Artificial intelligence is increasingly used in cardiovascular medicine, with applications in diagnosis, risk prediction, and clinical decision-making. However, emerging evidence suggests that these tools may exhibit differences in performance between men and women, with the potential to amplify existing disparities in cardiovascular care. This narrative review examines the role of sex and gender in artificial intelligence models applied to cardiology, focusing on the main areas of application, including electrocardiography, cardiovascular imaging, risk prediction, and clinical decision support systems. In many settings, models demonstrate good overall performance; however, stratified analyses reveal reduced sensitivity and higher rates of false-negative results in women. These differences may lead to underdiagnosis, delayed treatment, and inadequate risk stratification. Major contributing factors include the underrepresentation of women in training datasets, the lack of sex-specific variables, and the use of non-sex-specific diagnostic criteria. A systematic evaluation of model performance across subgroups, together with the integration of sex- and gender-specific variables, is essential to ensure a more equitable and clinically appropriate use of artificial intelligence in cardiovascular practice.

L’intelligenza artificiale è sempre più utilizzata in cardiologia, con applicazioni nella diagnosi, nella predizione del rischio e nel supporto alle decisioni cliniche. Tuttavia, evidenze recenti indicano che questi strumenti possono presentare differenze di performance tra uomini e donne, con il rischio di amplificare disuguaglianze già esistenti nella cura cardiovascolare. La presente revisione narrativa analizza il ruolo del sesso e del genere nei modelli di intelligenza artificiale applicati alla cardiologia, esaminando le principali evidenze nei diversi ambiti applicativi, tra cui elettrocardiografia, imaging cardiovascolare, predizione del rischio e sistemi di supporto decisionale clinico. In molti contesti, i modelli mostrano buone performance globali; tuttavia, analisi stratificate evidenziano una ridotta sensibilità e un aumento dei falsi negativi nelle donne. Queste differenze possono tradursi in sottodiagnosi, ritardi terapeutici e inadeguata stratificazione del rischio. Tra i principali determinanti si riconoscono la sottorappresentazione femminile nei dataset, la mancata inclusione di variabili sesso-specifiche e l’utilizzo di criteri diagnostici non differenziati. Una valutazione sistematica delle performance nei sottogruppi, insieme all’integrazione di variabili sesso- e genere-specifiche, rappresenta un elemento fondamentale per garantire un uso più equo e appropriato dell’intelligenza artificiale nella pratica clinica.

Through the use of teleassistance, nurses play a fundamental role in the management of chronic cardiovascular diseases, contributing to improving patients' perceived quality of life and promoting self-care practices. This model of care actively supports the development of mindful and proactive behaviors by patients in managing their own lifestyle habits. Furthermore, teleassistance is an effective tool in promoting therapeutic adherence, particularly in the post-hospital discharge phase. The literature review carried out in this study confirms these benefits. However, there is a need to explore the effectiveness of nursing teleassistance in relation to other relevant clinical outcomes, such as the reduction of new hospitalizations, post-discharge complications, mortality and healthcare-related costs.

The present paper explores non-traditional cardiovascular risk factors that are not directly related to sex or gender but significantly impact cardiovascular health in both men and women. Socioeconomic status, psychological stress, environmental pollution, violence, and abuse contribute to increased cardiovascular risk through mechanisms such as chronic inflammation, altered neuroendocrine regulation, and unhealthy lifestyle behaviours. Depression and mental health disorders are more common in women and are associated with increased inflammatory markers and endothelial dysfunction, leading to higher rates of atherosclerosis and adverse outcomes. Chronic stress, sleep disorders, and autoimmune diseases further amplify cardiovascular risk, with women often experiencing distinct pathophysiological responses due to hormonal and genetic factors. Emerging evidence highlights the importance of metabolic dysfunction-associated steatotic liver disease (MASLD), migraine, and cancer therapies as additional risk factors, particularly in women. The need for personalised screening, prevention and treatment strategies that take into account sex and gender differences, as well as the influence of socio-economic and environmental determinants, is em-phasised. Recognizing and addressing these multifaceted risk factors is essential for improving cardiovascular outcomes and ad-vancing equitable healthcare for women.

Cardiovascular risk estimation in transgender people is an emerging research area with significant clinical implications. Healthcare for transgender people is challenging, as it encompasses the impact of hormone therapies, social inequalities, and chronic stress associated with potential discrimination. In fact, these factors may differently influence cardiovascular risk as compared to the cisgender population, although current evidence is still limited. The aim of this paper was to provide an overview of current knowledge about cardiovascular disease in transgender individuals in order to promote an evidence-based approach for this population and, finally, health equality in cardiovascular disease management.

Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among women, yet sex-specific and gender-specific differences in disease pathophysiology, clinical presentation, and treatment response are often underappreciated. This article presents the findings of a multidisciplinary expert consensus involving 59 specialists from cardiovascular and affine scientific societies. Experts were divided into 11 working groups, each focusing on distinct aspects of cardiovascular risk, prevention, diagnosis, and treatment in women. Utilizing a Delphi-like method, 71 key statements were developed, refined, and evaluated to establish a consensus on best practices for addressing sex-specific and gender-specific disparities in cardiovascular care. The findings underscore critical gaps in current guidelines, particularly regarding hormonal influences, pharmacological responses, and environmental and socioeconomic determinants of cardiovascular risk in women. The consensus highlights the need for improved screening strategies, individualized risk assessment models incorporating female-specific factors, and increased representation of women in cardiovascular research. Telemedicine and digital health tools offer promising solutions for bridging existing disparities. The study reinforces the necessity for a paradigm shift in cardiovascular medicine, advocating for gender-sensitive policies and clinical guidelines. Future research should focus on integrating gender-specific considerations into all facets of cardiovascular care to optimize outcomes for women.

Cardiovascular risk estimation in transgender people is an emerging research area with significant clinical implications. Healthcare for transgender people is challenging, as it encompasses the impact of hormone therapies, social inequalities, and chronic stress associated with potential discrimination. In fact, these factors may differently influence cardiovascular risk as compared to the cisgender population, although current evidence is still limited. The aim of this paper was to provide an overview of current knowledge about cardiovascular disease in transgender individuals in order to promote an evidence-based approach for this population and, finally, health equality in cardiovascular disease management.

Cardiovascular disease is the leading cause of death in women, yet prevention and management have historically relied on male-centered models. Sex and gender critically influence risk, clinical presentation, and outcomes. Depression, anxiety, and psychosocial stress, more prevalent in women, act as key amplifiers of cardiovascular risk. We conducted a clinically oriented narrative review based on a broad, non-systematic search of major databases, integrating evidence selected for relevance and methodological robustness to clarify biological and psychosocial mechanisms linking mental health and cardiovascular disease in women. Affective disorders and stress contribute to cardiovascular risk through interconnected pathways, including hormonal fluctuations, autonomic and neuroendocrine dysregulation, inflammation, endothelial dysfunction, and heightened platelet reactivity. These mechanisms interact with gender-related exposures such as caregiving burden, occupational stress, and interpersonal violence. Stress-related phenotypes, including mental stress, induced ischemia and takotsubo syndrome, exemplify the heart-brain axis and its clinical implications. Incorporating mental health into cardiovascular risk assessment is essential for precision prevention in women. A women-centered approach should include systematic psychosocial evaluation, multidisciplinary care, and tailored strategies to improve risk control, adherence, and outcomes.

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.

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.

AimsThis study reports on the concerns about myocarditis and pericarditis following COVID-19 vaccination that have been raised worldwide. However, the heterogeneous diagnostic criteria for postvaccination inflammatory heart diseases may result in overestimating incidence rates. The aim of this multicentre Italian registry is to evaluate the impact of COVID-19 vaccines on the incidence of myocarditis and pericarditis in the Italian population.MethodsConsecutive patients admitted to Italian hospitals for endomyocardial and/or cardiac magnetic resonance proven acute myocarditis and/or pericarditis in the same period (1 June-31 October) of 2019 and 2021 were enrolled, irrespective of the potential association with the COVID-19 vaccines. Acute pericarditis and/or myocarditis were defined as 'vaccine-related' if clinical presentation occurred within 15 days after COVID-19 vaccination, independently of the dose.ResultsThere was a comparable incidence rate ratio (IRR) for inflammatory heart diseases in 2019 and 2021 (2019: IRR 0.67 versus 2021: IRR 0.74, P = 0.45). In particular, the IRR did not differ in myocardial involvement (2019: IRR 0.33 versus 2021: IRR 0.33, P = 1) and pericarditis (2019: IRR 0.37 versus 2021: IRR 0.49, P = 0.09) in both periods. Among 125 cases registered in 2021, 32 (25.6%) were 'vaccine-related'. Among those who experienced 'vaccine-related' myocarditis and/or pericarditis, men with age under 40 years were over-represented (53.12%, P = 0.021).ConclusionIn a nationwide Italian survey comparing pandemic with prepandemic periods, the overall data do not indicate an increase in the incidence of pericarditis and myocarditis, suggesting that the vaccine can be considered well tolerated for these specific conditions.

