Abstract: Background: Transcatheter aortic valve implantation (TAVI) has transitioned from a therapy for inoperable or extreme-risk patients to a standard option across broader risk categories. How this evolution has reshaped patient selection, procedural practice, and early outcomes within a mature program over extended time remains incompletely described. Methods: We conducted a single-center retrospective observational cohort study including all consecutive patients undergoing TAVI for severe symptomatic aortic stenosis between 2012 and 2024. Patients were stratified into three temporal eras (2012–2015, 2016–2020, 2021–2024). Baseline clinical, imaging, and procedural variables were prospectively recorded. The primary endpoint was 1-month major adverse events (MAE), defined as a composite of all-cause death, stroke, myocardial infarction, major vascular complications, or major bleeding. Comparisons across eras used ANOVA and chi-square or Fisher exact tests, as appropriate; multivariable logistic regression was applied to identify independent predictors of MAE. Results: A total of 1,946 patients were included (n=230, 396, and 1,320 across the three eras). Mean age (~81 years) and sex distribution (~60% women) remained stable, whereas cardiovascular risk factors became more prevalent over time (dyslipidemia 46.4% to 89.9%, hypertension 90.9% to 97.7%, smoking 1.1% to 11.2%; all p<0.001). Functional status improved (NYHA III–IV 78.2% to 18.0%; p<0.001), and EuroSCORE II decreased (5.7±5.1 to 3.2±3.6; p<0.001). Angiographically significant coronary artery disease and bicuspid valves were more frequently treated in the most recent era. Transfemoral access under local anesthesia remained predominant, while fluoroscopy time, contrast volume, and procedural duration significantly decreased (all p≤0.003). Residual aortic regurgitation ≥moderate became rare, with none/trace regurgitation increasing from 57.8% to 91.3% (p<0.001). Hospital stay shortened (7.3±2.8 to 6.1±3.1 days; p<0.001). MAE declined from 17.4% to 7.2% (p<0.001), driven by marked reductions in major bleeding (10.0% to 0.7%; p<0.001) and stroke (2.6% to 0.3%; p=0.002), while 1-month mortality remained low (2.6% to 1.0%; p=0.087). The need for new permanent pacemaker implantation was frequent but stable (~17–19%; p=0.645). Conclusions: Over 12 years, this high-volume TAVI program has progressively shifted towards patients with more conventional cardiovascular risk profiles, lower surgical risk, and more complex coronary and valvular anatomy, while achieving shorter, more efficient procedures and improved early safety. These findings support the robustness of a structured Heart Team approach and underscore the importance of continuous optimization of TAVI pathways in an evolving and increasingly heterogeneous patient population.

Abstract: Background: There is paucity of information concerning automatic mitral valve apparatus analysis of patients with mitral valve prolapse (MVP). Objectives: We aimed to study with an automatic three-dimensional transesophageal echocardiography (TEE) dedicated software patients with moderate and severe mitral regurgitation when compared to patients with no structural cardiac chamber alterations (patients with patent foramen ovale (PFO) who underwent TEE) . Methods: We employed a TEE software dedicated to automatic analysis of 34 parameters of the mitral valve apparatus comparing MVP patients with moderate and severe mitral regurgitation and patients with PFO without cardiac chamber structural alterations. Mitral valve effective regurgitant orifice (ERO) and regurgitant volume were correlated to automatic MVP parameters. Results: 59 MVP patients and 43 PFO patients were analysed. All MVP patients presented P2 mitral valve prolapse, 15 (25.4 % ) with both posterior and anterior prolapse. Twenty-seven automatic parameters (79%) were different concerning MVP and PFO patients (p< 0.05): diameters, area, perimeter, height, angle, coaptation width, lenght, closure line lenght, annulus. ERO was 0.43 + 0.11 cm2 , and regurgitant volume: 62.2 + 14.9 ml/beat. Automatic analysis correlated to 75 percentile ERO MVP patients (ERO> 0.48 cm2): Posterior Leafltet Area (r:0.74, p:0.031); Posterior Leafltet Lenght (r:0.73, p:0.032); Tenting area (r:0,41, p:0.048). Conclusions: Automatic mitral valve parameters analysis were different concerning MVP and no structural cardiac chamber (PFO) patients. 75 percentile ERO MVP patients (ERO> 0.48 cm2) correlated to posterior leaflet parameters.This anatomic information could be useful to planning and surgical treatment of mitral valve prolapse patients.

