Ospedale Sandro Pertini

Intravascular imaging modalities such as optical coherence tomography (OCT), intravascular ultrasound (IVUS) and near-infrared spectroscopy allow the detection of vulnerable coronary plaques, which may predict the risk of future major adverse cardiovascular events (MACEs). However, the prognostic relevance of specific plaque characteristics remains incompletely defined. This updated meta-analysis aimed to identify the most reliable intracoronary imaging-derived parameters for predicting MACE in untreated coronary lesions. A systematic search of PubMed, Scopus and Google Scholar was performed according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines to identify adjusted observational studies reporting the prognostic impact of plaque vulnerability features assessed by OCT or IVUS. The primary outcome was study-defined MACE. HRs were pooled using random-effects or fixed-effects models depending on heterogeneity. Subgroup and sensitivity analyses were conducted to explore the impact of imaging modality and plaque feature definitions. 12 studies including 8453 patients and 22 319 lesions were analysed. All investigated plaque features were significantly associated with an increased risk of MACE. Among predictors, thin-cap fibroatheroma (TCFA) demonstrated the lower positive association (HR 3.06, 95% CI 1.97 to 4.77), while plaque burden showed the highest (HR 3.92, 95% CI 1.45 to 10.59). IVUS-derived parameters (minimum lumen area and high-risk plaque definition) were superior to their OCT counterparts, whereas OCT better discriminated prognostic TCFA. The combination of minimum lumen area, TCFA and lipid arc yielded the strongest predictive performance for MACE risk. Intracoronary imaging-derived plaque features are significantly associated with future cardiovascular events. Multiparametric models integrating compositional and morphological features apparently enhance risk stratification compared with single parameters. CRD420251047286.

Background: This retrospective cross-sectional study evaluated the association of the global wall thickness index (GTI), derived from cardiovascular magnetic resonance (CMR), with demographic, clinical, and imaging findings, as well as heart failure history in transfusion-dependent thalassemia (TDT) patients. Methods: We analyzed 1154 TDT patients (52.9% female, 37.46 ± 10.67 years) from the Extension-Myocardial Iron Overload in Thalassemia project and 167 healthy controls (54.5% female, 36.33 ± 15.78 years). The CMR protocol included the T2* technique for the assessment of iron overload, cine imaging for the assessment of left ventricular (LV) function and size, and late gadolinium enhancement (LGE) imaging for the detection of replacement myocardial fibrosis (in the subset of 366 patients who underwent contrast administration). GTI (in mm/m2) was calculated from LV mass and end-diastolic volume. Results: GTI discriminated TDT patients from controls better than the LV end-diastolic volume index. Among TDT patients, GTI was higher in males, in those with diabetes, and in those with severe myocardial iron overload (cardiac T2* < 10 ms), but was unrelated to age, hemoglobin and ferritin levels, splenectomy, hepatic and pancreatic T2* values, LV ejection fraction, and fibrosis. GTI showed a diagnostic performance comparable to global heart T2* and superior to LV ejection fraction in identifying patients with prior heart failure. Conclusions: GTI is elevated in TDT patients compared with healthy controls. Male sex and severe myocardial iron overload are key determinants of GTI in TDT. Increased GTI is linked to a history of heart failure, supporting its role as a complementary tool to conventional CMR indices.

SummaryObjectiveTo understand the state of the art of Italian thyroid cytopathology practice, a survey was sent by the Italian Committee of cytopathology to the 846 registered emails of the Italian society of pathology and cytology (SIAPEC) members.MethodsA survey divided in 4 sections (geographic distribution, pre-analytics, diagnostic work up, molecular testing) was sent to SIAPEC members in April 2023. An additional set of questions regarding molecular analysis was sent to first round participants.ResultsA total of 104/846 (12.2%) SIAPEC members replied to the survey. Non-pathologist physicians performed FNA in the majority of cases (78/104, 75%). The Italian Consensus for the Classification and Reporting of Thyroid Cytology (ICCRTC) system is adopted by most centers (94/104 90,38%), although in 32.6% it was used along with other classifications systems. Only 44/104 (42.2%) of the participants performed molecular tests on thyroid FNA, mostly upon requests from the caring physician (25/41, 61.1%).ConclusionThis survey offers a snapshot of the current Italian thyroid FNA practice. The volume of thyroid FNA performed is similar to the pre-Covid workload and the ICCRTC is the most frequently adopted classification system. Molecular tests are performed by a significant minority of participants, with different testing modalities and clinical-pathological indications.

