creation. We aimed to investigate periprocedural coronary artery dissections in porcine hearts during educational bifurcation stenting sessions in the VHL.

Antiplatelet Therapy in Myocardial Bridge: Insights From the RIALTO Registry.

Background: Myocardial bridge (MB) is a frequent coronary artery anomaly. The aims of this study are to describe the use of antiplatelet therapy (APT) in a cohort of patients with MB and assess its impact on ischemic and bleeding events.

Methods: The RIALTO (Myocardial Bridge Evaluation Towards Personalized Medicine) registry (ID: NCT05111418) is an ambispective multicenter observational registry, enrolling patients with a clinical indication to coronary angiography and evidence of MB.

Evaluation of the Effects of the Sodium-Glucose Cotransporter 2 Inhibitors and Sacubitril/Valsartan Combined Therapy in Patients with HFrEF: An Echocardiographic Study.

Sodium-glucose cotransporter 2 inhibitors (iSGLT2) have become the fourth pillar of the medical treatment for heart failure with reduced ejection fraction (HFrEF). However, the mechanisms of action of iSGLT2 remain poorly understood. The effectiveness of combined ARNI and iSGLT2 therapy in left ventricular (LV) remodeling is still under study.

The Coronary Access After TAVI (CAvEAT) Study: A Prospective Registry of CA After TAVR.

Background: As transcatheter aortic valve replacement (TAVR) is now performed in patients with longer life expectancy, the need for coronary access (CA) after TAVR is expected to rise.

Objectives: The aim of this study was to evaluate the feasibility of CA after TAVR with 4 different types of transcatheter heart valves (THVs).

Methods: In the multicenter, prospective CAvEAT (Coronary Access After TAVI; NCT04647864) registry, coronary angiography was performed immediately following transfemoral TAVR using short-frame SAPIEN 3 or SAPIEN 3 Ultra (SAPIEN 3/Ultra) and tall-frame ACURATE neo or ACURATE neo2 (ACURATE neo/neo2), Portico or Navitor, and Evolut Pro or Evolut Pro+ (Evolut Pro/Pro+) THVs.

15-Year Outcomes of PFO Closure in Patients With Cryptogenic Embolism: Insights From the PROLONG Registry.

Background: Transcatheter patent foramen ovale (PFO) closure has become the gold-standard treatment for patients with cryptogenic embolism and PFO, but long-term outcomes data are limited.

Objectives: The aim of this study was to report the extended clinical outcomes of patients who underwent transcatheter PFO closure for cryptogenic embolism.

Methods: PROLONG (PFO Transcatheter Occlusion Long-Term Outcomes National Group) is an investigator-initiated, multicenter, retrospective registry that enrolled patients who underwent transcatheter PFO closure between 1999 and 2013 at 12 centers in Italy.