BACKGROUND:Giant coronary artery aneurysms are rare and may cause thrombosis, distal embolization, and myocardial infarction. Owing to their low prevalence, optimal management remains uncertain. CASE SUMMARY:A 56-year-old man presented with a non-ST-elevation myocardial infarction. Coronary angiography showed diffuse coronary ectasia and aneurysms, chronic right coronary artery occlusion, and no significant obstructive stenosis. Percutaneous revascularization failed because of the complex aneurysmal anatomy. Three years later, recurrent angina prompted multimodality imaging. Cardiac magnetic resonance revealed preserved left ventricular ejection fraction, inferior wall akinesia, transmural late gadolinium enhancement consistent with prior infarction, and new lateral wall motion abnormalities. Cine and tissue-characterization sequences suggested a giant partially thrombosed left circumflex aneurysm, confirmed by coronary computed tomography angiography, which demonstrated an hourglass-shaped aneurysm with minimal residual lumen. The patient underwent successful thrombectomy, capitonnage, and triple coronary artery bypass grafting. DISCUSSION:Multimodality imaging is essential for diagnosis and surgical planning, whereas treatment should be individualized according to aneurysm morphology and clinical presentation. TAKE-HOME MESSAGES:Thrombosed coronary artery aneurysms may be underestimated by coronary angiography because of limited opacification of the aneurysmal sac. Multimodality imaging, integrating coronary computed tomography angiography and cardiac magnetic resonance with angiography, provides complementary information on aneurysm anatomy, thrombus burden, vessel wall characteristics, and myocardial involvement, thereby supporting diagnosis and individualized management.

Structured exercise is a cornerstone of secondary prevention after percutaneous coronary intervention (PCI), yet its specific relationship with in-stent restenosis (ISR) is less well characterized. This narrative review summarizes the biological rationale, clinical evidence, safety, and practical prescription of exercise training in patients with coronary stents, with a focus on its potential impact on ISR. Exercise training improves endothelial nitric oxide bioavailability, reduces systemic inflammation, and favorably modulates neointimal proliferation in experimental and clinical studies. Pooled clinical data suggest that exercise-based cardiac rehabilitation after PCI is associated with a reduction in angiographically defined restenosis, although individual trials, largely from the bare-metal and early drug-eluting stent (DES) eras, have shown inconsistent results on binary restenosis endpoints. Available contemporary data do not suggest an excess risk of stent thrombosis, clinically relevant arrhythmias, or adverse ventricular remodeling when exercise is initiated in clinically stable patients using an individualized and supervised approach. The direct anti-restenotic effect of exercise remains biologically plausible and clinically suggestive but is not yet firmly established, particularly in the contemporary thin-strut DES era. Nevertheless, the well-documented benefits of exercise on functional capacity, endothelial health, and cardiovascular prognosis justify its role as an essential, time-sensitive component of post-PCI care. Larger, contemporary trials with standardized intracoronary imaging endpoints are needed to clarify whether, and in which patient subsets, exercise meaningfully affects the biology of ISR.

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.

Cardiovascular disease remains the leading cause of death worldwide, accounting for more than 20 million deaths each year, over 75

Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease worldwide and is increasingly recognized as a major contributor to cardiovascular morbidity and mortality. Beyond liver involvement, MASLD represents a systemic metabolic disorder closely linked to cardiovascular disease (CVD), the leading cause of death in affected patients. This association persists independently of traditional cardiometabolic risk factors and is driven by multiple mechanisms, including insulin resistance, chronic low-grade inflammation, atherogenic dyslipidemia, endothelial dysfunction, and prothrombotic states. Disease severity, particularly liver fibrosis, appears to further increase cardiovascular risk. This review summarizes current evidence on the epidemiological and pathophysiological links between MASLD and CVD, including its role in atherosclerosis, coronary artery disease, and heart failure. Clinical implications for cardiovascular risk stratification, screening, and multidisciplinary management are also discussed, highlighting the need for integrated strategies to reduce both hepatic and cardiovascular complications.

