Publications by authors named "Cosimo Napoletano"

Patients suffering from acute coronary syndrome (ACS) present a high risk of recurrence and new adverse cardiovascular events after hospital discharge. Elevated plasma LDL-cholesterol (LDL-C) levels have been shown to be a causal factor for the development of coronary heart disease, and robust clinical evidence has documented that LDL-C levels decrease linearly correlates with a reduction in cardiovascular events. Recent studies have also demonstrated the safety and efficacy of an early and significant reduction in LDL-C levels in patients with ACS.

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Patients suffering from acute coronary syndromes (ACS) present a high risk of recurrence and new adverse cardiovascular events after hospital discharge. Elevated plasma LDL-cholesterol (LDL-C) levels have been shown to be a causal factor for the development of coronary heart disease, and robust clinical evidence has documented that a decrease of LDL-C levels correlates linearly with a reduction in cardiovascular events. Recent studies have also demonstrated the safety and efficacy of an early and significant reduction in LDL-C levels in patients with ACS.

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Article Synopsis
  • * Recent trials involving over 12,000 patients have shown the safety of various combinations of oral antiplatelet and anticoagulant medications for these individuals.
  • * The ANMCO position paper presents a decision-making algorithm for antithrombotic strategies during key phases: before the procedure, at discharge, and for long-term care.
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Sodium-glucose cotransporter 2 (SGLT2) inhibitors, dapagliflozin, and empagliflozin, first developed as glucose-lowering agents for the treatment of Type 2 diabetes, have been demonstrated to improve prognosis in patients with heart failure and reduced ejection fraction (HFrEF) regardless of the presence of diabetes. Since these drugs have only recently been included among the four pillars of HFrEF treatment, cardiologists are still unfamiliar with their use in this setting. This article provides an up-to-date practical guide for the initiation and monitoring of patients treated with SGLT2 inhibitors.

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Article Synopsis
  • The appropriateness of prescribing direct oral anticoagulants (DOACs) like dabigatran, rivaroxaban, apixaban, and edoxaban relies on criteria from Phase III trials, which are outlined in their product characteristics.
  • In real-world clinical practice, prescriptions often deviate from these guidelines, particularly with lower doses that can lead to a significant increase in the risk of stroke and other serious complications.
  • Factors contributing to this improper dosing include prescription errors, heightened concerns about bleeding risks, and the complexity of treating frail patients not represented in clinical trials, which can complicate the application of study findings to diverse patient populations.
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Patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI) with or without acute coronary syndromes (ACS) represent a subgroup with a challenging pharmacological management. Indeed, if on the one hand antithrombotic therapy should reduce the risk related to recurrent ischemic events and/or stent thrombosis, on the other hand care should be taken to avoid major bleeding events. In recent years, several trials, which overall included more than 12 000 patients, have been conducted demonstrating the safety of different therapeutic combinations of oral antiplatelet and anticoagulant agents.

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The prescription appropriateness of direct oral anticoagulants (DOACs [dabigatran, rivaroxaban, apixaban, and edoxaban]) is carefully regulated, taking into account the criteria established in phase III trials and listed in the summary of the product characteristics of the four DOACs. In clinical practice, prescriptions are not always in compliance with established indications. In particular, the use of doses lower than those recommended in drug data sheets is relatively frequent.

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Article Synopsis
  • This study investigates how echocardiographic laboratories in Italy were organized and operated during the second wave of the COVID-19 pandemic, comparing it to the same period in 2019.
  • Findings show significant reductions in both hospital and outpatient echocardiographic activities, with many labs partially or fully interrupted during the pandemic.
  • Safety measures improved for operators, with a widespread use of personal protective equipment, and the study noted an increase in outpatient waiting times for echocardiograms and a rise in the use of point-of-care cardiac ultrasound during the pandemic.
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Today, left atrial dissection is described as a rare complication of cardiac surgery, particularly after a mitral valve replacement. We report a rare case of left subacute atrial dissection occurred as a result of a domestic accidental fall. Transesophageal echocardiogram, angio-computed tomography, and magnetic resonance imaging showed an intramural formation with clear margins and a seamless cleavage with the posterolateral wall of the left atrium, which determined an obstacle to the ventricular filling.

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Clozapine may be associated with cardiovascular adverse effects including QTc prolongation and, more rarely, with myocarditis and pericarditis. Although rare, these latter cardiovascular adverse effects may be life-threatening and must be immediately recognized and treated. Several cases of clozapine related-pericarditis have been described and often it has a subtle and insidious onset with symptoms that may be often misdiagnosed with psychiatric manifestations (e.

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