Niccolo Bonini

🚨 Managment of AHF is advancing! Glad to share our review, aimed at: 🔄 Bring together management algorithms across different healthcare settings and resources 🏥 Translate contemporary evidence into practical bedside management #HeartFailure #AcuteHeartFailure #JACC

New JACC study | ADEL Cohort (n=12,650) In hypertensive adults, aldosterone dysregulation matters — a lot. Renin-aldosterone profiling predicts cardiorenal outcomes in HTN — not just BP numbers. Time to rethink how we phenotype our hypertensive patients?

Treatment of angina pectoris: lessons from trials. Read this Viewpoint just published in #EHJ 👉 ow.ly/PwBs50Z43QT @RoccoMontone @ehj_ed #angina #PCI #ANOCA

112 days to optimize GDMT in HFrEF. That’s the standard. The SHORT Trial cut it to 29. 🫀⚡ Start ARNi + SGLT2i + β-blocker simultaneously. Rapid titration. Home BP monitoring. Result? ✅ Half the clinic visits (5 vs 10) ✅ 0 vs 5 CV deaths/worsening HF events

Check out our latest State-of-the-art review on #AI in #AFib management: ✅AI may support the entire AF care pathway, from early detection to risk prediction & personalized treatment 🖇️tinyurl.com/26f6dr6h @DavideMei93 @BorianiGiuseppe @marcovitoloMD

Does digoxin modify the benefit of heart failure therapies? A subgroup analysis across 4 landmark HFrEF trials gives a clear answer 🧵 The 4 pillars of HFrEF therapy (MRA, ARNI, SGLT2i) retain their efficacy regardless of background digoxin use. No meaningful interaction

HFpEF: • eGFR ≥60 → SGLT2i, nsMRA, ARNI if EF closer to 50% • eGFR 30–59 → SGLT2i, nsMRA, ARNI if EF closer to 50% • eGFR 15–29 → SGLT2i (if >20), nsMRA (if >25)

Interaction of Kidney Function and Dapagliflozin in Patients With Acute Heart Failure: DICTATE-AHF Early dapagliflozin initiation during AHF hospitalization is safe and similarly effective on acute diuretic measures across a wide range of eGFR ajconline.org/article/S0002-…

Chronic renal failure is a systemic disease — not just a kidney problem. As GFR falls, the consequences cascade: 🩸 Anemia → ↓ erythropoietin 📈 Hypertension → renin + SNS activation ⚗️ Acidosis → catabolism, bone loss 🦴 Demineralization → ↓ calcitriol, ↑ PTH

🫀 Delaying Heart Failure Meds Has Real Consequences Risks of omitting guideline-directed medical therapy (GDMT) ⚠️ Delaying or Omitting GDMT Leads To: • Patients never being initiated on GDMT, or substantial delay • Worse quality of life and health status

🚨 GLP-1 RA in HFrEF — the data is striking. n=1,275 vs 1,275 · PSM 1:1 · 1-year follow-up All-cause mortality: 7.1% vs 10.2% → OR 0.68 (p=0.006) ADHF hospitalization: 27.7% vs 32.8% → OR 0.79 (p=0.005) GLP-1 RAs were previously cautioned against in severe HFrEF.

💡 LGE location matters as much as presence. Lateral subendocardial involvement is the high-risk signal we should be looking for. 10.1093/ehjci/jeag015 + 10.1093/ehjci/jeaf376 #Cardiology #CardiacMRI #DCM #SCD #HFrEF #CMR #LGE

🔑 The eGFR threshold matters: • eGFR ≥45 → No survival benefit • eGFR 30–44 → 64% ↓ mortality (HR 0.36) • eGFR <30 → 54% ↓ mortality (HR 0.46) If eGFR <45, re-SHKT should be the default conversation.

📉 40 years of HFrEF drug trials — and enrollment efficiency has actually DECLINED over time, despite larger trials and more sites. Majority of patients are still enrolled at just a handful of top centers, limiting diversity and the real-world applicability of clinical guideline

🫘 Adding nsMRA to RASi+SGLT2i could delay kidney failure by ~12 years: 🔴 RASi+SGLT2i alone → eGFR hits 10 mL/min at ~16 years 🟢 Triple therapy (+nsMRA) → eGFR hits 10 mL/min at ~28 years Same starting eGFR of 66. One extra pill. ≈12 years of kidney function preserved.

A commento del video sugli attivisti della Flotilla trattenuti in Israele, il Presidente Mattarella ha parlato di “trattamento incivile inflitto a persone fermate illegalmente in acque internazionali, che tocca un livello infimo ad opera di un ministro del governo di Israele”.

vericiguat as potentially more than a hemodynamic drug — it may have direct vascular protective effects in patients with HFrEF and high calcification burden. Watch this space. 👀 #Vericiguat #HeartFailure #VascularCalcification #cGMP #Cardiology #MedTwitter #CardioTwitter

🧵 How do we actually measure exercise intolerance in #HFpEF? Figure 2 lays out the full spectrum — from a 6-min walk to invasive CPET with arterial catheters. The choice matters enormously. Not all exercise tests are created equal 👇

La visita del Presidente Mattarella agli ospedali di Modena e Bologna. Ai medici e ai soccorritori: “Grazie per quello che fate in questa circostanza drammatica”