Ospedale di Rivoli

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.

An iatrogenic pseudoaneurysm of the left main coronary artery (LMCA) originating from in-stent restenosis represents an exceedingly rare and life-threatening complication of percutaneous coronary intervention. When such a lesion presents as an ST-elevation myocardial infarction (STEMI), it creates a clinical scenario of extraordinary therapeutic complexity. We report the case of a 78-year-old man with a history of complex multivessel percutaneous coronary intervention who presented with an anteroseptal STEMI. His emergent coronary angiogram identified the culprit lesion as critical in-stent restenosis of a previously stented LMCA trifurcation, which was further complicated by a large pseudoaneurysm within the stent body. Following hemodynamic stabilization with an intra-aortic balloon pump, a novel hybrid percutaneous strategy was undertaken. The intervention involved meticulous high-pressure balloon angioplasty to address the restenosis, followed by the complete exclusion of the pseudoaneurysm using endovascular coil embolization. Finally, coronary perfusion was re-established by implanting a contemporary drug-eluting stent. Postprocedural optical coherence tomography confirmed the successful sealing of the pseudoaneurysm and optimal stent apposition. This case documents a uniquely catastrophic clinical event and appears to be the first documented instance of an iatrogenic LMCA pseudoaneurysm secondary to ISR presenting as a STEMI. Our successful management demonstrates that a hybrid technique integrating coil embolization with modern drug-eluting stent implantation is a viable and effective strategy for confronting this formidable clinical challenge.

The aim of this study is to evaluate the second medical opinions (SMOs) clinical value for endometriosis diagnostic strategy and patient profiles, using nationwide data from a specialized French physician network dedicated to SMOs and endometriosis management. We conducted an observational cohort study including patients from France who submitted a request for an SMO through a dedicated platform ( https://www.deuxiemeavis.fr/ ) between January 1st, 2020, and March 31st, 2024. Patients completed predefined questionnaires and subsequently received a written report following the expert SMO. A total of 3,061 patients requested a SMO for endometriosis. Most patients (61.1%) declared experiencing chronic painful symptoms a negative impact on daily life, corresponding to an Eastern Cooperative Oncology Group (ECOG) score ≥ 1. Dysmenorrhea was reported by 50.7% of patients, and 69.4% reported interruption of intercourse due to pain. Among the 2,987 patients with a complete medical record, the SMO modified the diagnosis in 51.1% of cases. After SMO, experts were unable to establish a conclusion in only 5.0% of cases, compared to 24.7% after the first medical opinion. For patients finally diagnosed with endometriosis, the SMO provided a diagnosis at a mean of 3.8 ± 1.5 years after symptom onset. Seeking a SMO with access to medical experts can be essential for patients dealing with painful symptoms unsuccessfully treated, or other problems such as endometriosis diagnosis.

Purpose: Although biomarkers of myocardial fibrosis and inflammation have been proposed as potential modulators of response to cardiac resynchronization therapy (CRT), their clinical utility and interaction with echocardiographic parameters remain incompletely understood. This study aims to assess the dynamic changes in these biomarkers, their relationship with echocardiographic variables, and their association with structural response to CRT. Methods: We retrospectively evaluated 86 consecutive patients referred for CRT with symptomatic heart failure, left ventricular (LV) ejection fraction ≤ 35%, QRS width ≥ 130 ms and LBBB morphology. We measured sST-2, Gal-3, NTpro-BNP and eGFR at baseline and after 1 year of CRT. An echocardiographic reduction of LV end-systolic volume ≥ 15% was used to define a patient as a responder to CRT. Results: The mean baseline and follow-up values of Gal-3 (responders: 24.1 [16.8;32] ng/mL, non-responders: 30 [20;39.3] ng/mL, p = 0.03) and sST2 (responders: 28.5 [20;36] ng/mL, non-responders: 34.5 [25;37.7] ng/mL, p = 0.03) were lower in responders than non-responders. Responders showed a significant reduction between baseline and follow-up values of ΔGal-3 (−12.1% vs. −2.5%, p = 0.04), ΔsST2 (−30.8% vs. 2.2%, p < 0.001), ΔNT-proBNP (−16.4% vs. 5.2, p = 0.04) and ΔeGFR (6.7 ± 24.3% vs. -6.3 ± 27.9%, p = 0.03). At the multivariate analyses, baseline Gal-3 [cut-off: 38.5 ng/mL, AUC: 0.63, p = 0.03, (OR 7.13 [1.12;45.41], p = 0.03), together with TAPSE > 17.5 mm (OR 10.86 [3.15;37.44], p < 0.001) significantly correlated with the structural response to CRT in several prediction models. Among echocardiographic parameters, TAPSE remained the strongest predictive factor of positive response to CRT at the univariate and multivariate analyses. Conclusions: In patients with heart failure and reduced ejection fraction undergoing CRT, Gal-3 and TAPSE are significantly associated with a positive structural response to CRT.

Spontaneous coronary artery dissection (SCAD) is a distinct and increasingly recognized cause of acute coronary syndromes, primarily affecting young and middle-aged women with few cardiovascular risk factors. While SCAD often resolves spontaneously with conservative management, percutaneous coronary intervention (PCI) is sometimes necessary, especially in patients with ongoing ischemia or high-risk anatomical features. This review summarizes the current state of knowledge regarding the interventional approach in SCAD, emphasizing the rationale for conservative treatment, and the indications for and challenges associated with PCI. It also provides practical recommendations, particularly highlighting technical aspects of PCI in SCAD, the critical role of intracoronary imaging, and the modality and timing of post-PCI surveillance.