Background Carcinoid heart disease (CHD) commonly affects right-sided heart valves, often leading to progressive right heart failure (RHF) and structural valve deterioration.Case Summary A 30-year-old male with CHD and prior bioprosthetic tricuspid and pulmonic valve replacements presented with New York Heart Association Class III symptoms and RHF. Imaging revealed significant degeneration of both valves. Given the high surgical risk (EuroSCORE II 9.12%), the Heart Team opted for transcatheter pulmonary valve replacement (TPVR). Despite challenging anatomy, a Melody valve (Medtronic) was successfully implanted, resulting in improved haemodynamics and no significant residual regurgitation.Discussion Bioprosthetic failure in CHD poses significant treatment challenges. This case underscores the growing role of TPVR as a less invasive and effective alternative to surgery in high-risk patients, with advanced imaging playing a pivotal role in planning and execution.

Background: Both primary hyperparathyroidism (PHPT) and chronic hypoparathyroidism (HypoPT) are associated with the onset and development of cardiovascular diseases (CVDs). In particular, PHPT is accompanied by the presence of elevated atherothrombotic risk, while the importance of traditional and new anthropometric indices to reflect the cardiovascular risk remains uncertain in this condition. This study aims to investigate whether novel and traditional anthropometric indices distinguish PHPT and whether these indices are correlated with atherothrombotic risk. Methods: A total of 40 subjects with HypoPT, 40 with PHPT and 40 age- and sex-matched control subjects were consecutively enrolled for the evaluation of flow-mediated vasodilation (FMD) and carotid intima-media thickness (IMT). A blood sample was collected for evaluation of calcium-phosphate metabolism, PTH, TSH and 25-hydroxy vitamin D. Physical examination was performed to obtain traditional anthropometric parameters and derived indices of adiposity and cardiometabolic risk (waist-to-height ratio (WHtR), waist-to-hip ratio (WHR) and conicity index (CI)). Results: The PHPT group showed higher central adiposity indices (WHtR p = 0.002, and CI p = 0.008). Among patients with parathyroid disorders, PHPT subjects displayed the highest reduction in FMD (p < 0.001) and a marked increase in IMT (p < 0.001). In the Ctrl group, WHtR showed a weak-to-moderate positive association with IMT (r = 0.381, p = 0.018). In the PHPT group, no anthropometric index was significantly correlated with IMT or FMD (all p > 0.05). Conclusions: WHtR and CI provide evidence of increased central fat adiposity in PHPT but do not account for impaired atherothrombotic risk, indicating that anthropometric indices may lack relevance to cardiovascular risk in this condition and emphasizing the importance of a specific assessment profile.

Cardiogenic shock (CS) remains a life-threatening syndrome characterized by reduced cardiac output and end-organ hypoperfusion, most commonly resulting from acute myocardial infarction (AMI). Despite advances in early revascularization and increasing use of percutaneous mechanical circulatory support (MCS), short-term mortality in AMI-related CS (AMI-CS) remains high. This review summarizes the contemporary evidence on short-term percutaneous MCS in AMI-CS, with a focus on intra-aortic balloon pump (IABP), Impella microaxial flow pumps, and venoarterial extracorporeal membrane oxygenation (VA-ECMO), and provides insights into device selection and implementation in clinical practice. We performed a comprehensive analysis of the most relevant randomized controlled trials and key guideline recommendations from European and North American societies concerning the use of MCS. Despite its long-standing, IABP has not demonstrated a mortality benefit in contemporary trials and is no longer recommended for routine use in AMI-CS without mechanical complications. Nevertheless, it remains widely used due to its simplicity, safety profile, and broad availability. In contrast, Impella devices provide active left ventricular unloading and have shown promising hemodynamic effects, with the DanGer Shock trial suggesting a potential survival benefit in carefully selected patients, at the expense of higher complication rates. VA-ECMO offers full cardiopulmonary support but is associated with the highest complication rates and increases left ventricular afterload, often requiring adjunctive unloading with devices such as Impella (ECPELLA). However, recent randomized trials have not demonstrated a clear survival advantage for VA-ECMO, and concerns regarding its complications persist. In conclusion, CS continues to pose major therapeutic challenges, and no single MCS device has consistently shown a survival benefit across all AMI-CS patient populations. Individualized, phenotype-driven strategies that incorporate hemodynamic profiling and timely escalation of support are essential. Further randomized studies are urgently needed to define optimal device selection, the timing of placement, and appropriate patient selection criteria. Institutional protocols guided by clinical stage, etiology, and available expertise will be pivotal in improving outcomes.

