Roberto Badagliacca

Background: Indications for right ventricular assist device (RVAD) insertion include right heart failure after implantation of a left ventricular assist device or early graft failure following heart transplantation. This study aimed to investigate how the upstream and downstream circulatory network interacts with the Impella RP^® device. Methods: A numerical model of the Impella RP^® device was implemented within the CARDIOSIM^© software platform for this study. In the numerical configuration, the RVAD aspirated blood from either the right atrium (RA-PA connection) or the right ventricle (RV-PA connection) and delivered it to the pulmonary artery. Only RA-PA connection is the currently used setting for the Impella RP^® device in clinical practice. Based on right ventricular (RV) decompression and total flow, our study may help define the need for a direct RV-unloading Impella RP^®. Results: The simulations showed that while activating the RVAD in RA-PA mode, regardless of its rotational speed, the mean pulmonary artery pressure (PAP) percentage change was higher than that in the unsupported condition when the mean systemic venous pressure (SVP) and the pulmonary artery wedge pressure (PAWP) were both set to 20 [mmHg]. When RV-PA connection was applied, a similar trend was observed, although the PAP percentage changes were approximately halved compared to those when the RA-PA connection was applied. Conclusions: The Impella RP^® device has the potential to become a valid option for RV support based on current experimental and simulation data. Although already in use, further evaluation in the clinical setting will likely confirm its potential and lead to a more routinely application for RV support.

Heart failure (HF) is a complex systemic syndrome for which the HLM staging system has been proposed to better capture disease complexity. This study investigated the prognostic role of HLM staging according to SGLT2i status and the impact of in-hospital SGLT2i therapy across different stages of HF severity. In this prospective, multicenter, observational study, consecutive patients hospitalized for HF between November 2022 and August 2025 were enrolled and stratified according to HLM stage and according to SGLT2i status at discharge. The primary endpoint was the composite of cardiovascular (CV) death or HF hospitalization at 6-month follow-up. A total of 711 patients were included. The primary endpoint occurred in 82 patients with a significant increase across HLM stages (p < 0.001). Increasing HLM stage was associated with higher risk of adverse outcomes (HR = 1.40; 95% CI 1.02–1.90; p = 0.03), regardless of SGLT2i status. SGLT2i therapy initiation within the index hospitalization was independently associated with a lower risk of the composite endpoint (HR = 0.59; 95% CI 0.38–0.92; p = 0.02) across the HLM severity stages. In this cohort of HF patients, the HLM staging system provided potential clinically meaningful risk stratification irrespective of SGLT2i therapy, and SGLT2i therapy was associated with improved outcomes irrespective of HLM severity. These observations suggest a potential role for integrated pathophysiological staging in risk assessment and therapeutic evaluation.

Background and Objective: Indications for right ventricular assist device (RVAD) insertion include right heart failure after implantation of a left ventricular assist device or early graft failure following heart transplantation. This study aimed to investigate how the upstream and downstream circulatory network interacts with the Impella RP® device Methods: A numerical model of the Impella RP® was implemented within CARDIOSIM© software platform for this study. In the numerical configuration, the RVAD aspirated blood from either the right atrium (RA-PA connection) or the right ventricle (RV-PA connection) and delivered it to the pulmonary artery. Only RA-PA connection is the currently used setting for Impella RP® in clinical practice. Based on right ventricular (RV) decompression and total flow, our study may help define the need for a direct RV-unloading Impella RP® Results: The simulations showed that activating the RVAD in RA-PA mode, regardless of its rotational speed, the mean pulmonary artery pressure (PAP) percentage change was higher than the unsupported condition when the mean systemic venous pressure (SVP) and the pulmonary artery wedge pressure (PAWP) were both set to 20 mmHg. When RV-PA connection was applied, a similar trend was observed although the PAP percentage changes were about halved compared to the RA-PA connection Conclusions: The Impella RP ^® has the potential to become a valid option for RV support based on current experimental and simulation data. Although already in use, further evaluation in the clinical setting will likely confirm its potential and lead to a more routinely application for RV support.

Background: Sodium–glucose cotransporter 2 inhibitors (SGLT2i) promote beneficial effects on cardiac reverse remodeling (RR) in heart failure (HF). However, most imaging evidence focuses on single chambers, mainly the left ventricle (LV) or left atrium (LA), whereas integrated biventricular and atrial remodeling remains less explored. Moreover, real-world data are limited, and myocardial–flow coupling markers, such as hemodynamic forces (HDFs), are scarcely investigated, with uncertain sex-related differences. Purpose: To evaluate multi-chamber cardiac RR after SGLT2i initiation in a real-world HF population. Secondary aims are to assess whether changes in HDFs provide additional functional insight into myocardial–flow coupling beyond conventional echocardiographic indices, and to descriptively explore sex-related differences in echocardiographic remodeling. Methods: Patients with HF and ejection fraction (EF) ≤ 45%, naive to SGLT2i and on stable guideline-directed medical therapy for ≥3 months, were enrolled. Standard and advanced echocardiography were performed at baseline and follow-up, including speckle-tracking and HDFs assessment. NYHA class and NT-proBNP were collected. Analyses were performed overall and stratified by sex. Results: Sixty-eight patients were included. After 6 months, RR was observed across all chambers: LV-RR in 33 patients (49%), right ventricular (RV) RR in 35 (52%), biventricular RR in 18 (27%), and LA-RR in 14 (21%). HDFs showed significant realignment, suggesting association with improved myocardial–flow coupling. RR effects were comparable between sexes (p > 0.05). NT-proBNP significantly decreased. Conclusions: In this real-world cohort, SGLT2i therapy was associated with significant multi-chamber RR and HDFs realignment, supporting improved myocardial–flow coupling beyond conventional indices. Exploratory sex-related analyses showed no significant differences. Larger and longer-term randomized studies are warranted.

