Cardio-kidney-metabolic syndrome and heart failure remain complex clinical conditions with significant healthcare implications. While therapeutic plans were intended to ensure appropriate prescribing, they often represent bureaucratic barriers. Facilitating or removing such plans could enhance treatment timeliness, therapeutic continuity, and equitable access. This work also includes other widely used cardiovascular drugs such as direct oral anticoagulants, which remain under therapeutic plan requirements despite robust clinical experience and safety data. In light of the recent AIFA resolution of July 4, 2025, abolishing the therapeutic plan for sodium-glucose cotransporter 2 inhibitors, this paper considers such a decision as a major normative and operational breakthrough. The removal of this prescribing barrier reflects both the safety and manageability of these drugs and represents a potential model for broader regulatory simplifications. It is therefore believed that overcoming the prescribing barriers imposed by therapeutic plans is not only a clinical necessity but also an organizational and ethical imperative, in order to avoid delaying or limiting access to care.

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.

INTRODUCTION:ESC/ERS guidelines recommend risk stratification of prevalent patients with pulmonary arterial hypertension (PAH) using noninvasive parameters, whereas right heart haemodynamic parameters are left to the clinician's discretion if deemed necessary. The study aimed to define the possible contribution of invasive haemodynamic parameters in predicting both the risk of death from all causes and the risk of clinical worsening (CW) in patients with PAH categorized at follow-up by the noninvasive ESC/ERS 4-strata risk stratification model. METHODS:We evaluated incident patients with PAH enrolled in 11 Italian centres between 2005 and 2021 who had a first follow-up right heart catheterization within 6-12 months of diagnosis. In each noninvasive risk category, patients were subsequently stratified in a subgroup with a good haemodynamic profile if stroke volume index was ⩾38 mL/m2 and right atrial pressure was <8 mmHg and a subgroup with a poor haemodynamic profile if stroke volume index <38 ml/m2 and/or right atrial pressure ⩾8 mmHg. Median follow-up was 3.7 years (interquartile range 1.2-6.8) months. RESULTS:Among low-risk patients (n = 162) survival was similar, but the CW rate was better in the good haemodynamic compared with the poor haemodynamic subgroup (P = .033). Among patients at intermediate-low risk (n = 240), both survival and CW rates were significantly better in the good haemodynamic subgroup compared with the poor haemodynamic subgroup (P = .028 and P = .011, respectively). Among patients at intermediate-high risk (n = 339), the CW rate was similar but survival was significantly better in the good haemodynamic than in the poor haemodynamic subgroup (P = .015). In the high-risk group, only 1 out of 28 patients had a good haemodynamic profile. CONCLUSION:In prevalent patients with PAH, a good haemodynamic profile predicts better survival in intermediate-risk patients and, importantly, a lower CW rate in low-risk patients.

Background: Cardiac amyloidosis (CA) is frequently diagnosed in clinically stable patients, yet the risk of subsequent heart failure (HF) hospitalization remains difficult to predict using readily available tools. Early identification of high-risk outpatients is crucial to optimize follow-up and therapeutic strategies. Purpose: To develop a simple, non-invasive risk score to predict HF hospitalization in stable patients with cardiac amyloidosis using standard electrocardiographic and echocardiographic parameters. Methods: We prospectively enrolled 100 consecutive patients with confirmed cardiac amyloidosis from three tertiary centers. Baseline evaluation included clinical assessment, electrocardiography, and transthoracic echocardiography. The primary endpoint was HF hospitalization during follow-up; secondary endpoints were HF-related and all-cause mortality. Cox regression analysis was used to identify independent predictors of HF hospitalization and to derive a point-based risk (CAMY-HF) score. Results: During a median follow-up of 36 months, 55% of patients required HF hospitalization and 47% died. Low QRS voltage, interventricular septal thickness ≥14 mm, and left ventricular ejection fraction ≤40% independently predicted HF hospitalization and were incorporated into the CAMY-HF score (range, 0-4). HF hospitalization occurred in 0% of low-risk, 47.9% of intermediate-risk, and 80.6% of high-risk patients at 3 years. Higher CAMY-HF scores were also associated with increased HF-related and all-cause mortality. Conclusions: The CAMY-HF score is a simple, widely applicable tool for early risk stratification in clinically stable patients with cardiac amyloidosis. By relying on routine ECG and echocardiographic parameters, it may help identify outpatients at high risk of HF hospitalization and guide follow-up intensity and management strategies.

