Giornale italiano di cardiologia最新文献

{"title":"[After the ISCHEMIA trial and the new guidelines, does it still make sense to search for myocardial ischemia? When should a patient with chronic coronary syndrome be revascularized?]","authors":"Stefano Urbinati","doi":"10.1714/4531.45331","DOIUrl":"10.1714/4531.45331","url":null,"abstract":"<p><p>The ISCHEMIA study enrolled patients with chronic coronary syndrome, moderate-to-severe myocardial ischemia, and critical coronary stenosis, demonstrating that coronary revascularization is not superior to optimized medical therapy in a population with LDL cholesterol <70 mg/dl in both treatment groups. Despite its bias, ISCHEMIA was able to demonstrate the limitations of a strategy based on coronary revascularization in this clinical setting. Five years after its publication, after even studies based on coronary anatomy have failed to identify a population that benefits from an interventional strategy, coronary revascularization remains the first choice in unstable or worsening angina, in individuals with left main stem disease, complex three-vessel disease, and two-vessel disease with involvement of the proximal anterior interventricular branch or in subjects in whom the objective is to control angina symptoms. In all other cases, medical therapy aimed at achieving lesion stabilization should be preferred. The time has come to promote a critical reflection and question the still dominant practice of performing coronary revascularization directly during coronary angiography based solely on anatomical considerations.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"26 8","pages":"559-563"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729526","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 for randomized controlled trials in cardiology: applications and future perspectives].","authors":"Christian Basile, Alessandro Villaschi, Francesco Orso, Aldo Pietro Maggioni","doi":"10.1714/4531.45330","DOIUrl":"10.1714/4531.45330","url":null,"abstract":"<p><p>Integrating artificial intelligence (AI) into cardiovascular clinical trials is emerging as a key factor in streamlining patient selection, data collection, endpoint monitoring, and outcome analysis. On the one hand, machine learning and deep learning algorithms facilitate the management and review of ever-increasing volumes of clinical, imaging, and telemonitoring data, identifying predictive patterns and automating repetitive tasks. On the other hand, the high cost and long duration of traditional trials, coupled with the need for adequate population diversity, underscore the urgency of re-engineering trial design. AI can contribute to more adaptive study protocols, minimize interobserver variability, and improve endpoint accuracy. However, technical and ethical challenges remain, including algorithmic bias, privacy, model interpretability, and legal accountability for errors. Looking ahead, the introduction of digital biomarkers, synthetic control arms, and increasingly decentralized trials may redefine experimental paradigms and make cardiovascular trials faster, more inclusive, and more targeted. The aim of this review is to describe the use of AI in randomized controlled trials in cardiology.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"26 8","pages":"549-558"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729529","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":"[An unusual left retroatrial mass].","authors":"Annita Bava, Maria Rosaria Giuffrè, Stefano Postorino, Maria Stelitano, Domenica Zema, Carmelo Massimiliano Rao, Francesco Antonio Benedetto","doi":"10.1714/4531.45339","DOIUrl":"10.1714/4531.45339","url":null,"abstract":"<p><p>We describe the case of a 75-year-old hypertensive patient who comes to the emergency room for an infero-postero-lateral myocardial infarction. The entry echocardiogram showed a rounded formation with mixed echogenicity (maximum transverse diameter 4.5 cm), attached to the free wall of the left atrium and without any hemodynamic impact. Coronary angiography revealed a giant aneurysm of the circumflex artery, followed by an occlusion of the distal tract. After Heart Team evaluation, angioplasty with implantation of a drug-eluting stent was performed in the occluded coronary tract. This is one of the very rare cases in the literature of a giant coronary aneurysm diagnosed within the clinical picture of acute coronary syndrome. There is a lack of guidelines and consensus documents regarding management of this condition. In our case report, we discuss the resulting therapeutic challenges.