Abstract Background Anthracyclines remain a cornerstone of systemic anticancer therapy but are limited by their well-recognized cardiotoxic potential, which may manifest as cancer therapy–related cardiac dysfunction (CTRCD). Despite increasing emphasis on preventive strategies in cardio-oncology, robust evidence supporting pharmacological cardioprotection is scarce. Sacubitril/valsartan has demonstrated clear benefits in heart failure populations; however, its preventive role in patients exposed to anthracyclines has not been systematically evaluated. Methods We performed a systematic review and meta-analysis of randomized controlled trials assessing sacubitril/valsartan for the prevention of CTRCD in adult patients treated with anthracycline-based chemotherapy (PROSPERO CRD420261278068). PubMed, Embase, Scopus, and the Cochrane Library were searched through December 2025. The primary outcome was CTRCD, defined according to 2022 ESC cardio-oncology guidelines. Secondary outcomes included changes in left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), and symptomatic hypotension. Random-effects models were used as the primary analytical approach. Results Three randomized trials including 352 patients (mean age 52 ± 9 years; 94% breast cancer) were included. Sacubitril/valsartan was associated with a numerically lower risk of CTRCD that did not reach statistical significance in the random-effects model (RR 0.69, 95% CI 0.38–1.23; p=0.21), while the fixed-effects model showed a significant association favoring sacubitril/valsartan. Directionally favorable but non-significant trends were observed for LVEF and GLS. Sacubitril/valsartan was associated with a higher risk of symptomatic hypotension (RR 4.10, 95% CI 1.46–11.54). Conclusions This meta-analysis identifies a consistent, hypothesis-generating signal suggesting that sacubitril/valsartan may reduce CTRCD incidence and favorably influence cardiac imaging parameters in anthracycline-treated patients, at the cost of increased symptomatic hypotension. Larger, adequately powered trials are needed to define its role in cardio-oncology prevention strategies.

Cardiovascular disease is the leading cause of morbidity and mortality in the elderly. Managing cardiovascular risk in this group is uniquely challenging due to physiological changes, multimorbidity, polypharmacy, and frailty, compounded by the under-representation of older adults in clinical trials Recent advances, including the SCORE2-OP risk stratification tool and emerging therapies such as sodium-glucose cotransporter-2 inhibitors and glucagon-like peptide-1 receptor agonists, have reshaped approaches to risk reduction. This review synthesizes the latest evidence and guideline recommendations for the management of hypertension, dyslipidaemia, diabetes, obesity, and antithrombotic therapy in older patients, with particular attention to frailty, adherence challenges, and individualized care. By addressing the complexities of cardiovascular risk management in older adults, this paper provides a practical framework for clinicians navigating this critical area.

Anthracyclines remain a cornerstone of cancer therapy but are associated with a spectrum of cardiovascular toxicity, ranging from subclinical myocardial injury to overt heart failure (HF). Despite strong biological rationale, the role of universal pharmacologic prophylaxis remains uncertain. In this context, the recent meta-analysis by Pizzi et al. provides a timely synthesis of randomized evidence evaluating angiotensin-converting enzyme inhibitors (ACEi) for the prevention of anthracycline-related cardiotoxicity. The analysis demonstrates a statistically significant attenuation of left ventricular ejection fraction decline with ACEi prophylaxis, although the absolute effect size is modest and accompanied by substantial heterogeneity. Importantly, the magnitude of benefit appears to be context-dependent, with more consistent effects observed in higher-risk settings, such as combined anthracycline and trastuzumab exposure or in patients with early markers of myocardial injury. Contemporary data suggest that declining event rates and improved supportive care may limit the ability of prophylaxis trials to detect clinically meaningful differences in low-risk populations. Furthermore, the absence of significant effects on clinical endpoints underscores the limitations of current surrogate markers and trial design. Emerging evidence supports a more nuanced, risk-adapted approach, integrating early detection strategies such as global longitudinal strain and biomarker-guided intervention. Within this framework, ACEi prophylaxis may be most appropriately targeted to patients with higher baseline risk or early evidence of myocardial injury, rather than applied universally. Future studies should prioritize risk enrichment, standardized imaging protocols, and clinically meaningful outcomes to better define the role of cardioprotective strategies in cardio-oncology.

