Aneurysmal subarachnoid hemorrhage (aSAH) remains associated with substantial morbidity and mortality despite best medical treatment. Increasing evidence implicates thrombo-inflammation (TI), driven by neutrophils and neutrophil extracellular traps (NETs), in the pathogenesis of delayed cerebral ischemia (DCI) and cognitive impairment. This narrative review summarizes experimental and clinical data linking neutrophil activation and NETs formation to DCI after aSAH and outlines emerging therapeutic strategies. This review was structured according to the SANRA (Scale for the Assessment of Narrative Review Articles) guidelines and followed general recommendations for narrative reviews. A comprehensive PubMed and clinicaltrials.gov search identified experimental and clinical studies published in English without time window, focusing on TI, neutrophil activation, or NETosis in the acute phase of aSAH. Past and ongoing clinical trials were classified by mechanism of action. Experimental models and human data show early and sustained neutrophil activation within cerebral and systemic compartments after aSAH. NETs promote microvascular thrombosis, blood-brain barrier disruption, microglial activation, and neuronal injury, ultimately contributing to DCI and long-term cognitive impairment. Outside the brain, NETs may also aggravate neurogenic pulmonary edema and cardiac dysfunction. In animal models, deoxyribonuclease I (DNase I) effectively degrades NETs, improving perfusion, limiting neuronal apoptosis, and enhancing recovery. Several ongoing trials target TI pathways, including the RESET trial, which evaluates the impact of IV DNase I on clinical outcome after aSAH. NETs produced after neutrophil activation may be central to DCI. Targeting NETs represents a promising translational path to improve cerebral and systemic outcomes after aSAH.

Objective:Post-implant thrombocytopenia and subclinical leaflet thrombosis (SLT) are two common phenomena, yet their potential interplay remains unexplored. This study aimed to determine whether early platelet dynamics differed in patients diagnosed with SLT on multidetector computed tomography (MDCT) compared with those without SLT. Methods and results:A total of 118 consecutive patients treated with self-expandable supra-annular and intra-annular prostheses were longitudinally analysed. Platelet count was assessed using the corrected platelet count (CPC) from baseline to day 7 (or hospital discharge) and at 30 days. Platelet-to-lymphocyte ratio (PLR) and lymphocyte-to-monocyte ratio (LMR) were also measured as inflammatory markers. Spleen volume was assessed at baseline. MDCT was performed at 6-month follow-up to evaluate SLT. SLT, ranging from mild to severe, was detected in 22 patients at the 6-month MDCT follow-up. The SLT group had a lower baseline platelet count compared to the No-SLT group, with persistently lower levels from day 1 to day 7 post-implant. Platelet count was significantly lower in the SLT group on days 5 and 6 (CPC: 170 (IQR: 50) × 10³/μL vs. 215 (IQR: 72) × 10³/μL, P = 0.048; and 175 (IQR: 55) × 10³/μL vs. 240 (IQR: 85) × 10³/μL, P = 0.038). No significant differences were observed in PLR or LMR. Spleen volume was also significantly lower in the SLT group. Conclusion:We demonstrated a reversible thrombocytopenia during the first week post-implant, which was more pronounced in the SLT group than in the No-SLT group. Additionally, spleen volume was smaller in the SLT group, suggesting a potential interplay between these factors.

Cardiovascular medicine continues to move towards precision-based, individualised patient care, supported by novel biomarkers, refined imaging protocols, and multidisciplinary risk assessment. The studies featured in this issue of Acta Cardiologica span cardio-oncology, structural heart disease, immune and proteomic biomarkers, sepsis-related cardiac dysfunction, arrhythmia management, and vascular disease. Collectively, they underscore the growing importance of individualised diagnostic and therapeutic strategies across the cardiovascular spectrum, from cancer-related heart failure to conduction system pacing and cardiac arrest prevention.

Over the past two decades, cardiovascular interventions have undergone major transformation, extending indications while improving safety and efficiency. The focus has progressively shifted from procedural feasibility towards complications, durability, and patient-centred outcomes. This editorial integrates recent data across transcatheter aortic valve implantation (TAVI), coronary interventions, and aortic diseases. Procedural simplification, personalised strategies, and improved mechanistic understanding are reshaping clinical practice and supporting a more integrated approach to cardiovascular care.

Soft polymer networks are attractive for drug-eluting medical implants because their elasticity mimics soft tissues, and their swelling enables drug loading. Although polyurethanes (PUs) are widely used for long-term implantation, concerns over their toxic isocyanate precursors motivated the development of nonisocyanate alternatives. We report elastic poly(propylene glycol)-polyoxazolidone (PPG-POx) networks prepared from bis(α-alkylidene cyclic carbonate) (BisαCC) via a three-step, catalyst-free strategy: (i) step-growth polyaddition of BisαCC with PPG diamines, forming poly(hydroxy-oxazolidone)s, (ii) easy thermal dehydration to produce poly(alkylidene oxazolidone), and (iii) thiol-ene photo-cross-linking with a trithiol. By varying the BisαCC spacer, PPG molecular weight, dehydration degree, and cross-linker ratio, the properties of the networks were evaluated. The most promising candidate demonstrated biocompatibility with human fibroblasts, hemocompatibility, and sustained release under physiological conditions of acetylsalicylic acid (ASA), chosen for its widespread use in cardiovascular prevention and its antiplatelet activity. These results position BisαCC-derived PPG-POx networks as bio- and hemocompatible isocyanate-free alternatives to polyurethanes for drug-eluting implants.

