Journal of Cardiovascular Medicine最新文献

{"title":"Anterior ST-elevation myocardial infarction in the very elderly: does ​​​​​anatomy still matter?","authors":"Marco Spagnolo, Davide Capodanno","doi":"10.2459/JCM.0000000000001880","DOIUrl":"10.2459/JCM.0000000000001880","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 4","pages":"287-290"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815472","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demographic and training variations across cardiology subspecialties in Italy: a national survey.","authors":"Federico Fortuni, Giuseppe Ciliberti, Pietro Scicchitano, Luca Franchin, Stefano Cangemi, Stefano Cornara, Antonella Spinelli, Enrica Vitale, Michele Magnesa, Filippo Zilio, Federico Nardi, Domenico Gabrielli, Furio Colivicchi, Fabrizio Oliva, Massimo Grimaldi","doi":"10.2459/JCM.0000000000001849","DOIUrl":"10.2459/JCM.0000000000001849","url":null,"abstract":"<p><strong>Background: </strong>Advances in cardiovascular medicine and subspecialization have improved patient care but exposed persistent workforce disparities. Evidence on sex, age, and training mobility within cardiology is fragmented, and comprehensive analyses across subspecialties are lacking.</p><p><strong>Methods: </strong>A nationwide survey was conducted by the Italian Association of Hospital Cardiologists (ANMCO) during its 2025 National Congress. The questionnaire included 17 multiple-choice items covering demographics, sex distribution, age, and training patterns across five subspecialties: interventional cardiology, clinical cardiology/acute care, cardiovascular imaging, heart failure, and electrophysiology. Responses were analyzed using descriptive statistics.</p><p><strong>Results: </strong>A total of 355 cardiologists responded, 51% of whom were women, with 53% aged >45 years. Significant sex-based differences were observed across subspecialties ( P  < 0.001). Female underrepresentation was most pronounced in interventional cardiology (69% reporting <25% women) and electrophysiology (66%), while cardiovascular imaging showed the highest female representation (>50% in 51% of responses). Age distributions also differed significantly ( P  < 0.001), with interventional cardiology, clinical cardiology, and electrophysiology dominated by the 40-50-years age range, whereas imaging showed a higher proportion of younger cardiologists. Training mobility varied but did not reach statistical significance ( P  = 0.054), with greater local stability in electrophysiology and higher external training reported in imaging and clinical cardiology. Stratification by respondent sex confirmed similar perceptions of female underrepresentation.</p><p><strong>Conclusions: </strong>This survey highlights persistent gender imbalances, mid-career clustering, and heterogeneous training mobility across Italian cardiology subspecialties. Targeted national and international strategies are needed to promote equity, strengthen training pathways, and support sustainable workforce development.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":" ","pages":"296-305"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503631","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and efficacy of transcatheter aortic valve replacement for native pure aortic valve regurgitation.","authors":"Giulio Giovanni Cavalli, Albino Vallabini, Maurizio Braccio, Paola Spatuzza, Rossella Alemanni, Eleonora Russo, Paola Siena, Michele Palladino, Nunzio Gallo, Giuseppe Arcudi, Luca Di Marco, Alessandro Leone, Francesco Greco, Davide Pacini, Mauro Cassese","doi":"10.2459/JCM.0000000000001856","DOIUrl":"10.2459/JCM.0000000000001856","url":null,"abstract":"<p><strong>Aims: </strong>Transcatheter aortic valve replacement has become the standard of care for high-risk patients with aortic stenosis. Considering the unique procedural challenges posed by native pure aortic regurgitation (NPAR), our aim was to evaluate the early and mid-term results of off-label transcatheter aortic valve replacement (TAVR), investigating the possibility of brief Veno-Arterial extracorporeal membrane oxygenation (VA ECMO) support for most complex procedures.</p><p><strong>Methods: </strong>We retrospectively enrolled 65 consecutive patients, who underwent TAVR for NPAR because they were deemed ineligible for surgery. Patients with aortic valve calcification or stenosis were excluded. Primary endpoints were technical and device success according to the VARC-3 criteria. Secondary endpoints were clinical efficacy at 1 year and absence of at least moderate paravalvular leak.