Niccolò Marchionni

Introduction. Cardiovascular diseases are the leading cause of morbidity and mortality in older adults, highlighting the need for effective preventive strategies. Structured screening programs may enhance the early detection and management of cardiovascular risk factors in this population. To describe the impact of the PREVASC multidisciplinary model in promoting collaboration in cardiovascular prevention, collecting evidence on cardiovascular risk, and assessing gender differences in cardiovascular risk prevention among the older population. Methods. In this descriptive correlational cross-sectional study data were collected from 1,836 participants aged 65–94 years enrolled in the PREVASC screening program. All professionals involved in the PREVASC screening campaign entered data into a standardized data collection system. Participants underwent structured cardiovascular assessments, and adherence to pharmacological therapy, sociodemographic characteristics, and time spent at the screening center were recorded. Descriptive statistics were used to analyze frequencies, percentages, and measures of central tendency and dispersion. Results. Among the scheduled participants, 1,640 (89.37%) attended the screening, while 196 (10.63%) did not. Adherence to pharmacological therapy was high, with 1,453 participants (90%) reporting ongoing treatment; adherence was higher among women (91.4%) than men (88.3%). The mean age of participants was 72.52 years, with a predominance of women (55.9%). The average time spent at the screening center was 1 hour and 3 minutes (range: 22 minutes–3 hours and 47 minutes), indicating an efficient organizational structure. Discussion. The PREVASC program demonstrated high participation rates and sustainable operational performance, supporting the feasibility of structured cardiovascular screening in older adults. The integration of multiprofessional expertise and community-based preventive activities represents a replicable model for effective cardiovascular prevention and early risk identification, with potential relevance for public health planning.

Background: Coronary computed tomography angiography (cCTA) is now indicated as a non-invasive tool for ruling out obstructive coronary artery disease (O-CAD) in patients who are candidates for transcatheter aortic valve implantation (TAVI) showing low-intermediate pre-test probability of O-CAD. In elderly and comorbid TAVI candidates, the safety and accuracy of cCTA as an alternative to invasive coronary angiography (ICA) for ruling out O-CAD remain to be established. Aim: To assess the feasibility, diagnostic accuracy, and clinical safety of cCTA for ruling out proximal O-CAD in elderly, comorbid, high-risk patients undergoing TAVI. Methods: We conducted a retrospective, single-center study including all consecutive patients with severe symptomatic aortic stenosis who underwent TAVI between January 2019 and December 2020. All patients underwent pre-TAVI cCTA. Patients with positive or non-diagnostic cCTA underwent ICA selectively (ICA group). In patients with no-O-CAD, ICA was omitted and proceeded directly to TAVI (no-ICA group). Accordingly, patients were divided into two groups: no-ICA and ICA group. Clinical follow-up was extended up to 5 years, with assessment of major adverse cardiovascular events (MACEs), mortality, heart failure hospitalizations, and unplanned revascularization. Results: Among 355 patients enrolled, 210 were included in the study. Among them, 140 (66.7%) had negative cCTA for O-CAD, and ICA was safely omitted in 132 patients (62.8%). cCTA was inconclusive in 43 patients (20.5%) and positive in 27 (12.9%). ICA confirmed O-CAD in 53 of 78 patients (67.9%) and PCI was performed in 35 of 53 (66.0%). The accuracy of cCTA for ruling in O-CAD was low (66.28%). During the follow-up period (1513 ± 508 days), the no-ICA group showed comparable outcomes to the ICA group in terms of periprocedural complications and long-term results—at both 1 and 5 years—for MACEs, heart failure hospitalizations, mortality and unplanned revascularization. Outcomes remain comparable between the two groups after performing matched-pair analyses. Conclusions: Our data show that cCTA may provide a reliable, safe, and effective alternative to ICA for ruling out obstructive CAD in elderly patients undergoing TAVI when image quality is diagnostic. A cCTA-based strategy allows deferral of ICA in most cases without compromising procedural safety or long-term clinical outcomes, enabling a personalized and tailored clinical pathway. Whether advanced CT techniques, such as CT-FFR and photon-counting CT, may help refine patient selection for invasive coronary assessment remains to be demonstrated.

BACKGROUND: The prevalence of transthyretin cardiac amyloidosis among older adults (often octogenarians) is increasing. We aimed to determine whether age and geriatric syndromes bear any impact on the management and outcomes in transthyretin cardiac amyloidosis and assess the risk of ageism. METHODS: In a prospective, multicenter cohort study, 256 patients diagnosed with transthyretin cardiac amyloidosis from March 2021 to March 2024 underwent comprehensive geriatric assessment (CGA). The study evaluated the prevalence and clinical associations of CGAs across different disease stages (National Amyloidosis Centre stage). Key CGA domains included disability, malnutrition, depression, frailty, Short Physical Performance Battery, and cumulative deficits (sum of the single CGA items). Associations of these measures with disease-modifying therapy and overall mortality were analyzed. RESULTS: Median age was 82 years (men: n=223 [87%]; variant: n=19 [7.4%]); 129 (50.3%) patients received disease modifiers. Those ≥85 years had significantly lower odds of receiving disease-modifying therapy even after adjusting for disability, frailty, and cumulative deficits. Over 1.9 (interquartile range, 1.0–2.3) years, 45 (17.6%) patients died. After adjustment for National Amyloidosis Centre stage, diuretics and disease modifiers, CGA domains of disability, malnutrition, Short Physical Performance Battery, frailty, and number of deficits, but not age, were significantly associated with mortality. Assessment of CGA domains improved National Amyloidosis Centre prognostic accuracy. CONCLUSIONS: In a national prospective cohort of patients with transthyretin cardiac amyloidosis, older age was associated with lower prescription of disease modifiers, even among individuals with a low burden of geriatric syndromes. However, when adjusted for geriatric domains, age was not associated with survival, indicating potential ageism. Because some geriatric syndromes may be modifiable, a CGA could enhance risk stratification, reduce age-related bias, and improve outcomes.