L’impatto della terapia ormonale sostitutiva (TOS) sull’apparato cardiovascolare (CV) nelle donne in menopausa è stato oggetto di un vivace dibattito per molti anni. Dopo una fase contrassegnata da un utilizzo restrittivo in seguito agli esiti dei primi trial randomizzati negli anni 2000, nel corso dell’ultimo decennio si è assistito ad una significativa rivalutazione dei rischi e dei benefici della terapia, soprattutto del rischio CV. Grazie a nuovi studi condotti su popolazioni più selezionate e a sottoanalisi dei precedenti trial, vi è oramai ampia evidenza riguardante l’alto profilo di sicurezza della TOS, e addirittura di protezione sul sistema CV per le donne giovani a basso profilo di rischio CV nella fase iniziale della menopausa. Queste evidenze sono state inserite in tutte le linee guida nazionali ed internazionali per la menopausa e, recentemente, anche in un documento di consenso della Società Europea di Cardiologia. Pertanto, il cardiologo assume un ruolo centrale nella valutazione del rischio e nel trattamento dei fattori di rischio CV modificabili durante la fase di transizione menopausale, periodo critico per le donne poiché associato a significativi cambiamenti nell’equilibrio glico-metabolico. Questo articolo riassume le attuali conoscenze sull’argomento e fornisce una guida pratica per la gestione cardiologica di tali pazienti.

The impact of hormone replacement therapy (HRT) on the cardiovascular (CV) system in menopausal women has been the subject of significant debate for many years. After a phase marked by restrictive use following the outcomes of the first randomized trials in the 2000s, the last decade has witnessed a significant reassessment of the risks and benefits of therapy, especially CV risk. Thanks to new studies conducted in more selected populations and sub-analyses of earlier trials, there is now ample evidence regarding the high safety profile of HRT, and even protection on the CV system, for young women with a low CV risk profile in the early menopausal phase. This evidence has been incorporated into all national and international menopausal guidelines and, recently, also in a consensus document by the European Society of Cardiology. Therefore, the cardiologist assumes a central role in the risk assessment and treatment of modifiable CV risk factors during the menopausal transition, a critical period for women as it is associated with significant changes in the glycometabolic balance. This article summarises current knowledge on the subject and provides practical guidance for the cardiological management of such patients.

Suppressive antibiotic therapy (SAT) is a palliative, non–curative approach for managing infective endocarditis (IE) in selected patients. This retrospective observational descriptive study aimed to evaluate the efficacy and safety of SAT in IE patients ineligible for cardiac surgery. We analyzed 14 IE patients treated with SAT between 2017 and 2023, selected from a cohort of 129 IE cases diagnosed according to ESC 2023 guidelines of which detailed data were collected. Follow–up was defined as the period from the transition from curative parenteral therapy to SAT until death or the most recent follow–up date. The study cohort primarily comprised elderly males with significant comorbidities such as diabetes, heart failure, and chronic kidney disease. Prosthetic valve IE was most common, predominantly affecting biological valves (42% aortic, 29% mitral). Native valve and CIED IE were less frequent. Streptococcus species were the main pathogens identified (Table 1). SAT lasted an average of 575 days, with 36% of patients on long–term therapy. Beta–lactams were the primary antibiotics used. The study reported a 14% IE recurrence rate and 29% mortality rate, with a mean time to all–cause death of 177 days (Table 2). These findings align with recent studies, (SATIE study and Lemmet et al.‘s research): in fact the observed outcomes suggest effective management of this high–risk population, and, comparatively, the extended mean SAT duration indicates good tolerability in selected inoperable IE patients with multiple comorbidities and high surgical risk. Recent guidelines recognize SAT as a potential strategy for IE patients ineligible for cardiac surgery. However, they highlight the lack of robust evidence supporting its efficacy and provide no specific protocols. Despite limitations such as small sample size, retrospective design, and absence of a control group, our preliminary findings, in line with existing literature, suggest potential efficacy and safety of SAT in selected high–risk IE cases with limited treatment options. Future research should focus on determining optimal SAT duration, clarifying its role in specific patient populations (especially those with CIED–related IE), and evaluating advanced imaging modalities like PET/CT for assessing recurrence rates and guiding follow–up management. These efforts will contribute to developing more comprehensive, evidence–based guidelines for SAT use in IE management. Table 1 Table 2

