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We regret to inform our readers that the editorial titled “The burden of congestion monitoring in acute decompensated heart failure: the need for multiparametric approach.” Available online 17 June 2024, has been withdrawn. This decision was made following the withdrawal of the manuscript it referred to, titled “Parameters of cardiac indices on the ultrasonic cardiac output monitor as potential indicators for predicting the achievement of ultrafiltration endpoint for acute heart failure treatment.”The withdrawal of the manuscript necessitated the retraction of the editorial to maintain the integrity and accuracy of our publication. We apologize for any inconvenience this may have caused to our readers and appreciate your understanding.Thank you for your continued support and trust in our publication.The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/policies/article-withdrawal.

Three files have been created in SEG-Y format after conversion from the raster images of selected parts of the ViDEPI open project: seismic reflection profiles D-445, D-451 and D-452, crossing the Mattinata–Gondola fault system. This dataset was obtained using the freely downloadable MATLAB© program IMAGE2SEGY. The program requires input TIFF and TXT files containing the image and specific parameters for the seismic reflection profiles to convert the raster images to the SEG-Y file format. The TIFF file of each profile was made using Adobe Photoshop®; the TXT format file was created with comma-separated number values and has a three-row and six-column structure, according to the program requirements. Once the raster images were converted to the SEG-Y file format, a light processing using DELPH Seismic® software improved the obtained seismic images. Creating this freely available dataset overcomes the problem of poor-quality representation of the original raster seismic reflection profiles. Hence, this dataset allows geologists to better interpret these profiles, especially by using dedicated software that can modify the colours of the reflectors as desired. Thus, these data are useful for researchers who want to investigate the deeper structures associated with the seismogenic Mattinata–Gondola fault system.

Abstract The knowledge of geomorphodynamic aspects is crucial for understanding marine and coastal processes/dynamics as well as for characterizing coastal environments heavily affected by anthropogenic activities. To provide a framework of analysis that can be applied in a consistent way for the geo-environmental characterization of highly contaminated coastal sites, in this paper a set of operational guidelines is proposed. Special attention is given to the role of geomorphological-based surveys and analyses in defining (i) the site-specific geological model of the investigated site, (ii) the anthropogenic impacts on marine and coastal sediments, (iii) the expected morphodynamic variations induced by climate change and anthropogenic interventions, (iv) tailored dissemination activities and community engagement plans. Then, an evaluation of the state of the art of activities already performed for the characterization of the coastal contaminated sites located in the Apulia region (southern Italy) is provided. The outcomes of this research are also provided in the form of infographics to favor their dissemination among communities and stakeholders.

Abstract Extreme atmospheric-marine events, known as medicanes (short for “Mediterranean hurricanes”), have affected the Mediterranean basin in recent years, resulting in extensive coastal flooding and storm surges, and have occasionally been responsible for several casualties. Considering that the development mechanism of these events is similar to tropical cyclones, it is plausible that these phenomena are strongly affected by sea surface temperatures (SSTs) during their development period (winter and autumn seasons). In this study, we compared satellite data and the numerical reanalysis of SSTs from 1969 to 2023 with in situ data from dataloggers installed at different depths off the coast of southeastern Sicily as well as from data available on Argo floats on the Mediterranean basin. A spectral analysis was performed using a continuous wavelet transform (CWT) for each SST time series to highlight the changes in SSTs prior to the occurrence of Mediterranean Hurricanes as well as the energy content of the various frequencies of the SST signal. The results revealed that decreases in SST occurred prior to the formation of each Mediterranean hurricane, and that this thermal drop phenomenon was not observed in intense extra-tropical systems. The spectral analyses revealed that high CWT coefficients representing high SST energy contents were observed before the occurrence of a Mediterranean hurricane. This information may provide a useful fingerprint for distinguishing Mediterranean hurricanes from common seasonal storms at the onset of these events.

