The Evolving Features of Takotsubo Syndrome.

Purpose Of The Review: Takotsubo syndrome (TTS) is a transient form of left ventricular dysfunction, typically affecting post-menopausal females, often preceded by emotional or physical stressful events that act as triggers. Initially believed to be a rare and benign condition for its reversible nature, TTS has recently emerged as a complex multifaceted clinical entity, with heterogenous clinical presentations and a non-negligible risk of serious in-hospital complications, including acute heart failure, arrhythmias and death.

Recent Findings: Emerging pathophysiological hypotheses, ranging from microvascular dysfunction to systemic inflammation, offer new insights into the underlying mechanisms of TTS.

Functional assessment in angina and non-obstructive coronary arteries: from microvascular resistance reserve to subtypes of coronary microvascular dysfunction.

Aims: Coronary microvascular dysfunction (CMD) is a heterogeneous condition defined by reduced coronary flow reserve (CFR). The new index 'microvascular resistance reserve' (MRR) has been developed, but its role is unclear. We investigate the relationships between functional indices in ANOCA (angina and non-obstructive coronary arteries) patients and evaluate the hemodynamic features of different CMD subtypes.

Fractional flow reserve (FFR) and index of microcirculatory resistance (IMR) relationship in patients with chronic or stabilized acute coronary syndromes.

Aims: To investigate the influence of index of microcirculatory resistance (IMR) on fractional flow reserve (FFR) and adenosine-induced hyperemia (ΔPd/Pa-FFR) in patients with chronic (CCS) or stabilized acute coronary syndromes (ACS), utilizing various IMR threshold values.

Methods: Data were extracted from two ongoing Italian registries involving patients with CCS or stabilized ACS who underwent a #FullPhysiology approach [Pd/Pa, FFR, IMR, coronary flow reserve (CFR)] by bolus thermodilution technique in the left anterior descending artery. Correlations between IMR and both FFR and ΔPd/Pa-FFR were analyzed both globally and within three IMR-defined groups: Group 1 (IMR <25), Group 2 (25 ≤ IMR <40), and Group 3 (IMR ≥40).

Management, Flow, and Outcomes of Patients with Aortic Stenosis Followed by a Heart Valve Clinic: The Untold "Behind the Scene" from a High-Volume, Real-World Experience.

According to current guidelines, patients with heart valve disease should be followed by Heart Valve Clinics (HVCs). Regular quality analysis is a major prerequisite of an HVC's program, but few data have been reported so far. We retrospectively collected patients with isolated, native aortic valve stenosis who had been visited in our HVC at least once between 2021 and 2024.

High-risk percutaneous coronary intervention in patients with reduced left ventricular ejection fraction deemed not suitable for surgical revascularisation. A clinical consensus statement from the European Association of Percutaneous Cardiovascular Interventions (EAPCI) in collaboration with the ESC Working Group on Cardiovascular Surgery.

This clinical consensus statement of the European Association of Percutaneous Cardiovascular Interventions was developed in association with the European Society of Cardiology Working Group on Cardiovascular Surgery. It aims to define procedural and contemporary technical requirements that may improve the efficacy and safety of percutaneous coronary intervention (PCI), both in the acute phase and at long-term follow-up, in a high-risk cohort of patients on optimal medical therapy when clinical and anatomical high-risk criteria are present that entail unacceptable surgical risks, precluding the feasibility of coronary artery bypass grafting (CABG). This document pertains to patients with surgical contraindication according to the Heart Team, in whom medical therapy has failed (e.

Diagnosis and management of peripartum cardiomyopathy and recurrence risk.

Peripartum cardiomyopathy (PPCM) is a rare, but serious condition, with a non-negligible risk of adverse events. Several risk factors for PPCM have been individuated over the years, including Afro-American ethnicity, preeclampsia, advanced maternal age, genetic predisposition, multiparity, twin pregnancy, obesity, smoking and diabetes. However, PPCM pathophysiology is still poorly understood, thus making it challenging to develop disease specific therapies.

Cardiac replacement therapy: Critical issues and future perspectives of heart transplantation and artificial heart.

Diagnostic and therapeutic advances in the cardiovascular field have caused a progressive reduction in mortality from acute causes, with an ever-increasing chronicity of cardiovascular pathologies. In recent years, mechanical supports have played a fundamental role, allowing the patient to be stabilized in the most critical phase of acute heart failure (AHF) and acting as a "bridge" for definitive therapies. Heart transplantation (HTx) is the gold-standard treatment for end-stage HF, but it is burdened by a series of critical issues that limit its use, first of all the shortage of grafts.