In 2023, the VAS international working group on Buerger's Disease (BD) recommended two diagnostic criteria based on a prior Delphi study: "definitive" and "suspected". The "definitive" criteria are history of smoking, typical angiography, and typical histopathological features. All three features are mandatory to confirm a "definitive" diagnosis of BD. The conundrum is-what features should be considered typical of BD angiography? According to this review, segmental occlusion of infrapopliteal arteries, corkscrew collaterals that appear to continue the occluded arterial segment (Martorell's sign) or bypass the segmental occlusion, absence of atherosclerotic plaque or aneurysm could differentiate BD from ASO. Hence, for "typical" BD angiography, these manifestations should certainly be considered. However, data for differentiating angiography patterns of BD from the small- and medium-sized vasculitis including Behcet's disease, scleroderma, hepatitis associated vasculitis, and anti-phospholipid syndrome are limited. Further studies for investigating the angiography pattern in BD patients in early and late presentation of BD, particularly in the patients with long-term follow up, are highly recommended.

Cardiovascular risk stratification represents a cornerstone in preventing and managing atherosclerotic diseases. There has been a profound transformation in risk assessment models in recent years, shifting from static and uniform approaches to dynamic, integrated, and increasingly personalized paradigms. The SCORE2, SCORE2-OP, SCORE2-Diabetes and SMART2 tools allow for a more accurate and context-specific estimation of absolute cardiovascular risk by incorporating clinical and demographic variables such as age, comorbidities, metabolic profile, and geographic context. In parallel, the use of advanced non-invasive imaging techniques, parameters such as coronary artery calcium scoring and carotid intima-media thickness, as well as biomarkers, has enabled the early identification of apparently healthy individuals who are at hidden risk. This shift also challenges the traditional dichotomy of primary and secondary prevention, favoring a more continuous and nuanced concept of risk stratification. The integration of clinical, instrumental, and biological data now allows for more refined and timely risk assessment, paving the way for earlier, more targeted, and intensive preventive strategies aimed at reducing the incidence of cardiovascular events and significantly improving long-term outcomes.

Carotid stenosis is a common pathology in clinical practice and unfortunately carries a high risk of serious cerebrovascular events. The early recognition of carotid plaque and, consequently, a careful analysis by means of multimodal imaging are the necessary steps to undertake a correct management pathway, aimed at preventing or, if not possible, reducing the risk of atherogenic phenomena responsible for cerebral infarction. In particular, the presence or absence of clinical symptoms, understood as the occurrence of events such as TIAs in the last 6 months, non-disabling strokes or repeated episodes of amaurosis fugax, and the degree of carotid stenosis, are certainly the most studied parameters, and as reported by several international guidelines, can lead to the best therapeutic strategy: whether to rely on conservative medical therapy or to resort to mechanical revascularization of the carotid stenosis. According to the recommendations of the European Society of Vascular Surgery, mechanical revascularization is recommended for stenosis > 50% in symptomatic patients and stenosis > 60% in asymptomatic patients. In contrast, the latest findings on plaque vulnerability have focused attention on individual patient characteristics and clinical comorbidities that may be responsible for plaque inflammation and should therefore be taken into consideration to decide if revascularization treatment is needed even in those subjects who present stenosis with less degree than reported as critical value. Moreover, further radiological investigations are fundamental to finding the presence of entities such as plaque ulceration, plaque neo-vascularization, fibrous caps, and intraplaque lipid core that are responsible for increased vulnerability. Medical therapy involves interventions aimed at eliminating cardiovascular risk factors by administering drugs that control the comorbidities responsible for worsening carotid stenosis. Recent studies are also evaluating the effectiveness of new plaque-modifying drugs or targeted anti-inflammatory agents in reducing the risk of plaque development and complications. Revascularization therapies, on the other hand, include surgery (CEA), the endovascular technique (CAS), and a new hybrid technique (TCAR): they are all valid alternatives for the treatment of carotid stenosis, each with specific technical difficulties, but on the whole with comparable safety profiles and risk rates of postoperative complications, although some recent emergencies have focused attention on possible short- and long-term gender-dependent outcome differences. The aim of this manuscript is to present the state of the art in the management of patients with carotid stenosis and to take a closer look at revascularization options. In our opinion, the choice of one strategy over another should therefore depend on gender, anatomical features of the patient, preoperative comorbidities, and last but not least, the experience of the center and the multidisciplinary team involved in the management of the patient.