Abstract Background Antimicrobial resistance has been identified as a major threat to global health. The pig food chain is considered an important source of antimicrobial resistance genes (ARGs). However, there is still a lack of knowledge on the dispersion of ARGs in pig production system, including the external environment. Results In the present study, we longitudinally followed one swine farm located in Italy from the weaning phase to the slaughterhouse to comprehensively assess the diversity of ARGs, their diffusion, and the bacteria associated with them. We obtained shotgun metagenomic sequences from 294 samples, including pig feces, farm environment, soil around the farm, wastewater, and slaughterhouse environment. We identified a total of 530 species-level genome bins (SGBs), which allowed us to assess the dispersion of microorganisms and their associated ARGs in the farm system. We identified 309 SGBs being shared between the animals gut microbiome, the internal and external farm environments. Specifically, these SGBs were characterized by a diverse and complex resistome, with ARGs active against 18 different classes of antibiotic compounds, well matching antibiotic use in the pig food chain in Europe. Conclusions Collectively, our results highlight the urgency to implement more effective countermeasures to limit the dispersion of ARGs in the pig food systems and the relevance of metagenomics-based approaches to monitor the spread of ARGs for the safety of the farm working environment and the surrounding ecosystems.

Summary: Aiming to shed light on the biology of wild ruminants, we investigated the gut microbiome seasonal dynamics of the Alpine ibex (Capra ibex) from the Central Italian Alps. Feces were collected in spring, summer, and autumn during non-invasive sampling campaigns. Samples were analyzed by 16S rRNA amplicon sequencing, shotgun metagenomics, as well as targeted and untargeted metabolomics. Our findings revealed season-specific compositional and functional profiles of the ibex gut microbiome that may allow the host to adapt to seasonal changes in available forage, by fine-tuning the holobiont catabolic layout to fully exploit the available food. Besides confirming the importance of the host-associated microbiome in providing the phenotypic plasticity needed to buffer dietary changes, we obtained species-level genome bins and identified minimal gut microbiome community modules of 11–14 interacting strains as a possible microbiome-based solution for the bioconversion of lignocellulose to high-value compounds, such as volatile fatty acids.

In this work, we study a Mediterranean cyclone, Helios, which took place during 9–11 February 2023 in the southeastern part of Sicily and Malta, by a multiparametric approach combining microseism results with sea state and meteorological data provided by wavemeter buoy, HF radar, hindcast maps and satellite SEVIRI images. The sub-tropical system Helios caused heavy rainfall, strong wind gusts and violent storm surges with significant wave heights greater than 5 m. We deal with the relationships between such a system and the features of microseism (the most continuous and ubiquitous seismic signal on Earth) in terms of spectral content, space–time variation of the amplitude and source locations tracked by means of two methods (amplitude-based grid search and array techniques). By comparing the location of the microseism sources and the area affected by significant storm surges derived from sea state data, we note that the microseism location results are in agreement with the real position of the storm surges. In addition, we are able to obtain the seismic signature of Helios using a method that exploits the coherence of continuous seismic noise. Hence, we show how an innovative monitoring system of the Mediterranean cyclones can be designed by integrating microseism information with other techniques routinely used to study meteorological phenomena.

This Special Issue of Biomolecules, entitled “Molecular Biomarkers in Cardiology 2022–2023”, presents a comprehensive collection of research and reviews exploring the rapidly evolving field of cardiovascular biomarkers [...]

Summary: The human gut microbiome is losing biodiversity, due to the “microbiome modernization process” that occurs with urbanization. To keep track of it, here we applied shotgun metagenomics to the gut microbiome of the Baka, a group of forager-horticulturalists from Cameroon, who combine hunting and gathering with growing a few crops and working for neighboring Bantu-speaking farmers. We analyzed the gut microbiome of individuals with different access to and use of wild plant and processed foods, to explore the variation of their gut microbiome along the cline from hunter-gatherer to agricultural subsistence patterns. We found that 26 species-level genome bins from our cohort were pivotal for the degradation of the wild plant food substrates. These microbes include Old Friend species and are encoded for genes that are no longer present in industrialized gut microbiome. Our results highlight the potential relevance of these genes to human biology and health, in relation to lifestyle.