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"26 8","pages":"619-622"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729527","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":"[Icosapent ethyl for the reduction of residual cardiovascular risk].","authors":"Simona Giubilato, Leonardo De Luca","doi":"10.1714/4531.45332","DOIUrl":"10.1714/4531.45332","url":null,"abstract":"<p><p>Despite the effectiveness of statins in reducing cardiovascular events and slowing the progression of coronary atherosclerosis, significant residual cardiovascular risk persists. In the REDUCE-IT trial, icosapent ethyl (IPE), a highly purified ethyl ester of eicosapentaenoic acid (EPA), has been demonstrated to significantly lower the risk of primary and secondary composite endpoints, including major adverse cardiovascular events and cardiovascular death, when added to a statin compared to placebo. This clinical benefit may partially result from IPE's moderate triglyceride-lowering properties; however, it also significantly reduces levels of atherogenic remnant particle-cholesterol. Previous trials using mixed formulations of omega-3 fatty acids (EPA/docosahexaenoic acid [DHA]) or low-dose IPE have not demonstrated similar benefits, despite achieving comparable triglyceride reductions. These discrepancies have prompted investigations into the mechanistic differences between omega-3 fatty acids, as EPA and DHA exhibit distinct membrane interactions, metabolic products, tissue distributions, and biological effects. Moreover, IPE exerts several beneficial actions on atherosclerosis beyond its triglyceride-lowering properties, improving endothelial function, reducing intra-plaque inflammation and oxidative stress, exhibiting antithrombotic properties, and improving insulin sensitivity. IPE is scientifically plausible as a potential antiatherosclerotic agent based on mechanistic, pathophysiological, outcomes, and plaque-imaging studies. This review aims to synthesize the current evidence regarding IPE and examine its potential applications in light of the European Society of Cardiology guideline recommendations and existing national regulations.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"26 8","pages":"564-575"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729532","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":"[Real-world experience with early use of vericiguat in worsening heart failure].","authors":"Laura Scelsi","doi":"10.1714/4551.45503","DOIUrl":"10.1714/4551.45503","url":null,"abstract":"<p><strong>Background: </strong>Despite guideline-directed medical therapy for heart failure with reduced ejection fraction (HFrEF), a residual risk of adverse outcomes persists, particularly after worsening heart failure (WHF). The VICTORIA trial demonstrated the benefit of adding vericiguat in high-risk patients. However, its real-world adoption in Italy remains unclear. The aim of this study was to assess the use, safety, and prescription patterns of vericiguat in Italian patients with recent WHF.</p><p><strong>Methods: </strong>The multicenter VeriChange survey was conducted across 28 hospitals in Northern Italy. A total of 399 anonymized clinical records of HFrEF patients with recent WHF were collected. The survey included demographic, clinical, therapeutic data and safety outcomes.</p><p><strong>Results: </strong>Overall, 68% of patients were classified as NYHA III-IV and 77% had a left ventricular ejection fraction ≤35%. Vericiguat was initiated after the first WHF episode in 54% of cases, and during hospitalization in 50%. The target dose of 10 mg/day was reached in 56% of patients. Tolerability was high, with only 3% treatment discontinuation. Prescription occurred in a context of strong adherence to guideline-based therapy.</p><p><strong>Conclusions: </strong>Vericiguat was introduced early and safely in Italian real-world practice, especially in tertiary and referral centers. Broader implementation and earlier WHF recognition are still needed to reduce residual risk in advanced heart failure patients.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"26 8 Suppl. 1","pages":"e1-e7"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729540","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":"[Individual's eHealth literacy: an update].","authors":"Maria Teresa Manes, Simona Giubilato, Maura Francese, Antonia Mannarini, Giuseppe Ciliberti, Daniela Pavan, Stefania Angela Di Fusco, Roberta Rossini, Georgette Khoury, Daniela Aschieri, Beatrice Scardovi, Noemi Bruno, Sara Cocozza, Michele Massimo Gulizia, Giovanna Geraci, Domenico Gabrielli, Furio Colivicchi, Massimo Grimaldi, Fabrizio Oliva","doi":"10.1714/4531.45336","DOIUrl":"10.1714/4531.45336","url":null,"abstract":"<p><p>The escalation in demand for digital health services, particularly highlighted by recent global health crises, has emphasized the significance of eHealth literacy (eHL). This concept encompasses the skills necessary to effectively search for, comprehend, evaluate, and apply online health information to solve health-related issues. eHL not only facilitates navigation through the digital health landscape but also broadens the understanding of the digital divide within the context of health information accessibility. In this review, we encompassed individual eHL definitions and tools, focusing on the role of eHL during the COVID-10 outbreak, and with regard to gender, age and social inequalities.