Rocco Mollace

Background: Left ventricular outflow tract obstruction (LVOTO) is a rare but potentially life‐threatening complication of transcatheter mitral valve replacement (TMVR). Mitral valve‐in‐valve procedures are generally associated with a lower risk of LVOTO because of the predictable geometry provided by the surgical bioprosthesis, yet severe obstruction may still occur and precipitate abrupt hemodynamic collapse. Case: A 79‐year‐old woman with a degenerated 27‐mm Carpentier‐Edwards Perimount mitral bioprosthesis presented with acute decompensated heart failure due to severe bioprosthetic mitral stenosis. Following multidisciplinary Heart Team evaluation, she was considered not a candidate for redo mitral valve surgery and underwent urgent transseptal valve‐in‐valve TMVR with a 26‐mm balloon‐expandable SAPIEN valve. Intervention: Immediately after valve deployment, severe LVOTO developed, with an invasive peak‐to‐peak LV‐aortic gradient of 120 mmHg. A mechanism‐guided percutaneous rescue strategy was undertaken. Correction of the structural component of obstruction reduced the gradient to 60 mmHg. Persistent obstruction suggested a significant dynamic contribution, prompting selective septal branch coil embolization, which further reduced the gradient to 20 mmHg and resulted in immediate hemodynamic stabilization. Conclusion: Severe LVOTO after valve‐in‐valve TMVR may reflect both structural and dynamic mechanisms. Persistence of significant obstruction after structural correction should prompt consideration of a dynamic component and may guide effective rescue therapy.

Eicosanoids and their receptors act as key regulators of inflammation, calcium homeostasis, mitochondrial function, and cardiomyocyte survival, thereby contributing to the onset and progression of cardiac dysfunction. This review aims to summarize the evidence to underscore the pivotal role of eicosanoids and their receptors in the pathophysiology of cardiomyopathy, analysing the potential protective activity of traditional and natural compounds to counteract cardiovascular disease onset and progression. Among eicosanoid receptors, prostaglandin E2 receptor 3 (EP3), prostaglandin E2 receptor 4 (EP4), chemoattractant receptor expressed on type 2 helper T cells (CRTH2), and thromboxane prostanoid (TP) emerge as critical modulators with distinct and often opposing effects on cardiac physiology. While EP3 and CRTH2 are predominantly associated with detrimental outcomes such as impaired contractility and enhanced apoptosis, EP4 signalling consistently demonstrates cardioprotective properties, including improved calcium handling and preservation of mitochondrial integrity. These findings highlight the therapeutic potential of selectively targeting eicosanoid receptor pathways to mitigate cardiac remodelling and dysfunction. In parallel, increasing attention has been directed toward natural bioactive compounds as complementary strategies for cardioprotection. Polyphenols, flavonoids, carotenoids, and other nutraceuticals exert beneficial effects through antioxidant, anti-inflammatory, and anti-apoptotic mechanisms, often intersecting with eicosanoid signalling pathways. Their ability to modulate oxidative stress and inflammatory responses suggests a promising role in preventing or attenuating cardiomyopathy, particularly in metabolic and drug-induced contexts. Future research should focus on well-designed clinical trials, a deeper characterization of receptor-specific signalling networks, and the development of targeted therapies that combine pharmacological and nutraceutical approaches. Overall, a better understanding of eicosanoid-mediated mechanisms may open new ways for cardiomyopathy prevention and treatment, ultimately improving patient outcomes and reducing the burden of cardiovascular disease.

Current approaches to estimating the probability of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM) often fail to reflect th