IntroductionIn our paper, we explored the impact of different anthropogenic stressors, namely, mussel farming, methane extraction platforms, and summer mass tourism, on the epipelagic microbiomes of the North-Western Adriatic Sea.MethodsBy 16S rRNA gene sequencing, we provided the epipelagic microbiome layout from selected sites corresponding to each of the considered impacts. As an unimpacted reference, we used already published 16S rRNA sequencing data.ResultsAccording to our findings, each one of the anthropogenic stressors resulted in a peculiar increase of specific epipelagic microbial components, including copiotrophic R-strategists and host-restricted bacteria, as well as some pathobiome components, the latter being detected exclusively in impacted sites. Particularly, potentially harmful pathogenic species such as Legionella impletisoli and Staphylococcus epidermidis have been detected in proximity to the mussel farms, and Escherichia coli and Campylobacter ureolyticus were present close to the methane extraction platform and at the summer mass tourism site, respectively. Particularly, C. ureolyticus is an emerging human gastrointestinal pathogen, capable of destroying intestinal microvilli.DiscussionIn addition to providing evidence supporting the existence of recognizable and impact-driven fingerprints on the epipelagic marine microbiome peculiar to the different anthropogenic stressors, our findings also raise concern about the ecological relevance of the observed changes, in terms of possible loss of ecosystem services and also for the potential release of pathogenic microorganisms in the environment.

Mediterranean hurricanes, also known as medicanes, can cause significant damage to coastal communities. Consequently, they have been the subject of intense study in recent decades. Geographic Information Systems (GISs) and Web-GIS applications are essential for processing and analyzing geographic data from various sources, particularly in the field of spatial planning. Due to their ability to integrate heterogeneous information, these tools can provide experts with a comprehensive overview of relevant geospatial data. Here, we present ARCHIMEDE, a relational geodatabase connected to an open-source Web-GIS platform focused on Mediterranean hurricanes that contains data from recent research on these extreme weather phenomena. These datasets comprise climatic and oceanographic data obtained from remote sensing techniques as well as seismic and geomorphological data obtained from field observations. Consequently, this Web-GIS platform can enhance our understanding of Mediterranean cyclones by relating the physical properties of these natural phenomena with their impacts on coastal regions. ARCHIMEDE is an innovative tool for the dissemination of geographic information to stakeholders, researchers, and decision-makers, offering valuable support for the development of robust coastal management strategies aimed at mitigating the challenges posed by Mediterranean hurricanes.

Lipid disorders represent one of the most worrisome cardiovascular risk factors. The focus on the impact of lipids on cardiac and vascular health usually concerns low-density lipoprotein cholesterol, while the role of triglycerides (TGs) is given poor attention. The literature provides data on the impact of higher plasma concentrations in TGs on the cardiovascular system and, therefore, on the outcomes and comorbidities of patients. The risk for coronary heart diseases varies from 57 to 76% in patients with hypertriglyceridemia. Specifically, the higher the plasma concentrations in TGs, the higher the incidence and prevalence of death, myocardial infarction, and stroke. Nevertheless, the metabolism of TGs and the exact physiopathologic mechanisms which try to explain the relationship between TGs and cardiovascular outcomes are not completely understood. The aims of this narrative review were as follows: to provide a comprehensive evaluation of the metabolism of triglycerides and a possible suggestion for understanding the targets for counteracting hypertriglyceridemia; to describe the inner physiopathological background for the relationship between vascular and cardiac damages derived from higher plasma concentrations in TGs; and to outline the need for promoting further insights in therapies for reducing TGs plasma levels.