Aims:Extensive coronary artery disease (CAD) coexisting with chronic total occlusion (CTO) is associated with adverse outcomes, yet patients with advanced CAD are often underrepresented in randomized trials, and the prognostic impact of CTO percutaneous coronary intervention (CTO-PCI) across different levels of anatomical complexity remains uncertain. We aimed to determine whether the overall CAD burden, quantified by the SYNTAX score (SS), influences the prognostic effect of CTO-PCI. Methods and results:A systematic search of PubMed, Embase, Google Scholar, and Cochrane databases was conducted. Eligible studies compared successful CTO-PCI vs. no CTO-PCI and reported the mean SYNTAX score of the cohort. Two reviewers independently extracted data. The primary endpoint was annualized cardiovascular (CV) mortality. Pooled hazard ratios (HRs) were calculated using fixed- or random-effects models with inverse-variance weighting. Meta-regression explored the relationship between SS and CV mortality, and subgroup analyses were performed according to predefined SS categories. Seventeen studies (3 randomized and 14 prospective observational; n = 11 001) were included. Successful CTO-PCI was associated with significantly lower CV mortality compared with non-revascularization (HR 0.54; 95% CI 0.46-0.64; P < 0.001). The prognostic benefit increased with CAD complexity, with HRs of 0.61, 0.44, and 0.10 across low (SS < 22), intermediate (SS 23-32), and high (SS > 33) strata, respectively (P-trend = 0.04). Meta-regression confirmed a CAD complexity-dependent effect (∼1.5% lower annual CV mortality per 10-point SS increase; P = 0.001). These findings apply to a PCI-selected population, as CABG-treated patients were not included. Conclusion:The survival benefit of CTO-PCI appears to increase with the extent of overall coronary disease, suggesting that patients with higher anatomical burden may derive greater prognostic benefit from successful CTO revascularization.

Extensive evidence now confirms Lipoprotein(a) [Lp(a)] as a causal, independent risk factor for atherosclerotic cardiovascular disease. Elevated Lp(a) levels are detected in approximately 20% of the global population, positioning it as a major contributor to residual cardiovascular risk. Circulating Lp(a) levels are determined predominantly by genetic factors, so they are largely unresponsive to lifestyle modifications or conventional lipid-lowering therapies. Therefore, multiple international guidelines now endorse a one-time, lifetime measurement of Lp(a), as lowering Lp(a) concentrations is expected to have a positive impact on the reduction of cardiovascular risk. Currently, the therapeutic landscape of Lp(a) lowering drugs is rapidly evolving. Some RNA-based therapies (antisense oligonucleotides (ASOs) and small interfering RNAs (siRNAs)) have been demonstrated to reduce plasma Lp(a) concentrations by up to 98% in early-phase clinical trials. The efficacy and safety of these compounds are currently being evaluated in large-scale cardiovascular outcome trials. The results of these studies will be critical in validating the “Lp(a) hypothesis”: specific reduction of Lp(a) levels can lead to a measurable decrease in cardiovascular events. The purpose of this narrative review is to examine and discuss the available evidence on the role of Lp(a) as a risk factor and pharmacological target to provide a practical tool for decision-making in clinical practice.