This editorial highlights key advances featured in the current issue of Acta Cardiologica, reflecting the shift toward more precise, personalized, and evidencebased cardiovascular care. Contributions span artificial intelligence, bedside clinical assessment, biomarker-driven risk stratification, lifestyle determinants, advanced imaging, and interventional cardiology. Together, they illustrate how emerging technologies can be effectively integrated with rigorous clinical judgment, while maintaining a pragmatic focus on real-world applicability. The collected studies emphasize the importance of human oversight, simple yet powerful diagnostic tools, and individualized risk assessment to optimize patient outcomes in contemporary cardiology practice.

Cardiovascular medicine continues to evolve rapidly through advances in molecular biology, biomarkers, digital technologies, and interventional strategies. Recent contributions highlight progress in arrhythmia management, artificial intelligence-assisted diagnostics, metabolic and inflammatory risk stratification, and the understanding of rare cardiomyopathies. These developments illustrate the transition towards more precise and individualised cardiovascular care while raising new clinical and ethical challenges. Integrating technological innovation with clinical expertise remains essential to ensure that advances translate into improved patient outcomes.

Thermoplastic elastomers (TPEs) of the polyurethane (PU)-type have broad applications in healthcare. However, these materials have a number of drawbacks. Their synthesis requires the use of toxic isocyanates.  Their hemocompatibility remains insufficient, resulting in high rates of thrombotic complications of most common blood-contacting devices, which further increases the risk of infection. Here, we report the facile, up-scalable preparation of a greener non-isocyanate polyurethane (NIPU) TPE, poly(hydroxy-oxazolidone) (PHOx). We show that PHOx can be processed by multiple relevant manufacturing techniques, i.e., hot pressing, injection-molding, electrospinning, and additive manufacturing. In vitro hemocompatibility tests with human blood demonstrate better performance than a conventional medical grade PU. PHOx triggers less contact phase activation of coagulation, less plasma protein adsorption and less platelet adhesion than PU. The adhesion of Staphylococcus epidermidis is also reduced in the first 2 hours of contact as compared to PU. PHOx is neither hemolytic nor cytotoxic upon indirect or direct contact with endothelial cells or fibroblasts. Additionally, subcutaneous implantation of PHOx in rabbits for one and four weeks confirms in vivo biocompatibility and no material degradation. PHOx is therefore a highly valuable biomaterial and a potential isocyanate-free alternative to conventional PU-based TPEs for manufacturing customizable blood-contacting devices with improved hemocompatibility.

Polyurethanes (PUs) are used in many applications, including in the medical sector (e.g., breast implants, vascular access and cardiac assist devices) due to their remarkable mechanical performances combined with proven in vivo biocompatibility. However, their industrial synthesis from toxic isocyanate precursors poses environmental and health concerns. With regulations increasingly restricting the isocyanate use, exploring greener alternatives has become imperative. Extensive research of health-friendlier synthesis processes triggered the emergence of a new family of PUs called Non-Isocyanate Polyurethanes (NIPUs). Recent developments have shown that NIPUs are already competitive with PUs, for example in the adhesives and coatings field, and new opportunities emerged in biomedical applications. This review highlights recent breakthroughs regarding NIPUs development, emphasizing their appealing properties for biomedical applications as well as their biocompatibility. By shedding light on the close relationship between their peculiar structure and specific properties, we highlight the potential of NIPUs to engineer biomaterials and we position them as unprecedented options for the design of future medical devices.

Despite the development of potent drugs for modifiable risk factors and advances in mechanistic biomedical research, cardiovascular diseases (CVDs) collectively remain the leading cause of death globally, indicating a need for new, more effective therapies. A foundational challenge is the multilevel heterogeneity that characterizes CVDs—from their complex pathobiological mechanisms at the molecular and cellular levels, to their clinical presentations and therapeutic responses at the individual and population levels. This variability arises from individuals’ unique genomic and exposomic characteristics, underscoring the need for precision approaches. Other key challenges include the long navigation times, high costs, and low success rates for drug development, often compounded by the poor “druggability” of new targets. In this article, we explore how these challenges have inspired novel technologies that offer promise in improving health outcomes globally through an integrative precision medicine approach. Key to this transformation is the use of systems biology and network medicine, whereby the application of artificial intelligence to “big data”, ranging from clinical information to unbiased multiomics (e.g., genomics, transcriptomics, proteomics, and metabolomics) can elucidate disease mechanisms, yield novel biomarkers for disease progression, and identify potential drug targets. In parallel, new computational approaches are helping translate these discoveries into novel therapies and overcome druggability barriers. The transition to a precision-based research and innovation paradigm in cardiovascular medicine will require greater interdisciplinary collaboration, data science implementation at every stage, and new partnerships between academia and industry. Global policy leadership is also essential to implement suitable models of research funding and organization, data infrastructures and policies, medicines regulations, and patient access policies promoting equity.

