Cardiogenetics aims to identify the genetic causes of inherited cardiac diseases, with significant implications for early diagnosis, clinical management, and prevention of sudden cardiac death in both patients and their relatives. In Italy, however, access to structured cardiogenetic services remains uneven and is often limited to tertiary care centers, partly due to economic sustainability constraints. We developed a second-level outpatient model that integrates telemedicine to facilitate access to genetic testing. The pathway includes pre-test genetic counseling performed by the cardiologist based on clinical and instrumental phenotype assessment, molecular analysis through blood sample collection and referral to the Medical Genetics Unit of Ferrara, and post-test counseling conducted as a teleconsultation, involving remote participation of a geneticist via a dedicated telemedicine platform (c4C Dedalus). In case of a positive result, the patient undergoes an in-person cardiology consultation in Piacenza, while negative or uncertain results are managed through further phenotypic or familial investigations as needed. In the first year of activity, 78 probands and 20 first-degree relatives underwent genetic testing. The positivity rates, including relevant variants of uncertain significance, were 44% for hypertrophic cardiomyopathy, 75% for non-dilated left ventricular cardiomyopathy, 20% for dilated cardiomyopathy, 100% for arrhythmogenic right ventricular cardiomyopathy, 100% for long QT syndrome, and 50% for Brugada syndrome. This model demonstrates that telemedicine can be an effective and sustainable tool to extend access to specialized genetic counseling in peripheral settings, improving equity of care and optimizing the use of resources for the management of inherited cardiomyopathies.
Cardiovascular diseases remain the leading cause of death and disability in industrialized countries. The workplace represents an ideal setting for primary prevention, allowing for the early identification of individuals at cardiovascular risk who are often not reached by traditional screening pathways. In this context, Occupational Cardiology has emerged as a new branch of preventive cardiology, focused on population health within occupational settings. The aim of this review article is to describe the role, fields of application, and clinical, organizational, and economic potential of Occupational Cardiology, with particular reference to Corporate Wellness programs and high-risk occupational groups. Corporate Wellness programs encompass clinical and instrumental screenings, promotion of physical activity, health education, stress management, and the utilization of digital health technologies. The "Formula Benessere" project implemented at Ferrari has demonstrated significant benefits in terms of health outcomes, participation rates, and economic return. In parallel, numerous professional categories, such as firefighters, military personnel, pilots, and high-altitude workers, are exposed to specific cardiovascular risk factors that require tailored, innovative, and standardized assessment protocols. Personalized strategies enable better risk stratification and more effective management of cardiovascular health in the workplace. Occupational Cardiology represents a new opportunity for large-scale cardiovascular prevention at the community level. Its broader implementation at the national level, the development of dedicated clinical guidelines, and the integration of Digital Health tools are key elements in establishing this discipline as a new frontier in preventive cardiology.
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We present the case of a 58-year-old man with negative T waves in the inferior and lateral leads observed on a routine ECG in the context of persistent peripheral eosinophilia, 6 months after an intestinal parasitic infection. The diagnostic workup excluded coronary artery disease and led to a diagnosis of endomyocardial fibrosis with apical thrombosis. Endomyocardial fibrosis, also known as Loeffler endocarditis, represents the cardiac involvement of the hypereosinophilic syndrome, resulting in a cardiomyopathy with a restrictive phenotype. After initiating specific therapy, further investigations identified chronic eosinophilic leukemia as the underlying cause of hypereosinophilia. The patient remained asymptomatic regarding heart failure manifestations. Additionally, diastolic function was pseudo normal on transthoracic echocardiography, with no restrictive pattern, and troponin and natriuretic peptide levels were only mildly elevated. The moderate peripheral eosinophilia was firstly attributed to the recent parasitic infection, supported by the decrease in eosinophil count following treatment with metronidazole. Cardiac involvement occurred relatively shortly after the onset of peripheral eosinophilia (approximately 6 months). Early diagnosis through advanced cardiac imaging allowed the detection of this condition before irreversible myocardial damage occurred and facilitated the initiation of targeted therapy for both ventricular thrombosis and cardiomyopathy.
