Transplant coronary artery disease (TCAD) represents a severe complication after heart transplantation, modulated by hypercholesterolemia. Management of dyslipidemia in this setting is complex due to interactions between statins and immunosuppressants resulting in an increased risk of rhabdomyolysis and the potential of immunosuppressants themselves to elevate LDL and triglyceride levels. Inclisiran, an mRNA inhibitor of PCSK9, has demonstrated high efficacy without reported pharmacokinetic interactions and a favorable administration regimen. We present the first case of treatment with inclisiran after heart transplantation. We report the case of a 67-year-old male patient who underwent heart transplantation in 2011 with a high cardiovascular risk profile and a history of statin intolerance, treated with ezetimibe. In 2022, due to severe TCAD and elevated LDL-C levels (125 mg/dL), treatment with inclisiran (300 mg on days 0 and 90 and then every 6 months) was initiated in addition to ezetimibe. Lipid and immunosuppressant levels were monitored during follow-up visits. After two doses of Inclisiran, at 6 months, LDL-C was reduced to 69 mg/dL, without side effects or significant alterations in immunosuppressant levels. Subsequently, LDL-C levels showed a further reduction to 31 mg/dL and remained controlled (51 mg/dL and 28 mg/dL in subsequent follow-ups). Despite the reduction in LDL-C, the patient showed progression of TCAD, requiring multiple percutaneous revascularizations. This case suggests the potential value of inclisiran in the treatment of dyslipidemia in heart transplant patients with TCAD, especially in the presence of statin intolerance or risk of drug interactions. The infrequent administration regimen is advantageous in such patients with a high medication burden and can be made to coincide with follow-up visits. However, the progression of TCAD despite LDL-C reduction highlights the multifactorial nature of the disease, with a significant immunological component still not effectively controlled by current preventive therapies.

Prolonged dual antiplatelet therapy (DAPT) with ticagrelor 60 mg is recommended in post-myocardial infarction (MI) patients at moderate to high ischemic risk. Beyond physician-led discontinuation, persistence with therapy in real-world settings may be limited due to adverse effects and patient choices. The aim of this study is to assess the real-world incidence of non-compliance with prolonged DAPT and to elucidate reasons for discontinuation.

Previous studies have highlighted the role of inflammatory and nutritional markers in predicting outcomes in cardiovascular diseases. However, to our knowledge, no study has explored the impact of the combination of these two aspects on outcome of patients undergoing transcatheter aortic valve implantation (TAVI). This study aims to assess the predictive value of the pre-procedural platelet-to-lymphocyte ratio (PLR)/albumin ratio on one-year mortality in this population METHODS: This retrospective observational study screened 867 patients who underwent TAVI between December 2018 and September 2023 at our tertiary center, IRCCS A. Gemelli University Polyclinic Foundation, Rome, Italy. After excluding patients with systemic inflammatory or autoimmune diseases (223), cancer (257), acute or chronic infections (22), and those with missing data (77), the final cohort comprised 288 patients. PLR and albumin levels were calculated from pre-procedural blood samples, and the PLR/albumin ratio was subsequently derived. The prognostic discriminatory capacity and cutoff value of the PLR/albumin ratio were assessed using multivariate Cox regression and ROC analysis, respectively.

The optimal percutaneous coronary intervention (PCI) revascularization strategy in patients presenting with multi-vessel (MV) coronary artery disease (CAD) and acute myocardial infarction (MI) has not been systematically addressed. Accordingly, we performed a frequentist network meta-analysis with the aim of assessing the prognostic impact of different PCI strategies.

Procedure-related vascular and bleeding complications after transcatheter aortic valve implantation (TAVI) still represents an important issue that impact on patients' mortality and morbidity. The aim of this study was to compare the effectiveness of single or double suture-based devices (SBDs) combined with a plug-based device to obtain large bore arteriotomy hemostasis after transfemoral (TF) TAVI.

Acute coronary syndromes (ACS) are frequently the first manifestation of cardiovascular disease and require timely intervention. Primary percutaneous coronary intervention (pPCI) significantly reduces mortality and major adverse cardiovascular events in patients with ST-elevation myocardial infarction (STEMI). However, despite successful epicardial recanalization, pPCI can be complicated by inadequate myocardial reperfusion, a phenomenon known as coronary no-reflow (NR) or microvascular obstruction (MVO), which is associated with adverse outcomes. The aim is to describe a novel interventional approach - the saline technique - for the treatment of MVO following stent implantation during pPCI. The saline technique consists of a rapid, manual intracoronary injection of 10 mL of saline over 2-4 seconds using a 6-Fr thrombus aspiration catheter positioned distally to the stented segment. The aim is to rapidly increase distal coronary pressure and volume, promoting microvascular recruitment and displacement of micro-emboli and vasoconstrictive agents. A diagnostic step using distal angiography precedes treatment to confirm MVO. Preliminary data from a single-center matched cohort (N.=32) showed that the Saline Technique significantly improved TIMI flow grade and ST-segment resolution compared to standard care. No major complications were observed. Post-procedural Index of Microvascular Resistance (IMR) was reduced in most cases. The saline technique is a safe, cost-effective, and rapidly deployable option for managing coronary NR/MVO. While promising, these findings are hypothesis-generating and require confirmation in larger, randomized trials.

Heart failure (HF) remains a leading cause of hospitalization globally, exerting significant strain on healthcare systems and impacting patients' quality of life. Seasonal changes in climate and temperature are known to affect HF-related outcomes. This study investigates the seasonal variations in hospitalization outcomes among HF patients in the United States.

Multiple valvular heart disease (M-VHD) is a common condition, often involving aortic stenosis (AS) plus a mitral or tricuspid valve disease. We aim to evaluate the evolution and prognostic impact of M-VHD in patients undergoing transcatheter aortic valve implantation (TAVI).