Abstract: Introduction: Sjogren’s is an autoimmune disease that affects several organs, especially the heart, and raises cardiovascular risk. Investigating associations of hemoglobin-to-RDW ratio (HRR), vitamin D status, and cardiac function could provide valuable insights and biomarkers regarding early cardiovascular risk in patients with SD. Method: This cross-sectional study involved 61 patients diagnosed with primary Sjogren’s syndrome (pSS) based on ACR/EULAR criteria. Data on demographics, hematological (Hb, RDW), echocardiography, and serum vitamin D levels were collected. Echocardiograms were conducted by trained cardiologists following established guidelines, while vitamin D levels were measured using ELISA, and statistical analyses, including univariate linear regression, were adjusted for confounders. were performed with SPSS in order to identify whether HRR tertiles were related to cardiac function and vitamin D status. Results: A study of 61 Sjogren’s disease patients (mean age 59.8 years, 89% female) revealed that patients with a lower hemoglobin-to-RDW ratio (HRR ≤0.98) had significantly higher pulmonary artery pressures (PAPs) and lower values for the TAPSE/PAPs ratio, contributing to poor right heart function. These associations were particularly strong in patients with insufficient levels of vitamin D (< 30 ng/mL), while differences in other echocardiographic parameters remained nonsignificant between HRR groups. Conclusion: These findings underscore the clinical value of HRR as a composite biomarker that reflects the interplay between anemia, inflammation, and cardiovascular health in Sjogren’s disease. They also suggest that vitamin D status may be an important therapeutic consideration to mitigate cardiopulmonary risks in this population.

Abstract:

Embolization of intracardiac occlusion devices is an uncommon but potentially serious complication requiring interventional radiology management. We report a case of delayed migration of an Amplatzer patent foramen ovale occluder into the infrarenal abdominal aorta. An 18-year-old woman presented with acute abdominal pain one month after percutaneous PFO closure. Contrast-enhanced computed tomography performed for suspected intra-abdominal bleeding incidentally revealed the embolized device in the infrarenal aorta, with preserved renal artery patency. After multidisciplinary evaluation, endovascular retrieval was planned. Via right common femoral artery access, the device was successfully captured using a snare system and removed through a large-bore introducer sheath without complications. Final angiography confirmed normal aorto-iliac patency. This case highlights the importance of cross-sectional imaging and demonstrates that endovascular snare retrieval is a safe and effective first-line treatment for delayed device embolization.

Abstract: Background: Cardiac rehabilitation (CR) is a key component of secondary prevention after acute coronary events, coronary and valve interventions, and device implantation, yet participation and longterm adherence remain suboptimal. Digital technologies offer the potential to extend CR beyond the centrebased model and to support more flexible, patientcentred care. Methods: This narrative review synthesizes original clinical studies published between 2005 and 2025 that evaluated the use of digital technologies as an integral part of CR in adults after myocardial infarction, revascularization, valve procedures or implantation of cardiac devices. Interventions were grouped into four categories: mobile health (mHealth) and telerehabilitation, virtual reality (VR) and exergaming, virtual education platforms, and other multicomponent digital CR solutions. Only original studies with clinical, functional, or patientreported outcomes were included. Results: Twenty-one studies on the categories mentioned above met the eligibility criteria. mHealthenabled homebased or hybrid CR programs consistently achieved improvements in functional capacity and physical activity that were broadly comparable to centrebased CR, with generally high adherence. VR and exergaming interventions were feasible and safe, produced at least similar functional gains, and showed more consistent benefits as far as anxiety levels and engagement levels. Virtual education platforms delivered knowledge and produced behaviour change similar to traditional education and, in some studies, supported better control of blood pressure and lipids. Comprehensive digital CR platforms improved riskfactor profiles and quality of life to a degree comparable with facetoface CR. Conclusions: Digital technologies can credibly support core objectives of CR in highrisk patients and expand access, but must be implemented as a complement to, rather than a replacement for, multidisciplinary, patientcentred rehabilitation.

