Perone, Francesco

Abstract Aims Nutritional counselling is a core component of cardiac rehabilitation (CR), yet the evidence base for specific dietary interventions within CR remains fragmented. This scoping review aimed to map the range of nutritional interventions evaluated in adult CR programmes, characterize their reported outcomes, and identify key gaps in current evidence and practice. Methods and results Following the Arksey and O’Malley framework and reporting according to PRISMA-ScR, a systematic search of PubMed, Embase, Web of Science, and Cochrane Library was conducted from inception to June 2026. Eligible studies included randomized controlled trials, non-randomized trials, and observational studies evaluating an explicitly described nutritional intervention within a structured CR programme in adults with established cardiovascular disease. Of 2765 identified records, 35 studies met eligibility criteria. Interventions spanned Mediterranean and heart-healthy dietary patterns, calorie-restriction and weight-loss programmes, comprehensive lifestyle interventions, structured nutrition education and counselling, supplementation, functional foods, and individualized diet prescriptions. Across categories, improvements in body weight, central adiposity, and adherence to cardioprotective dietary recommendations were commonly reported, particularly when nutrition was delivered with repeated contact and individualized support. Effects on lipid profiles, inflammatory markers, blood pressure, functional capacity, and clinical outcomes were more variable. Conclusion Nutritional interventions within CR were most consistently associated with improvements in intermediate behavioural, anthropometric, and cardiometabolic outcomes, particularly when structured and reinforced over time. However, heterogeneity in study design, intervention delivery, comparator groups, outcome reporting, and follow-up duration precludes definitive conclusions about comparative efficacy, optimal intervention format, or the magnitude of benefit. Greater standardization, longer follow-up, and further evaluation of personalized nutritional strategies are needed to strengthen the nutritional component of CR.

Acute type A aortic dissection is a life-threatening condition requiring emergency surgery and complex postoperative management. Although survival rates have improved, many patients experience long-term functional impairments, reduced quality of life, and an elevated risk of complications. Despite strong evidence supporting cardiac rehabilitation in other cardiovascular populations, structured programs remain underutilized in patients with surgically resolved acute type A aortic dissection. Exercise-based cardiac rehabilitation appears feasible and can be delivered safely in carefully selected patients when appropriately adapted to individual needs and conducted under close supervision. Postoperative patients are often physically deconditioned, prone to hospital-acquired disability, and may misjudge exercise intensity. Therefore, individualized exercise prescription, guided by exercise testing when available, is important to support safe training thresholds. Early and gradual introduction of physical activity may help prevent complications associated with immobility, support blood pressure control, and contribute to improvements in functional capacity. However, training volume should be purposefully lower than in conventional program settings to reduce hemodynamic stress. Education on safe exercise parameters and self-monitoring plays a central role in enabling long-term adherence and promoting patient autonomy. Cardiac rehabilitation programs should incorporate dietary, nutritional, and psychological support. Although evidence specific to this patient population remains limited, available data suggest the feasibility and potential benefits of cardiac rehabilitation when delivered with appropriate precautions. Our review underscores the need for a tailored, multidisciplinary CR approach aimed at enhancing physical recovery, supporting cardiovascular stability, and improving overall quality of life in patients following surgery. Further research is required to define optimal program protocols.

Cardiac rehabilitation is strongly recommended in secondary cardiovascular prevention. In patients after coronary artery bypass grafting, this intervention is suggested to reduce mortality, morbidity, and disability. In addition, rehabilitation programs improve quality of life and cardiorespiratory fitness. Modern cardiac rehabilitation programs include structured exercise training, education, nutritional counseling, psychosocial support, and management of cardiovascular risk factors, each tailored to the specific needs of post-coronary artery bypass grafting patients who often face a high burden of comorbidities and surgical recovery challenges. For these reasons, cardiac rehabilitation should be regarded as standard of care. Evidence supports early cardiac rehabilitation initiation and individualized multidisciplinary plans, which have shown to improve exercise capacity, health-related quality of life, and medication adherence. Long-term follow-up is essential, as studies have demonstrated a clear association between sustained cardiac rehabilitation engagement and decreased rates of rehospitalization and all-cause mortality. Therefore, this comprehensive review presents recent advances and updates on the management of patients after coronary artery bypass grafting during cardiac rehabilitation, with a focus on the core components and long-term follow-up.