PURPOSE:Platelet-rich plasma (PRP) could be a vector for certain diseases, and its composition may vary by pathologic condition. The main comorbidities that could affect PRP composition are infectious, oncologic and haematologic. In addition to potential alteration of clinical response, these pathologies could have a significant impact on the local tolerance of PRP as well as a risk of disease dissemination to the injection site. To date, there are few specific recommendations related to these comorbidities to guide clinicians. Therefore, the International Research Group on Platelet Injections (GRIIP) supported a consensus project to develop these recommendations. METHODS:Following the 'recommendations by formal consensus' methodology, a steering committee performed a literature review and drafted an initial set of recommendations. They were evaluated by an international rating group (15 specialists in musculoskeletal [MSK] diseases, five haematologists, four oncologists, three infectiologists and four scientists specialising in platelet physiology). From this rating, the first set of recommendations was discussed in a plenary meeting and then modified by the steering committee. Finally, four overarching principles and 23 recommendations were re-evaluated by the rating group. Recommendations were classified as appropriate or not, with strong or relative agreement, or uncertain. RESULTS:From the 23 recommendations, 10 concerned infectious diseases (viral and bacterial infections; dialysis; immunosuppressive drugs; dental care…), five oncologic diseases (local tumour; cured, active or in remission cancer…) and eight haematologic diseases (cytopenia; cured, active or stabilised cured hemopathy; monoclonal gammopathy…). All were considered appropriate by the experts (median = 9; range = 8-9), with strong or relative agreement. Due to the paucity of literature data, the recommendations are mainly based on expert opinion (Grade D). CONCLUSION:This consensus project provides four overarching principles and 23 recommendations related to contraindications of PRP injections in case of infectious, oncologic or hematologic diseases, validated by an international expert group. LEVEL OF EVIDENCE:Level I.

Background: Many studies recognize a close link between inflammation, cardiovascular disease (CVD), and oncological diseases. High-sensitivity C-reactive protein (hs-CRP), a marker of low-grade systemic inflammation, is a shared feature of these conditions. This retrospective study aims to assess the predictive value of hs-CRP for the development of cancer in patients with CVD. Methods: Analyzing data from 174 patients undergoing coronary angiography, we assessed hs-CRP levels and collected demographic, biological, and therapeutic data that could influence the studied parameters. Results: Only smoking and dyslipidemia correlated significantly with CRP levels (p = 0.018 and 0.049, respectively). However, hs-CRP did not predict cancer development (p = 0.52) but correlated with 1-year and follow-up mortality (p = 0.011 and 0.021, respectively). Antiplatelet and statin use was higher in the cancer-free group and associated with a lower probability of developing cancer (p < 0.001 and p = 0.009, respectively). Conclusions: While hs-CRP did not prove effective as a cancer predictor in our study, it correlated with all-cause mortality. Our findings suggest a potential protective effect of antiplatelet and statin treatments against cancer development, prompting further research to understand underlying processes and identify key factors in the pathophysiology of these diseases.

BACKGROUND:Heart valve diseases remain a leading cause of death in industrialized nations. Polycarbonate urethane (PCU) is a promising material for heart valve prostheses due to its biocompatibility and low calcification tendency. However, the impact of processing methods on calcification remains unclear. METHODS:PCU patches were fabricated via hot pressing or solution casting. Both groups (n = 3 each), along with bovine pericardium patches as positive controls (n = 3), were incubated for 10 weeks in a custom in vitro calcification fluid. Calcification, cytocompatibility, and material properties were assessed using light and electron microscopy, infrared spectroscopy, and gel permeation chromatography (GPC). RESULTS:Calcification was observed in hot-pressed PCU and control patches but not in solution-cast PCU. Both PCU types showed comparable cytocompatibility. Spectroscopy and GPC revealed chemical and structural changes in hot-pressed PCU, likely promoting calcification. CONCLUSION:Hot pressing alters the chemical structure of PCU and increases its calcification propensity without affecting cytocompatibility. These findings highlight the importance of process control and in vitro screening during heart valve material development.

Valvular heart disease (VHD) is a common condition that poses several challenges from the standpoints of diagnosis and therapeutic management. While several studies have explored the role of blood biomarkers in assessing the severity and risk of progression of VHD, as well as in evaluating related cardiac damage and predicting the occurrence of adverse events, blood biomarkers are generally not considered criteria to trigger valve intervention in the latest European and American guidelines for VHD management. This review article provides an up-to-date overview of the utility of blood biomarkers to (i) assess the presence, severity, and progression of left-sided VHD; (ii) establish the presence and extent of cardiovascular damage; (iii) predict clinical outcomes before and after valve interventions; and (iv) identify patients at risk for early structural valve deterioration, valve thrombosis, and paravalvular leak.