Giornale italiano di cardiologia最新文献

{"title":"[Cardioneuroablation for vasovagal syncope: rationale, evidence, and limitations of an emerging therapy].","authors":"Biagio Sassone","doi":"10.1714/4776.47988","DOIUrl":"10.1714/4776.47988","url":null,"abstract":"<p><p>Cardioneuroablation (CNA) is an emerging catheter-based neuromodulation strategy aimed at reducing vagal influence on the sinoatrial and atrioventricular nodes through ablation of atrial ganglionated plexi. Its rationale is particularly strong in forms with a predominant cardioinhibitory component, especially asystolic forms, whereas it appears weak in purely vasodepressor forms. Available evidence suggests a reduction in syncope recurrence and disease burden in selected patients, but derives largely from observational, often single-center studies, with heterogeneous selection criteria, procedural techniques, endpoints, and follow-up duration. Relevant issues remain unresolved, including placebo effect, reinnervation, post-procedural sinus tachycardia, long-term safety, and comparison with pacemaker therapy. Pending the results of ongoing randomized trials, CNA remains a promising but non-standardized therapy, to be reserved for selected patients with severe cardioinhibitory vasovagal syncope, in qualified centers and within structured pathways for systematic outcome collection.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 10","pages":"714-725"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149037651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Influenza vaccination as an intervention for cardiovascular prevention and protection in high-risk patients. SIPREC/ANMCO/SIMI/FADOI/ARCA consensus document].","authors":"Massimo Volpe, Stefania Angela Di Fusco, Dario Manfellotto, Allegra Battistoni, Giovanni Battista Zito, Andrea Montagnani, Federico Nardi, Giuseppe Di Pasquale, Nicola Montano","doi":"10.1714/4776.47989","DOIUrl":"10.1714/4776.47989","url":null,"abstract":"<p><p>Influenza infection is associated with an increase of cardiovascular events and hospitalizations due to cardiovascular disease. Influenza vaccination is in turn associated with a reduction or mitigation of cardiovascular complications of influenza. For this reason, influenza vaccination represents an additional pillar for cardiovascular prevention and protection. Recent randomized studies conducted in a very large European population have shown that high-dose influenza vaccination provides significant advantages when compared to standard-dose vaccination. These new data derived from the FLUNITY-HD pooled analysis strongly suggest that high-dose vaccination may be appropriate in elderly patients as well as in patients with cardiovascular disease in whom strengthening the immune response may provide better protection. The present consensus document has been promoted by five Italian cardiovascular or internal medicine scientific societies committed to promote cardiovascular prevention with the aim to update current knowledge on influenza vaccination and promote call-to-action initiatives in Italy to enhance the use of influenza vaccination and overcome current hesitancy and relatively low uptake in the population at risk.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 10","pages":"726-737"},"PeriodicalIF":1.5,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149037726","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Feasibility and outcomes of a structured doctor-nurse follow-up program following hospitalization for myocardial infarction or heart failure: the Phase 1 of the DIMACC Project].","authors":"Fausto Avanzini, Alfredo Corticelli, Donata Saltafossi, Luisa Chiappa, Paola Di Giulio, Lorenzo Acone, Erica Arienti, Chiara Bersano, Patrizia Bertocchi, Chiara Bova, Chiara Casarola, Alessio Conti, Giuseppe Iacuitti, Barbara Lucia, Maria Grazia Paone, Gerarda Viviana Russo, Morgana Santambrogio, Sara Tonetto, Felice Achilli","doi":"10.1714/4755.47728","DOIUrl":"10.1714/4755.47728","url":null,"abstract":"<p><strong>Background: </strong>The year following hospitalization for acute myocardial infarction (AMI) or acute heart failure (AHF) is associated with a high risk of rehospitalization and death, often related to inadequate patient follow-up. To improve care and prognosis in these patients, the DIMACC Project (DIMissioni ACCompagnate) was developed: a structured physician-nurse follow-up program aimed at ensuring continuity of care between hospital and community settings through successive phases. Phase 1 evaluated the feasibility of the program and the clinical outcomes observed during the first year.