Malnutrition represents a common and important feature in elderly people affected by cardiovascular diseases. Several studies have investigated its prevalence and prognostic role in most clinical settings, including cardiovascular disease. However, in daily practice it usually remains unrecognized and consequently untreated. The present review was ideated to answer the main questions about nutritional status assessment in patients with cardiovascular disease: why, when, where, how to evaluate it, and what to do to improve it. The three main cardiovascular diseases, namely aortic stenosis, ischaemic heart disease, and heart failure were considered. First, the main evidence supporting the prognostic role of malnutrition are summarized and analyzed. Second, the main tools for the assessment of malnutrition in the hospital and outpatient setting are reported for each condition. Finally, the possible strategies and interventions to address malnutrition are discussed.

Background: The use of acetylcholine for the diagnosis of vasospastic angina is recommended by international guidelines. However, its intracoronary use is still off-label due to the absence of safety studies. We aimed to perform a systematic review of the literature to identify adverse events related to the intracoronary administration of acetylcholine for vasoreactivity testing to fill this gap. Methods and results: We conducted a systematic review of observational studies and randomized controlled trials dealing with the intracoronary administration of acetylcholine. Articles were searched in MEDLINE (PubMed) using the MeSH strategy. Three independent reviewers determined whether the studies met the inclusion and exclusion criteria. A total of 434 articles were selected. Data concerning clinical characteristics, study population, acetylcholine dosage, and adverse effects were retrieved from the articles. Overall, 71,566 patients were included, of which only 382 (0.5%) developed one adverse event, and there were no fatal events reported (0%). Conclusions: Intracoronary administration of acetylcholine in the setting of coronary spasm provocation testing is safe and plays a central role in the evaluation of coronary vasomotion disorders, making it worthy of becoming a part of clinical practice in all cardiac catheterization laboratories.

Recent data support the existence of a distinctive ‘vascular’ phenotype with the involvement of both pulmonary parenchyma and its circulation in COVID-19 pneumonia. Its prompt identification is important for the accurate management of COVID-19 patients. The aim is to analyse the pro and contra of the different modalities to identify the ‘vascular’ phenotype. Chest computed tomography scan and angiogram may quantify both parenchyma and vascular damage, but the presence of thrombosis of pulmonary microcirculation may be missed. Increased d-dimer concentration confirms a thrombotic state, but it cannot localize the thrombus. An elevation of troponin concentration non-specifically reflects cardiac injury. Echocardiogram and electrocardiogram provide specific signs of right ventricular pressure overload. This is particularly relevant for the ‘vascular’ phenotype, which does not necessarily represent the result of thrombo-embolic venous complications, but more frequently, it is the result of pulmonary microcirculation thrombosis in situ and needs immediate therapeutic action. Condensed abstract Despite diagnosis of the ‘vascular’ phenotype of COVID-19 pneumonia may be subtle, the evidence indicates a reasonable possibility of identifying it already in the initial stage of the infection. Chest computed tomography scan and angiogram, increased d-dimer concentration, and elevation of troponin concentration may be not sufficient to identify ‘vascular’ phenotype. Echocardiogram and electrocardiogram provide specific signs of right ventricular pressure overload. This is particularly relevant for the ‘vascular’ phenotype, which does not necessarily represent the result of thrombo-embolic venous complications, but more frequently, it is the result of pulmonary microcirculation thrombosis in situ and needs immediate therapeutic action.

Background: At the same conditions of delivered power and contact force, open-irrigated radiofrequency ablation catheters are believed to create deeper lesions, while non-irrigated ones produce shallower lesions. This ex vivo study aims to directly compare the lesion dimensions and characteristics of an irrigated ablation catheter with a flexible tip and a non-irrigated solid-tip catheter. Methods: Radiofrequency lesions were induced on porcine myocardial slabs using both open-tip irrigated and non-irrigated standard 4 mm catheters at three power settings (20 W, 30 W, and 40 W), maintaining a fixed contact force of 10 gr. A lesion assessment was conducted including the lesion depth, depth at the maximum diameter, and lesion surface diameters, with the subsequent calculation of the lesion volume and area being undertaken. Results: Irrigated catheters produced lesions with significantly higher superficial widths at all power levels (3.8 vs. 4.4 mm at 20 W; 3.9 mm vs. 4.4 mm at 30 W; 3.8 mm vs. 4.5 mm at 40 W; p = 0.001, p = 0.019, p = 0.003, respectively). Non-irrigated catheters resulted in significantly higher superficial areas at all power levels (23 mm² vs. 18 mm² at 20 W; 25 mm² vs. 19 mm² at 30 W; 26 mm² vs. 19 mm² at 40 W; p = 0.001, p = 0.005, p = 0.001, respectively). Irrigated catheters showed significantly higher values of lesion maximum depth at 40 W (4.6 mm vs. 5.5 mm; p = 0.007), while non-irrigated catheters had a significantly higher calculated volume at 20 W (202 µL vs. 134 µL; p = 0.002). Conclusions: Radiofrequency ablation using an irrigated catheter with a flexible tip has the potential to generate smaller superficial lesion areas compared with those obtained using a non-irrigated catheter.

Introduction: Palpitations are one of the most common cardiovascular complaints, affecting approximately 6% to 11% of the general population. Since palpitations often occur sporadically and resolve before medical evaluation, diagnosing the underlying rhythm disturbance requires documentation via an electrocardiogram (ECG) recorded during the symptomatic episode. The standard tool for this purpose has long been the 24-h Holter monitor, which has significant limitations, with diagnostic yields as low as 10% to 15%. Objective: This study aims to evaluate the feasibility and diagnostic yield of single-lead ECG recordings from smartwatches in patients presenting with palpitations. Methods: From 1 May 2023 to 1 May 2025, we conducted a prospective, real-world cohort study among consecutive adults referred to the University Hospital of Ferrara-based arrhythmia outpatient clinics for evaluation of palpitations. Eligibility required patients to be ≥21 years of age, report palpitations for which ambulatory documentation was clinically indicated, and already own a compatible smartwatch capable of single-lead ECG. Participants were trained to record a 30-s single-lead ECG at the onset of symptoms. Tracings were transmitted securely and independently reviewed by two blinded electrophysiologists. Results: Fifty-nine patients were enrolled (mean age 52 years, 64% male). Thirty-one patients (52%) transmitted at least one smartwatch-derived electrocardiographic tracing. Seventy-seven smartwatch tracings were received. Of these, 73 (95%) were interpretable; 57 (78%) showed an arrhythmia, whereas 16 (22%) demonstrated normal sinus rhythm. Four recordings (5%) were non-interpretable. From the 57 arrhythmic tracings, 44 distinct arrhythmic diagnoses were identified. Paroxysmal atrial fibrillation (AF) accounted for 16 episodes. Other diagnosed arrhythmias included atrial flutter (n = 6), paroxysmal supraventricular tachycardia (PSVT) (n = 4), premature atrial complexes (PAC) (n = 6), premature ventricular complexes (PVC) (n = 9), inappropriate sinus tachycardia (n = 12), and second-degree atrioventricular (AV) block type I (n = 4). Conclusions: Smartwatch-based ECG monitoring in symptomatic patients is feasible and provides a high diagnostic yield for a broad spectrum of arrhythmias. Unlike large-scale population screening approaches, which generate vast datasets with limited clinical benefit, a symptom-driven strategy applied to carefully selected, educated, and motivated patients proves both clinically valuable and organizationally sustainable. Indeed, the mean number of tracings transmitted per patient was low (1.3), confirming the clinical and operational sustainability of this patient-triggered, real-world approach.