Skeletal muscle regeneration entails a multifaceted process marked by distinct phases, encompassing inflammation, regeneration, and remodeling. The coordination of these phases hinges upon precise intercellular communication orchestrated by diverse cell types and signaling molecules. Recent focus has turned towards extracellular vesicles (EVs), particularly small EVs, as pivotal mediators facilitating intercellular communication throughout muscle regeneration. Notably, injured muscle provokes the release of EVs originating from myofibers and various cell types, including mesenchymal stem cells, satellite cells, and immune cells such as M2 macrophages, which exhibit anti-inflammatory and promyogenic properties. EVs harbor a specific cargo comprising functional proteins, lipids, and nucleic acids, including microRNAs (miRNAs), which intricately regulate gene expression in target cells and activate downstream pathways crucial for skeletal muscle homeostasis and repair. Furthermore, EVs foster angiogenesis, muscle reinnervation, and extracellular matrix remodeling, thereby modulating the tissue microenvironment and promoting effective tissue regeneration. This review consolidates the current understanding on EVs released by cells and damaged tissues throughout various phases of muscle regeneration with a focus on EV cargo, providing new insights on potential therapeutic interventions to mitigate muscle-related pathologies.

The latest progress in deep learning approaches has garnered significant attention across a variety of research fields. These techniques have revolutionized the way marine parameters are measured, enabling automated and remote data collection. This work centers on employing a deep learning model for the automated evaluation of tide and surge, aiming to deliver accurate results through the analysis of surveillance camera images. A mode of deep learning based on the Inception v3 structure was applied to predict tide and storm surges from surveillance cameras located in two different coastal areas of Italy. This approach is particularly advantageous in situations where traditional tide sensors are inaccessible or distant from the measurement point, especially during extreme events that require accurate surge measurements. The conducted experiments illustrate that the algorithm efficiently measures tide and surge remotely, achieving an accuracy surpassing 90% and maintaining a loss value below 1, evaluated through Categorical Cross-Entropy Loss functions. The findings highlight its potential to bridge the gap in data collection in challenging coastal environments, providing valuable insights for coastal management and hazard assessments. This research contributes to the emerging field of remote sensing and machine learning applications in environmental monitoring, paving the way for enhanced understanding and decision-making in coastal regions.

Cardiovascular conditions in the spectrum of acute coronary syndromes are characterized by sex differences with regard to pathophysiology, risk factors, clinical presentation, invasive and pharmacologic treatment, and outcomes. This review delves into these differences, including specific subsets like myocardial infarction with non-obstructed coronary arteries or Spontaneous Coronary Artery Dissection, and alternative diagnoses like Takotsubo cardiomyopathy or myocarditis. Moreover, practical considerations are enclosed, on how a sex-specific approach should be integrated in clinical practice: in fact, personal history should focus on female-specific risk factors, and hormonal status and hormonal therapy should be assessed. Moreover, physical and psychological stressors should be investigated, particularly in the event of Spontaneous Coronary Artery Dissection or Takotsubo cardiomyopathy. [Display omitted] [ABSTRACT FROM AUTHOR]

In recent years remote working (RW) arrangements have increased in many countries, mainly because of the COVID-19 pandemic, which has also intensified the need for humans to live closer to nature. Within this context, the paper aims to discuss three possible future scenarios for the spread of RW by 2050, and how this could affect residential choices, people's relationship with the natural environment, and thus the renewed role of large cities, small towns, and areas close to nature. A specific focus is placed on the city of Milan in northwest Italy. To give empirical foundations to our scenarios, we analyzed data for the year 2021. The first scenario we consider (the Gentrified City) implies the risk that Milan will become a gentrified city, thus pushing social and economic inequality. However, on the contrary, our data suggest that in Italy a potential pool of workers would leave the city and move to a small town or closer to nature if allowed to work remotely. This trend could lead to the second scenario (the Doughnut City), but data for Milan show that the share of those willing to leave Milan is lower than the national average, which can be explained by the good quality of offered services; thus, the city center is unlikely to empty due to RW. The desirable option would be represented by the third scenario: some remote workers move to intermediary cities (the Intermediary Cities scenario), reducing territorial disparities. • We discuss possible future scenarios for the spread of remote working (RW) by 2050 in Italy. • We highlight how RW could affect residential choices and people's relationship with the natural environment. • A potential pool of remote workers in Italy would leave the city and move to a small town or closer to nature. • Based on these challenges, we provide some policy recommendations. [ABSTRACT FROM AUTHOR]