</p><p><strong>Results: </strong>Patients' mean age was 76.15 ± 8.91. We adopted light sedation and local anesthesia in 60 patients (92.3%). High-risk patients (53.8%) were briefly supported with percutaneous femoro-femoral VA ECMO, allowing safer and more precise valve deployment. One intraprocedural death was recorded (1.5%). Although the overall 30-day mortality was 7.7%, primary composite outcomes were significantly better in the second half of the population ( P  = 0.023 and P  = 0.026). Only one moderate paravalvular leak (1.5%) was detected at 1-month follow-up. Clinical efficacy at 1 year was 76.3%, being available for 38 patients.</p><p><strong>Conclusion: </strong>TAVR is still considered an off-label approach for NPAR because of the increased stroke volume and absence of annular and leaflet calcification, which might increase the complication rate. Nonetheless, a standardized approach, with the aid of brief VA ECMO support for complex cases, should be considered a safe and valid option in high-volume centers for inoperable patients.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":" ","pages":"326-335"},"PeriodicalIF":2.6,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147592216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of left anterior descending lesions on 30-day mortality in very elderly STEMI patients: insights from a multicenter registry.","authors":"Andrea Agbariah, Alessandro Ruzzarin, Filippo Zilio, Enrico Fabris, Monica Verdoia, Simone Muraglia, Giorgio Caretta, Andrea Pezzato, Gianluca Campo, Matthias Unterhuber, Luca Donazzan","doi":"10.2459/JCM.0000000000001876","DOIUrl":"10.2459/JCM.0000000000001876","url":null,"abstract":"<p><strong>Aims: </strong>ST-elevation myocardial infarction (STEMI) in very elderly patients (≥85 years) poses a major clinical challenge due to frailty and comorbidities. In the general population, left anterior descending (LAD) artery involvement predicts adverse outcomes, but data in the very elderly are limited. We aimed to evaluate the impact of LAD culprit lesions on 30-day mortality in this population.</p><p><strong>Methods: </strong>In this multicenter registry (six Italian Hub hospitals, 2010-2023), 586 consecutive STEMI patients aged ≥85 years undergoing coronary angiography and percutaneous coronary intervention (PCI) were retrospectively analyzed. Patients were stratified by culprit vessel: LAD (n = 288) vs. non-LAD (n = 298). Demographic, clinical, procedural characteristics, and 30-day outcomes, including mortality and major adverse cardiovascular events, were collected. Multivariable analysis identified independent predictors of mortality.</p><p><strong>Results: </strong>Baseline differences included prior myocardial infarction (MI) (9.4% vs. 18.5%, P < 0.01), prior CABG (0.3% vs. 4.7%, P < 0.01), and dyslipidemia (35.4% vs. 45.6%, P = 0.02), less frequent in LAD STEMI. Single-vessel disease was more common in LAD STEMI (42.0% vs. 31.5%, P = 0.01). Overall, 30-day mortality was 19.3% (113/586), higher in the LAD group [hazard ratio (HR) 1.57; 95% confidence interval (CI) 1.06-2.33; P = 0.024]. In LAD STEMI, cardiogenic shock at presentation was the strongest independent predictor of death (HR 6.10; 95% CI 3.70-10.35; P = 0.01), while dyslipidemia was associated with lower mortality (HR 0.51; 95% CI 0.28-0.92; P = 0.03).</p><p><strong>Conclusions: </strong>In very elderly STEMI patients, LAD culprit lesions are associated with higher short-term mortality. Cardiogenic shock at presentation and absence of dyslipidemia identify a high-risk subgroup, emphasizing the need for tailored risk stratification and careful procedural planning in this vulnerable population.