Vascular endothelium balances antithrombotic and anti-inflammatory activity to control blood vessel tone under physiological conditions. However, endothelial dysfunction impairs these processes, causing a state that promotes clotting and inflammation. Eicosanoids are a major class of bioactive lipid mediators crucial for modulating endothelial and platelet function. Research has highlighted the roles of eicosanoids in vascular diseases, showing pro-inflammatory, prothrombotic, and protective activities. Specifically, prostaglandin E₂ (PGE₂) is crucial because of its major role in atherosclerosis development and progression, acting via EP receptors involved in forming, maintaining, and stabilizing atherosclerotic lesions, thereby making PGE₂-EP signalling a specific target for treating cardiovascular diseases. This review will explore the evidence on eicosanoids and the role of their receptor modulation in platelet and vascular dysfunction in atherothrombosis. The studies included in this scoping review were retrieved from PubMed, Web of Science, Cochrane, and Scopus in accordance with the Preferred Reporting Items for Scoping Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) statement and the Population Intervention Comparison Outcome Population (PICO) framework. Eight clinical studies were found, which highlighted the crucial role of eicosanoids, like prostaglandins and their receptors, in endothelial and platelet dysfunction, and also how pharmacological mechanisms affect atherothrombosis. A new therapeutic approach for cardiovascular dysfunction is indicated by the recent findings, specifically against atherothrombosis, focusing on eicosanoids, their receptors, and processes like oxidative stress. Despite this evidence, there is a lack of comprehensive research results from scientific databases; therefore, further in vitro, in vivo, and clinical studies should be promoted to validate the preliminary results.

Background: Polyphenols have garnered significant interest because of their potential health benefits, but their bioavailability is limited. According to recent studies, in vivo metabolites of phenol compounds may mediate their biological activity, potentially countering systemic oxidation and inflammation and therefore reducing multi-organ dysfunction associated with gut microbiota alterations. This pre-clinical study aims to characterize a novel formulation, enhancing metabolite bioavailability, ensuring long-term stability, and employing sustainable production methods. Our research provides the first evidence of the presence of these metabolites in the blood plasma of animals receiving different Bergamot polyphenols fraction (BPF) formulations. Methods: Male Sprague-Dawley were used throughout the study. The animals were subdivided into three groups of six animals each receiving 50 mg/kg of BPF standard (BPF), 50 mg/kg of Bergamot polyphenols fraction micronized (BPFmicro), and 50 mg/kgof Bergamot polyphenols fraction encapsulation (BPFencap), respectively, by oral gavage. Blood samples were collected, and plasma was prepared with a specific protocol and analysed for the presence of primary and secondary metabolites through ultra-high performance liquid chromatography-tandem mass spectrometry (UHPLC-MS/MS). Results: UHPLC-MS/MS analysis showed significantly higher plasma concentrations of naringin and its metabolites in the BPFencap group compared to the BPF standard and BPFmicro groups at all time points. In comparison to BPF, plasma Area Under Curve (AUC) analysis of metabolites revealed substantially elevated values for the BPFencap group and substantially reduced values for the BPFmicro group. Conclusion: While BPFmicro greatly increased bioavailability, the improvement was only temporary, highlighting a stability problem. The bioavailability and stability of metabolites are significantly improved over time by the new BPFencap formulation (micronized BPF in hybrid phospholipid systems with citrus albedo fibers).

Heart failure with preserved ejection fraction (HFpEF) represents nearly half of all heart failure cases and remains diagnostically challenging due to its heterogeneous pathophysiology and often subtle myocardial dysfunction. Conventional echocardiographic parameters, such as left ventricular ejection fraction (LVEF) and the left atrial volume index (LAVI), frequently fail to detect early functional changes. Advanced echocardiographic techniques have emerged as valuable tools for early diagnosis and risk stratification. Global Longitudinal Strain (GLS) allows for the identification of subclinical systolic dysfunction, even with preserved LVEF. Left Atrial Strain (LAS), particularly reservoir and pump strain, provides sensitive markers of diastolic function and elevated filling pressures, offering additional diagnostic and prognostic insights. Myocardial Work (MW), through non-invasive pressure–strain loops, enables load-independent assessment of contractility, while Right Ventricular Free Wall Longitudinal Strain (RVFWLS) captures early right heart involvement, often present in advanced HFpEF. The integration of these advanced parameters can enhance diagnostic precision and guide personalized treatment strategies. This review highlights the current evidence and clinical applications of strain-based imaging in HFpEF, underscoring the importance of a multiparametric, pathophysiology-oriented approach in heart failure evaluation.