Arterial hypertension (AH) is one of the most common pathologic conditions and uncontrolled AH is a leading risk factor for cardiovascular disease and mortality. AH chronically causes myocardial and arterial remodelling with hemodynamic changes affecting the heart and other organs, with potentially irreversible consequences leading to poor outcomes. Therefore, a proper and early treatment of AH is crucial after the diagnosis. Beyond medical treatment, physical exercise also plays a therapeutic role in reducing blood pressure, given its potential effects on sympathetic tone, renin-angiotensin-aldosterone system, and endothelial function. International scientific societies recommend physical exercise among lifestyle modifications to treat AH in the first stages of the disease. Moreover, some studies have also shown its usefulness in addition to drugs to reduce blood pressure further. Therefore, an accurate, personalized exercise prescription is recommended to optimize the prevention and treatment of hypertension. On the other hand, uncontrolled AH in athletes requires proper risk stratification and careful evaluation to practice competitive sports safely. Moreover, the differential diagnosis between hypertensive heart disease and athlete's heart is sometimes challenging and requires a careful and comprehensive interpretation in order not to misinterpret the clinical findings. The present review aims to discuss the relationship between hypertensive heart disease and physical exercise, from diagnostic tools to prevention and treatment strategies., (Copyright © 2024 The Authors. Published by Elsevier B.V. All rights reserved.)

This Special Issue of Biomolecules , entitled "Molecular Biomarkers in Cardiology 2022-2023", presents a comprehensive collection of research and reviews exploring the rapidly evolving field of cardiovascular biomarkers [...].

The consumption of energy drinks (ED) has become a growing public health issue, since potentially ED-related serious adverse cardiovascular events, including arrhythmias, myocardial infarction, cardiomyopathies, and sudden cardiac death, have been reported in recent years. The substances contained in ED include caffeine, taurine, sugars, B group vitamins and phyto-derivatives, which, especially if taken in large quantities and in a short amount of time, could cause serious side effects through various mechanisms of action, such as increased blood pressure and QT interval prolongation. Although there are still many open questions on ED that require further specific investigations, there is an urgent need for information and educational plans to the population, as well as for regulatory actions, particularly regarding transparency of substances and possible adverse effects.

Lipid disorders represent one of the most worrisome cardiovascular risk factors. The focus on the impact of lipids on cardiac and vascular health usually concerns low-density lipoprotein cholesterol, while the role of triglycerides (TGs) is given poor attention. The literature provides data on the impact of higher plasma concentrations in TGs on the cardiovascular system and, therefore, on the outcomes and comorbidities of patients. The risk for coronary heart diseases varies from 57 to 76% in patients with hypertriglyceridemia. Specifically, the higher the plasma concentrations in TGs, the higher the incidence and prevalence of death, myocardial infarction, and stroke. Nevertheless, the metabolism of TGs and the exact physiopathologic mechanisms which try to explain the relationship between TGs and cardiovascular outcomes are not completely understood. The aims of this narrative review were as follows: to provide a comprehensive evaluation of the metabolism of triglycerides and a possible suggestion for understanding the targets for counteracting hypertriglyceridemia; to describe the inner physiopathological background for the relationship between vascular and cardiac damages derived from higher plasma concentrations in TGs; and to outline the need for promoting further insights in therapies for reducing TGs plasma levels.