Cardiac Output (CO) measurement is critical for assessing cardiovascular efficiency, particularly in patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI). Traditional CO monitoring techniques, including invasive and non-invasive methods, often provide only intermittent measurements, limiting their ability to track rapid hemodynamic changes. This study presents a novel approach using wearable wireless inertial measurement units (IMUs) to continuously measure CO through electrocardiogram (ECG) and seismocardiogram (SCG) signals. Our method leverages seismocardiographic techniques combined with machine learning algorithms to provide real-time insights into hemodynamic status. Clinical trials involving 11 patients demonstrated the feasibility and accuracy of this approach, with data collected on the patient’s chest from multiple auscultation areas, including the aortic, mitral, pulmonary, and tricuspid valves, as well as the xiphoid process. To assess whether the choice of valve position or measurement axis significantly affected the accuracy of CO estimations, a Kruskal–Wallis non-parametric analysis of variance (ANOVA) for each performance metric was performed. This test was chosen due to the small sample size and the lack of normality in the data distributions. The analysis did not reveal any statistically significant difference. This study validates the proposed method’s accuracy against the indirect Fick method and investigates different measurement sites. Our findings suggest that continuous, non-invasive CO monitoring using SCG and ECG signals could enhance clinical decision-making during TAVI and potentially other surgical procedures, offering a practical and portable alternative to traditional invasive monitoring systems.

Sodium-glucose cotransporter-2 inhibitors (SGLT2i), initially developed as antihyperglycemic agents, have revolutionized heart failure (HF) management, offering substantial benefits across all stages and phenotypes of the disease. Regardless of left ventricular ejection fraction (LVEF), these agents have proven efficacy in both chronic and acute HF presentations. This review explores SGLT2i applications spanning the HF continuum, from early stages (Stage A) in at-risk individuals to the mitigation of progression in advanced HF (Stage D). Evidence from numerous trials has shown that SGLT2i significantly lower rates of HF hospitalization, improve renal function, and decreases cardiovascular mortality, highlighting their multifaced mechanisms of action in HF care. This review also highlights the potential mechanisms by which SGLT2i exert their beneficial effects on the cardiovascular and renal systems, each contributing to early and sustained clinical improvements. However, the integration of SGLT2i into guideline-directed medical therapy poses practical challenges, including initiation timing, dosing, and monitoring, which are addressed to support effective treatment adaptation across patient populations. Ultimately, this review provides a comprehensive assessment of SGLT2i as a foundational therapy in HF, emphasizing their role as an intervention across multiple stages aimed at improving outcomes across the entire HF spectrum.

Glucagon-like peptide-1 receptor agonists (GLP1-RAs) have demonstrated significant cardiometabolic benefits, particularly in patients with type 2 diabetes and obesity. Their role in heart failure (HF) is gaining increasing attention, with growing evidence supporting their efficacy in HF with preserved ejection fraction (HFpEF). Recent trials have shown that semaglutide improves symptoms, functional capacity, and weight loss in patients with HFpEF. However, these trials did not demonstrate a reduction in HF hospitalizations or mortality. In contrast, tirzepatide has revealed a significant reduction in cardiovascular death and worsening HF events in patients with obesity-related HFpEF, suggesting broader cardioprotective effects. Concordantly, the benefit of GLP1-RAs in the setting of HF with reduced ejection fraction (HFrEF) remains uncertain. Although their mechanisms suggest potential advantages, particularly for patients with a cardiometabolic phenotype, clinical evidence supporting improvements in major clinical outcomes is lacking. Additionally, concerns regarding risk of increased HF hospitalizations, fluid retention and arrhythmic risk have led to a cautious approach in this population. As HF management continues to evolve, GLP1-RAs emerge as a promising yet complex therapeutic option. This review synthesizes the current evidence, highlights key knowledge gaps, and explores how these medications might be integrated into guideline-directed medical therapy (GDMT) to determine their optimal role across the LVEF spectrum in HF.

This study aimed to assess the feasibility of measuring Left Ventricular Ejection Time (LVET) using wearable inertial sensors in patients with aortic stenosis (AS) during pretranscatheter aortic valve implantation (pre-TAVI) evaluation. 11 patients with symptomatic AS undergoing pre-TAVI assessment were included. LVET was measured at 5 different locations using inertial sensors: aortic valve (AV), pulmonary valve (PV), transpulmonary valve (TV), mitral valve (MV) and xiphoid process ($\mathbf{X}$). The results were compared with LVET measurements obtained in the same 5 positions from 11 healthy subjects, maintaining identical experimental conditions. It was found that the sensors, as reported in the literature, measure higher LVET values in patients with AS. The dispersion between different positions was calculated for each subject, supporting the validity of the LVET measurement by demonstrating limited variation across sensor placements. This demonstrated the feasibility of using non-invasive sensors for this type of measurement.

