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Aortic stenosis is the most frequent valvular disease to require intervention in the western world and has always been featured as a progressive disease. The rate of progression can be assessed by carefully performed Doppler echocardiography and can vary greatly between individuals with a profound impact on prognosis. Unfortunately, the determinants of disease progression had been insufficiently studied and remain challenging to define, particularly in the outpatient setting. Multiple factors have been proposed and tested, but at present, there are no proven therapies to slow the course of the stenotic process. Heart valve clinics may be particularly important to define the progression rate and tailor follow-up and management at an individual level. This review enlightens knowledge and gaps regarding the progression-rate of aortic valve stenosis, from the historical perspective to the molecular one.

The right heart has been traditionally considered a passive conduit between the venous system and the lungs. Today, we know that a close hemodynamic interdependence exists between right ventricle, pulmonary circulation, and left ventricle, and that the right ventricle plays a key role in the ability to adapt to many super-physiological and pathological conditions. Dynamic exercise is a considerable stress for the "right heart-pulmonary circulation unit", which responds, in healthy subjects, with an increase of right ventricular contractility and cardiac output, a decrease of pulmonary vascular resistance, and a non-significant rise in pulmonary pressures. In patients affected by cardiac and/or pulmonary diseases (e.g. ischemic heart disease, heart failure, severe valvular stenosis or regurgitation, systemic sclerosis, chronic obstructive pulmonary disease, etc.) right ventricular contractile reserve may be impaired, and pulmonary artery systolic pressure may abnormally increase during exercise. From this perspective, stress echocardiography is a primary tool to evaluate right ventricle and pulmonary circulation during exercise, and can be useful in setting diagnosis, prognosis, and therapeutic timing of many cardiopulmonary diseases.

The right heart has been traditionally considered a passive conduit between the venous system and the lungs. Today, we know that a close hemodynamic interdependence exists between right ventricle, pulmonary circulation, and left ventricle, and that the right ventricle plays a key role in the ability to adapt to many super-physiological and pathological conditions. Dynamic exercise is a considerable stress for the "right heart-pulmonary circulation unit", which responds, in healthy subjects, with an increase of right ventricular contractility and cardiac output, a decrease of pulmonary vascular resistance, and a non-significant rise in pulmonary pressures. In patients affected by cardiac and/or pulmonary diseases (e.g. ischemic heart disease, heart failure, severe valvular stenosis or regurgitation, systemic sclerosis, chronic obstructive pulmonary disease, etc.) right ventricular contractile reserve may be impaired, and pulmonary artery systolic pressure may abnormally increase during exercise. From this perspective, stress echocardiography is a primary tool to evaluate right ventricle and pulmonary circulation during exercise, and can be useful in setting diagnosis, prognosis, and therapeutic timing of many cardiopulmonary diseases.

Background: Clinical and experimental evidence suggest that testosterone levels play a role in cardiac and vascular pathology. A long history of observational studies investigating serum testosterone level and cardiovascular risks, specifically mortality, reveals important associations between low testosterone and mortality, while higher serum testosterone level appear to be predictive in the majority of studies. On the other hand, it is well documented and accepted that endothelial dysfunction is expression of preclinical atherosclerosis and it is associated with an increased amount of CV events in the follow-up. Erectile dysfunction is also an early manifestation of arteriosclerosis associated with endothelial damage/dysfunction. Endothelial function plays a very important role in the process of erection. Moreover, erectile dysfunction and coronary artery disease (CAD) overlap in risk factors, etiology and clinical outcomes. Endothelial dysfunction is considered to be their shared etiological factor. There is growing evidence that patients presenting with erectile dysfunction should be investigated for CAD, even if with no symptoms of the problem. Earlier diagnosis of erectile dysfunction can facilitate prompt intervention, reduce long-term complications, especially the risk of CAD, and provide effective treatment for erectile dysfunction. Objectives: We aimed to assess whether baseline testosterone levels may be predictors of future CV events in a cohort of patients at intermediate cardiovascular risk. Methods: Our cohort included 802 adult subjects, males from 40 to 80 years (mean age of the whole population was 57.52±13.85 years old). Thy were at intermediate cardiovascular risk, according to the Framingham risk score and all referred between 2009 and 2014. Patients were excluded if they had a past history of peripheral artery disease, coronary revascularization, angina pectoris, myocardial infarction, carotid surgery or cerebrovascular event. The study of the endothelial function was performed by using the method of flow mediated vasodilation. Moreover, it was administered a standard questionnaire for the evaluation of the erectile function and the dosage of the plasma testosterone was carried out. The median follow-up time for major CV events was 5.1 years. Results: Patients with lower serum testosterone levels (n=332) had a higher prevalence of traditional CV risk factors, such as hypertension (p=0.009), diabetes (p=0.03), dyslipidemia (p