Eosinophilic myocarditis (EM) is characterized by acute myocardial inflammation due to eosinophilic tissue infiltration. It is a rare and underdiagnosed condition, which may be either idiopathic or secondary to vasculitides, hypereosinophilic syndromes, drugs, or infections. Diagnosis is based on laboratory findings, echocardiography, cardiac magnetic resonance imaging and may sometimes need endomyocardial biopsy. Treatment depends on the underlying cause and often consists of immunosuppressive agents and anticoagulation therapy. This case series includes nine patients with EM, specifically seven cases secondary to eosinophilic granulomatosis with polyangiitis, one case secondary to acute lymphocytic leukemia, and one case of idiopathic EM, and aims to describe and review the diagnostic work-up and tailored treatment of this heterogeneous disease.

Liraglutide is a key therapeutic agent in managing type 2 diabetes mellitus (T2DM), with benefits extending beyond glycemic control to address cardiovascular and renal comorbidities. As T2DM prevalence rises globally, the need for medications that provide comprehensive health benefits becomes increasingly important. Liraglutide, a GLP-1 receptor agonist, has demonstrated effectiveness in reducing cardiovascular events, especially among patients with high cardiovascular risk, such as those with a prior history of myocardial infarction or stroke. It has shown significant reductions in major adverse cardiovascular events (MACE), including cardiovascular mortality and stroke risk, making it an essential component in secondary prevention for patients with established atherosclerotic cardiovascular disease (ASCVD). Moreover, liraglutide has a favorable safety profile, presenting a lower incidence of hypoglycemia compared to many other glucose-lowering agents, which is crucial for patient safety and adherence. Given these wide-ranging benefits, liraglutide serves as a valuable tool for optimizing health outcomes in diverse diabetic populations, particularly in those with complex comorbidities. To support this narrative review, a search in three electronic databases yielded 44 relevant journal articles and book chapters about liraglutide published from 2010 to 2022, providing a robust foundation for evaluating its cardiovascular impact and clinical utility in T2DM patients with concurrent cardiac conditions.

In the face of numerous studies concerning the technical advances of percutaneous coronary intervention [PCI] and clinical outcomes, only a few studies focus on patients' lived experiences after PCI. This study aims to explore patients' lived experiences after PCI, both in clinical terms and in terms of their perception of their health status, functional capacity, and autonomy at home.

Whilst aortic stenosis remains the most prevalent valvular abnormality, the management of asymptomatic severe aortic stenosis remains a clinical challenge. Recently, two randomised-controlled trials (RCTs) - EVOLVED (Early Intervention in Patients With Asymptomatic Severe Aortic Stenosis and Myocardial Fibrosis) and Early TAVR (Transcatheter Aortic-Valve Replacement for Asymptomatic Severe Aortic Stenosis) - have been published, alongside an extended follow-up from the AVATAR (Aortic Valve Replacement Versus Conservative Treatment in Asymptomatic Severe Aortic Stenosis) study.

The aim of this paper was to determine whether vitamin D supplementation reduces the incidence of postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG).

Spontaneous coronary artery dissection (SCAD) is an emerging cause of acute coronary syndrome (ACS), disproportionately affecting women. Data on the management and outcomes of these patients remain limited, especially regarding the overall risk of major adverse cardiovascular events (MACE) and arrhythmic complications. This study aimed to investigate the incidence and independent predictors of MACE in SCAD patients.

Despite the significant improvement in guidewire technology, in-vivo comparison of workhorse guidewires is lacking. This study aims to assess the feasibility of randomized data collection regarding the wiring time and its variability among three guidewires: Sion Blue, Minamo, and Runthrough, and to identify key lesion characteristics for future guidewire research.

Cardiovascular diseases (CVD) remain the leading cause of morbidity and mortality worldwide, accounting for significant public health and economic burdens. Cardiac rehabilitation (CR) is a comprehensive, multidisciplinary program designed to aid patients in recovering from cardiac events and to prevent further complications. The aim of CR is to improve their quality of life and prognosis. It involves continued prognostic stratification, clinical stabilization, optimization of pharmacological and non-pharmacological therapy, management of comorbidities, treatment of disabilities, reinforcement of secondary prevention interventions, and maintenance of adherence to therapy. The most recent European Society of Cardiology guidelines for the diagnosis and management of atrial fibrillation (AF) emphasize the importance of cardiorespiratory fitness, recommending that patients engage in moderate-intensity exercise and remain physically active to prevent AF incidence or recurrence. Through this symbiotic relationship, CR addresses all aspect of cardiac fitness in AF management. The program's structured exercise regimens are specifically tailored to address the challenges associated with AF, promoting overall cardiovascular health and reducing the risk for cardiac death. CR is also crucial for emotional well-being, offering support and coping mechanisms for the psychological impact of AF, beyond the physical training program. CR programs involve a multidisciplinary approach that is carried out collaboratively by a team of healthcare professionals, including nurses, physiotherapists, psychologists, and dietitians. Moreover, CR in AF patients aims to carry out comprehensive patient support through clinical stabilization and therapy optimization interventions, prescription and implementation of physical activity, educational support on lifestyle risk factors and social-emotional distress, and periodic assessment of outcomes. This narrative review aims to elucidate the role of CR in AF patients, shedding light on the potential benefits and challenges associated with integrating rehabilitation programs into the care of individuals with AF.

Transcatheter aortic valve replacement (TAVR) is increasingly performed nowadays, bleeding and vascular complications are not uncommon. Current recommendations for the use of protamine in the post-TAVR setting remain uncertain. This study aimed to evaluate the efficacy and safety of protamine in this setting.