La gestione dei pazienti in terapia intensiva comporta una speciale attenzione per pazienti complessi con comorbilità multiple e dis­funzione multiorgano, per i quali è richiesta una formazione continua e avanzata del personale. Recenti evidenze mostrano che la malnutrizione influisce negativamente sui risultati cardiovascolari, ma può essere migliorata con strategie mirate. Tuttavia, rimangono lacune nella standardizzazione della valutazione e della gestione nutrizionale. L’obiettivo del gruppo di lavoro Best Practice è quello di elaborare una flow chart operativa per supportare le valutazioni sulla nutrizione dei pazienti ricoverati presso le unità di terapia intensiva cardiologica (UTIC) e valutarne l’impatto sulla pratica clinica. Dopo un’accurata recensione della letteratura, incluse le linee guida e le revisioni Cochrane, sono state sintetizzate le evidenze disponibili sulla nutrizione in UTIC e sono stati sviluppati algoritmi decisionali operativi per le seguenti condizioni cliniche: insufficienza cardiaca acuta, sindrome coronarica acuta, cura post-arresto cardiaco, shock cardiogeno. Tutti questi quadri clinici sono stati inseriti in un unico algoritmo per facilitare la consultazione e l’uso nella pratica clinica. Questo progetto mira a diffondere e standardizzare le decisioni basate sulle migliori prassi nelle UTIC e rappresenta un primo step strutturato verso una maggiore sensibilizzazione alla valutazione della nutrizione e alla sua gestione in maniera più omogenea ed efficace.

BACKGROUND: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. METHODS: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. RESULTS: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. CONCLUSIONS: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.

Background:Catheter ablation is useful to treat patients with scar-related heart disease and ventricular tachycardia (VT). QDOT Micro catheter is a next generation catheter. Its optimized temperature control and micro-electrode technology are designed to provide more efficient and consistent lesion creation with an accurate myocardial substrate analysis. This study aims to compare the myocardial electro-anatomic maps obtained using QDOT and Pentaray (PR) catheters. Method:This study enrolled patients with symptomatic VT and indication to perform CA following the latest guidelines. Myocardial electro-anatomic maps were obtained using QDOT and Pentaray (PR) catheters. The primary objective was to assess the absence of sustained VTs or ICD interventions 12 months after the procedure. Results:Twelve patients were enrolled. The percentage of myocardial scar was higher using QDOTB map (15.5%) compared to PR (13.5%) and QDOTM-map (9%) (< 0.001). The percentage of myocardial borderzone was higher using QDOTB map (7.5%) compared to PR (6%) and QDOTM-map (3%) (p < 0.001). The average EGM amplitude acquired in the myocardial scar was higher in the QDOTM-map (0.24 mV) compared to PR (0.10 mV) and QDOTB-map (0.10 mV) (p < 0.001). The average EGM amplitude acquired in the myocardial borderzone was higher in the QDOTM-map (1.07 mV) compared to PR (0.80 mV) and QDOTB-map (0.72 mV) (p < 0.001). No sustained VT was documented at 12 month FU. No adverse events were documented. Conclusion:Microelectrode mapping allows detection of higher voltage electrograms compared to standard bipolar mapping and PR mapping. In our small population, the HPSD protocol was used inside the low voltage areas without acute procedural complications.

Acute coronary syndromes (ACS) represent one of the leading causes of cardiovascular mortality and morbidity, with a substantial clinical, organizational, and economic impact on the Italian National Health Service (NHS). On behalf of the National Center for Clinical Excellence, Quality and Safety of Care of the Italian National Institute of Health (Istituto Superiore di Sanità, ISS), the Italian Association of Hospital Cardiologists (ANMCO) promoted the development of consensus-based recommendations for good clinical practice (RBPCA) for the diagnosis and management of ACS, with the aim of integrating and contextualizing the most recent European Society of Cardiology guidelines within the Italian healthcare setting. The recommendations were developed through a multidisciplinary Consensus Conference, according to the ISS methodological framework, addressing 16 clinical and organizational issues of major relevance related to the diagnostic and therapeutic pathway of ACS. The RBPCA aim to reduce variability in clinical management, promote appropriateness and uniformity of care, and improve clinical outcomes for patients with ACS within the context of the Italian NHS.

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.