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"26 8","pages":"604-610"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729533","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":"[Win ratio, a new technique for the analysis of multiple events in clinical trials].","authors":"Paolo Verdecchia, Fabio Angeli, Gianpaolo Reboldi","doi":"10.1714/4531.45335","DOIUrl":"10.1714/4531.45335","url":null,"abstract":"<p><p>The win ratio is a relatively recent statistical technique introduced with the aim of better managing the analysis of clinical trials involving more than one clinical event as an endpoint in the evaluation of a treatment. The calculation of the win ratio begins by defining a \"hierarchy\" of clinical events on the basis of their severity, e.g. death, followed, for example, by the number of hospitalizations for heart failure, followed, for example, by softer endpoints including functional or laboratory changes. The analysis begins by comparing each patient in a hypothetical \"Group A\" with each patient in a hypothetical \"Group B\" on the hierarchically most important clinical event only. If the patient in Group B dies and the one in Group A does not, or if the one in Group B dies before the one in Group A, then that particular comparison is \"won\" by Group A. If the patient in Group A dies and the one in Group B does not, or if the one in Group A dies before the one in Group B, then that comparison is \"won\" by Group B. If nobody dies, or if they die on the same day, then that specific comparison ends in a tie. All comparisons of each patient in Group A with each patient in Group B are then performed. On the comparisons that end in a tie, we move on to the analysis of the endpoint hierarchically in second place, using the same technique. Then we proceed to the analysis of the endpoint hierarchically in third place, and so on down to the event in the lowest position in the hierarchy. The win ratio represents the total sum of comparisons in which, for example, Group A wins, divided by the total sum of comparisons in which Group A \"loses\". The absolute difference, rather than the ratio, between these two sums indicates the \"win difference\". Compared to the conventional \"time-to-event\" statistical techniques including, for example, the Cox model, the win ratio calculation has advantages, but also potential disadvantages. This review aims to offer a summary of the advantages and potential disadvantages of the win ratio, with some practical examples derived from the use of the win ratio in the analysis of important trials in the cardiovascular area.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"26 8","pages":"597-603"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729539","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":"[Kidney protection: role of sodium-glucose co-transporter 2 inhibitors and finerenone].","authors":"Manuela Benvenuto, Emilia D'Elia, Marco Cittar, Ilaria Battistoni, Gianluigi Tagliamonte, Daniele Masarone, Geza Halasz, Raul Limonta, Maria Denitza Tinti, Luisa De Gennaro, Renata De Maria, Samuela Carigi, Matteo Bianco, Concetta Di Nora, Paolo Manca, Maria Vittoria Matassini, Vittoria Rizzello, Vittorio Palmieri, Claudio Bilato, Giovanna Geraci, Mauro Gori, Furio Colivicchi, Massimo Grimaldi, Fabrizio Oliva, Massimo Iacoviello","doi":"10.1714/4531.45333","DOIUrl":"10.1714/4531.45333","url":null,"abstract":"<p><p>Chronic kidney disease, diabetes mellitus and heart failure represent three chronic conditions closely linked to each other from a pathophysiological and prognostic point of view. This link has led to an ever-increasing emphasis in recent years on the need for a holistic approach to patients who are affected by optimizing the therapeutic management of what has recently been defined as cardio-kidney-metabolic syndrome. The cardiorenal and metabolic approach has gained relevance thanks to recent studies on new drug classes. Initially in diabetic patients and later in those suffering from heart failure and chronic kidney disease, these new drugs have demonstrated their effectiveness in reducing cardiovascular risk, the progression of heart failure and chronic kidney disease. This review aims to address the main pharmacological aspects of two of these new classes, that of sodium-glucose co-transporter 2 inhibitors and the more recent one of non-steroidal mineralocorticoid receptor antagonists.