Scopo del lavoro Il ruolo dei livelli di testosterone plasmatico e della disfunzione erettile come marcatori precoci di disfunzione endoteliale non è ben definito. Pertanto, abbiamo cercato di analizzare la relazione tra testosterone plasmatico e disfunzione erettile, in rapporto alla funzione endoteliale. Materiali e metodi Abbiamo quindi arruolato 802 pazienti in prevenzione primaria, con una stima di rischio cardiovascolare (CV) intermedio secondo la carta del rischio di Framingham, di età compresa fra 40 e 80 anni, che si sono sottoposti all’esame ecografico della dilatazione flusso mediata dell’arteria brachiale destra, alla valutazione della disfunzione erettile attraverso il questionario International index of erectile function-5 score (IIEF-5) , e al dosaggio dei livelli plasmatici di testosterone totale. Risultati All’analisi di regressione lineare, con l’aumentare dei livelli di testosterone, aumentavano in maniera statisticamente significativa sia la funzione endoteliale (t=9.40; 95% CI da 0.9318 a 1.4234; p < 0.0001) che la funzione erettile (t=8.96; 95% CI da 0.7642 a 1.1932; p< 0,001) sia con la disfunzione erettile severa (OR 0,78; CI 0,62 -0,86), e moderata (OR 0,85; CI 0,72 - 0,97) che con una peggiore funzione endoteliale [(OR 0,68; CI 0,59- 0,79) e (OR 0,76; CI 0,63 - 0,83) rispettivamente]. Invece, le forme più sfumate di disfunzione erettile come quella lieve (OR 0.94; CI 0.82 - 1.07; p=0.03) e lieve-moderata (OR 0,8; CI 0,69 - 0,94; p Discussione Abbiamo quindi dimostrato una correlazione significativa tra livelli più bassi di testosterone plasmatico totale, disfunzione erettile ed una peggiore funzione endoteliale in una popolazione di soggetti asintomatici e a rischio CV intermedio. In particolar modo, nel sottogruppo di pazienti con disfunzione erettile moderatasevera, abbiamo visto che coloro che hanno livelli più bassi di testosterone hanno anche delle percentuali di dilatazione flusso mediata inferiori, e quindi una peggiore funzione endoteliale. Conclusioni Sulla base di questi risultati, consigliamo la valutazione della disfunzione erettile attraverso l’IIEF-5, e il dosaggio dei livelli di testosterone totale plasmatico, per ottenere una stratificazione più accurata del rischio CV nei pazienti asintomatici, ma con rischio intermedio secondo le stime della carta di Framingham.

Coronary flow reserve is the capacity of the coronary circulation to augment the blood flow in response an increase in myocardial metabolic demands and has a powerful prognostic significance in different clinical situations. It might assess with invasive and noninvasive technique. Transthoracic echocardiography Doppler is an emerging diagnostic technique, noninvasive, highly feasible, safe for patient and physician, without radiation, and able to detect macrovascular and microvascular anomalies in the coronary circulation. This review aims to describe the benefit and limits of echocardiographic assessment of coronary flow reserve.

Cor pulmonale is the condition in which the right ventricle undergoes morphological and/or functional changes due to diseases that affect the lungs, the pulmonary circulation, or the breathing process. Depending on the speed of onset of the pathological condition and subsequent effects on the right ventricle, it is possible to distinguish the acute cor pulmonale from the chronic type of disease. Echocardiography plays a central role in the diagnostic and therapeutic work-up of these patients, because of its non-invasive nature and wide accessibility, providing its greatest usefulness in the acute setting. It also represents a valuable tool for tracking right ventricular function in patients with cor pulmonale, assessing its stability, deterioration, or improvement during follow-up. In fact, not only it provides parameters with prognostic value, but also it can be used to assess the efficacy of treatment. This review attempts to provide the current standards of an echocardiographic evaluation in both acute and chronic cor pulmonale, focusing also on the findings present in the most common pathologies causing this condition.

In recent years, the survival of patients with cancer has improved thanks to advances in antineoplastic therapeutic protocols. This has led to an increasing burden of cardiovascular complications related to cancer treatment. Therefore, a new branch of cardiology has been created, ``cardio-oncology,'' with the aims of preventing cardiovascular complications related to antineoplastic treatment, achieving early diagnosis and treatment of any complications, and allowing completion of the expected antineoplastic treatment. Stress echocardiography has a pivotal role in achieving a timely diagnosis of coronary artery disease and thus is the best management approach in this clinical setting. Atherosclerotic processes can be exacerbated by both chemotherapy and chest irradiation in patients with cancer, even several years after anticancer treatment completion. Moreover, stress echocardiography has many other potential applications, such as in the evaluation of subclinical left ventricular dysfunction and contractile reserve in patients treated with anticancer drugs that have the potential to induce myocardial damage, as well as evaluating valve disease. The objective of this review is to delineate the role of stress echocardiography in cardio-oncology.