La prevenzione cardiovascolare primaria è stata uno dei principali temi di discussione nel corso degli Stati Generali ANMCO 2025. L’attenzione nei confronti di questo argomento è conseguente alle evidenze che, sebbene nei paesi a più alto reddito la mortalità per malattie cardiovascolari si sia ridotta nel corso dei decenni, il trend in riduzione è rallentato negli ultimi anni. Le malattie cardiovascolari restano tra le principali cause di morte in tutto il mondo e una significativa proporzione di eventi cardiovascolari, incluse le morti, si presentano in pazienti senza precedenti manifestazioni di malattia. In questo documento vengono presentate le iniziative che ANMCO realizza con la Fondazione per il Tuo cuore per diffondere la cultura della prevenzione primaria: da giornate dedicate allo screening per le malattie cardiovascolari a campagne di formazione nelle scuole e di informazione e sensibilizzazione attraverso vari strumenti digitali (pagine web, social media). Un ulteriore aspetto cui punta ANMCO per la prevenzione cardiovascolare è l’implementazione dell’approccio One Health promosso dall’Organizzazione Mondiale della Sanità. Un’alimentazione sana come la dieta mediterranea rappresenta non solo uno stile di vita che può favorire la prevenzione cardiovascolare ma anche un approccio alla salute che rispetta e protegge l’ambiente. In aggiunta ci sono i “killer silenziosi”, fattori ambientali come l’inquinamento dell’aria, l’inquinamento acustico e luminoso, e l’inquinamento chimico di terreni e acque, tutti fattori di rischio emergenti da considerare come target di un approccio One Health.

Lo scompenso cardiaco a frazione di eiezione ridotta (HFrEF) ed eziologia ischemica rappresenta una delle principali cause di morbilità e mortalità ed è associato a prognosi sfavorevole. La rivascolarizzazione miocardica costituisce una strategia terapeutica potenzialmente in grado di migliorare sintomi e outcome, ma il beneficio non è uniforme e dipende da molteplici fattori, tra cui anatomia coronarica, severità della disfunzione ventricolare sinistra e presenza di tessuto cicatriziale. Le evidenze disponibili indicano che il bypass aortocoronarico è l’unica strategia ad aver dimostrato un beneficio prognostico a lungo termine nei pazienti selezionati, a fronte di un aumentato rischio perioperatorio precoce. Al contrario, l’angioplastica coronarica percutanea sembra offrire principalmente un beneficio sintomatologico e in termini di qualità di vita, senza un impatto significativo sulla sopravvivenza. Parallelamente, i progressi della terapia medica ottimale hanno profondamente modificato la storia naturale della malattia, riducendo il beneficio incrementale della rivascolarizzazione. In questo contesto, la selezione dei pazienti richiede un approccio integrato e multidisciplinare, con decisione condivisa in Heart Team per ottimizzare il rapporto rischio-beneficio. Scopo della presente rassegna è analizzare criticamente il ruolo della rivascolarizzazione nell’HFrEF ad eziologia ischemica alla luce delle evidenze più recenti, con particolare attenzione alla selezione dei pazienti e all’integrazione tra dati clinici e di imaging.

Preventing the development and progression of atherosclerotic cardiovascular disease is a challenge that is part of the mission of many clinicians, particularly those working in cardiology. Given the demonstrated cumulative effect of risk factors, early recognition of these factors and the implementation of both pharmacological and non-pharmacological interventions allows for more effective prevention of cardiovascular events. The purpose of this ANMCO position paper is to guide clinicians in the early identification of conditions that increase the risk of developing cardiovascular events and to provide guidance on the most appropriate interventions. The paper briefly reviews the evidence supporting the cumulative impact of traditional risk factors over time. The role of risk stratification tools such as SCORE2, SCORE2-OP, and SCORE2-Diabetes, as well as emerging biomarkers, is discussed. For risk factors such as hypertension, dyslipidemia, and diabetes, the recommended targets and current therapeutic options are illustrated. The pharmacological interventions currently available for managing obesity-associated cardiovascular risk and the indications for antiplatelet treatment in the context of primary prevention are also discussed. Overall, early diagnosis and primary prevention are the foundation of an efficient and economically sustainable healthcare system.