Artificial intelligence (AI) is rapidly transforming the field of aortic imaging, enhancing diagnostic accuracy, risk stratification, and treatment planning. This review provides a comprehensive overview of AI applications in measuring aortic dimensions, detecting and characterizing aneurysms, dissections, and atherosclerotic disease, as well as predicting clinical outcomes. Automated measurement and segmentation tools, powered by deep learning algorithms, offer reproducible and time-efficient assessments, reducing inter- and intraobserver variability. In atherosclerotic disease, AI enables objective quantification of calcification burden and advanced radiomic analysis for prognostic stratification. In acute aortic syndromes, AI-based models improve diagnostic sensitivity, assist in differentiating true from false lumens, and predict complications or surgical outcomes. The integration of emerging technologies such as radiomics, dual-energy computed tomography, photon-counting computed tomography, and computational fluid dynamics further expands predictive capabilities, potentially leading to personalized "digital twin" models for therapeutic decision-making. Despite promising results, challenges remain in software availability, cost, data integration, and defining the radiologist's evolving role. AI holds the potential to become an indispensable tool in aortic disease management, bridging imaging, clinical, and computational domains to improve patient outcomes.
Primary mediastinal B-cell lymphoma is a rare subtype of non-Hodgkin lymphoma. Typical symptoms include cough, chest pain, and dyspnea; however, cardiac tamponade as the primary manifestation is exceedingly rare. We hereby present a case of a 83-year-old woman, who presented to our emergency department with dyspnea, cough and hypotension. On admission, echocardiography (transthoracic and transesophageal), computed tomography and cardiac magnetic resonance demonstrated a large 70 x 38 mm pericardial mass, with pericardial effusion and signs of cardiac tamponade. Positron emission tomography highlighted a marked hyperaccumulation of the tracer at the mass level, compatible with high metabolic activity. The patient underwent further workup with diagnostic and therapeutic pericardiocentesis, which demonstrated histopathology consistent with primary mediastinal B-cell lymphoma. This precise and complete diagnosis allowed the start of chemotherapy treatment with complete remission of the disease and regression of the mass in a few months. Our case highlights the importance of a complete and thorough workup for patients with chronic untraditional symptoms, like tamponade as the primary clinical presentation. Advanced multimodality imaging is crucial for early non-invasive assessment of primary cardiac tumors, helps guiding further investigations, treatment decision, assessing for potential complications, and allows documentation of therapeutic success.
Cardiac amyloidosis is considered a rare disease but is increasingly frequent in elderly patients. In these patients, heterogeneous and peculiar clinical manifestations require specific approaches and dedicated diagnostic-therapeutic pathways. Early diagnosis is important because mortality is high, and the disease is often latent and underdiagnosed. In particular, the light chain form represents a real emergency, due to the rapidly fatal course in the absence of treatment. Specific programs based on a multispecialist approach should be implemented to reduce delays in diagnosis. Thanks to these programs, in recent years patients are often diagnosed at an early stage with a reduction in mortality. In the elderly, health status does not only depend on the disease or age, but also on factors such as frailty, comorbidity, living conditions and psychological factors. In these patients, a pragmatic approach should include a frailty screening using simple and easy-to-use tools. The therapeutic approach in the elderly has the dual objective of treating symptoms and complications of the disease and modifying the course of the disease and slowing its progression with specific therapies. In the context of a universalistic health system such as the Italian one, the introduction of highly innovative, but also expensive, therapies raises significant questions in terms of economic sustainability, accessibility of care and protection of patients' dignity.