Assessing diagnostic accuracy of intravascular imaging for functionally significant coronary stenosis: updated findings from a meta-analysis.

Background: Accurate discrimination of functionally significant coronary stenosis using intravascular imaging remains uncertain, particularly with regard to vessel size. This meta-analysis evaluates the diagnostic performance of intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for identifying functionally significant coronary stenosis as confirmed by fractional flow reserve (FFR).

Methods: A systematic search of PubMed, Scopus and Google Scholar identified studies that assessed the diagnostic accuracy of IVUS and OCT by minimal luminal area (MLA) with FFR as the reference standard.

Multimodal Imaging of Coronary Bifurcation TAP Procedures Utilizing Visible Heart® Methodologies: EBC Recommended Steps and Bailout Procedures.

In some cases it is critical to clinically perform coronary bifurcation stenting to minimize the potential risk for restenosis and/or stent thrombosis. The European Bifurcation Club (EBC) has provided guidelines for optimally performing such procedures. Yet, sometimes such procedures do not go as planned, and in some cases bailout procedures are required.

Does a Poor Preoperative Nutritional Status Impact outcomes of Heart Valve Surgery?

Background: Malnutrition has been variously associated with poor postoperative outcomes. Of note, 10-25 % of cardiac surgery patients are reported to be malnourished.

Objectives: To assess the impact of nutritional status (evaluated with the Geriatric Nutritional Risk Index - GNRI) on outcomes of older patients undergoing heart valve surgery.

Echocardiographic left atrial stiffness index predicts high left ventricular filling pressures in patients with acute heart failure: an observational study.

Background: In acute heart failure (AHF) patients, non-invasive estimation of left ventricular filling pressures (LVFPs) appears crucial to guide management. Although poorly investigated, left atrial (LA) mechanics play a pivotal role in this setting. This report sought to assess the correlation of echocardiographic LA stiffness index with invasive LVFPs and its diagnostic accuracy as compared to other parameters used in clinical practice.

Aspirin Hypersensitivity in Patients with Coronary Artery Disease: An Updated Review and Practical Recommendations.

Acetylsalicylic acid (ASA) represents a cornerstone of antiplatelet therapy for the treatment of atherosclerotic coronary artery disease (CAD). ASA is in fact indicated in case of an acute coronary syndrome or after a percutaneous coronary intervention with stent implantation. Aspirin hypersensitivity is frequently reported by patients, and this challenging situation requires a careful evaluation of the true nature of the presumed sensitivity and of its mechanisms, as well as to differentiate it from a more frequent (and more easily manageable) aspirin intolerance.

Feasibility, safety and clinical impact of a less-invasive totally-endovascular (LITE) technique for transfemoral TAVI: A 1000 patients single-centre experience.

Background: Trans-femoral (TF) represents the main access for TAVI. Although there are various technical strategies to conduct TF-TAVI (pacing modality, secondary arterial access, primary access puncture etc.), the optimal technique is not recognized.

Optical Coherence Tomography in Myocardial Infarction Management: Enhancing Precision in Percutaneous Coronary Intervention.

In acute myocardial infarction (AMI), the urgency of coronary revascularization through percutaneous coronary intervention (PCI) is paramount, offering notable advantages over pharmacologic treatment. However, the persistent risk of adverse events, including recurrent AMI and heart failure post-revascularization, underscores the necessity for enhanced strategies in managing coronary artery disease. Traditional angiography, while widely employed, presents significant limitations by providing only two-dimensional representations of complex three-dimensional vascular structures, hampering the accurate assessment of plaque characteristics and stenosis severity.

Non-invasive physiological assessment of intermediate coronary stenoses from plain angiography through artificial intelligence: the STARFLOW system.

Background: Despite evidence supporting use of fractional flow reserve (FFR) and instantaneous waves-free ratio (iFR) to improve outcome of patients undergoing coronary angiography (CA) and percutaneous coronary intervention, such techniques are still underused in clinical practice due to economic and logistic issues.

Objectives: We aimed to develop an artificial intelligence (AI)-based application to compute FFR and iFR from plain CA.

Methods And Results: Consecutive patients performing FFR or iFR or both were enrolled.