L’intelligenza artificiale (IA) sta rapidamente trasformando il mondo e la medicina in particolare è travolta da innovazioni continue. In cardiologia, l’IA offre ogni giorno strumenti innovativi per la diagnosi, la stratificazione prognostica, la pianificazione interventistica e la personalizzazione delle cure. Dall’interpretazione automatizzata dell’ECG e dell’imaging cardiovascolare, fino all’integrazione nei flussi procedurali e predittivi della cardiologia interventistica, l’IA si sta affermando come alleato potente del clinico e del ricercatore. Tuttavia, le sue applicazioni sollevano importanti sfide etiche, legali e regolatorie, che impongono trasparenza, validazione indipendente e una governance multidisciplinare. In questa rassegna esploriamo il potenziale e i limiti dell’IA in ambito cardiovascolare, con un focus sulle tecnologie emergenti, le implicazioni per la pratica clinica quotidiana e il ruolo crescente di strumenti generativi come ChatGPT nella ricerca scientifica. Come HAL 9000, l’IA può amplificare le capacità umane ma richiede una supervisione attenta per evitare derive incontrollate. La cardiologia del futuro sarà sempre più digitale, ma dovrà restare saldamente umana.

INTRODUCTION:Dermatological disorders are emerging as important indicators of systemic health and have drastic implications for cardiovascular disease (CVD). Skin and cardiovascular diseases share common pathophysiological mechanisms, including chronic inflammation, oxidative stress, and endothelial dysfunction. These overlapping pathways contribute to the increased cardiovascular (CV) risk observed in patients with inflammatory and genetic dermatological conditions, such as psoriasis, atopic dermatitis, and systemic lupus erythematosus. METHODS:This narrative review was conducted by evaluating current evidence from peer-reviewed literature on the association between dermatological disorders and cardiovascular risk. Particular attention was given to pathophysiological mechanisms and therapeutic implications relevant to both specialties. RESULTS AND DISCUSSION:Since systemic inflammation is a major risk factor for CVD, treatments that reduce the inflammatory burden represent promising strategies to prevent or mitigate cardiovascular complications in patients with dermatological conditions. Traditional therapies (e.g., methotrexate and statins) remain the gold standard to reduce CV risk. In addition, advances in the field of inflammation-such as inhibitors targeting IL-17 and IL-23 pathways-along with new systemic biomarkers and the development of targeted therapies, are paving the way for improved patient stratification and personalized approaches. CONCLUSIONS:This review highlights the importance of interdisciplinary collaboration in optimizing patient outcomes and emphasizes the need for closer integration of dermatological and cardiological expertise. Future research should focus on clarifying molecular mechanisms, identifying therapeutic targets, and refining shared clinical guidelines. By bridging dermatology and cardiology, this review underscores the potential for earlier detection, better risk prediction, and integrated management of coexisting dermatological and cardiovascular conditions.

OBJECTIVES:Large language models (LLMs) have the potential to assist in complex decision making for interventional cardiology (IC). However, their comparative performance in providing clinical recommendations remains uncertain. In this blinded model‑comparison study, the authors evaluated and compared the quality of recommendations produced by 6 LLMs for complex IC cases. METHODS:Twenty detailed and complex clinical cases focusing on coronary artery disease (n=10) and structural heart disease (n=10) were developed. Six LLMs were tested: default ChatGPT (ChatGPTd), ChatGPT with European Society of Cardiology guidelines (ChatGPT-gl), ChatGPT with internet search enabled (ChatGPTi), Gemini (Google), Mistral 7B (Mistral AI), and Perplexity AI (Perplexity AI, Inc.). Only the ordering of anonymized outputs was randomized to ensure blinding. Five expert ICs independently assessed the anonymized and randomized responses using a 0 to 10 scale for appropriateness, accuracy, relevance, clarity, and clinical utility, generating a composite score. Statistical analysis was performed using a mixed linear model. RESULTS:Six hundred blinded evaluations (20 cases x 6 models x 5 raters) were analyzed, yielding an overall composite score of 7.1 (95% CI, 7.0-7.2). Performance significantly varied across LLMs (P less than .001), with ChatGPTi (7.8 [7.5-8.0]) and ChatGPT-gl (7.7 [7.4-7.9]) outperforming others. ChatGPTd (6.9 [6.6-7.3]), Mistral 7B (7.0 [6.7-7.3]), and Perplexity AI (7.0 [6.7-7.3]) performed moderately, while Gemini had the lowest score (6.3 [6.0-6.7]). These differences were consistent across all scoring dimensions (P less than .001). Case type did not affect LLM performance (P = .900). CONCLUSIONS:LLMs show promise in IC decision making, but their performance remains suboptimal. Maximizing their potential requires systematic integration of web search capabilities and guideline-based knowledge retrieval.

