During the Coronavirus Disease 2019 worldwide pandemic, patients with heart failure are a high-risk group with potential higher mortality if infected. Although lockdown represents a solution to prevent viral spreading, it endangers regular follow-up visits and precludes direct medical assessment in order to detect heart failure progression and optimize treatment. Furthermore, lifestyle changes during quarantine may trigger heart failure decompensations. During the pandemic, a paradoxical reduction of heart failure hospitalization rates was observed, supposedly caused by patient reluctance to visit emergency departments and hospitals. This may result in an increased patient mortality and/or in more complicated heart failure admissions in the future. In this scenario, different telemedicine strategies can be implemented to ensure continuity of care to patients with heart failure. Patients at home can be monitored through dedicated apps, telephone calls, or devices. Virtual visits and forward triage screen the patients with signs or symptoms of decompensated heart failure. In-hospital care may benefit from remote communication platforms. After discharge, patients may undergo remote follow-up or telerehabilitation to prevent early readmissions. This review provides a comprehensive appraisal of the many possible applications of telemedicine for patients with heart failure during Coronavirus disease 2019 and elucidates practical limitations and challenges regarding specific telemedicine modalities.

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Cardiac involvement has been frequently reported in COVID-19 as responsible of increased morbidity and mortality. Given the importance of right heart function in acute and chronic respiratory diseases, its assessment in SARS-CoV-2 infected patients may add prognostic accuracy. Transthoracic echocardiography has been proposed to early predict myocardial injury and risk of death in hospitalized patients. This systematic review presents the up-to-date sum of literature regarding right ventricle ultrasound assessment. We evaluated commonly used echocardiographic parameters to assess RV function and discussed their relationship with pathophysiological mechanisms involved in COVID-19. We searched Medline and Embase for studies that used transthoracic echocardiography for right ventricle assessment in patients with COVID-19.

Objective: polyvascular atherosclerotic involvement is one of the definitions of extreme CV risk. For this reason, the search for carotid or lower limb asyntomatic atherosclerotic pathology can be useful to guarantee more intensive treatments for these individuals, who have already had a myocardial infarction. To understand how much the polyvascular patients can improve in functional terms after Cardiological Rehabilitation, comparing them with monovasculars. Furthermore, we want to evaluate how many patients are reclassified with an active research of asyntomatic atherosclerotic disease with carotid ultrasound and Ankle Brachial Index (ABI). Design and method: The study sample was composed by 87 patients who underwent a cardiological rehabilitation cycle at the Niguarda hospital in Milan from March 2021 to April 2022. Anamnestic, clinical, laboratory and instrumental data were collected. Functional improvement was assessed as the difference in meters walked on the 6-minutes walking test (6MWT) at the beginning (6MWT-1) and at the end of the rehabilitation (6MWT-2). All patients underwent ABI (to evaluate asyntomatic PAD) and carotid ultrasound (to evaluate asyntomatic cerebrovascular disease). Results: Pre-riclassification, polyvascolar patients (13) compared to monovascular (74) were older (70 years vs 59 years, p = 0.01), more frequenly males (100% vs 73%, p<0.001), had more previous recurrent myocardial infarctions (46% vs 8%, p = 0.002) and had a worse performance in terms of 6MWT-1 (428m vs 514m, p = 0.002) and 6MWT-2 (517m vs 597m, p = 0.008). However, absolute functional improvement durgin rehabilitation is imilar between the two group (81m vs 82m, p = 0.919). Following reclassification, 7 patients switched from monovascular (87) to polyvascular (20). Conclusions: Our data showed that polyvascular patients can improve as much as monovasculars after Cardiological Rehabilitation. Furthermore, following ABI and carotid ultrasound, 8% of patients were reclassified. Polyvascular patients may receive more targeted and intensive therapies if properly diagnosed.