Abstract: Cardio-renal syndrome (CRS) is a term referring to a bidirectional group of disorders in which there is a concomitant compromise of both organs, the heart and the kidney, leading to a significant increase in morbidity and mortality. In recent years, numerous publications have addressed this complex entity from different points of view.For better understanding, five subtypes have been established: depending on its form of presentation, acute or chronic; the organ initially affected and whether there is another responsible systemic disease.CRS represents a complex interaction between both organs with several neurohormonal, inflammatory and hemodynamic pathophysiological mechanisms involved. Its different forms of presentation and the difficulty of its management requires a multidisciplinary and comprehensive therapeutic approach targeting all the mechanisms involved in its pathogenesis. Throughout this review we will analyze all relevant aspects of CRS from its classification to current diagnosis and treatment.

Abstract: Background: Arterial hypertension and increased blood pressure variability (BPV) are major prognostic determinants in patients with ischemic heart disease (IHD). While exercise training is known to improve blood pressure (BP) control, the effects of different combined exercise modalities on BPV in IHD remain poorly defined. This randomized pilot study compared the effects of continuous combined training (CCT; moderate-intensity continuous aerobic exercise plus resistance training) and interval combined training (ICT; high-intensity interval aerobic exercise plus resistance training) on BPV and BP parameters in hypertensive patients with IHD. Methods: Thirty-six clinically stable patients with IHD and hypertension were randomized to CCT or ICT for 12 weeks. Outcomes included short-term BPV assessed by 24-hour ambulatory BP monitoring, resting and 24-hour BP, and exercise capacity. Results: Short-term systolic BPV significantly decreased in the CCT group but remained unchanged in the ICT group: [adjusted between-group difference −2.1 mmHg (95% CI: −4.1 to −0.1; p 0.029]. Resting systolic BP decreased similarly in both groups, whereas no significant changes were observed in 24-hour BP values. Peak oxygen uptake improved in both groups with a greater increase in the ICT group [adjusted between-groups difference +1.7 mL·kg⁻¹·min⁻¹ (95% CI: 0.7 to 2.8); p = 0.032). Conclusion: These findings suggest that, in patients with IHD, continuous combined training may be more effective than interval combined training in reducing short-term BPV, whereas interval training may confer greater improvements in aerobic capacity. Further adequately powered studies are warranted to confirm these results.

Abstract:

Background and aims. Carotid atherosclerosis remains one of the primary etiological factors underlying ischemic stroke, contributing to adult neurological disability and mortality. In recent years, non-coding RNAs (ncRNAs) have emerged as key regulators of gene expression, actively modulating molecular pathways involved in atherogenesis. This systematic review, the first to be exclusively focused on carotid atherosclerosis, aimed at synthesizing current findings on the differential expression of ncRNAs throughout the natural history of the disease, thus providing the first comprehensive attempt to delineate a stage-specific ncRNA expression profile in carotid disease. Methods. A comprehensive literature search was conducted in PubMed and Scopus databases in January 2025, following PRISMA guidelines. Original studies involving human subjects with carotid atherosclerosis, evaluating the expression of intracellular or circulating ncRNAs were included and then categorized according to their association with cardiovascular risk factors, carotid intima-media thickness (cIMT), presence of atherosclerotic plaques, plaque vulnerability, clinical symptoms, and ischemic stroke. Results. Out of 148 articles initially identified, 49 met the inclusion criteria and were analyzed in depth. Among the different classes of ncRNAs, microRNAs (miRNAs) were the most frequently reported as dysregulated, followed by circular RNAs (circRNAs) and long non-coding RNAs (lncRNAs). Notably, the majority of identified ncRNAs were implicated in key pathogenic mechanisms such as inflammatory signaling, vascular smooth muscle cell (VSMC) phenotypic modulation, and ABCA1-mediated cholesterol efflux. Conclusions. Collectively, the evidence underscores the association and possible involvement of ncRNAs in the initiation and progression of carotid atherosclerosis and its cerebrovascular complications. Their relative stability in biological fluids and cell-specific expression profiles highlight their strong potential as minimally invasive biomarkers and – possibly – novel therapeutic targets.