AIMS:Some studies about myocarditis and pericarditis following COVID-19 vaccination raised concerns worldwide. However, the heterogeneous diagnostic criteria for postvaccination inflammatory heart diseases may result in overestimating incidence rates. The aim of this multicentre Italian registry is to evaluate the impact of COVID-19 vaccines on the incidence of myocarditis and pericarditis in the Italian population. METHODS:Consecutive patients admitted to Italian hospitals for endomyocardial and/or cardiac magnetic resonance proven acute myocarditis and/or pericarditis in the same period (1 June-31 October) of 2019 and 2021 were enrolled, irrespective of the potential association with the COVID-19 vaccines. Acute pericarditis and/or myocarditis were defined as 'vaccine-related' if clinical presentation occurred within 15 days after COVID-19 vaccination, independently of the dose. RESULTS:There was a comparable incidence rate ratio (IRR) for inflammatory heart diseases in 2019 and 2021 (2019: IRR 0.67 versus 2021: IRR 0.74, P = 0.45). In particular, the IRR did not differ in myocardial involvement (2019: IRR 0.33 versus 2021: IRR 0.33, P = 1) and pericarditis (2019: IRR 0.37 versus 2021: IRR 0.49, P = 0.09) in both periods. Among 125 cases registered in 2021, 32 (25.6%) were 'vaccine-related'. Among those who experienced 'vaccine-related' myocarditis and/or pericarditis, men with age under 40 years were over-represented (53.12%, P = 0.021). CONCLUSION:In a nationwide Italian survey comparing pandemic with prepandemic periods, the overall data do not indicate significant concerns about an increased incidence of pericarditis and myocarditis, suggesting that the vaccine is generally well tolerated for these specific conditions.

Il costante aumento della domanda di servizi sanitari digitali, particolarmente evidenziata dalle recenti crisi sanitarie globali, ha sottolineato l’importanza dell’alfabetizzazione sanitaria (eHealth literacy, eHL). Per eHL si intende il complesso di competenze necessarie per cercare, comprendere, valutare e applicare in modo efficace le informazioni sanitarie online per risolvere problemi relativi alla salute. L’eHL non solo facilita l’accesso e la fruizione dei servizi sanitari, ma può anche permettere di analizzare il divario digitale nel contesto dell’accessibilità delle informazioni sanitarie, offrendo possibili spunti di riflessione e soluzioni per affrontare tale criticità In questa rassegna vengono discusse le definizioni e gli strumenti dell’eHL degli utenti, con particolare attenzione alle disuguaglianze di genere, sociali e anagrafiche, nonché al ruolo dell’eHL durante la pandemia COVID-19.

Artificial intelligence (AI) is revolutionizing cardiology, offering new opportunities to improve diagnosis, therapy, and prevention of cardiovascular diseases. By analyzing large amounts of data and supporting clinical decisions, AI can simplify modern medical complexities. However, its development is limited by methodological, ethical, and organizational obstacles. This review aims to present the potential applications of AI in cardiology in a practical and accessible manner, exploring key algorithms, opportunities, and limitations. It is crucial to address the challenges associated with AI to ensure its ethical and responsible use in support of clinical expertise while actively promoting collaboration between clinicians and information technology specialists to fully realize the potential of AI in daily cardiological practice.

L’intelligenza artificiale (IA) sta rivoluzionando la cardiologia, offrendo nuove opportunità per migliorare la diagnosi, la terapia e la prevenzione delle malattie cardiovascolari. Grazie alla sua capacità di analizzare grandi quantità di dati e supportare le decisioni cliniche, l’IA può semplificare complessità mediche moderne. Tuttavia, il suo sviluppo è limitato da ostacoli metodologici, etici e organizzativi. Questa rassegna mira a presentare i possibili utilizzi dell’IA in cardiologia in modo pratico ed accessibile, esplorando algoritmi chiave, opportunità e limiti. Risulta cruciale affrontare le criticità associate all’IA al fine di garantirne un uso etico e responsabile a supporto dell’expertise clinica, promuovendo attivamente la collaborazione tra clinici e specialisti informatici per realizzare appieno il potenziale dell’IA nella pratica cardiologica quotidiana.

It is well established that gender strongly influences cardiovascular risk factors, playing a crucial role in cardiovascular prevention, clinical pathways, diagnostic approach and treatment. Beyond the sex, which is a biological factor, gender entails a socio -cultural condition that impacts access and quality of care due to structural and institutional barriers. However, despite its great importance, this issue has not been adequately covered. Indeed sex and gender differences scarcely impact the clinical approach, creating a lot of disparities in care and outcomes of patients. Therefore, it becomes essential to increase the awareness of the importance of sex and gender influences on cardiovascular diseases. Moreover, new strategies for reducing disparities should be developed. Importantly, these differences should be taken into account in guideline recommendations. In this regard, it is crucial to include a greater number of women in clinical trials, since they are currently underrepresented. Furthermore, more women should be involved as member of international boards in order to develop recommendations and guidelines with more attention to this important topic. The aim of this ANMCO position paper is to shed light on gender differences concerning many cardiovascular drugs in order to encourage a more personalized therapeutic approach.