University of Modena and Reggio Emilia

Women with aortic stenosis (AS) are underdiagnosed and undertreated compared to men and face a higher mortality risk despite similar symptoms and fewer comorbidities. Sex-specific differences in left ventricular (LV) remodeling may contribute to this disparity. We investigated whether a fully automated, machine-learning-based three-dimensional echocardiography (3DE) approach, the Dynamic Heart Model (DHM), improves the detection of these differences compared to conventional two-dimensional echocardiography (2DE). This study investigates sex-related differences in cardiac remodeling and hemodynamics in AS patients with a preserved ejection fraction (EF ≥ 50%), comparing results from 2D echocardiography (2DE) and 3D echocardiography (3DE) via the DHM. The study included 101 consecutive patients with AS (42% women) who were assessed with 2DE and DHM. Parameters such as LV volumes, mass (LVM), stroke volume (SV), and aortic valve area (AVA) were measured and indexed to body surface area (BSA). Sex-specific differences were analyzed, with a focus on identifying significant remodeling patterns. Women exhibited smaller LV end-diastolic volume (EDV) and end-systolic volume (ESV) by DHM compared to men (115 mL vs. 155 mL, p < 0.001; 51 mL vs. 66 mL, p < 0.001). Indexed EDV (EDVi) and ESV (ESVi) were also significantly lower in women (69 mL/m² vs. 84 mL/m², p < 0.001; 30 mL/m² vs. 34 mL/m², p = 0.002). LVM and indexed LV mass (LVMi) were significantly lower in women when measured by DHM (131g vs. 163g, p < 0.001; 75g/m² vs. 89g/m², p = 0.005), whereas 2DE did not reveal statistically significant differences. Women exhibited a more concentric LV geometry, as reflected by higher relative wall thickness than men (0.42 vs. 0.36; p = 0.04). Despite similar hemodynamic parameters, women had significantly smaller DHM-derived AVA (0.90cm² vs. 1.20cm², p < 0.001), correlating with reduced SV (64 mL vs. 90 mL, p < 0.001). This study highlights that significant sex-related differences in LV remodeling and AS severity are better captured by DHM than 2DE, emphasizing the importance of sex-specific considerations and accurate measurements in evaluating and managing AS.

The 4th UN General Assembly declaration on non-communicable diseases (NCDs) and mental health, adopted on Dec 15, 2025, was notable for its explicit inclusion of dementia, bringing dementia prevention into focus as an international public policy priority.1 A central question therefore becomes how dementia prevention will be prioritised, resourced, and implemented and how it will be integrated into existing NCD policies and health-system strategies (appendix).

Mental disorders and chronic pain frequently co-occur. The prevalence of this comorbidity varies widely across investigations and is certainly overestimated using screening self-reports. The main aim of this cross-sectional research was to calculate prevalence rates of mental disorders in a chronic pain population during their first consultation in an Italian specialized pain clinic using the narrow diagnostic criteria of the DSM-5. Additionally, we examined the relationship between this psychiatric comorbidity and a broad range of socio-demographic and clinical parameters related to chronic pain. 174 participants were enrolled in the Pain Therapy Service at the Parma University Hospital. They completed the Structured Clinical Interview for DSM-5 mental disorders (SCID-5) and the Brief Pain Inventory (BPI). Associations between psychiatric comorbidity and other parameters were explored using regression analyses. 57 (32.7%) subjects with chronic pain had DSM-5 psychiatric comorbidity, particularly major depression and anxiety disorders. This comorbid psychopathology showed significant associations with BPI pain severity and interference scores, as well as with the presence of widespread chronic pain (including fibromyalgia) and the prescription of anti-neuropathic medication at entry. Notably, only a minority (n=18; 31.6%) of these participants with current comorbid mental disorders were treated in psychiatric services. A large portion of chronic pain patients with comorbid psychiatric syndromes remain undiagnosed and undertreated. The presence of mental health operators in multidisciplinary chronic pain teams is justified and recommended.