The issue of suboptimal drug regimen adherence in secondary cardiovascular prevention presents a significant barrier to improving patient outcomes. To address this, the utilization of drug combinations, specifically single pill combinations (SPCs) and polypills, was proposed as a strategy to simplify treatment regimens. This approach aims to enhance treatment accessibility, affordability, and adherence, thereby reducing healthcare costs and improving patient health. The document is an ANMCO scientific statement on simplifying drug regimens for secondary cardiovascular prevention. It discusses the underuse of treatments despite available, effective, and accessible options, highlighting a significant gap in secondary prevention across different socioeconomic statuses and countries. The statement explores barriers to implementing evidence-based treatments, including patient, healthcare provider, and system-related challenges. The paper also reviews international guidelines, the role of SPCs and polypills in clinical practice, and their economic impact, advocating for their use in secondary prevention to improve patient outcomes and adherence.

Obesity is a chronic and relapsing disease due to the coexistence of a patient with predisposing individual characteristics and an obesogenic environment. The recent acquisition of detailed knowledge on the mechanisms underlying the energetic homeostasis paved the way to more effective therapeutic hypotheses as compared to traditional treatments. Since obesity is a complex issue, it requires a multidisciplinary approach which is difficult to implement. However, new drugs appear promising. Currently, therapeutic success is discrete in the short term, but unsatisfying in the long term due to the high probability of body weight gain. Cardiologists play a key role in managing patients with obesity, but they are not used to manage them. The aim of this document is to summarize knowledge that clinicians need to have to appropriately manage these patients. The paper emphasizes the pivotal role of an appropriate relationship with the patient to embark on a successful treatment journey. We analyze the criteria commonly used to diagnose obesity and point out strengths and limitations of different criteria. Furthermore, we discuss the figure of the obesitologist and the role of the cardiologist. In addition, we report the main components of an effective therapeutic strategy, from educational questions to pharmacological options.

Scientific societies promote numerous activities, including the training of professionals. With the continuous growing of knowledge and the availability of new evidence in the cardiological field, the achievement and maintenance of knowledge and know-how is difficult. The evolving educational needs of professionals in cardiology have been analyzed during the 2023 ANMCO General States. Furthermore, the initiatives implemented to meet professionals' needs after the university medical training have been discussed. In this document, we report the main and most innovative training activities promoted by ANMCO, from distance training to simulation training, including courses for master's degree, training to and through clinical research and the potential role of teaching hospitals.

Technological innovation provides easily accessible tools capable of simplifying healthcare processes. Notably, digital technology application in the cardiology field can improve prognosis, reduce costs, and lead to an overall improvement in healthcare. The digitization of health data, with the use of electronic health records and of electronic health files in Italy, represents one of the fields of application of digital technologies in medicine. The 2023 States General of the Italian Association of Hospital Cardiologists (ANMCO) provided an opportunity to focus attention on the potential benefits and critical issues associated with the implementation of the aforementioned digital tools, artificial intelligence, and telecardiology. This document summarizes key aspects that emerged during the event.

For over 40 years, clinical research has been one of the most important aims of the Italian Association of Hospital Cardiologists (ANMCO), being an essential tool in pursuing promotion and fulfillment of good clinical practices in prevention, treatment and rehabilitation of cardiovascular diseases. Since 1992, with the creation of the Research Center (now part of the Heart Care Foundation), ANMCO is capable of independently and professionally managing all the aspects related to planning, management, and publication of the results of clinical studies. The other strength of ANMCO is the network built in Cardiology Departments on the whole territory of Italy, a human capital that allows ANMCO to deal with the new scientific challenges, in a context of profound changes in the social, economic, technological, and methodological setting. This document is based on the debate about the state of clinical research in Italy and the role of ANMCO in this setting that took place during the 2023 ANMCO States General.