Arterial hypertension, a widespread disease, whose prevalence increases with age, represents a major risk factor for cardiovascular events, causing damage in several organs, including the heart. In this context, echocardiography has a clear and pivotal role, being able to assess cardiac morphology and detect haemodynamic changes induced by this disease. 2018 European Society of Cardiology/European Society of Hypertension guidelines on AH identified main echo parameters such as left ventricular mass, relative wall thickness and left atrial volume, for detecting cardiac organ damage. The present review highlights the advantage of additional echocardiographic parameters such as diastolic measurement and both thoracic and abdominal aortic dimensions. An overlook on aortic valve should also be suggested to detect aortic regurgitation and stenosis, both frequent complications in hypertensive patients. In this kind of comprehensive assessment, the combination of standard and advanced echocardiography (speckle tracking echocardiography and, with a lesser extent, three-dimensional echocardiography) could be considered to improve the diagnostic accuracy, stratify prognosis and address management in arterial hypertension.

To analyze left ventricular myocardial deformation and contractile reserve in endurance athletes at rest and during exercise, and their possible correlations with functional capacity. The athlete’s heart in endurance training is characterized by physiologic eccentric remodeling, with left ventricle adaptation at rest and echocardiographic parameters at low end of normality. Assessment of left ventricle systolic function and contractile reserve has an important role in the decision-making and in differential diagnosis with cardiomyopathies. Standard echo, lung ultrasound, left ventricle 2D speckle-tracking strain and myocardial work were performed at rest and during exercise in endurance athletes and in age- and sex-comparable healthy controls. 350 endurance athletes (male sex 58.5%; 31.6 ± 4.2 years) and 150 healthy controls were enrolled. Left ventricular ejection fraction at baseline was comparable between the two groups. Resting left ventricular global longitudinal strain was reduced in endurance athletes (− 18.4 ± 2.6% vs. − 22.4 ± 3.3% in controls; p

Advanced chronic heart failure (ACHF) is the last phase in the evolution of heart failure and is characterized by high hospitalization and mortality rates and is refractory to medical therapy, therefore requiring more aggressive therapies, such as mechanical circulatory support or heart transplantation. Over the last years, the incidence of ACHF was continuously growing, together with the increase in population survival rates. Therefore, the early recognition of the transition to ACHF is of crucial importance in HF patients, which also helps in prognostication of such patients, since advanced therapeutic options are limited to selected patients and they also have some important risk implications. Echocardiography is the gold standard tool for the evaluation of patients with HF; moreover, the recent technological advances provided new structural and functional indices of the four cardiac chambers that showed to be comparable to advanced imaging or invasive hemodynamic parameters. This allows us to operate an accurate study of ACHF with first- and second-level echocardiographic techniques, which are now being integrated in daily clinical practice. The present review presents an overview of the currently available tools for the echocardiographic examination of patients with ACHF, with its advantages and limitations, based on the latest supporting evidences.

Background: The role erectile dysfunction (ED) coupled with low testosterone levels as early markers of atherosclerosis is not well understood. Objectives: To analyze the relationship between serum testosterone levels with both ED and brachial artery flow-mediated vasodilation (FMD), in a primary prevention sample of men. Methods: We enrolled 802 asymptomatic, intermediate CV risk patients, according to the Framingham Risk Score, aged 40e80 years, who underwent the ultrasound examination of FMD, the evaluation of ED and the assessment of total serum testosterone levels. Results: Testosterone levels correlated both with FMD (r ¼ 0.85; p < 0.0001) and IIEF-5 score (rs ¼ 0.65; p < 0.0001). Multivariable logistic regression analyses revealed that lower serum testosterone levels were strongly associated (p < 0.001) with severe (OR 0.78; 95% CI: 0.62e0.86), and moderate ED (OR 0.85; 95% CI: 0.72 e0.97), while impaired FMD percentages were strongly associated (p < 0.001) with severe (OR 0.68; 95% CI: 0.59e0.79), moderate (OR 0.76; 95% CI: 0.63e0.83) and mild to moderate ED (OR 0.8; 95% CI: 0.69 e0.94). Mild ED resulted statistically associated with lower FMD (OR 0.94; 95% CI: 0.82 e 1.07; p ¼ 0.03) but not with serum testosterone levels. These relations were not substantially affected by adjustments for further potential confounders including smoking status, hypertension, diabetes mellitus and body mass index. Conclusions: lower total serum testosterone levels are associated with impaired FMD and ED in this sample of intermediate CV risk men according to the Framingham Risk Score