Aims: Valvular heart disease (VHD) is the third leading cause of cardiovascular morbidity, with its incidence and public health impact projected to increase significantly. This study adopts a novel perspective, focusing on elderly individuals residing in rural areas, highlighting the unique dynamics of small-town settings. Methods: This multicenter, observational study was conducted from May 2022 to September 2023, under the coordination of the AOU Careggi Echo Core-Lab, which managed the entire screening program. In 10 small Italian villages, each municipality facilitated the enrollment of asymptomatic individuals aged ≥ 65 years, with no prior VHD history, through voluntary participation. Participants were grouped into three age categories (65–69, 70–74, and ≥ 75 years) and underwent a thorough evaluation, including a Quality of Life (QoL) questionnaire and comprehensive echocardiographic assessment focusing on VHD detection and grading. Results: Among 1,113 participants, the prevalence and severity of VHD showed a significant increase with age (p < 0.0001). Remarkably, 94% of individuals aged ≥ 75 years had at least one valvular defect, with 22.5% presenting moderate or severe valvulopathy, including a prevalence of 4.8% for moderate or severe aortic valve stenosis and 7.5% for mitral regurgitation. Right-sided valvulopathies followed a similar trend, affecting 71.9% of elderly participants. QoL evaluations revealed a generally positive perceived health status, with a mean score of 77 ± 16. Conclusions: Our registry highlights that the prevalence of VHD in asymptomatic individuals over 65 years living in small Italian communities is substantial, increases with age, and is predominantly degenerative in etiology. Notably, most individuals with undiagnosed VHD perceived themselves as healthy.

Background and Objectives: In patients with severe aortic stenosis (AS), left ventricular systolic dysfunction is one of the main predictors of adverse events after surgical aortic valve replacement (SAVR). However, more patients undergo surgery earlier, often with preserved systolic function. In these cases, global longitudinal strain (GLS) has been proposed as a marker of ventricular remodeling post-surgery. This study aims to evaluate GLS variation in patients undergoing SAVR and explore differences across the diastolic dysfunction classes. Methods: From June 2020 to March 2023, patients with AS and preserved ejection fraction (EF) requiring SAVR were enrolled. Echocardiographic evaluations were conducted preoperatively, seven days post-surgery, and twelve months after surgery. Patients were divided into two groups based on the severity of diastolic dysfunction: Group A (grade I) and Group B (grades II–III). Results: The final analysis included 108 patients (mean age 71.3 ± 7.2 years). Twenty-two patients (20.4%) also underwent coronary artery bypass grafting (CABG). The preoperative EF averaged 61.6 ± 6.03%, with no significant differences between groups. Preoperative GLS was 16 ± 4.3%, decreasing to 12.8 ± 3.4% postoperatively (p < 0.0001). GLS was comparable between the groups preoperatively (p = 0.185) and postoperatively (0.854). After twelve months, GLS improved in both groups (Group A: 17.7 ± 3.4%, Group B: 15.7 ± 3.2%, p < 0.0001), but only Group A showed significant improvement from preoperative values (p = 0.018). SAVR improved GLS regardless of CABG intervention. Conclusions: SAVR in patients with preserved LVEF results in an early reduction in GLS, regardless of diastolic dysfunction. After twelve months, GLS improved significantly, with significant recovery only in patients with mild dysfunction.

Aortic stenosis (AS) represents a notable paradigm for cardiovascular (CV) and geriatric disorders owing to comorbidity. Transcatheter aortic valve replacement (TAVR) was initially considered a therapeutic strategy in elderly individuals deemed unsuitable for or at high risk of surgical valve replacement. The progressive improvement in TAVR technology has led to the need to refine older patients’ stratification, progressively incorporating the concept of frailty and other geriatric vulnerabilities. Recognizing the intricate nature of the aging process, reliance exclusively on chronological age for stratification resulted in an initial but inadequate tool to assess both CV and non-CV risks effectively. A comprehensive geriatric evaluation should be performed before TAVR procedures, taking into account both physical and cognitive capabilities and post-procedural outcomes through a multidisciplinary framework. This review adopts a multidisciplinary perspective to delve into the diagnosis and holistic management of AS in elderly populations in order to facilitate decision-making, thereby optimizing outcomes centered around patient well-being.