Introduction Not applicable. Material and methods Not applicable. Results Not applicable. Conclusions Not applicable.

Cardiovascular diseases and cancer are the primary causes of morbidity and mortality globally and often occur together. The emergence of cardio-oncology as an independent interdisciplinary field of medicine emphasizes the need for enhanced approaches to diagnose cardiovascular complications in patients with cancer. Although anthracyclines, especially doxorubicin (DOX), are effective against many malignancies, their dose-dependent cardiotoxicity necessitates careful cardiovascular monitoring. Cardiovascular imaging plays a key role in the noninvasive assessment of doxorubicin-associated cardiovascular changes complemented by biomarkers and the evaluation of clinical status. Evidence-based selection and interpretation of images can facilitate early detection of cardiovascular damage, potentially affecting therapeutic interventions and enhancing outcomes following cancer treatment. Advances in innovative diagnostic technologies are crucial for improving the early diagnosis, risk assessment, and monitoring of cardiovascular complications in doxorubicin-treated cancer patients. Further research in this area will refine the patient management strategies at the intersection of cardiology and oncology. This article aims to provide an overview of the diagnostic considerations in cardio-oncology, especially DOX-induced cardiovascular toxicity.

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.

Patients with chronic coronary syndromes deserve high attention and tailored management for the effective reduction of the residual cardiovascular risk. Long-term secondary prevention strategies are the key to reaching this goal and mitigating the overall cardiovascular burden. Four pillars should be the cornerstones of the management of patients with chronic coronary syndromes: lifestyle interventions, cardiac rehabilitation, risk factor control and achievement of treatment targets, and guideline-directed medical therapy. These interventions should be personalized to achieve prevention and treatment goals in order to improve prognosis and health-related quality of life. Herein, we present a state-of-the-art review on the comprehensive cardiovascular risk assessment and secondary prevention among patients with chronic coronary syndromes. In addition, we provide practical guidance for the management of this patient population in complex clinical scenarios and specific groups, including those with heart failure, older adults, sex-specific considerations, high bleeding risk, atrial fibrillation, and chronic kidney disease.

ABSTRACT:The impact of blood pressure (BP) reduction induced by levosimendan infusion on in-hospital mortality in patients with acute heart failure (AHF) and systolic ventricular dysfunction still needs to be clarified. We conducted a retrospective cohort study involving 161 patients hospitalized for AHF and treated with a 24-hour infusion of levosimendan between 2017 and 2024, following a standard protocol. During hospitalization, biometric, clinical, laboratory, and echocardiographic parameters were assessed. The results revealed that the difference in systolic and mean BP before and after levosimendan infusion (delta-SBP and delta-MAP) was significantly associated with higher in-hospital mortality (delta-SBP in survivors: 10.1 ± 19.1 mm Hg vs. in nonsurvivors: 21.4 ± 23.6 mm Hg, P = 0.023; delta-MAP in survivors: 8.8 ± 15.8 mm Hg vs. in nonsurvivors: 17.8 ± 23.3 mm Hg, P = 0.034), regardless of baseline BP values and despite the fact that most patients had absolute values of SBP after levosimendan infusion >90 mm Hg. Multivariable analysis confirmed that a larger reduction in SBP was an independent predictor of in-hospital mortality (OR: 1.053, 95% CI, 1.015-1.092, P = 0.006). Absolute values of SBP after levosimendan infusion (post-SBP) were also independently associated with mortality (OR: 0.942, 95% CI, 0.896-0.990, P = 0.019). However, when the analysis was repeated in a subgroup of subjects with SBP after infusion >90 mm Hg, only delta-SBP remained independently associated with mortality (OR 1.051, 95% CI, 1.009-1.095, P = 0.017). In patients with AHF treated with levosimendan, larger reductions in SBP after therapy are independently associated with in-hospital mortality. Monitoring SBP changes after levosimendan infusion may improve risk stratification and guide clinical decisions.