</p><p><strong>Methods: </strong>The DIMACC Project is a prospective observational quality improvement project conducted at the Cardiology Unit of Pio XI Hospital in Desio, in collaboration with the Community Health Centres of Giussano and Cesano Maderno. Patients hospitalized for AMI or AHF between May 1, 2023 and April 30, 2024 were offered 12-month risk-tailored follow-up pathways, including periodic examinations and 2-3 physician-nurse outpatient visits.</p><p><strong>Results: </strong>Of the 343 patients discharged after AMI and 133 after AHF, 263 (76.7%) and 68 (51.5%), respectively, were included in Phase 1. Follow-up was completed by 222 AMI patients (84.4%) and 53 AHF patients (77.9%). Patient adherence to the proposed follow-up and satisfaction were high. Quality of care was also high: 6 out of 7 European Society of Cardiology quality indicators of care for the follow-up of AMI and 10 out of 14 for AHF were achieved in more than 90% of cases. Adherence to recommended pharmacological treatments was high. Critical issues emerged in risk factor control and adherence to recommended lifestyle changes.</p><p><strong>Conclusions: </strong>The first year of the DIMACC Project demonstrates the feasibility of this follow-up model, and shows favourable clinical outcomes.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 9","pages":"647-657"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818054","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Acute perimyocarditis complicated by giant wall pseudoaneurysm].","authors":"Roberta D'Elia, Costanza Morea, Nicoletta Eletto, Michele Antonio Clemente, Mariarosa Liccese, Giandomenico Tarsia, Pasqualino Innelli, Maurilio Di Natale","doi":"10.1714/4756.47733","DOIUrl":"10.1714/4756.47733","url":null,"abstract":"<p><p>We present the case of a patient with a giant pseudoaneurysm in the left ventricular anterolateral wall and hemorrhagic pericardial effusion extending to the aortic arch. The patient survived after emergency aneurysmectomy and closure with a bovine pericardial patch. The pseudoaneurysm was a late complication of perimyocarditis with atypical clinical manifestations (traumatic syncope in the absence of fever). This case report is interesting because it describes a rare but possible complication of perimyocarditis and underlines the importance of multimodality imaging in the differential diagnosis between aneurysm and pseudoaneurysm.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 9 Suppl. 1","pages":"9S-12S"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Ventricular hypertrophy and pre-excitation: a diagnostic clue to PRKAG2-related cardiomyopathy].","authors":"Federico Quadrini, Davide Rodio, Pasquale Maddaluna, Gianluigi Novielli, Massimo Grimaldi","doi":"10.1714/4756.47734","DOIUrl":"10.1714/4756.47734","url":null,"abstract":"<p><p>PRKAG2-related cardiomyopathy is a metabolic phenocopy of hypertrophic cardiomyopathy characterized by ventricular hypertrophy, pre-excitation, and supraventricular arrhythmias, frequently leading to misclassification. We report the case of a 44-year-old man with a maternal family history of hypertrophic cardiomyopathy and long-standing atrial fibrillation. Cardiac magnetic resonance showed asymmetric hypertrophy, extensive late gadolinium enhancement, and early adverse remodeling, suggesting an overlap phenotype between hypertrophic cardiomyopathy and arrhythmogenic left ventricular cardiomyopathy. After primary prevention cardiac defibrillator implantation, genetic testing revealed the heterozygous PRKAG2 c.1024G>A, p.(Glu342Lys) variant, of maternal origin and classified as pathogenic by the local laboratory. Re-evaluation of the baseline ECG demonstrated a short PR interval, ventricular pre-excitation, and right bundle branch block, allowing diagnostic reclassification. This case report highlights the importance of an integrated clinical perspective and of recognizing ECG red flags in order to avoid diagnostic errors is in hypertrophic phenotypes.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 9 Suppl. 