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 4","pages":"280-286"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815447","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In memoriam, Eugene Braunwald, MD: (15 August 1929-22 April 2026).","authors":"Ciro Indolfi","doi":"10.2459/JCM.0000000000001883","DOIUrl":"https://doi.org/10.2459/JCM.0000000000001883","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 4","pages":"263-264"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815500","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"BRASH syndrome: new mechanistic insights from contemporary cardiometabolic therapies.","authors":"Lucio Giuseppe Granata, Simona Giubilato, Giuseppina Maura Francese, Michele Massimo Gulizia","doi":"10.2459/JCM.0000000000001859","DOIUrl":"10.2459/JCM.0000000000001859","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 4","pages":"345-346"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815449","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Long-term clinical outcomes of TAVI in hospitals without on-site cardiac surgery: insights from the MURGIA-TAVI Registry.","authors":"Giandomenico Mancini, Maria Scarcia, Eloisa Basile, Marcello Martimucci, Pietro Guida, Vito Casamassima, Alessandro Xhelo, Giuseppe Speziale, Giuseppe Visicchio, Fabrizia Massaro, Giovanna Magnesa, Tommaso Langialonga, Valeria Paradies, Elia Iorio, Massimo Grimaldi","doi":"10.2459/JCM.0000000000001875","DOIUrl":"10.2459/JCM.0000000000001875","url":null,"abstract":"<p><strong>Aims: </strong>Transcatheter aortic valve implantation (TAVI) is the standard of care for elderly (≥70 years) or high-risk patients with severe aortic stenosis, yet current guidelines recommend its performance only in Heart Valve Centres with on-site cardiac surgery. This study evaluated procedural safety and long-term outcomes of TAVI performed in selected non-surgical centres.</p><p><strong>Methods: </strong>We retrospectively analysed 186 consecutive patients undergoing TAVI at 'F. Miulli' Hospital between 2016 and 2024, enrolled in the MURGIA-TAVI Registry. The programme operated without institutional on-site cardiac surgery, supported by a structured Heart Team approach and a visiting surgical back-up. Outcomes were assessed according to Valve Academic Research Consortium-3 definitions and survival was evaluated up to 5 years.</p><p><strong>Results: </strong>Among 186 patients (mean age 82 years; STS score 7%), transfemoral access was used in 93%. Technical success was 98.9%, with no intraprocedural deaths. Conversion to emergent cardiac surgery occurred in two patients (1.1%); both survived at 30 days. In-hospital mortality was 1.6%, never valve-related. Major complications included cardiac tamponade (1.6%), major bleeding (2.2%) and major vascular complications (1.1%). At 1 year, mortality was 15.6% with no valve-related deaths, and valve dysfunction occurred in 1.9% of patients. Five-year survival reached 52.5%. Outcomes, including rates of emergent cardiac surgery, were comparable to those reported in published registries from centres without institutional on-site cardiac surgery.</p><p><strong>Conclusions: </strong>Our findings suggest that TAVI can be safely performed in selected hospitals without on-site cardiac surgery within a structured Heart Team framework and a visiting surgical back-up, potentially expanding access, shortening waiting times, and meeting the growing demand for TAVI.</p>","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 4","pages":"268-276"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Geographical inequity in access to transcatheter aortic valve implantation: can centers without on-site cardiac surgery close the gap?","authors":"Martin Geyer","doi":"10.2459/JCM.0000000000001879","DOIUrl":"10.2459/JCM.0000000000001879","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 4","pages":"277-279"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147815463","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thrombectomy for coronary plaque erosion with large thrombus burden.","authors":"Andrea Milzi, Antonio Landi","doi":"10.2459/JCM.0000000000001860","DOIUrl":"10.2459/JCM.0000000000001860","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":" ","pages":"347-348"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147503691","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In memoriam, Eugene Braunwald, MD: (15 August 1929-22 April 2026).","authors":"Ciro Indolfi","doi":"10.2459/JCM.0000000000001883","DOIUrl":"https://doi.org/10.2459/JCM.0000000000001883","url":null,"abstract":"","PeriodicalId":15228,"journal":{"name":"Journal of Cardiovascular Medicine","volume":"27 4","pages":"263-264"},"PeriodicalIF":2.0,"publicationDate":"2026-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147868609","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}