Patent foramen ovale (PFO) is a common cardiac abnormality with a prevalence of 25% in the general population. PFO has been associated with the paradoxical embolism causing cryptogenic stroke and systemic embolization. Results from clinical trials, meta-analyses, and position papers support percutaneous PFO device closure (PPFOC), especially if interatrial septal aneurysms coexist and in the presence of large shunts in young patients. Remarkably, accurately evaluating patients to refer to the closure strategy is extremely important. However, the selection of patients for PFO closure is still not so clear. The aim of this review is to update and clarify which patients should be considered for closure treatment.

Although real-time 3D echocardiography (RT3DE) has only been introduced in the last decades, its use still needs to be improved since it is a time-consuming and operator-dependent technique and acquiring a good quality data can be difficult. Moreover, the additive value of this important diagnostic tool still needs to be wholly appreciated in clinical practice. This review aims at explaining how, why, and when performing RT3DE is useful in clinical practice.

Background/Objectives: Two-dimensional echocardiography (2D echo) is widely used for assessing left ventricular ejection fraction (LVEF). This single-center comparative study aims to evaluate the accuracy of LVEF measurements obtained using the AI-assisted handheld ultrasound device Kosmos against cardiac magnetic resonance (CMR), the current gold standard. Methods: A total of 49 adult patients undergoing clinically indicated CMR were prospectively enrolled. AI-based LVEF measurements were compared with CMR using the Wilcoxon signed-rank test, Pearson correlation, multivariable linear regression, and Bland–Altman analysis. All analyses were performed using STATA v18.0. Results: Median LVEF was 57% (CMR) vs. 55% (AI-Echo), with no significant difference (p = 0.51). Strong correlation (r = 0.99) and minimal bias (1.1%) were observed. Conclusions: The Kosmos AI-based autoEF algorithm demonstrated excellent agreement with CMR-derived LVEF values. Its speed and automation make it promising for bedside assessment in emergency departments, intensive care units, and outpatient clinics. This study aims to fill the gap in current clinical evidence by evaluating, for the first time, the agreement between LVEF measurements obtained via Kosmos’ AI-assisted autoEF and those from cardiac MRI (CMR), the gold standard for ventricular function assessment. This comparison is critical for validating the reliability of portable AI-driven echocardiographic tools in real-world clinical practice. However, these findings derive from a selected population at a single Italian center and should be validated in larger, diverse cohorts before assuming global generalizability.

Background/Objectives: Heart failure (HF) with reduced ejection fraction remains a significant global health challenge despite advances in medical therapy. Cardiac contractility modulation (CCM) is a promising treatment for symptomatic HF patients who are ineligible for cardiac resynchronization therapy (CRT). Non-invasive methods to assess the acute hemodynamic effects of CCM are critical to optimize care and guide treatment. This study aimed to evaluate the acute impact of CCM on stroke volume (SV) and total peripheral resistance index (TPRI) using the non-invasive bioimpedance-based system (NICaS^®). Methods: Eight HF patients (median age: 64.6 years, median left ejection fraction (LVEF): 34.5%) underwent implantation of the Optimizer Smart Mini CCM device. Hemodynamic parameters, including SV and TPRI, were measured using NICaS^® at baseline (pre-implantation) and at 1 week, 1 month, and 3 months post-implantation. Measurements were repeated eight times per session and analyzed using non-parametric statistical tests, including the Kruskal–Wallis test, Mann–Whitney test, and Kolmogorov–Smirnov test. Results: Median SV increased significantly from 40.02 mL (interquartile range (IQR): 32.62–78.16 mL) at baseline to 69.83 mL (IQR: 58.63–86.36 mL) at 3 months (p < 0.0001). Median TPRI decreased significantly from 2537 dn s/cm⁵ m² (IQR: 1807–3084 dn s/cm⁵ m²) to 1307 dn s/cm⁵ m² (IQR: 1119–1665 dn s/cm⁵ m²) over the same period (p < 0.0001). CCM therapy significantly improved SV and reduced TPRI in HF patients within three months of implantation. Conclusions: NICaS^® provided a reliable, non-invasive tool for monitoring these acute hemodynamic changes, supporting its use in clinical practice.

Anadolu Kardiyoloji Dergisi, Anadolu Kardiyol Derg, The Anatolian Journal of Cardiology, Anatol J Cardiol, Cardiology, Cardiovascular Medicine, Surgery, Pediatric Cardiology, Angiology