1","pages":"13S-15S"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[A case of percutaneous closure of a complex coronary artery fistula].","authors":"Gianmarco Cozzani, Carlo Mario Lombardi, Serena Finetti, Giulia Ghizzoni, Lisa Serafini, Enrico Passamonti, Matteo Della Torre, Marco Loffi","doi":"10.1714/4756.47732","DOIUrl":"10.1714/4756.47732","url":null,"abstract":"<p><p>Coronary artery fistulas (CAFs) are rare coronary anomalies defined as abnormal direct communications between a coronary artery and a cardiac chamber or great vessel. We report the case of a 66-year-old man admitted for left ventricular dysfunction (ejection fraction 40%) caused by a large, complex septal coronary artery fistula draining into the pulmonary artery, associated with a critical mid-left anterior descending artery (LAD) stenosis. Multimodal imaging (coronary angiography, coronary computed tomography, and dobutamine stress echocardiography) confirmed significant coronary steal and complex anatomical features. A sequential percutaneous approach was performed: first, fistula occlusion was achieved by deploying 15 coils via a microcatheter; subsequently, a drug-eluting stent was implanted in the mid-LAD. Final intravascular ultrasound confirmed adequate stent expansion and angiography complete fistula exclusion. The patient was discharged asymptomatic on dual antiplatelet therapy. At 3-month follow-up, an improvement of left ventricular ejection fraction was observed. This case demonstrates the feasibility of an entirely percutaneous strategy (coiling and stenting) in the management of complex coronary fistulas with multiple aneurysms and concomitant coronary artery disease.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 9 Suppl. 1","pages":"6S-8S"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818128","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Interarterial anomalous right coronary artery in a competitive athlete: case report].","authors":"Elisa Lodi, Lucia Tardini, Maria Luisa Poli, Giovanni Lodi, Emanuela Paoloni, Stefano Cappelli, Giampiero Patrizi, Maria Grazia Modena","doi":"10.1714/4756.47731","DOIUrl":"10.1714/4756.47731","url":null,"abstract":"<p><p>Anomalous origin of the right coronary artery from the left sinus of Valsalva with an interarterial course is a congenital coronary anomaly associated with myocardial ischemia and sudden cardiac death, particularly in athletes exposed to intense hemodynamic stress. In this setting, risk is dynamic and results from the interaction between anatomical features and exercise. We report the case of a 37-year-old competitive endurance athlete in whom anomalous origin of the right coronary artery from the left sinus of Valsalva with an interarterial course and an intramural segment was identified during pre-participation screening. Coronary computed tomography angiography demonstrated high-risk anatomical features, while stress cardiac magnetic resonance revealed inducible ischemia in the inferolateral myocardial territory. Invasive evaluation with intravascular ultrasound confirmed dynamic luminal compression of the intramural segment. The presence of objective ischemia represented the key determinant for clinical decision-making, leading to surgical correction with the unroofing technique. At 6-month follow-up, absence of residual ischemia allowed gradual return to competitive sports according to COCIS recommendations. This case highlights the central role of multimodality imaging in integrating anatomical and functional information, guiding risk stratification and management decisions in athletes with coronary anomalies.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 9 Suppl. 1","pages":"2S-5S"},"PeriodicalIF":1.5,"publicationDate":"2026-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148818115","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Consensus-based good clinical practice recommendations for the diagnosis and treatment of acute coronary syndromes].","authors":"Leonardo De Luca, Massimo Grimaldi, Aldo Pietro Maggioni","doi":"10.1714/4741.47569","DOIUrl":"10.1714/4741.47569","url":null,"abstract":"<p><p>Acute coronary syndromes (ACS) represent one of the leading causes of cardiovascular mortality and morbidity, with a substantial clinical, organizational, and economic impact on the Italian National Health Service (NHS). On behalf of the National Center for Clinical Excellence, Quality and Safety of Care of the Italian National Institute of Health (Istituto Superiore di Sanità, ISS), the Italian Association of Hospital Cardiologists (ANMCO) promoted the development of consensus-based recommendations for good clinical practice (RBPCA) for the diagnosis and management of ACS, with the aim of integrating and contextualizing the most recent European Society of Cardiology guidelines within the Italian healthcare setting. The recommendations were developed through a multidisciplinary Consensus Conference, according to the ISS methodological framework, addressing 16 clinical and organizational issues of major relevance related to the diagnostic and therapeutic pathway of ACS. The RBPCA aim to reduce variability in clinical management, promote appropriateness and uniformity of care, and improve clinical outcomes for patients with ACS within the context of the Italian NHS.