BACKGROUND:Integrating end-of-life (EoL) care in cardiac intensive care units (CICUs) is particularly complex because it requires a shift from a purely curative approach to one that emphasizes symptom management, emotional and spiritual support and patient-centered care. Moreover, this transition is challenging due to the need to balance life-sustaining treatments with the goals of comfort and dignity. The concept of EoL care varies across countries and is influenced by cultural, ethical and legal factors. METHODS:This narrative review examines palliative and EoL care in critically ill cardiac patients, including those with advanced heart failure, cardiogenic shock and other acute or chronic cardiac conditions, with a focus on models of care, multidisciplinary team involvement, ethical challenges and barriers to implementation in the CICU setting. RESULTS:Key candidates for palliative care (PC) in heart disease include patients with advanced heart failure, cardiogenic shock and other acute or chronic cardiac conditions; however, its implementation remains limited compared to other disciplines, such as oncology. In EoL care, multidisciplinary teams, including cardiologists, nurses, PC specialists and social workers, play a crucial role in providing holistic care. Effective communication with patients and their families is essential for aligning treatment with individual values and goals. Ethical dilemmas, such as the withdrawal of life-sustaining treatments and the deactivation of implanted cardiac devices, require compassionate and transparent decision-making. Unlike previous reviews, this work specifically highlights the timing of palliative care integration as the main factor influencing patient outcomes and family experience. CONCLUSIONS:Timely integration of palliative care in the CICU remains a major challenge. Significant gaps persist in training, resource allocation and quality indicators for palliative and EoL care. Addressing these shortcomings through enhanced education, standardized protocols and rigorous research is essential to ensure the effective delivery of PC in the CICU setting.

BACKGROUND:Despite evidence of a bidirectional relationship between cardiac and mental health, psychological care remains insufficiently integrated into cardiology practice. This study explored cardiologists' perceptions and attitudes toward the role of psychology in cardiovascular disease (CVD) care. METHODS:We conducted an online cross-sectional survey of cardiologists affiliated with the Italian National Association of Hospital Cardiologists (ANMCO). The questionnaire assessed their experiences with psychologists, attitudes toward managing psychological distress in CVD, perceived barriers to referral, and attitudes toward psychological help. RESULTS:Of 268 cardiologists who accessed the survey, 218 (mean age 54.0 ± 13.8 years) completed it. Although 96.3% acknowledged the relevance of psychological factors to CVD management and treatment, 33.9% reported never having collaborated with a psychologist, and 39.0% reported withholding psychological referrals despite recognizing patient need. Major barriers included concern that patients might interpret a referral as minimization of somatic symptoms or that it could reinforce stigma. Overall, 64.2% had never received training on psychological aspects of CVD, although interest in such training was high (≥82.6%). Prior collaboration with psychologists and more positive help-seeking attitudes were associated with greater perceived usefulness of psychological care. CONCLUSIONS:Cardiologists recognize the importance of psychological factors, yet educational, structural, and cultural barriers limit the integration of psychological interventions into cardiovascular care. Targeted training, clear communication strategies, and stronger interprofessional collaboration may improve patient outcomes and advance a biopsychosocial approach in cardiology.

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.

Transthoracic echocardiography is the cornerstone of cardiac imaging, yet conventional volumetric and Doppler indices may fail to detect clinically meaningful changes in ventricular performance. Patients often improve symptomatically and biochemically after device-based or medical therapies without parallel changes in standard echocardiographic measures, reflecting that the left ventricle functions not only as a pressure-volume pump but as a complex fluid-dynamic system in which myocardial mechanics and intracavitary blood flow are tightly coupled. Blood speckle imaging (BSI) tracks red blood cell speckle patterns, enabling angle-independent, contrast-free, real-time visualization and qualitative assessment of intraventricular vortex organization. We present a three-patient proof-of-concept case series including non-ischemic dilated cardiomyopathy treated with cardiac contractility modulation, ischemic cardiomyopathy managed by conduction-system pacing (CSP), and heart failure with preserved ejection fraction treated with medical optimization. BSI was performed before and after therapy and interpreted alongside a review of the intracardiac flow-dynamics literature. In all patients, symptoms and N-terminal pro-B-type natriuretic peptide levels improved despite minimal changes in left ventricular volumes and conventional systolic indices, whereas BSI revealed reorganization of intraventricular flow, characterized by fewer competing vortices, reduced late-diastolic persistence, and more physiological vortex positioning. These observations support the hypothesis that flow reorganization may represent an early marker of ventricular recovery preceding detectable structural remodeling. To our knowledge, this is among the first adult reports of therapy-associated left ventricular flow reorganization assessed by BSI across distinct heart failure phenotypes. These findings are hypothesis-generating and require prospective validation against quantitative four-dimensional flow cardiovascular magnetic resonance.