Cardiovascular diseases remain the leading cause of morbidity and mortality worldwide, exerting a substantial burden on healthcare systems. Their management requires multidisciplinary approaches, continuity of care, and advanced monitoring tools. Artificial intelligence (AI) has recently emerged as a transformative resource, owing to its ability to analyze large, heterogeneous datasets and generate accurate predictive models. Techniques such as machine learning, deep learning, and natural language processing, combined with multimodal data (electronic health records, imaging, wearable devices, sensors), can enable earlier diagnosis, dynamic risk stratification, and personalized therapies. Furthermore, the integration of AI with telemedicine and digital therapeutics provides new opportunities for remote monitoring, clinical decision support, and patient empowerment, with significant potential to improve clinical outcomes, optimize healthcare resources, and reduce hospitalizations. However, challenges remain, including algorithmic bias, lack of interpretability, ethical and legal concerns, and the need for adequate training of healthcare professionals. The recent adoption of the European AI Act establishes stricter regulatory standards to ensure safety and transparency, though it may slow down large-scale implementation. In conclusion, AI represents a pivotal innovation in cardiovascular medicine, provided it is embedded into validated clinical pathways, supported by scientific evidence, and embraced by clinicians. The future of digital cardiology will rely on the ability to develop predictive, personalized, and patient-centered healthcare models.
The benefits of physical exercise are well established and universally recognized, but, at the same time, in our nation we are forced to face extremely annoying data about sedentary habits that directly correlate with the outbreak of many cardiovascular risk factors or with the worsening of pre-existing cardiovascular diseases. For these reasons, the Italian Society of Sports Cardiology (SIC Sport) and the Italian Federation of Sport Medicine (FMSI), in collaboration with the Italian Society of Cardiology (SIC) and the Italian Association of Hospital Cardiologists (ANMCO), have decided to update the only previous edition, dating back to 2007, of the "Document on physical exercise prescription in a cardiological setting". Our aim is to provide physicians and other professional subjects directly involved (i.e. kinesiologists) with, at the same time, updated scientific knowledge and clear and precise indications in order to arrive to a really tailored prescription of "physical exercise-drug". The aim of this review is to summarize this new version and underline its innovations when compared to the previous edition.
A 44-year-old man with no known cardiovascular history or risk factors experienced chest pain after a volleyball match. ECG showed ST-segment elevation in the inferior leads, a finding consistent with ST-elevation myocardial infarction (STEMI). The patient was urgently taken to the cath lab, where coronary angiography revealed complete occlusion of the distal left anterior descending artery and of an obtuse marginal branch. Plain old balloon angioplasty was attempted but unsuccessful. During the procedure, an abnormal vascular network originating from the right coronary artery and the circumflex artery and directed toward the left atrium was observed. Transthoracic echocardiography revealed a 30 x 32 mm ovoid, pedunculated mass attached to the atrial roof. Transesophageal echocardiography confirmed the finding, very suggestive of an atrial myxoma. Upon deeper anamnesis, the patient reported transient episodes of visual loss. Brain magnetic resonance imaging revealed multiple small gliotic lesions, indicative of systemic embolization. The patient underwent surgical resection of the mass via right mini-thoracotomy. Histological analysis confirmed the diagnosis of atrial myxoma. This case highlights the importance of considering an embolic etiology in STEMI, especially in young patients without traditional cardiovascular risk factors.
Type 2 diabetes mellitus (T2DM) is a common risk factor for atherosclerotic cardiovascular disease. Although in patients with coronary artery disease T2DM has a non-negligible prevalence, it is often overlooked. Due to its prognostic impact and the availability of pharmacological intervention, as sodium-glucose cotransporter 2 inhibitors (SGLT2i) and glucagon-like peptide-1 receptor agonists (GLP1-RA), able to improve the prognosis, an early diagnosis is crucial. T2DM diagnosis is based on three evaluations: fasting serum glucose levels; glycate hemoglobin levels; and oral glucose tolerance test. In addition, it is important to know the clinical significance of stress-induced hyperglycemia, commonly found in patients with an acute cardiovascular event. As regards T2DM therapy, SGLT2i and GLP1-RA represent two pillars to reduce cardiovascular disease risk but, despite international guidelines, their use remains rather low in routine cardiovascular care. This review reports indications for an appropriate use of these treatments with an analysis of benefits and precautions to consider in clinical practice.