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 8","pages":"564-592"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148601572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Artificial intelligence in hypertension: where do we stand?]","authors":"Paolo Verdecchia, Fabio Angeli, Gianpaolo Reboldi","doi":"10.1714/4741.47563","DOIUrl":"10.1714/4741.47563","url":null,"abstract":"<p><p>Artificial intelligence (AI) is entering the study of hypertension, serving both primarily clinical purposes - to assist practicing physicians - and research objectives. Hypertension presents certain specific characteristics that should be carefully considered when using AI. The measured value of blood pressure is an extremely variable parameter that is difficult to standardize and measure with precision. At present, AI is able to provide very simple, clear, and well-documented answers to clinical questions regarding the management of patients with hypertension. Its role in research is perhaps somewhat less well developed. Several studies have been published on the use of AI in identifying patients with secondary hypertension, on the risk of future hypertension in normotensive individuals, and on the risk of heart failure and other complications of hypertension. A common issue with all these studies is the relative paucity of controlled clinical trials comparing AI with traditional procedures drawing on medical literature and clinical experience (\"natural intelligence\"), precisely designed to quantify the potential superiority of AI over natural intelligence on key end-points of real clinical value. This is similar to the approach currently taken when testing a new diagnostic or therapeutic procedure. Obviously, these considerations should be viewed as encouragement, not as a barrier, to continuing clinical research in the field of AI in hypertension. It is also important that scientific articles on AI published in medical journals be written using terms that doctors can understand, to ensure transparency and interpretability.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 8","pages":"533-538"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148601579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Laboratory investigations to rule out AL amyloidosis: practical guidance for the cardiologist].","authors":"Giovanni Palladini, Leonardo De Luca, Paolo Milani, Marco Basset, Valeria Di Simone, Valentina Carini, Roberta Mussinelli, Laura Obici, Stefano Perlini, Mario Nuvolone, Riccardo Albertini","doi":"10.1714/4741.47564","DOIUrl":"10.1714/4741.47564","url":null,"abstract":"<p><p>Cardiac amyloidosis is an increasingly recognized cause of heart failure. Among systemic forms, immunoglobulin light chain (AL) amyloidosis is characterized by the most rapid progression and worst prognosis in the absence of prompt treatment, but also by the greatest potential for complete reversal of cardiac dysfunction. Therefore, rapid exclusion of AL amyloidosis is the first and most critical step in the diagnostic work-up of patients with suspected cardiac amyloidosis. The presence of a monoclonal protein in serum and/or urine, detectable in 98-100% of AL amyloidosis cases, must be investigated by combining serum and urine immunofixation electrophoresis with free light chain (FLC) assay. Five different FLC assays are currently available in Italy; they are not interchangeable and require the use of method-specific reference intervals for the κ/λ ratio. The cardiologist should select one method and apply it consistently to the same patient, using the validated reference intervals for that specific assay, preferably performed in the same laboratory to optimize data standardization. This review article provides practical guidance on ordering and interpreting these laboratory tests, which are essential for promptly directing patients to the appropriate diagnostic and therapeutic pathway.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"27 8","pages":"539-543"},"PeriodicalIF":1.5,"publicationDate":"2026-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148601216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}