Contrast-associated acute kidney injury (CA-AKI) remains a serious complication after percutaneous coronary revascularization (PCI), with limited effective preventive strategies especially for diabetic patients. This study aimed to assess the effects of novel antidiabetic agents (NAD), i.e., glucagon-like peptide-1 receptor agonists (GLP-1RAs), sodium-glucose transporter-2 inhibitors (SGLT2i), and dipeptidyl peptidase-4 inhibitors (DPP4i), on the occurrence of this outcome in diabetic patients undergoing PCI. We enrolled 293 consecutive diabetic patients receiving NAD at the time of PCI (NAD group) and paired them with 293 diabetic individuals undergoing revascularization who were not on NAD (no-NAD group), matched according to age and sex. CAAKI was defined as an increase in serum creatinine (SCr) >= 0.3 mg/dl or >50% from baseline within 48 to 72 hours after contrast exposure. A propensity score-adjusted logistic regression analysis was performed to account for potential selection bias. NAD treatment was associated with a significantly reduced incidence of CA-AKI than standard glucose-lowering therapies (4.1 vs. 8.5%, p = 0.023). Furthermore, patients using SGLT2i and GLP-1RAs exhibited a lower incidence of CA-AKI compared to those taking DPP4i. Both multivariate and propensity-score-adjusted regression analyses identified NAD therapy as an independent predictor of CAAKI (OR 0.45, 95% CI 0.22-0.98, p = 0.040 and OR 0.48, 95% CI 0.23-0.98, p = 0.045). In conclusion, this study is the first to explore the potential benefit of all three NAD classes on CA-AKI incidence. The use of these agents is associated with a lower incidence of renal damage in diabetic patients undergoing PCI, with the greatest benefit observed with SGLT2i and GLP-1RAs use. (c) 2025 Elsevier Inc. All rights are reserved, including those for text and data mining, AI training, and similar technologies.

Wearable single-lead ECG devices are increasingly used for continuous cardiac monitoring in both clinical and everyday settings. However, their diagnostic value critically depends on the quality of the acquired signals, which can be affected by device design and usage conditions. This study compares the signal quality of three commercially available wearable ECG devices, two chest straps (Movesense strap and Zephyr BioHarness), and an adhesive patch (Movesense patch), during static and dynamic activities typical of daily activities. Ten healthy volunteers performed a standardized protocol while ECG signals were simultaneously recorded from all devices. Signal quality was assessed using a signal quality index (SQI) algorithm. Results showed that cheststrap based devices consistently achieved higher SQI values, whereas the adhesive patch demonstrated lower signal quality, likely due to adhesive degradation over time. These findings highlight the trade-offs between signal reliability and wearability among different ECG wearable designs, supporting informed device selection for both clinical applications and longterm monitoring.

The introduction of transcatheter aortic valve replacement (TAVR) has revolutionized the management of aortic stenosis (AS), leading to significant improvements in patient outcomes. Over time, advancements in device technology have further optimized safety and performance of TAVR. However, as the pool of low-risk patients undergoing TAVR expands, many of whom present with concomitant coronary artery disease (CAD), new challenges have emerged. A large proportion of TAVR candidates suffer from CAD, and the clinical implications of this comorbidity remain a subject of debate. Research on the relationship between AS and CAD has yielded conflicting results, but severe CAD is generally linked to worse outcomes in AS patients. The coexistence of AS and CAD complicates diagnosis and management, requiring a comprehensive understanding of both invasive and non-invasive diagnostic techniques, along with careful revascularization strategies. This review explores the prevalence, clinical impact, and diagnostic challenges of CAD in TAVR patients, highlighting emerging methods for its assessment. Key aspects of treatment, including the timing of coronary revascularization, coronary re-access after TAVR in different settings, as well as practical tips and tricks for coronary cannulation, are also discussed. The complexity of managing AS and CAD is further intensified by the need for individualized approaches, particularly in hybrid procedures and subsequent TAVR interventions. Ongoing research and technological innovations offer promising solutions for refining the management of CAD in AS patients undergoing TAVR, with an emphasis on improving prognostic accuracy, optimizing revascularization strategies, and enhancing post-procedural care.

