: Heart failure with preserved ejection fraction (HFpEF) accounts for approximately 50% of heart failure cases and is primarily characterized by impaired diastolic function, leading to increased ventricular filling pressures and symptoms like dyspnea and reduced exercise tolerance. Significant gender-specific differences are observed, with women, particularly post-menopausal, experiencing higher prevalence and distinct clinical profiles compared to men. Diastolic dysfunction in HFpEF involves altered cellular mechanisms such as reduced SERCA2a expression, impacting calcium handling and myocardial relaxation. Diagnostic strategies mainly employ echocardiography, including Doppler imaging, tissue Doppler imaging, and strain imaging, to assess ventricular relaxation and stiffness. However, early identification remains challenging, necessitating advanced tools like cardiac magnetic resonance and exercise stress testing for accurate diagnosis, especially in women who often present with subtle symptoms. Treatment options for HFpEF have traditionally been limited, but recent trials, notably EMPEROR-PRESERVED and DELIVER, demonstrated significant cardiovascular benefits using sodium–glucose cotransporter-2 (SGLT2) inhibitors. Additionally, glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have shown promising results, particularly in obese patients. Despite these advances, gender differences in therapeutic response necessitate further research for personalized management strategies. Understanding sex-specific pathophysiological mechanisms and optimizing diagnostic criteria remain essential to improving prognosis and quality of life in HFpEF patients.

Vitamin D plays several roles beyond bone metabolism, potentially protecting the cardiovascular system. Systemic sclerosis (SSc) is an autoimmune disease characterized by fibrosis and vascular dysfunction, carrying a high cardiovascular risk. However, the relationship between vitamin D insufficiency and cardiovascular involvement in SSc patients remains unclear. This study aims to assess the association between low vitamin D levels, echocardiographic parameters indicative of ventricular dysfunction, and cardiovascular risk factors in SSc patients. A retrospective observational study involved 160 SSc patients undergoing echocardiography and serum 25-hydroxyvitamin D measurement. Patients were categorized into two groups: vitamin D insufficiency (<30 ng/mL) and normal levels (≥30 ng/mL). Echocardiographic parameters and cardiovascular risk factors were evaluated. Vitamin D insufficiency was detected in 68.9 % of patients. Patients with insufficient vitamin D had higher systolic pulmonary arterial pressure (PAPs; 37.68 ± 7.56 mmHg vs. 33.12 ± 6.17 mmHg; p = 0.004), reduced TAPSE/PAPs ratio (0.65 ± 0.13 vs. 0.72 ± 0.14; p = 0.021), increased interventricular septal thickness (8.17 ± 1.28 mm vs. 7.69 ± 1.18 mm; p = 0.028), and greater left ventricular end-diastolic diameter (44.06 ± 4.28 mm vs. 42.67 ± 3.44 mm; p = 0.037), indicating ventricular dysfunction. Vitamin D insufficiency significantly correlated with hypertension (OR = 2.31; p = 0.032), dyslipidemia (OR = 2.45; p = 0.015), and overweight/obesity (OR = 4.73; p = 0.002), but not with diabetes or smoking. Vitamin D insufficiency may contribute to cardiovascular dysfunction in SSc patients. Monitoring vitamin D levels might improve cardiovascular risk stratification. Further studies are necessary to determine if supplementation could enhance cardiac outcomes.

Adherence to exercise-based cardiac rehabilitation (CR) is essential for preventing and managing cardiovascular disease (CVD). Participation in CR reduces all-cause mortality by 27% and cardiac deaths by 31% and lowers rehospitalization rates while also improving functional capacity and quality of life. However, many patients do not start, complete, or maintain CR, resulting in reduced functional abilities, a higher risk of recurring events, and poorer long-term outcomes. This narrative review summarizes patterns of adherence to exercise and CR in CVD, with a specific focus on sex- and gender-related differences in referral, participation, and completion. We synthesize evidence on biological, psychological, and social barriers that limit engagement and describe emerging strategies, such as technology-enabled and home-based programs, multidisciplinary care, and family-centered models, to enhance adherence. Finally, we propose a practical, gender-aware framework for CR design and delivery that can be adjusted and evaluated across diverse healthcare settings to guide clinical practice and future research.