Abstract:

Acute aortic dissection is the most common and most severe manifestation of the acute aortic syndrome. Isolated dissecting aneurysm of the abdominal aorta is defined as a dissecting aneurysm distal to the diaphragm and is an extremely rare disease. Detection of an intimal flap between two lumens using different imaging methods is a definitive diagnostic sign of aortic dissection. A number of studies have validated ultrasound, including Point of Care Ultrasound, as the standard initial imaging modality for diagnosis of aortic dissection. We present a 39-year-old patient who was sent to our institution under the suspicion of renal colic. The clinical findings revealed pale discoloration of the skin with sweating and abdominal pain. An emergency ultrasound showed an abdominal aortic aneurysm with an intimal flap, as well as free perirenal fluid on the left side. Multislice computed tomography aortography was then performed and the findings indicated rupture of a dissecting aneurysm of the abdominal aorta with a large retroperitoneal hematoma. The patient was then sent to a tertiary institution where he underwent emergency surgery and successfully recovered.

Abstract: Hypertension is highly prevalent among patients with chronic kidney disease (CKD), contributing significantly to cardiovascular morbidity and progressive renal decline. This overview explores the intricate pathophysiologic mechanisms driving hyperten-sion in renal insufficiency, including volume overload, renin-angiotensin-aldosterone system (RAAS) activation, sympathetic overactivity, and vascular dysfunction. Diag-nostic challenges such as white-coat hypertension and the underuse of ambulatory monitoring are discussed, along with the importance of volume assessment and target organ evaluation. We also emphasize individualized management strategies combin-ing lifestyle modification, pharmacotherapy—including RAAS inhibitors, diuretics, and novel agents—and the growing role of device-based interventions. In particular, renal denervation (RDN) has recently emerged as a novel and promising adjunct for resistant hypertension in CKD, with evidence supporting its efficacy and safety even in dialysis-dependent patients. Special considerations for transplant recipients, elderly individuals, and those on dialysis are highlighted, underscoring the need for nuanced, patient-centered care. Misconceptions surrounding RAAS blockade, dialysis hypoten-sion, and therapeutic inertia are critically appraised. Finally, future directions point to biomarker-driven approaches, digital health integration, and large-scale trials on RDN to refine treatment paradigms. This comprehensive synthesis offers a pragmatic framework for clinicians managing hypertension in CKD, aligning mechanistic in-sights with emerging evidence and clinical realities.

Abstract: Magnetocardiography has reached its clinical breakthrough, at least as a contactless, highly sensitive method to diagnose or exclude an ischemic cardiomyopathy, with or without coronary obstruction, in patients with chest pain of uncertain origin and still normal troponin and ECG patterns. This diagnostic advantage has already been recognized with regulatory approvals. However, despite its intrinsic advantages, including unrivalled non-invasive inverse estimation of cardiac currents and a strong potential for 3D- and 4D multimodal integration with other imaging modalities, its clinical adoption remains limited by the absence of internationally shared standards. This perspective review aims to highlight the point of view of the clinical end-user and propose the establishment of an interdisciplinary expert commission for the standardization and interpretation, now essential to define consensus-based recommendations for MCG clinical use.

Abstract: The mutation in the Myosin Heavy Chain 7 (MYH7) gene, which encodes the β-myosin heavy chain, is one of the most common and clinically significant genetic abnormalities associated with cardiomyopathy. While it is most frequently linked to hypertrophic cardiomyopathy, recent studies have increasingly linked MYH7 mutations to certain forms of restrictive cardiomyopathy (RCM) as well. Case Presentation: We present the case of a 25-year-old patient without personal or family history of cardiovascular disease. The patient was admitted with symptoms of fatigue, exertional dyspnea, and a transient loss of consciousness. Electrocardiogram revealed bradycardia and repolarization abnormalities. Echocardiography showed normal left ventricular volumes and ejection fraction, severely dilated left atrium, and restrictive LV filling pattern. Cardiac magnetic resonance imaging (CMR) showed preserved systolic function, evidence of interstitial fibrosis, and marked left atrial dilation. Subsequent genetic testing revealed a pathogenic MYH7 variant and a likely pathogenic ABCC9 variant, supporting the diagnosis of a genetically determined cardiomyopathy with restrictive features. This case highlights the importance of integrating advanced imaging and genetic testing in patients with unexplained restrictive physiology and preserved systolic function, even in the absence of myocardial hypertrophy.