Cardiac sarcoidosis is a rare but potentially life-threatening condition characterized by the formation of non-caseating granulomas in the myocardium. Clinical manifestations range from asymptomatic forms to atrioventricular blocks, ventricular arrhythmias, heart failure, and sudden cardiac death. Diagnostic work-up requires a multimodality approach combining advanced imaging, clinical criteria, and, when possible, histological confirmation. Immunosuppressive therapy remains the cornerstone of treatment, aimed at suppressing myocardial inflammation and preventing irreversible damage. Risk stratification for sudden cardiac death is crucial, and cardiac implantable electronic devices play a key role in selected patients. This review, structured in ten clinical questions, provides an overview of the epidemiology, clinical presentation, diagnostic criteria, differential diagnosis, therapeutic strategies, and risk stratification of cardiac sarcoidosis, in light of the most recent international guidelines and consensus documents.
The introduction of non-dilated left ventricular cardiomyopathy (NDLVC) represents one of the key highlights of the 2023 European Society of Cardiology guidelines on cardiomyopathies. NDLVC is defined by the presence of left ventricular systolic dysfunction in the absence of ventricular dilation and/or non-ischemic myocardial fibrosis detectable by cardiac magnetic resonance. The clinical manifestation may be arrhythmogenic, with a risk of life-threatening ventricular arrhythmias even in patients with preserved ejection fraction. The phenotypic heterogeneity and variability in clinical expression reflect the complex interplay between genetic predisposition (involving variants in genes such as FLNC, DSP, and LMNA) and environmental, epigenetic, or inflammatory factors. A synergistic approach combining comprehensive clinical and family assessment, electrocardiographic and echocardiographic findings, advanced imaging, and genetic testing enables more accurate phenotypic characterization, definitive diagnosis, and consequently, tailored therapeutic strategies.
Angina in non-obstructive coronary artery disease (ANOCA) is a common clinical condition affecting 20-50% of patients undergoing coronary angiography for suspected angina. Despite recent 2024 European guidelines on chronic coronary syndrome emphasizing its significance and clinical implications, ANOCA remains often underdiagnosed and undertreated. The management of ANOCA differs from obstructive coronary artery disease and requires careful interpretation of diagnostic tests and tailored treatment based on accurate clinical assessment. ANOCA diagnosis may involve microvascular dysfunction or vasospasm (epicardial or microvascular), and treatment should be individualized. The impact on patients' quality of life is considerable, with symptom regression due to correct diagnosis. A timely diagnostic and therapeutic approach is crucial to improving patient's quality of life. This review aims to provide a practical guide in managing ANOCA patients, emphasizing the need for comprehensive coronary functional evaluation and optimal risk factor management.
Congestion management is a key therapeutic target in heart failure, closely linked to both prognosis and quality of life. Loop diuretics play an important role in the management of decongestive therapy, but their efficacy is often limited by diuretic resistance and empiric dosing strategies. In this context, the concept of sequential nephron blockade - combining agents acting on different tubular segments, such as thiazide diuretics - has gained relevance. More recently, sodium-glucose co-transporter 2 inhibitors have emerged as effective decongestive agents, offering modest but sustained osmotic-diuretic effects, synergistic with loop diuretics, and a favorable safety profile with low impact on electrolytes, blood pressure, or renal function. Optimal decongestion, however, requires a tailored and dynamic approach, guided by clinical and laboratory markers (e.g. early spot urinary sodium), aimed at enhancing diuretic response while minimizing risks such as worsening renal function, electrolyte disturbances, or metabolic alkalosis. Patient education and home-based monitoring - potentially supported by point-of-care technologies - are critical to improve adherence and reduce inappropriate diuretic use in the chronic management of heart failure.
Light chain (AL) amyloidosis is a rare systemic disease caused by monoclonal immunoglobulin light chains with abnormal folding that aggregate into fibrils, which deposit in extracellular tissues. This process leads to cytotoxicity and organ dysfunction. Cardiac involvement is the main prognostic determinant and requires a multidisciplinary management approach. In recent years, the treatment of AL amyloidosis has significantly evolved with the introduction of innovative agents such as proteasome inhibitors, immunomodulators, and monoclonal antibodies like daratumumab, which has shown a favorable impact on hematological outcomes and organ function. The daratumumab-CyBorD regimen is currently the standard first-line therapeutic option. The therapy is tailored based on the stage of cardiac and renal damage, aiming for a complete hematological and organ response. The management of cardiac involvement, including aortic stenosis, atrial fibrillation, thromboembolic risk, conduction disorders, arrhythmias, and heart failure, plays a crucial role in prognosis. An integrated multidisciplinary approach in specialized centers experienced in the disease is essential to optimize clinical outcomes.