(1) Background: Assessment of right ventricular (RV) function has become increasingly important in echocardiography due to its prognostic significance in cardiac and systemic diseases. (2) Objectives: Tricuspid Annular Plane Systolic Excursion (TAPSE) and Tissue Doppler Imaging (TDI S′) are commonly used methods to assess RV function. The aim of this study was to compare the reproducibility of TAPSE and TDI S′ among experienced operators. (3) Methods: A study was conducted on 100 consecutive patients with systemic sclerosis undergoing echocardiography evaluation screening for pulmonary hypertension. Standardized echocardiography images were acquired using a Philips EPIQ system (Philips Healthcare, Amsterdam, The Netherlands), measuring TAPSE and TDI S′. Five operators independently analyzed the images, with each blinded to the results. Exclusion criteria included pathological TAPSE or TDI S′ values, as well as indirect echocardiography signs of pulmonary hypertension. (4) Results: The study’s results indicate that there was superior inter-operator agreement for TDI S′ (ICC = 0.891) compared to TAPSE (ICC = 0.47). The mean TAPSE measurements ranged from 23.49 mm to 23.99 mm, while TDI S′ values ranged from 12.16 cm/s to 12.35 cm/s, with TDI S′ showing narrower confidence intervals. (5) Conclusions: Echocardiographic assessment of right ventricular (RV) function is crucial in clinical practice. Tissue Doppler imaging-derived systolic velocity (TDI S′) demonstrated superior reproducibility compared to tricuspid annular plane systolic excursion (TAPSE) in evaluating RV function. This enhanced reproducibility supports the routine incorporation of TDI S′ as a highly reproducible parameter within a multiparametric assessment framework.

Out-of-hospital cardiac arrest (OHCA) remains a leading cause of sudden death worldwide, with wide variation in reported incidence and outcomes driven by heterogeneity in registries, emergency medical services (EMS) organization, and case definitions. Despite substantial advances in resuscitation systems, survival after EMS-treated OHCA generally remains below 10%, and outcomes are critically time dependent. Delays in emergency call activation, bystander cardiopulmonary resuscitation (CPR), and—most importantly—early defibrillation are associated with a rapid decline in return of spontaneous circulation and favorable neurological recovery. This narrative review synthesizes current evidence and implementation strategies aimed at reducing “time-to-CPR” and “time-to-shock,” with a specific focus on public-access defibrillation (PAD) as a tool to mitigate avoidable delay. Randomized trials and large registry studies consistently demonstrate that automated external defibrillator (AED) use before EMS arrival is a key determinant of survival in patients with shockable rhythms. However, the real-world effectiveness of PAD remains limited by suboptimal AED placement, restricted 24/7 accessibility, low public awareness, and underutilization driven by fear and lack of confidence. We compare different PAD delivery models—including EMS-based, police and first-responder-based, and fully integrated community systems—and summarize evidence supporting targeted, high-yield AED deployment and cost-effectiveness. In addition, we review emerging strategies to reduce avoidable delay and strengthen the early links of the chain of survival, such as school-based training programs, smartphone- and SMS-based citizen-responder networks, improved dispatch recognition of cardiac arrest (including artificial intelligence–supported tools), and drone-enabled AED delivery. Across these approaches, patient benefit critically depends on system integration, alert performance, and true AED accessibility. Finally, we describe the Italian “Progetto Vita” experience as a community-integrated model explicitly designed to minimize avoidable delay through widespread AED deployment, lay responder training, and real-time integration with EMS. We conclude by outlining future priorities, including the development of robust national OHCA registries and scalable solutions for the high burden of cardiac arrests occurring at home, such as population-level deployment of low-cost, ultra-portable AEDs.