Abstract Exercise training improves cardiovascular health and reduces the risk for future cardiovascular events and mortality. However, emerging evidence suggests that Masters athletes may have a higher prevalence of cardiovascular abnormalities, such as atrial arrhythmias, coronary atherosclerosis, aortic dilatation, and myocardial fibrosis, compared to their less active peers. The clinical management of Masters athletes may be challenging as available guidelines for such conditions are generally based on data derived from symptomatic sedentary patients, limiting their applicability to highly trained individuals. Other unique challenges in the clinical assessment of Masters athletes include differences in symptomatic presentations compared to sedentary individuals, potential resistance to the initiation of pharmacologic treatment, and the increasing availability of consumer wearable health data that may provide relevant information on their cardiovascular health status. The purpose of this joint EAPC/ESC and ACC Clinical Consensus Statement is to provide an in-depth update on the current state of knowledge on abnormal cardiovascular findings in Masters athletes. We present an expert-based approach on the diagnostic assessment, management, and prognosis of (i) atrial fibrillation, (ii) bradyarrhythmias, (iii) ventricular arrhythmias, (iv) coronary atherosclerosis, (v) aortic dilatation, (vi) myocardial fibrosis, and (vii) exercise-induced arrhythmogenic cardiomyopathy. Clinical challenges, areas of ongoing controversy, and uncertainty and the potential underlying mechanisms are discussed. We also present future perspectives and research directives to further refine current best practice strategies. This includes the need for clinical outcome studies, dedicated randomized controlled trials in athletes, and international registries with diverse populations and longitudinal follow-up to evaluate the natural history of cardiac abnormalities and facilitate development of evidence-based approaches in the clinical management of Masters athletes with cardiovascular abnormalities.

Coronary artery bypass grafting (CABG) remains a cornerstone of treatment for patients with advanced or complex coronary artery disease, yet long-term success is influenced by graft patency, progression of native disease, and ventricular remodeling. Optimizing the follow-up of these patients requires a structured approach in which multimodality cardiovascular imaging plays a central role. Echocardiography remains the first-line modality, providing readily available assessment of ventricular function, valvular competence, and wall motion, while advanced techniques, such as strain imaging and myocardial work, enhance sensitivity for subclinical dysfunction. Coronary computed tomography angiography (CCTA) offers excellent diagnostic accuracy for graft patency and native coronary anatomy, with emerging applications of CT perfusion and fractional flow reserve derived from CT (FFR-CT) expanding its ability to assess lesion-specific ischemia. Cardiovascular magnetic resonance (CMR) provides comprehensive tissue characterization, quantifying scar burden, viability, and inducible ischemia, and stress CMR protocols have demonstrated both safety and independent prognostic value in post-CABG cohorts. Nuclear imaging with single-photon emission computed tomography (SPECT) and positron emission tomography (PET) remains essential for quantifying perfusion, viability, and absolute myocardial blood flow, with hybrid PET/CT approaches offering further refinement in patients with recurrent symptoms. In patients after CABG, multimodality imaging is tailored to the patient’s characteristics, symptoms, and pre-test probability of disease progression. In asymptomatic patients, imaging focuses on surveillance, risk stratification, and the early detection of subclinical abnormalities, whereas in symptomatic individuals, it focuses on establishing the diagnosis, defining prognosis, and guiding therapeutic interventions. Therefore, the aim of our review is to propose updated and comprehensive guidance on the crucial role of multimodality cardiovascular imaging in the evaluation and management of post-CABG patients and to provide a practical, evidence-based framework for optimizing outcomes.