Introduction: Olive oil’s health benefits are widely known and extensively documented; its advantages are widespread, covering numerous areas of human health. Clinical and experimental data indicate that a Mediterranean Diet (MedDiet) with Extra Virgin Olive Oil (EVOO) lowers the risk of illnesses associated with oxidative stress, chronic inflammation, and weakened immunity, including cancer and cardiovascular disease (CVD). The European Food Safety Authority (EFSA) confirms that olive oil’s polyphenols help protect blood lipids against oxidative damage; thus, EVOO, crucial in the MedDiet, could be a functional food component. Olive oils must contain at least 5 mg of Hydroxytyrosol (HYTY) and its derivatives (oleuropein and Tyrosol (TY)) per 20 g to qualify for the EFSA-approved health claim. To provide a summary of clinical study results, this systematic review assessed the impact of Virgin olive oil (VOO) consumption on cardiovascular risk and disease prevention. Methods: The systematic review’s studies were collected from PubMed, Cochrane, Web of Science, and Scopus following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and the Population Intervention Comparison Outcome Population (PICO) framework. Results: Seventeen clinical studies were identified, which highlighted the association between VOO consumption (including EVOO) and a reduced risk of cardiovascular disease. Particularly, improvements in biomarkers involved in cardiometabolic pathways and subsequent cardiovascular events were recorded. The beneficial effect was attributed to the polyphenols contained in EVOO. Indeed, EVOO supplementation as part of the Mediterranean diet could improve patients’ quality of life in secondary prevention by demonstrating a positive correlation with the cardioprotective role of polyphenols. Discussion: A balanced diet with VOO represents a simple yet potent method to counteract metabolic dysfunctions associated with CVD. Despite these results, further multicenter clinical studies with a wider range of patients are required to confirm and better understand EVOO’s effects on the prevention of cardiovascular risk.

The significance of thiamine in human health is linked to its role in several pathways that control different disease processes. Significant improvements in cardiometabolic diseases, substantially impacted by thiamine imbalances, are observed with thiamine supplementation. Diabetic patients could see a reduction in cardiovascular (CV) risk due to thiamine’s significant impact on glucose metabolism. Specifically, increased ventricular filling pressures and oxygen consumption, indicative of CV dysfunction, are caused by oxidative and inflammatory damage to blood vessels, diabetic nephropathy, and elevated lactic acid production. Despite promising pre-clinical results for thiamine, clinical trials have yielded conflicting and contradictory findings due to limitations like small sample sizes and insufficient follow-up. To provide a summary of clinical study results, this systematic review assessed the impact of thiamine supplementation on diabetes and its CV complications. The studies included in this systematic review were retrieved from PubMed and Medline databases, in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and following the Population Intervention Comparison Outcome (PICO) framework. Seven clinical studies were identified, which enlighten the association between thiamine supplementation, hyperglycemia, and cardiovascular disease (CVD). Although large-scale, multicenter studies with longer follow-up periods are needed, the association between thiamine and chronic metabolic dysfunction related to CV risk suggests its crucial role in preventing severe heart failure (HF).

The isolation, structural elucidation, and synthesis of pure thiamin were achieved in 1936, marking a milestone in vitamin research. As an organic compound soluble in water, thiamin is essential for carbohydrate metabolism in plants and animals, and in its active form—as part of the thiamin pyrophosphate coenzyme—performs these functions. Thereby, thiamin represents an essential vitamin to human health and is involved in several pathways that regulate several pathophysiological mechanisms. Cardiovascular disease is significantly impacted by thiamine imbalance and its supplementation offers substantial improvements to the associated conditions. In this comprehensive review, we aimed to examine the dual role of thiamine deficiency and accumulation, focusing on an analysis of the causes of thiamine deficiency. We detailed the effects of thiamine deficiency on metabolism and on cardiovascular risk and heart failure, explaining the molecular mechanisms involved in metabolic dysfunction, and highlighting the role of B1 vitamin supplementation in diabetes mellitus management and atherosclerosis development and progression. Indeed, B1 supplementation counteracts oxidative stress and inflammation, significantly ameliorating glycemic and lipemic profiles. Additionally, we reported the beneficial effects of thiamine in counteracting cardiotoxicity induced by cancer therapy. Although preclinical data strongly support the benefits of thiamine, clinical trial findings are in contrast and contradictory, hampered by limitations such as small sample sizes and inadequate follow-up. Further research is needed to investigate thiamine’s potential benefits, overcoming current study limitations and evaluating its use as a supplemental therapy alongside standard treatments in different high-cardiovascular-risk conditions.