Abstract Study question The primary objective of the study is to explore the role of dyadic emotion dysregulation in the perception of infertility-related stress. Summary answer The primary result concerns the distinctive role of the lack of awareness regarding partners' emotions in predicting infertility-stress levels in the relational and social domains. What is known already Infertility represents a significant cause of stress for couples and medically assisted procreation procedures expose to the risk of failure; indeed, the primary reason for stopping treatment following negative results is the emotional burden linked to these outcomes (Bergh et al., 2004). Research showed that individual emotion dysregulation is linked to higher levels of psychological distress in infertile women (Hahn et al., 2021; Hoyle et al., 2022), while the recently conceptualized construct of dyadic emotion dysregulation remains unexplored, despite evidence that emotional closeness between partners contributes to better couple functioning in coping with this condition (Kiełek-Rataj et al., 2020). Study design, size, duration The study design is cross-sectional. A total of 139 individuals, with an average age of 38.42 years (SD 5.06), were recruited, specifically 60 men and 79 women, from a public medically assisted reproduction center, at the beginning of infertility treatments. Participants were enrolled between April 2022 and December 2023. Completing the two administered self-report instruments and the socio-demographic form took approximately 15 minutes for each participant. Participants/materials, setting, methods Participants completed two questionnaires via the EuSurvey platform: the Difficulties in Emotion Regulation Scale–Dyadic (Faccini et al., 2023) for dyadic emotion dysregulation and the Fertility Problem Inventory-Short Form (Zurlo et al., 2017) for infertility-related distress. After descriptive and preliminary analyses on instruments’ reliability, partial correlations explored associations between variables. Regression analyses, controlling for gender and age, examined the predictive role of dyadic emotional awareness and clarity on relationship and social concerns related to infertility. Main results and the role of chance Correlational analyses revealed a significant association between the dimensions of dyadic emotion dysregulation and infertility-stress levels. More specifically, both the lack of awareness and the lack of clarity regarding each other’s emotions in the couple were linked to higher relationship (r = 0.394, p &amp;lt; 0.001; r = 0.340, p &amp;lt; 0.001) and social concerns (r = 0.414, p &amp;lt; 0.001; r = 0.367, p &amp;lt; 0.001) and to lower levels in the subscale referring to the rejection of a childfree lifestyle (r= -0.189, p = 0.027; r= -0.186, p = 0.029). No significant relationships emerged with the FPI-SF dimension describing the need for parenthood. Overall infertility-stress levels were positively associated with the lack of dyadic awareness (r = 0.223, p = 0.009), but not with the lack of dyadic clarity. Step-by-step regression analyses showed that the lack of dyadic awareness predicted both relationship (Beta= 0.287; p = 0.003) and social concerns (Beta= 0.297; p = 0.002) connected to infertility, controlling for gender, age, and the lack of dyadic clarity. The models explained 23.2% and 25.6% of the variance, respectively. The lack of dyadic clarity, instead, was not a significant predictor when the dimension indicating the lack of dyadic emotional awareness was included in the model. Limitations, reasons for caution The main limitations of the study include the lack of longitudinal data and the failure to consider other potentially relevant variables. However, the specific focus is on the role that can be played by dyadic emotion dysregulation processes in relation to the different facets of infertility-stress. Wider implications of the findings Findings suggest that paying attention to the partner’s emotions and perceiving that the partner cares about one’s own emotions is linked to lower levels of infertility stress, both in the couple relationship and in relationships with family and friends, providing valuable insights for psychological support interventions in this area. Trial registration number No

Abstract Introduction Unroofed coronary sinus is a rare congenital heart anomaly and the most unusual type of atrial septal defect with nonspecific clinical manifestations. Case Report A 73–year-old woman presented to the Emergency Department for palpitations and chest pain. She had History of recurrent palpitations and a previous access to the Emergency Room with electrocardiogram (ECG) evidence of supraventricular tachycardia with wide QRS left bundle block–type, treated with intravenous infusion of amiodarone. Physical examination revealed rhythmic cardiac activity and normal vital signs. The ECG showed sinus rhythm with isolated premature atrial beats, normal atrioventricular conduction, normal QRS and normal ventricular repolarization, without signs of ischemia. Troponin was negative. The patient therefore underwent an electrophysiological (EP) study which showed, in basic conditions, a sinus rhythm with normal conduction intervals, numerous isolated atrial ectopic beats with distal–proximal activation on the coronary sinus (CS). The study also demonstrated non–inducibility of supraventricular tachycardia or atrial fibrillation. During the EP study, an atypical manipulation of the decapolar catheter in the CS gave suspicion of an anomaly of this structure. Further imaging investigations were performed. A transesophageal echocardiogram showed marked dilation of the coronary sinus and, during infusion of microbubbles from the brachial vein, an immediate passage of microbubbles in the left atrium with apparent integrity of the interatrial septum was observed. At last the patient underwent Cardiac CT that documented the absence of the CS roof at the level of the superior–posterior wall with a communication between the CS and the left atrium (Figure 1-2); in addiction the presence of a persistent left superior vena cava (PLSVC) which continued into the coronary sinus was evidenced. Final diagnosis of unroofed–coronary–sinus was made. Discussion Unroofed coronary sinus is a rare type of atrial septal defect (ASD) and is caused by complete or partial absence of the CS roof, leading to a connection between CS and left atrium. It usually involves various anatomical characteristics depending on the location of the unroofed portion of the CS and ASD. This defect accounts for less than 1% of ASDs and is commonly associated with a PLSVC which is present in 75% of unroofed CS cases. It is often difficult to make an accurate diagnosis of unroofed CS with conventional echocardiography.Figure 1 Figure 2