Abstract: Background: Hepatic cholesterol synthesis inhibition is a cornerstone of atherosclerotic cardiovascular disease (ASCVD) prevention. Despite intensive lipid-lowering therapy, many very-high-risk patients with chronic coronary syndrome (CCS) fail to achieve recommended LDL-C targets. Bempedoic acid (BA), a liver-activated ATP citrate lyase (ACLY) inhibitor, suppresses cholesterol biosynthesis upstream of HMG-CoA reductase and may have metabolic and renal effects. Methods: We conducted a prospective, single-centre, real-world study including consecutive CCS patients with LDL-C ≥55 mg/dL despite stable intensive lipid-lowering therapy (high-intensity statin plus ezetimibe or PCSK9 inhibitor plus ezetimibe in statin-intolerant patients). BA 180 mg/day was added to background therapy. Lipid parameters, uric acid, and renal function were assessed at baseline and ≥8 weeks. Multivariable regression analyses identified predictors of LDL-C reduction and target attainment. Results: Among 118 patients with complete follow-up (mean age 62.4 ± 10.0 years; 79.2% male), BA reduced LDL-C by 22.8% (−16.36 mg/dL; p < 0.001), enabling 48.3% to achieve LDL-C < 55 mg/dL. Total and non–HDL cholesterol decreased significantly, whereas triglycerides and fasting glucose remained unchanged. HDL-C showed a modest reduction. Uric acid increased by 0.96 mg/dL without gout events, and renal function changes were small and clinically non-relevant. Higher historical untreated LDL-C and diabetes mellitus independently predicted greater LDL-C reduction; higher historical LDL-C and baseline uric acid predicted LDL-C goal attainment. Conclusions: ACLY inhibition with BA provides clinically meaningful LDL-C reduction in intensively treated CCS patients, revealing a cardiometabolic phenotype with proportional lipid responsiveness and modest urate changes. BA represents an effective translational strategy linking hepatic cholesterol metabolism to clinical lipid optimization in very-high-risk patients.

Abstract: Background: The monocarboxylate transporter 1 (MCT1) plays a central role in myocardial lactate handling and metabolic adaptation. The functional rs1049434 polymorphism (T1470A; Asp490Glu) affects MCT1-mediated lactate transport and substrate utilization, but its clinical relevance in sarcomere-related hypertrophic cardiomyopathy (HCM) remains poorly defined. Methods: We studied 56 carriers of pathogenic or likely pathogenic sarcomeric variants followed in a familial HCM program. All participants underwent standardized clinical phenotyping, including electrocardiography, transthoracic echocardiography and cardiac magnetic resonance imaging. Genotyping of MCT1 rs1049434 was performed on genomic DNA. Analyses focused on sex-stratified genotype distribution, phenotypic expression among the 26 individuals who fulfilled diagnostic criteria for HCM, and the influence of habitual vigorous exercise. Septal wall thickness was the primary structural endpoint. Results: Among the 26 patients with established HCM (10 women, 16 men), a marked sex-specific effect emerged. Female carriers of the T-allele (TT/TA) exhibited significantly greater interventricular septal thickness compared with AA homozygotes (23.2 vs. 14.2 mm; p = 0.037). In men, septal thickness did not differ by genotype. However, male patients engaged in vigorous physical activity showed a consistently milder structural phenotype, including lower septal thickness (18.3 vs. 19.9 mm; p = 0.585) and directionally favorable markers of mechanical severity. Phenotypic distribution was predominantly asymmetric septal hypertrophy in both sexes, without genotype-dependent differences. Conclusions: The phenotypic impact of MCT1 rs1049434 in sarcomere-positive HCM is context-dependent. In women, impaired monocarboxylate handling is associated with greater hypertrophic remodeling, whereas in men, exercise-related metabolic conditioning appears to attenuate disease severity. These findings support a genotype–sex–environment interaction relevant to precision medicine approaches in HCM..