The issue of sports participation in athletes with an implantable cardioverter-defibrillator (ICD) has gained increasing attention. Contrary to what is often reported by the media, in Italy there is no absolute ban on competitive sports for individuals with an ICD: according to the 2023 COCIS guidelines, eligibility is determined not by the device itself, but by the underlying heart disease and the type of sport practiced. This document reviews the main international (AHA/ACC, ESC, HRS) and Italian guidelines, emphasizing that the indication for ICD implantation must follow the same criteria used for the general population, without considering the desire to practice sports as a determining factor. It then discusses the conditions under which, in Italy as well, athletes with an ICD may be allowed to return to competitive sports. Available evidence, including data from international registries, shows that sports participation in ICD carriers can be safe if performed under specialist supervision, although the risk of appropriate shocks is not negligible. This document also examines the advantages and limitations of different device types and proposes a flow-chart for ICD programming and follow-up, both at baseline and during exercise testing. Finally, it reaffirms that properly prescribed and monitored physical activity remains recommended for patients with ICDs due to its clinical and psychological benefits.
Artificial intelligence (AI) is rapidly transforming the world, and medicine is at the forefront of this revolution. In cardiology, AI is increasingly providing innovative tools for diagnosis, risk stratification, interventional planning, and personalized care. From automated interpretation of ECGs and cardiovascular imaging to integration into interventional workflows and predictive models, AI is emerging as a powerful ally for both clinicians and researchers. However, its implementation also raises critical ethical, legal, and regulatory challenges that require transparency, independent validation, and multidisciplinary governance. This review explores the potential and limitations of AI in cardiovascular medicine, with a focus on emerging technologies, their clinical implications, and the growing role of generative tools such as ChatGPT in scientific research. Much like HAL 9000, AI can enhance human capabilities - but only under vigilant oversight to prevent uncontrolled drifts. The future of cardiology will undoubtedly be more digital, but must remain fundamentally human.
The ongoing digital transformation is reshaping organizational and care delivery models in cardiology, positioning telemedicine as a pivotal tool to address increasing clinical and demographic complexity. This ANMCO position paper presents a comprehensive and critical overview of telemedicine applications in cardiovascular care, with a focus on its role in strengthening hospital-community integration, its deployment within hospital-based healthcare systems, and the associated regulatory and operational frameworks. The analysis encompasses the management of chronic cardiovascular conditions, such as heart failure and atrial fibrillation, through telemonitoring, telecontrol, televisit, and teleconsultation. Additionally, it explores the use of digital technologies in post-myocardial infarction follow-up, oral anticoagulation management, preoperative assessment, and care for elderly patients. The position paper also highlights the challenges and opportunities linked to digital infrastructure, interoperability, data protection, and healthcare professional training.
Managing patients in intensive care units involves special attention for complex patients with multiple comorbidities and multi-organ dysfunction, for whom continuous and advanced staff training is required. Recent evidence shows malnutrition negatively impacts cardiovascular outcomes but can be improved with targeted strategies. However, gaps remain in standardizing nutritional assessment and management in clinical practice. The aim of the Best Practice working group is to draw up an operational flow chart to support assessments in nutrition for patients admitted to the cardiac intensive care unit (CICU) and to evaluate their impact on clinical practice. After a thorough literature review, including Cochrane guidelines and reviews, available evidence on nutrition in CICU has been synthesized and decision-making algorithms have been developed for the following clinical conditions: acute heart failure, acute coronary syndrome, after cardiac arrest, cardiogenic shock, which have been synthesized into a single algorithm to facilitate consultation and use in clinical practice. This project aims to disseminate and standardize best practice-based decision-making in the CICU, serving as a structured first step toward greater awareness and more consistent, effective management of nutrition assessment.