The role of the pregnancy heart team in clinical practice.

Significant maternal and fetal morbidity and mortality risk has been shown to be associated with cardiovascular disease in pregnancy. Several determinants, such as the increasing number of females with corrected congenital heart disease in reproductive age, a more advanced maternal age associated with cardiovascular risk factors, and a greater prevalence of preexisting comorbidities related to cardiac disorders such as cancer and COVID-19), lead to a higher incidence of cardiac complications in pregnancy in the last few decades. However, adopting a multidisciplinary strategy may influence maternal and neonatal outcomes. This review aims at assessing the role of the Pregnancy Heart Team, which should ensure careful pre-pregnancy counseling, pregnancy monitoring, and delivery planning for both congenital and other cardiac or metabolic disorders, addressing several emerging aspects in the multidisciplinary team-based approach.

[Long COVID: nosographic aspects and clinical epidemiology]. / Long COVID: aspetti nosografici ed epidemiologia clinica.

Recent evidence shows that a range of persistent or new symptoms can manifest after 4-12 weeks in a subset of patients who have recovered from acute SARS-CoV-2 infection, and this condition has been coined long COVID by COVID-19 survivors among social support groups. Long COVID can affect the whole spectrum of people with COVID-19, from those with very mild acute disease to the most severe forms. Like the acute form, long COVID has multisystemic aspects. Patients can manifest with a very heterogeneous multitude of symptoms, including fatigue, post-exertional malaise, dyspnea, cognitive impairment, sleep disturbances, anxiety and depression, muscle pain, brain fog, anosmia/dysgeusia, headache, and limitation of functional capacity, which impact their quality of life. Because of the extreme clinical heterogeneity, and also due to the lack of a shared, specific definition, it is very difficult to know the real prevalence and incidence of this condition. Risk factors for developing long COVID would be female sex, initial severity, and comorbidities. Globally, with the re-emergence of new waves, the population of people infected with SARS-CoV-2 continues to expand rapidly, necessitating a more thorough understanding of potential sequelae of COVID-19. This review summarizes up to date definitions and epidemiological aspects of long COVID.

COVID-19, Vaccines, and Thrombotic Events: A Narrative Review.

The coronavirus disease 2019 (COVID-19), a deadly pandemic that has affected millions of people worldwide, is associated with cardiovascular complications, including venous and arterial thromboembolic events. Viral spike proteins, in fact, may promote the release of prothrombotic and inflammatory mediators. Vaccines, coding for the spike protein, are the primary means for preventing COVID-19. However, some unexpected thrombotic events at unusual sites, most frequently located in the cerebral venous sinus but also splanchnic, with associated thrombocytopenia, have emerged in subjects who received adenovirus-based vaccines, especially in fertile women. This clinical entity was soon recognized as a new syndrome, named vaccine-induced immune thrombotic thrombocytopenia, probably caused by cross-reacting anti-platelet factor-4 antibodies activating platelets. For this reason, the regulatory agencies of various countries restricted the use of adenovirus-based vaccines to some age groups. The prevailing opinion of most experts, however, is that the risk of developing COVID-19, including thrombotic complications, clearly outweighs this potential risk. This point-of-view aims at providing a narrative review of epidemiological issues, clinical data, and pathogenetic hypotheses of thrombosis linked to both COVID-19 and its vaccines, helping medical practitioners to offer up-to-date and evidence-based counseling to their often-alarmed patients with acute or chronic cardiovascular thrombotic events.

[COVID-19, vaccines, and thrombotic events]. / COVID-19, vaccini ed eventi trombotici.

COVID-19, a deadly pandemic that has affected millions of people worldwide, is also associated with cardiovascular complications, such as venous and arterial thromboembolic events. The viral spike protein, in fact, may promote the release of prothrombotic and inflammatory mediators. Vaccines, coding for the spike protein, are the primary measure for preventing COVID-19. However, some unexpected thrombotic events at unusual sites, most frequently the cerebral venous and splanchnic districts, with associated thrombocytopenia, have emerged in subjects who received adenovirus-based vaccines, especially in fertile women. This clinical entity has been rapidly recognized as a new syndrome, named vaccine-induced immune thrombotic thrombocytopenia, probably caused by cross-reacting antiplatelet factor 4 antibodies activating platelets. This prompted the regulatory agencies of various countries to restrict the use of adenovirus-based vaccines to specific age groups. The prevailing opinion of most experts, however, is that the risk of developing COVID-19 disease, including thrombosis, clearly outweighs this potential extremely low risk.This paper aims at providing a comprehensive review of epidemiological issues, clinical data and pathogenetic hypotheses of thrombosis linked to both COVID-19 and its vaccines, helping cardiologists to offer an up-to-date and evidence-based counseling to their often-alarmed patients with acute or chronic coronary syndromes.

[Televisit for chronic heart disease: a new normal with many benefits and some obstacles]. / La televisita per la cronicità in cardiologia: un "new normal" con molti benefici e qualche ostacolo.

Our review specifically focuses on virtual visit (televisit) in cardiology. Telemedicine comes as a response to the challenge caused by the COVID-19 pandemic. Among the many possibilities offered by telemedicine, one is the videoconference modality which consists of an online consultation, where a live interaction is created in real time through a video call system: recent studies confirm the rapid increase in video consultations during the pandemic. Despite the ongoing debate around the effectiveness of telemedicine in cardiology, the COVID-19 pandemic has made it necessary to move more or less immediately towards remote modalities to guarantee the continuation of care for cardiological patients. The transition generated many important questions about quality of care and patient and medical use. Most patients would benefit from virtual visit, as its implementation has shown similar results to face-to-face consultation, improving patient health and satisfaction, and improving access to health services. Virtual visit programming and regulation will be required, with a homogeneous system of platforms within which the services will operate, integrated with the "normal" diagnosis and therapy paths. Virtual visit must be an ordinary way of providing services and not an exception. Finally, the use of digital systems cannot be limited to the experienced citizen, but must be adapted to the skills of younger and less competent patients.

Lipid-lowering therapy in high cardiovascular risk patients during COVID-19 pandemic: keep focused on the target.

To the Editor COVID-19 (COrona VIrus Disease) patients with cardiovascular (CV) disease, multiple CV risk factors or comorbidities (i.e., arterial hypertension and diabetes) were shown to be more prone to a worse prognosis. SARS-CoV-2 is a still unknown enemy and the role of concomitant cardiovascular therapies has been controversial in the early stages, particularly with regard to Angiotensin-Converting Enzyme inhibitors...