Objectives: Patients with acute heart failure (AHF) often receive initial non-invasive ventilation (NIV). This study aimed to evaluate the prognostic role of NIV in patients hospitalized for AHF. Methods: This was a retrospective cohort study. We enrolled patients admitted to our cardiac intensive care unit with a diagnosis of AHF. Anthropometric, clinical, pharmacological, and instrumental assessments were collected. Both in-hospital and 180-day post-discharge mortality were evaluated. Results: Among 200 patients (mean age 81 ± 9 years; 52% male), NIV was applied in 80 cases (40%). These patients had more severe NYHA functional class, a higher prevalence of de novo AHF, required higher diuretic doses, and had longer hospital stays. In multivariate analysis, NIV remained significantly associated with length of stay (LOS) (r = 0.26; p = 0.0004). In-hospital mortality was 5% overall and significantly higher in the NIV group compared to non-NIV patients (10% vs. 1.6%, p < 0.001). At 180 days, mortality was also significantly higher in the NIV group [hazard ratio (HR) 1.84; 95% confidence interval (CI): 1.18–2.85; p = 0.006]. After adjusting for age, BNP, CRP, arterial blood gas parameters, renal function, and LVEF, NIV remained an independent predictor of 180-day mortality (HR 1.61; 95% CI: 1.01–2.54; p = 0.04). Conclusions: Patients with AHF who required NIV exhibited more severe disease and longer hospital stays. NIV use was independently associated with both in-hospital and post-discharge mortality, suggesting its potential role as a prognostic marker in AHF.

Apical hypertrophic cardiomyopathy is a distinctive and often under-recognized variant of hypertrophic cardiomyopathy, characterized by predominant thickening of the apical segments of the left ventricle. Echocardiography and cardiac magnetic resonance imaging represent the two principal modalities for diagnosis and morphological assessment. While transthoracic echocardiography remains the first-line imaging technique, it may underestimate apical involvement, particularly when image foreshortening or poor endocardial/epicardial delineation occurs. Cardiac magnetic resonance has become the reference standard for defining apical morphology, quantifying hypertrophy, and characterizing myocardial tissue and perfusion. Beyond its diagnostic role, magnetic resonance serves as a research platform for the identification of new apical-centric criteria which, after appropriate validation, may be translated into echocardiographic practice. Echocardiography, however, retains unique strengths through its real-time evaluation of cardiac dynamics, ready-to-use approach to diastolic function assessment, and its ability to identify subtle apical or para-apical obstructive gradients that may raise the initial diagnostic suspicion. This review underscores the complementary roles of the two modalities and the multiple domains in which transthoracic echocardiography can derive substantial methodological and conceptual benefit from cardiac magnetic resonance imaging, both in imaging methodology and in the refinement of diagnostic evaluation.