Abstract: Endothelial cells (ECs) regulate vascular homeostasis, and their dysfunction is a key driver of many cardiovascular and cerebrovascular diseases. Human-induced pluripotent stem cell–derived endothelial cells (hiPSC-ECs) provide access to patient-specific vascular cells that can be directed toward arterial, venous, or organotypic phenotypes, enabling personalized in vitro modeling of endothelial pathology. In this review, we discuss how patient-specific iPSC-ECs are used as predictive and personalized two- and three-dimensional models to dissect disease mechanisms and prioritize targeted therapies, we highlight some limitations of this methodology, and outline future directions for integrating iPSC-EC–based assays into individualized treatment algorithms.

Abstract:

Background: Immune checkpoint inhibitors (ICIs) improve cancer outcomes but may cause cardiovascular toxicity, including early subclinical myocardial injury. Conventional echocardiography has limited sensitivity, whereas speckle-tracking echocardiography (STE) allows early detection of myocardial deformation. Data on short-term ICI-related effects on biventricular mechanics are limited, and atrial function remains poorly characterized. This study evaluated the early impact of ICI therapy on biventricular and biatrial mechanics using STE in patients with advanced cancer. Methods: In this prospective, single-center study, 28 consecutive patients with advanced cancer undergoing ICI therapy were followed for 3 months. Clinical, laboratory, electrocardiographic, and echocardiographic assessments were performed at baseline, 1 month, and 3 months. STE was used to assess left ventricular global longitudinal strain (LV-GLS) and circumferential strain, right ventricular GLS (RV-GLS), and left and right atrial reservoir, conduit, and contractile strain parameters. Subclinical LV dysfunction was defined as a relative LV-GLS reduction >15%. Logistic and Cox regression analyses identified predictors of strain impairment and adverse clinical events. Results: Conventional echocardiographic parameters, including left ventricular ejection fraction, remained stable. In contrast, LV-GLS declined progressively from 20.7 ± 2.1% to 17.6 ± 2.7% at 3 months (p = 0.002), with subclinical LV dysfunction observed in 85.7% of patients. RV-GLS also deteriorated despite preserved TAPSE. Both left and right atrial strain and strain-rate parameters showed an early and marked decline, accompanied by increased left atrial stiffness despite unchanged atrial volumes. Older age and higher neutrophil-to-lymphocyte ratio (NLR) were associated with LV-GLS impairment. Over a mean follow-up of 5.4 ± 3 months, baseline LV-GLS independently predicted adverse clinical events and mortality. Optimal cut-off values were 67 years for age, 4 for NLR, and 19.5% for LV-GLS. Conclusions: Short-term ICI therapy is associated with early, diffuse subclinical myocardial dysfunction involving both ventricles and atria, detectable only by STE. Comprehensive biventricular and biatrial strain assessment may enhance early cardio-oncology surveillance and risk stratification in ICI-treated patients.

Abstract: Background: We present our experience with the endovascular therapy (EVT) of a pseudo-aneurysm of the posterior tibial artery (PTA) with an associated arteriovenous fistula (AVF) and a systematic review was carried out to put a light on the EVT. Methods: A 31-year-old patient presented with pain in the lower leg with increasing severity and a history of war trauma. A CT-Angiogram confirmed an aneurysm of the PTA with an AVF. With a bidirectional endovascular approach, the aneurysm was occluded with Coils and excluded with a Viabahn Endoprosthesis. Aspirin and Clopidogrel were recommended postoperatively. After 18 months of follow-up, the patient is free of symptoms with patent endoprosthesis. Multiple databases (Scopus, Pubmed, Medline, OVID) were systematically searched with MeSH terms. The studies were scrutinized and data on demographics, procedural details, and follow-up was collected and pooled. Results: A total of 44 studies (56 patients) were eligible and included. Average age was 50 (15-87 years). The most common etiology was trauma (iatrogenic 29/56;51.7% and non-iatrogenic 15/56;26.7%). EVT strategies included coil-embolization (n=29), stent-implantation (n=25), and a combination of both (n= 2). Median stent diameter was 3mm (2.5–6). The follow-up period ranged from 1week-60 months. Primary Patency was 18/27 (66.6%) with no reported complications. Conclusion: EVT offers a feasible and safe alternative to simple ligation or occlusion of crural aneurysms to preserve distal flow to the foot. Dedicated stents for crural arteries are not available. Studies with long-term follow-up are lacking.

