Aims: Coronary artery disease (CAD) is a common cause of heart failure (HF). Whether coronary revascularization improves outcomes in patients with HF receiving guideline-recommended pharmacological therapy (GRPT) remains uncertain; therefore, we conducted a systematic review and meta-analysis of relevant randomized controlled trials (RCTs). Methods and results: We searched in public databases for RCTs published between 1 January 2001 and 22 November 2022, investigating the effects of coronary revascularization on morbidity and mortality in patients with chronic HF due to CAD. All-cause mortality was the primary outcome. We included five RCTs that enrolled, altogether, 2842 patients (most aged <65 years; 85% men; 67% with left ventricular ejection fraction ≤35%). Overall, compared to medical therapy alone, coronary revascularization was associated with a lower risk of all-cause mortality (hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.79–0.99; p = 0.0278) and cardiovascular mortality (HR 0.80, 95% CI 0.70–0.93; p = 0.0024) but not the composite of hospitalization for HF or all-cause mortality (HR 0.87, 95% CI 0.74–1.01; p = 0.0728). There were insufficient data to show whether the effects of coronary artery bypass graft surgery or percutaneous coronary intervention were similar or differed. Conclusions: For patients with chronic HF and CAD enrolled in RCTs, the effect of coronary revascularization on all-cause mortality was statistically significant but neither substantial (HR 0.88) nor robust (upper 95% CI close to 1.0). RCTs were not blinded, which may bias reporting of the cause-specific reasons for hospitalization and mortality. Further trials are required to determine which patients with HF and CAD obtain a substantial benefit from coronary revascularization by either coronary artery bypass graft surgery or percutaneous coronary intervention.

Background: Infective endocarditis (IE) could be suspected in any febrile patients admitted to the emergency department (ED). This study was aimed at assessing clinical criteria predictive of IE and identifying and prospectively validating a sensible and easy‐to‐use clinical prediction score for the diagnosis of IE in the ED. Methods and Results: We conducted a retrospective observational study, enrolling consecutive patients with fever admitted to the ED between January 2015 and December 2019 and subsequently hospitalized. Several clinical and anamnestic standardized variables were collected and evaluated for the association with IE diagnosis. We derived a multivariate prediction model by logistic regression analysis. The identified predictors were assigned a score point value to obtain the Clinical Rule for Infective Endocarditis in the Emergency Department (CREED) score. To validate the CREED score we conducted a prospective observational study between January 2020 and December 2021, enrolling consecutive febrile patients hospitalized after the ED visit, and evaluating the association between the CREED score values and the IE diagnosis. A total of 15 689 patients (median age, 71 [56–81] years; 54.1% men) were enrolled in the retrospective cohort, and IE was diagnosed in 267 (1.7%). The CREED score included 12 variables: male sex, anemia, dialysis, pacemaker, recent hospitalization, recent stroke, chest pain, specific infective diagnosis, valvular heart disease, valvular prosthesis, previous endocarditis, and clinical signs of suspect endocarditis. The CREED score identified 4 risk groups for IE diagnosis, with an area under the receiver operating characteristic curve of 0.874 (0.849–0.899). The prospective cohort included 13 163 patients, with 130 (1.0%) IE diagnoses. The CREED score had an area under the receiver operating characteristic curve of 0.881 (0.848–0.913) in the validation cohort, not significantly different from the one calculated in the retrospective cohort ( P =0.578). Conclusions: In this study, we propose and prospectively validate the CREED score, a clinical prediction rule for the diagnosis of IE in patients with fever admitted to the ED. Our data reflect the difficulty of creating a meaningful tool able to identify patients with IE among this general and heterogeneous population because of the complexity of the disease and its low prevalence in the ED setting.

Introduction: Many patients with heart failure (HF) have or develop atrial fibrillation (AF), which may contribute to worsening symptoms, hospitalizations, and mortality. Whether catheter ablation (CA) improves outcomes in patients with HF and AF receiving guideline-recommended pharmacological therapy (GRPT) is controversial. Aims: A systematic review and meta-analysis of relevant randomized controlled trials (RCT)s on the role of CA in patients with AF and HF. Methods: Public databases for trials published prior to 17 March 2025 and investigating the effects of CA on morbidity and mortality in patients with HF and AF were searched. Outcomes of interest were all-cause and cardiovascular mortality, adverse events due to HF or AF, changes in left ventricular ejection fraction (LVEF), 6-Minute Walking Distance (6-MWD) and Minnesota Living With Heart Failure Questionnaire (MLWHFQ) scores. Results: Altogether, 13 RCTs including 2490 patients (predominantly aged ≤65 years; of whom 73% were men and 79% reported persistent AF) were identified. Blinding of intervention was not attempted. Only three RCTs assessed the effect of CA in patients with preserved LVEF. Overall, compared with GRPT alone, CA was associated with lower all-cause mortality (hazard ratio [HR]: 0.58; 95% confidence interval [CI]: 0.44–0.76), cardiovascular death (HR: 0.52; 95% CI: 0.36–0.74), and adverse events related to HF or AF (HR: 0.69; 95% CI: 0.53–0.89). In addition, CA improved LVEF (+6% mean difference (MD) [95% CI: +4% to +9%]) and MLWHFQ (−12 points MD [95% CI: −18 points to −6 points]), with a trend to enhanced 6-MWD (+18 m MD [95% CI: −1 m to +38 m]). Conclusion: For a selected group of patients with chronic HF and AF enrolled in unblinded RCTs, CA improved cardiac function, well-being and outcomes, including all-cause mortality. Further RCTs are required to determine whether the benefits of CA extend to a broader population of patients at higher risk of procedural failure and recurrent AF.

Caseous calcification of the mitral annulus (CCMA) is a liquefactive necrosis of mitral annular calcification (MAC). CCMA is rare and usually asymptomatic, has a benign course, and, when incidentally found, can be misdiagnosed as a thrombus, abscess, cardiac tumor or vegetation. Although rarely, CCMA may complicate with rupture, which can lead to ventricular-atrial fistulization, pseudoaneurysm, severe mitral regurgitation (with possible heart failure and atrial fibrillation) and systemic embolism of caseous material (with cerebral ischemic events). A significant increase in CCMA dimensions and an infectious involvement of liquefactive necrosis make CCMA prone to rupture. To date, only case reports and some case series have been published on CCMA, without focusing on the pathophysiological mechanisms responsible for rupture, nor recommendations for prevention and management. However, despite general concerns about surgical treatment of CCMA because of high perioperative risks, most published cases actually underwent successful cardiac surgery. In the present review, we conducted a systematic review of the studies published in the medical literature up to March 2025, reporting cases of CCMA and its complications, as identified through the PubMed database. We analyzed clinical and biological risk factors for CCMA rupture and its diagnostic criteria, focusing on imaging features differentiating mitral annular calcification from uncomplicated CCMA and ruptured CCMA. To this regard, we focused on the key role of multimodality imaging in the achievement of the correct diagnosis. Finally, we propose a management strategy for CCMA, with the aim to fill a gap in this field in the current literature.