European Heart Journal Supplements最新文献

Tricuspid regurgitation (TR) has historically been under-recognized in clinical practice, yet growing evidence highlights its significant impact on prognosis, particularly in its severe forms. Severe TR is indeed associated with increased mortality and heart failure hospitalizations, with prognostic deterioration further stratified by emerging classifications such as 'massive' and 'torrential' TR. Accurate assessment of TR severity is essential for timely referral and management decisions. Traditional echocardiographic parameters-such as tricuspid annular plane systolic excursion and right ventricular (RV) fractional area change-are limited by their load-dependence, prompting growing interest in advanced imaging modalities such as strain imaging and cardiac magnetic resonance for more precise evaluation of RV function. In this setting, medical management remains only supportive, with diuretics and neurohormonal modulation forming the cornerstone of therapy, especially in patients with heart failure. However, evidence for pharmacological interventions specific to TR is limited. Surgical treatment is indicated in select patients, though associated with high perioperative risk, necessitating careful patient selection. In recent years, transcatheter tricuspid valve interventions have emerged as promising alternatives for high-risk patients, including edge-to-edge repair (T-TEER) and orthotopic tricuspid valve replacement, and also caval valve implantation is being explored for anatomically complex or high-risk cases. Early recognition, comprehensive risk assessment, and individualized therapeutic planning-including consideration of timely intervention-are crucial to improving outcomes in this often-neglected valvular condition.

Tricuspid regurgitation is a frequent and undertreated condition associated with poor outcomes. Over the past decade, transcatheter tricuspid valve interventions have emerged as a valuable alternative for high-risk patients. Edge-to-edge repair is the most widely adopted approach, while replacement technologies are advancing rapidly and offer the potential for near-complete elimination of regurgitation. In parallel, annuloplasty, spacers, and caval devices are broadening the therapeutic spectrum across diverse anatomies. This review outlines the expanding device armamentarium and the key opportunities and challenges in this evolving field.

Tricuspid regurgitation (TR) is a common yet often overlooked valvular disorder that carries a substantial impact on morbidity and mortality. It is increasingly recognized as a heterogeneous entity with different phenotypes identified (primary, atrial secondary, ventricular secondary, and cardiac implantable electronic device-related). Contemporary population studies and disease-specific registries reveal that secondary TR is highly prevalent in elderly patients, those with heart failure of any phenotype, and in candidates for transcatheter aortic or mitral interventions. Prognosis varies widely according to aetiology, with atrial secondary TR consistently associated with better survival than ventricular secondary TR. Across diverse settings, TR severity is an independent predictor of mortality, and several clinical scores, including the TRI-SCORE, Wang score, and TRIO score, have been developed to refine risk stratification. Recent staging models integrating ventricular function, renal status, and biomarkers suggest that intervention during an intermediate disease phase, before irreversible end-organ damage, may optimize outcomes. Together, these advances underscore the need for accurate phenotyping, structured prognostic assessment, and timely intervention to improve the care of patients with TR.

[This retracts the article DOI: 10.1093/eurheartjsupp/suaf043.].

[This corrects the article DOI: 10.1093/eurheartjsupp/suaf003.].

Recently, intensive cardiac care units (ICCUs) have undergone a significant transformation related to the evolution in management of acute coronary syndrome and influenced by other factors such as the epidemiological transition, the increasing complexity of clinical cases, the technological advancement, and the growth of clinical and scientific expertise of cardiologists. In the context of this evolution, a functional reorganization of ICCUs in Italy has to be implemented in order to meet the changing needs of the population with cardiovascular disease requiring critical care. Therefore, the Italian Association of Hospital Cardiologists (ANMCO) proposes this position paper for the reorganization of CICUs into three levels with increasing functional complexity, based on the hospital characteristics, the available technology, and the clinical cases treated. The system would be functionally integrated into a regional ICCU organization modelled on a time-dependent care network. This proposed network aims to standardize diagnostic and therapeutic protocols and establish unified data collection registries to facilitate self-assessment and support clinical research. The document delineates specific requirements for each ICCU level, including the management of clinical cases, the expertise of intensive care cardiologists, the technological facilities, and the medical and nursing staff needed to ensure optimal care delivery.

Semaglutide, a glucagon-like peptide-1 receptor agonist, has emerged as a pivotal therapeutic agent in the management of the cardio-renal-metabolic continuum. Initially developed for glycaemic control in Type 2 diabetes mellitus, its benefits extend far beyond glucose regulation. Clinical trials have demonstrated semaglutide's potential to reduce major adverse cardiovascular events, particularly in overweight/obese patients with high cardiovascular risk, as well as improving functional capacity in patients suffering from heart failure with preserved left ventricular function. Additionally, it has shown promise in improving renal outcomes, such as slowing the progression of albuminuria and reducing the risk of chronic kidney disease in diabetic populations. These effects are likely due to its multifaceted mechanisms, including anti-inflammatory properties, weight reduction, blood pressure lowering, and direct renal protection. This review synthesizes current evidence on semaglutide's role in the interrelated domains of cardiovascular, renal, and metabolic health.

Hypertrophic cardiomyopathy (HCM) is a non-rare genetic cardiomyopathy, with an estimated prevalence of 1:500, characterized by an increase in the left ventricular wall thickness in the absence of increased loading conditions. The hypertrophy is mostly asymmetric and predominantly affects the basal septum and anterior wall. Left ventricular outflow tract obstruction, at rest or after provocative tests, is detected in many patients and represents the primary cause of reduced functional capacity, as well as an independent predictor of sudden cardiac death and advanced heart failure. Until ∼1 year ago, symptomatic patients despite maximal therapy with β-blockers or calcium channel blockers plus disopyramide had only basal septal reduction therapy through myectomy or septal alcoholization as additional therapeutic options. Today, a new class of drugs that inhibit cardiac myosin activity is available for patients with obstructive HCM. In light of the new treatment perspectives, the correct clinical-therapeutic classification of affected patients becomes of fundamental importance for the cardiologist. The aim of this position paper is to increase the knowledge of cardiologists in the field of HCM, defining its epidemiological, genetic, and pathological characteristics, identifying the diagnostic criteria and instrumental methods capable of stratifying the risk profile, with the aim of an optimal therapy tailored on the single patient.

Heart failure is the leading cardiovascular cause of hospitalization with an increasing prevalence, especially in older patients. About 50% of patients with heart failure have preserved ventricular function, a form of heart failure that, until a few years ago, was orphaned by pharmacological treatments effective in reducing hospitalization and mortality. New trials, which have tested the use of gliflozins in patients with heart failure with preserved ejection fraction (HFpEF), have for the first time demonstrated their effectiveness in changing the natural history of this insidious and frequent form of heart failure. Therefore, diagnosing those patients early is crucial to provide the best treatment. Moreover, the diagnosis is influenced by the patient's comorbidities, and some HFpEF patients have symptoms common to other rare diseases that, if unrecognized, develop an unfavourable prognosis. This position paper aims to provide the clinician with a useful tool for diagnosing and treating patients with HFpEF, guiding the clinician towards the most appropriate diagnostic and therapeutic pathway.