Neuroendocrine tumors (NETs) are rare neoplasms arising from the diffuse neuroendocrine system that can range from indolent to highly aggressive diseases. They usually clinically manifest when reaching a significant size or when hepatic metastases develop, leading to overproduction and impaired hepatic metabolism of vasoactive substances. The clinical course of NETs may be complicated by cardiac involvement, known as carcinoid heart disease (CHD), predominantly affecting the right side of the heart. CHD is characterized by specific echocardiographic features, including thickening, reduced excursion and retraction of valvular leaflets, resulting in valvular stenosis or regurgitation. Despite its clinical relevance, awareness of CHD as a complex hormonal sequela of NETs remains limited among cardiologists, and its echocardiographic findings are not universally recognized. This review aims to (a) provide cardiologists with the main principles for understanding CHD pathophysiology; (b) illustrate the main echocardiographic features of CHD, using a stepwise approach; and (c) refine a diagnostic algorithm for detecting cardiac involvement in NET populations and identifying patients at high risk of developing CHD.

Background: Myocarditis is a potentially life-threatening inflammation of the myocardium that can be triggered by viral infections, including influenza. While corticosteroids have historically been used with caution in viral myocarditis due to concerns over impaired viral clearance, recent insights—particularly those emerging from the COVID-19 pandemic—suggest that early, moderate-dose corticosteroid therapy may offer clinical benefits in selected inflammatory cardiac syndromes. This study aimed to assess the incidence and clinical features, as well as short-term outcomes of influenza-related myocarditis and/or pericarditis. Methods: A retrospective, observational study was conducted, including all consecutive patients diagnosed with acute myocarditis and/or pericarditis between December 2024 and March 2025 who presented with chest pain or dyspnea and had a confirmed Influenza A (H1N1) infection. The diagnostic evaluation included cardiac biomarkers, ECG, TTE, and cardiovascular magnetic resonance (CMR). All patients were monitored during a three-month follow-up period. Results: Of 281 patients with laboratory-confirmed H1N1 infection, six (2%) were diagnosed with myocarditis and/or pericarditis. All patients diagnosed with myocarditis received corticosteroid therapy and an antiviral drug (oseltamivir). CMR confirmed the diagnosis in all cases of inflammatory cardiomyopathy. At 30 days, median LVEF improved from 49% to 58%. No deaths or rehospitalizations were reported. Conclusions: Influenza-related myocarditis and/or pericarditis are relatively uncommon, occurring in approximately 2% of cases. When they occur, they are primarily associated with an uncomplicated clinical course and with favourable short-term outcomes, including a rapid recovery of left ventricular function and the absence of adverse events at three-month follow-up.

The Anatolian Journal of Cardiology - Peer-reviewed cardiology journal publishing original research, reviews, case reports. Impact Factor 1.5. The Anatolian Journal of Cardiology - Leading international cardiology journal with Impact Factor 1.5. Publishing original research, reviews, and case reports in cardiovascular medicine. Indexed in PubMed, Scopus, and Web of Science.

BACKGROUND: Right ventricular functional adaptation to afterload is a major determinant of outcome in pulmonary arterial hypertension (PAH). We aimed to investigate if right ventricular-pulmonary artery (PA) coupling evaluated by the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (sPAP) improves risk assessment scores for survival prediction. METHODS: A total of 677 consecutive patients with PAH (55% idiopathic) were prospectively enrolled with follow-up clinical, right heart catheterization, and echocardiographic evaluations within 12 months (interquartile range, 180–344 days) after initiation of targeted therapies in 11 Italian centers. European Society of Cardiology/European Respiratory Society guidelines-derived risk scores and REVEAL 2.0 (US Registry to Evaluate Early and Long-Term PAH Disease Management 2.0) risk scores were collected at baseline and follow-up. 254 consecutive patients with PAH retrospectively enrolled in a German reference center served as a validation cohort. RESULTS: A low-risk status at a median of 3.7 years (interquartile range, 1.2–6.8) follow-up was significantly associated with each unit (0.1 mm/mm Hg) increase in TAPSE/sPAP under targeted therapies (European Society of Cardiology/European Respiratory Society score: odds ratio, 1.78; P ≤0.001; REVEAL 2.0 score: odds ratio, 1.43; P ≤0.001). At follow-up, the TAPSE/sPAP ratio increased the prognostic information of each risk stratum of the European Society of Cardiology/European Respiratory Society risk score, except the highest risk stratum, with 0.5 mm/mm Hg, 0.35 mm/mm Hg, and 0.30 mm/mm Hg, from the lowest to the intermediate-high risk score, identified as the best cutoff value. TAPSE/sPAP ratio increased the prognostic information of the REVEAL 2.0 score at follow-up, with 0.35 mm/mm Hg identified as the best cutoff value to discriminate within a score of 5 to 8, with no added value for scores 8. These results were confirmed in the validation cohort. CONCLUSIONS: Assessment of right ventricular-PA coupling by the TAPSE/sPAP ratio in PAH improves risk assessment scores except in the lowest or most advanced stage of the disease