Over the latest years, a worrying progressive reduction of medical specialists has been observed in Italy and in other European and non-European countries. This trend is assuming alarming proportions, especially considering the continuous population aging and the concomitant increase in the prevalence of chronic cardiovascular disease. The underlying reasons are complex and multifactorial. The purpose of this document, derived from the collegial discussion held during the 2023 ANMCO States General is to highlight the current critical issues regarding the lack of healthcare personnel in the cardiology field, examining the current and future Italian situation and proposing some potential strategies to counteract this alarming phenomenon.

It is well established that gender strongly influences cardiovascular risk factors, playing a crucial role in cardiovascular prevention, clinical pathways, diagnostic approach and treatment. Beyond the sex, which is a biological factor, gender entails a socio-cultural condition that impacts access and quality of care due to structural and institutional barriers. However, despite its great importance, this issue has not been adequately covered. Indeed sex and gender differences scarcely impact the clinical approach, creating a lot of disparities in care and outcomes of patients. Therefore, it becomes essential to increase the awareness of the importance of sex and gender influences on cardiovascular diseases. Moreover, new strategies for reducing disparities should be developed. Importantly, these differences should be taken into account in guideline recommendations. In this regard, it is crucial to include a greater number of women in clinical trials, since they are currently underrepresented. Furthermore, more women should be involved as member of international boards in order to develop recommendations and guidelines with more attention to this important topic.The aim of this ANMCO position paper is to shed light on gender differences concerning many cardiovascular drugs in order to encourage a more personalized therapeutic approach.

Over the last two decades, cardiovascular diseases have become the leading cause of chronic disease morbidity and mortality in Italy. Therefore, the chronic cardiovascular care landscape has evolved rapidly in an era of unprecedented demand. Furthermore, the COVID-19 pandemic has highlighted significant deficiencies in existing health and social care systems, especially in the management of chronic cardiovascular disease. In this scenario, the National Reform for Recovery and Resilience (PNRR) may represent a unique opportunity for the development of a new integrated care system between hospital and community. The Italian Association of Hospital Cardiologists (ANMCO) recognizes the need for a statement on the integrated cardiological community care to guide health professionals caring for people with chronic cardiovascular conditions. The aim of the present statement is to outline the evidence for a modern integrated cardiological community care identifying challenges and offering advice for a future transdisciplinary and multi-organizational approach to ensure best practice in the management of chronic cardiovascular disease.

Diagnosis of heart failure with preserved ejection fraction (HFpEF) can be challenging and it could require different tests, some of which are affected by limited availability. Nowadays, considering that new therapies are available for HFpEF and related conditions, a prompt and correct diagnosis is relevant. However, the diagnostic role of biomarker level, imaging tools, score-based algorithms and invasive evaluation, should be based on the strengths and weaknesses of each test. The aim of this review is to help the clinician in diagnosing HFpEF, overcoming the diagnostic uncertainty and disentangling among the different underlying causes, in order to properly treat this kind of patient., Competing Interests: Declaration of competing interest None., (Copyright © 2023 Hellenic Society of Cardiology. Published by Elsevier Inc. All rights reserved.)

In recent decades, an incredible evolution in antithrombotic therapies for the treatment of patients suffering from atherosclerosis, atrial fibrillation and venous thromboembolism occurred, leading to the availability of increasingly safe drugs. However, bleeding complications associated with these drugs still have an important health, social and economic impact. Recently, with the aim of improving the acute management of patients with or at risk of major bleeding events, specific reversal agents of antithrombotic drugs have been developed. Although these agents have demonstrated their effectiveness in small pharmacodynamic studies or clinical trials, it is important to consider that the benefit of reversal of an antiplatelet or anticoagulant drug must always be counterbalanced by the possible prothrombotic effect caused by the removal of antithrombotic protection as well as by prothrombotic mechanisms related to bleeding, major surgery or trauma.In this ANMCO/SIMEU consensus document we summarize the main characteristics and efficacy studies of the currently available reversal agents and present practical flow-charts in which we suggest their possible use in patients with active bleeding or at high risk of major bleeding events.