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"26 8","pages":"576-584"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729534","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":"[Real-world triglyceride levels in secondary prevention: insights from the JET-LDL registry].","authors":"Francesco Maria Sparasci, Luca Raone, Alessia Currao, Andrea Raffaele Munafò, Luigi Oltrona Visconti, Giuseppe Musumeci, Marco Ferlini","doi":"10.1714/4531.45338","DOIUrl":"10.1714/4531.45338","url":null,"abstract":"<p><strong>Background: </strong>Hypertriglyceridemia is a common finding in patients with coronary artery disease (CAD), contributing to the residual cardiovascular risk in this population. In CAD patients with persistently elevated triglyceride levels despite lipid-lowering therapies, treatment with icosapent ethyl (IPE), compared to placebo, significantly lowered the risk of ischemic events. We aimed to quantify the burden of real-world patients with high triglyceride levels despite optimal lipid-lowering therapy, and to provide the potential use of IPE as a therapeutic strategy of secondary prevention.</p><p><strong>Methods: </strong>We used the data of the multicenter and observational JET-LDL registry, which included 1095 patients with acute coronary syndrome undergoing percutaneous coronary intervention with at least one stent implantation at 35 Italian hospitals. In the present subanalysis, we investigated fasting triglyceride levels at index hospitalization and after 3 months of follow-up, and their relationship with LDL-cholesterol values. We also identified patients potentially eligible for IPE prescription based on inclusion/exclusion criteria of the REDUCE-IT trial and of the Italian Medicines Agency (AIFA).</p><p><strong>Results: </strong>Triglyceride levels at baseline and at 3-month follow-up were 109 (82.5-147) mg/dl and 98 (75-130) mg/dl, respectively. The reduction of triglycerides was also statistically significant (p<0.01) comparing paired matched patients. At 3 months, 15.6% of patients met the inclusion laboratory criteria of the REDUCE-IT trial, making them eligible for IPE based on these parameters. Additionally, 14.5% of patients were eligible according to AIFA authorized guidelines for the use of IPE, whereas only 0.2% qualified under the criteria for reimbursement.</p><p><strong>Conclusions: </strong>A non-negligible proportion of patients met the REDUCE-IT triglyceride cut-off levels for IPE prescription at 3-month follow-up post-acute coronary syndromes. However, the prescription of IPE can be very limited by the current restrictive reimbursement criteria.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"26 8","pages":"613-618"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729536","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":"[Management of cardiac implantable electronic devices in cancer patients undergoing radiotherapy. An Italian Association of Hospital Cardiologists (ANMCO) statement].","authors":"Maria Laura Canale, Carlo Pignalberi, Stefano Oliva, Simona Giubilato, Martina Nesti, Rossella Troccoli, Antonio Di Monaco, Irma Bisceglia, Fabio Turazza, Claudio Bilato, Furio Colivicchi, Massimo Grimaldi, Fabrizio Oliva","doi":"10.1714/4531.45340","DOIUrl":"10.1714/4531.45340","url":null,"abstract":"<p><p>A systematic and multidisciplinary approach is needed to manage cancer patients with a cardiac implantable electronic device undergoing radiation therapy. We report a statement from the Italian Association of Hospital Cardiologists (ANMCO) to provide guidance for clinicians involved in the care continuum of this challenging clinical setting. A comprehensive careful assessment of radiotherapy type, treatment plan and cardiac issues is recommended in order to minimize the risk of device malfunction. Risk stratification before radiation therapy as well as the timing of cardiological assessments during treatment and follow-up strategies are thoroughly discussed. An overview of oncological electrophysiology and radiotherapy-induced damage to devices is also provided. The proposed recommendations represent an expert consensus based on available literature data, guidelines and clinical evidence.</p>","PeriodicalId":12510,"journal":{"name":"Giornale italiano di cardiologia","volume":"26 8","pages":"623-633"},"PeriodicalIF":0.7,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144729535","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}