Heart failure with preserved ejection fraction (HFpEF) represents nearly half of all heart failure cases and remains diagnostically challenging due to its heterogeneous pathophysiology and often subtle myocardial dysfunction. Conventional echocardiographic parameters, such as left ventricular ejection fraction (LVEF) and the left atrial volume index (LAVI), frequently fail to detect early functional changes. Advanced echocardiographic techniques have emerged as valuable tools for early diagnosis and risk stratification. Global Longitudinal Strain (GLS) allows for the identification of subclinical systolic dysfunction, even with preserved LVEF. Left Atrial Strain (LAS), particularly reservoir and pump strain, provides sensitive markers of diastolic function and elevated filling pressures, offering additional diagnostic and prognostic insights. Myocardial Work (MW), through non-invasive pressure–strain loops, enables load-independent assessment of contractility, while Right Ventricular Free Wall Longitudinal Strain (RVFWLS) captures early right heart involvement, often present in advanced HFpEF. The integration of these advanced parameters can enhance diagnostic precision and guide personalized treatment strategies. This review highlights the current evidence and clinical applications of strain-based imaging in HFpEF, underscoring the importance of a multiparametric, pathophysiology-oriented approach in heart failure evaluation.

AIMS:Our study aims to evaluate the acute remodelling of the tricuspid valve annulus immediately after the tricuspid transcatheter edge-to-edge repair (T-TEER) by using intraprocedural transoesophageal 3D echocardiography. METHODS AND RESULTS:We prospectively enrolled 62 consecutive symptomatic patients with at least severe tricuspid regurgitation (TR), who underwent T-TEER with the TriClip System between March 2021 and June 2024. The following parameters were assessed using a multiplanar reconstruction analysis performed off-line using a 3D data set: septal-lateral (SL) and antero-posterior (AP) annulus diameters; annulus area; annulus perimeter; and eccentricity index. The acute procedural success was achieved in 85.5%. We observed an acute reduction in SL (from a median of 43 to 38 mm, P < 0.0001), AP (from a median of 46 to 45 mm, P < 0.0001), area (from a median of 17.9 to 15.95 cm2, P < 0.0001), perimeter (from a median of 145.5 to 137 mm, P < 0.0001), and eccentricity index (from 0.92 to 0.87, P < 0.0001). The tricuspid valve (TV) annulus was progressively larger in patients with higher residual TR. Analysis of the subgroups according to procedural success showed an acute inverse remodelling of the TV annulus independent of the acute procedural success. CONCLUSION:The TV geometry necessitates the use of 3D echocardiography for accurate assessment of annular remodelling post T-TEER. The reduction in TR grade and TV annulus dimensions begins immediately after TriClip implantation. Concurrently, the baseline TV geometry influences the procedural results.

Objective: Postsurgical chronic hypoparathyroidism (HypoPT) has been linked to an increased cardiovascular risk, but the underlying pathophysiological mechanisms remain incompletely understood. Emerging evidence suggests a potential direct role of parathyroid hormone (PTH) in modulating platelet function and oxidative stress, both contributors to atherothrombosis.Our study aimed to investigate the impact of PTH on platelet function and activation, with a particular focus on NOX2-mediated platelet activation in patients with HypoPT. Methods: We conducted a cross-sectional study involving 24 patients with HypoPT and 40 age- and sex-matched healthy controls. Clinical, biochemical, and platelet function parameters were assessed. In a subgroup of five HypoPT patients, changes were evaluated after 24 months of PTH (1–34) therapy. Platelet aggregation, oxidative stress biomarkers (sNOX2-dp, H2O2, 8-OHdG), and thrombus formation (T-TAS) were measured. The in vitro effect of PTH (1–34) was tested on isolated platelets. Results: Patients with HypoPT exhibited enhanced platelet activation, increased oxidative stress, and accelerated thrombus formation compared to controls. Enhanced platelet activation and increased oxidative stress observed in HypoPT were further amplified in HypoPT subjects treated with PTH (1–34). In vitro, PTH (1–34) increased oxidative stress and platelet aggregation only in platelets from HypoPT patients, through a specific signaling pathway involving PTH1R activation, intracellular calcium release, protein kinase C (PKC) activation and NOX2-dependent ROS generation. Conclusion: HypoPT is associated with heightened platelet reactivity and thrombotic risk. PTH therapy may exacerbate these alterations through a defined molecular mechanism. These findings highlight the need for careful cardiovascular monitoring in HypoPT patients, particularly those receiving PTH analogues.