Abstract:

Background: There exists some inconsistent evidence on the relationship between altered cardiac morphology, its function, and frailty. Therefore, this study aimed to assess the associations among frailty, lean body mass, central arterial stiffness, and cardiac structure and geometry in older people with a normal ejection fraction. Methods: A total of 205 patients >65 years were enrolled into this ancillary analysis of FRAPICA study and were assessed for frailty with Fried phenotype scale. Left ventricular dimensions and geometry were assessed with two-dimensional echocardiography. Fat-free mass was measured using three-site skinfold method. Parametric, non-parametric statistics and analysis of covariance were used for statistical calculations. Results: Frail patients were older and women comprised the majority of the frail group. Frail men and women had comparable weight, height, fat-free mass, blood pressure, central blood pressure, and carotid-femoral pulse wave velocity to their non-frail counterparts. There was a linear correlation between the sum of frailty criteria and left ventricular end diastolic diameter (negative) and relative wall thickness (positive). In the analysis of covariance, frailty and gender were independently associated with left ventricular mass, left ventricular mass indexed, and relative wall thickness. Frailty shifts heart remodeling toward concentric remodeling/hypertrophy. Conclusions: Frailty is independently associated with thickening of the left ventricular walls and a diminished left ventricular end-diastolic diameter, leading to concentric remodeling or hypertrophy. This phenomenon is more pronounced in women. This adverse cardiac remodeling may serve as another phenotype feature of frailty according to the phenotype frailty criteria.

Abstract: Cardiovascular involvement in SARS-CoV-2 infection and following vaccination has emerged as a clinically relevant phenomenon with distinct yet overlapping mechanisms. Myocardial injury in COVID-19 results from a complex interplay between direct viral ef-fects, immune-mediated inflammation, endothelial dysfunction, oxidative stress, and, in rare occasions, cytokine storm. The virus primarily binds to ACE2 receptors, which are highly expressed in endothelial cells and pericytes, leading to microvascular damage and a systemic prothrombotic state. Additional viral entry pathways, including CD147, Neu-ropilin-1, and CD26, further contribute to vascular and myocardial injury, which is a ra-ther immune-driven process rather than a direct cytopathic one. Histopathological studies that reveal macrophage-rich infiltrates, microthrombosis, and patchy fibrosis support the immune-driven process theory. In contrast, vaccine-associated myocarditis – predomi-nantly reported following mRNA vaccines – presents a self-limiting clinical course, with mechanisms probably involving molecular mimicry, aberrant immune activation, or hy-persensitivity reactions. Despite an increased incidence in young males after the second dose, the overall risk remains low compared to infection-related myocarditis. Under-standing the pathophysiological interplay between infection- and vaccine-related cardiac involvement is essential for accurate risk assessment, improved diagnostic strategies, and targeted therapeutic approaches. Future research should focus on elucidating immune pathways, refining biomarkers, and developing personalized management strategies in order to mitigate cardiovascular sequelae of both COVID-19 and vaccination.

Abstract: Aortic coarctation is a local narrowing of the aortic lumen, which is located at the level of the isthmus in 95% of patients and accounts for 5 to 8% of all congenital heart diseases. It can be associated with other congenital defects, such as bicuspid aortic valve (BAV), and in adulthood it is suspected in cases of severe resistant hyperten-sion. A correct diagnosis is necessary for the proper assessment and management of these patients. A multimodality imaging approach using ultrasound, CT, and MRI allows for accurate and effective diagnosis. The purpose of this review is to describe the different non-invasive imaging techniques pointing out their advantages and disadvantages, aiming to provide a guide to clinicians and cardiovascular imaging specialists in choosing the best imaging tools to use.