In recent years, the introduction of sodium-glucose transporter-2 inhibitors (SGLT2is) marked a significant advancement in the treatment of cardiovascular disease (CVD). Beyond their known effects on glycemic control and lipid profile, SGLT2is demonstrate notable benefits for cardiovascular morbidity and mortality, regardless of diabetic status. These agents are currently recommended as first-line therapies in patients with heart failure, both with reduced and preserved ejection fraction, as they improve symptoms and reduce the risk of hospitalization. While several studies have demonstrated that SGLT2is can reduce the incidence of major adverse cardiovascular events (MACEs), the true impact of these agents on atherosclerosis progression and myocardial ischemia remains to be fully understood. A global beneficial effect related to improved glycemic and lipid control could be hypothesized, even though substantial evidence shows a direct impact on molecular pathways that enhance endothelial function, exhibit anti-inflammatory properties, and provide myocardial protection. In this context, this narrative review summarizes the current knowledge regarding these novel anti-diabetic drugs in preventing and treating myocardial ischemia, aiming to define an additional area of application beyond glycemic control and heart failure.

Disclosure: A. Naciu: None. A. Nusca: None. F. Piccirillo: None. G. Tabacco: None. A. D'Amico: None. A. Di Tommaso: None. G. Sterpetti: None. M. Viscusi: None. F. Bernardini: None. M. Forte: None. L. D’Ambrosio: None. G. Frati: None. C. Nocella: None. N. Napoli: None. R. Carnevale: None. S. Sciarretta: None. F. Grigioni: None. A. Palermo: None. Objective. Both primary hyperparathyroidism (PHPT) and chronic hypoparathyroidism (HypoPT) are associated with the onset and development of cardiovascular diseases (CVDs). Endothelium is a recognized target tissue of PTH and there is an increasing body of evidence that PTH affects functional and structural properties of arteries. However, the molecular mechanisms underlying the effects of parathyroid disorders on endothelial dysfunction and platelet aggregation, two main determinants of CVDs, are not completely understood. Aim. To evaluate the effects of PHPT and HypoPT on oxidative stress, endothelial and platelet function. Material and methods: in a monocentric, cross-sectional study we enrolled hypoPT patients treated with calcium and calcitriol, PHPT subjects and age-matched controls. All patients underwent a biochemical examination including calcium-phosphorus metabolism, inflammation markers, circulating levels of markers of oxidative stress, endothelial function, and platelet activation. Moreover, we evaluated brachial artery endothelial function (flow-mediated dilation-FMD), common carotid intima-media thickness (ccIMT), diastolic function and global strain measures with ultrasound. Results. These are the results of this project that included 120 subjects (40 hypoPT, 40 PHPT and 40 age- and sex-matched control subjects). HypoPT and PHPT patients showed increased oxidative stress markers as compared to control subjects (p<0.001). Among patients with parathyroid disorders, those with PHPT demonstrated the highest reduction of nitric oxide (p<0.001 versus HypoPT and controls) and FMD (p<0.001 and p=0.001) and a marked increase of IMT (p<0.001 and p=0.001). We also observed an increased platelet aggregation in patients with parathyroid disorders, with the highest values in PHPT patients (p<0.001, PHPT vs controls; p=0.006, HypoPT vs controls; p<0.001, PHPT vs HypoPT), along with increased levels of soluble P selectin and thromboxane B2. Conclusions. PHPT and HypoPT patients have increased atherothrombotic risk due to endothelial and platelet function alterations. Our results suggest that PTH may influence platelet reactivity. Further research is needed to determine if personalized antiplatelet therapy is necessary in subjects with parathyroid disorders Presentation: Sunday, July 13, 2025