Anemia; NSTEMI

Background. The value of testosterone levels and erectile dysfunction (ED) as early markers of atherosclerosis is not well understood. Objectives. To analyze the relationship between plasma testosterone levels in men with both endothelial function (F) and ED. Methods. We enrolled 802 asymptomatic, intermediate cardiovascular risk patients, according to the Framingham Risk Score, aged 40 to 80 years, who underwent the study of EF, evaluation of ED and dosage of plasma testosterone. Results. At linear regression, EF (t=9.40; 95% CI from 0.9318 to 1.4234; p

Materials and Methods. We evaluated a series of 802 patients with intermediate cardiovascular risk according to the Framingham Risk Score (FRS). The endothelial function through flow-mediated vasodilatation (FMD), the erectile function (EF), and the total serum testosterone levels were assessed. Patients were followed for up to 5 years and the prevalence and predictors of MACEs were evaluated. Results. The levels of serum testosterone are related with both endothelial function (FMD) (t=9,4080, 95% CI= 0,9318 to 1,4234, p

Storicamente il cristianesimo deve molto al giudaismo. Il cristianesimo di San Paolo, tuttavia, ha cambiato il modo di ragionare su concetti come il sé, il corpo, e la cognizione umana. Senza volere trattare certi concetti teologici, mi prefiggo di sottolineare come il punto di vista della scienza moderna è più vicino al giudaismo tradizionale che al cristianesimo, e di spiegare la diffusione dell’“errore” di Paolo nel mondo occidentale, analizzando la semantica dei riferimenti linguistici (e in particolar modo le metafore e le metonimie) dei concetti anima e corpo e del rapporto con la concezione del sé. Cresciuto da “uomo franco” cioè, da cittadino romano in un ambiente cosmopolita, Paolo è considerato il testimone più influente e produttivo del pensiero cristiano nell’Asia Minore e nell’Europa Occidentale. Le sue epistole circolarono durante la sua vita e continuano ad influenzare miliardi di seguaci, i quali spesso interpretano le sue idee in modo contrastante, ma ciononostante attestando una specifica autorevolezza. Erudito greco-romano, inizialmente persecutore dei primi Cristiani, Paolo ha lottato per diffondere la storia di Gesù di Nazareth. La sua ideologia, infatti, è stata vista da molti come un amalgama tra il pensiero greco-romano e ciò che egli stesso ha appreso dai primi cristiani. Queste caratteristiche elleniche, più o meno reali, del sistema religioso introdussero una differenza significativa all’interno del pensiero giudaico tradizionale, dal quale, per mezzo dell’influenza dei suoi scritti, si sarebbe sviluppato il credo cristiano. Di fatti, il cristianesimo ha acquisito una struttura più coerente grazie a Paolo, quasi da inferire che la fede cristiana deve più a Paolo che a Gesù. Quale era l’errore di San Paolo? La domanda vuole essere sia allusiva che provocatoria. L’insegnamento giudaico a proposito del concetto del sé era piuttosto olistico. Per esempio, la parola ebraica nephesh è spesso tradotta come “anima” ma, metaforicamente, significa anche “corpo”, mentre, secondo i suoi interpreti, Paolo chiaramente fa delle distinzioni dualistiche, e parlando della “concupiscenza” predica la necessità di dominare la carne per esaltare lo spirito. Con gli strumenti della linguistica cognitiva, propongo un’analisi della polisemia e degli slittamenti semantici nei concetti di ANIMA e CORPO, e come l’autorità attribuita a Paolo eventualmente ha influenzato il pensiero occidentale sul ragionare di queste rappresentazioni mentali.

In this essay a hermeneutic model of the higher level understanding during on-line ritual reading by devotees of their respective sacred literatures is proposed, using the instruments provided by cognitive sciences. The way a devotee reads a sacred text differs from the way he or she would read a common piece of literature or how a lay person might read the same sacred text. After providing an overview of metaphor, anthropomorphism, and the “religious brain”, it is suggested how devotee-readers might make sense of a religious text and why it should be so important for their own personal everyday life. Universals are implicated in this genre of literature and the way it is interpreted.

THE BEGINNINGS OF SYMBOLIC-RELIGIOUS COGNITION - Cognitive Archeology and Cognitive Fluidity: About 30,000 years ago (70,000 years after the fossil records of the anatomically modern human), religious thought and symbolic conceptual activity arose from the capacity of integrating specific-domain a process called "cognitive fluidity" (Mithen 1996). Metaphor, Anthropomorphism and Cognitive Science: Metaphor is a basic mental capacity by which people understand themselves and the world around them through conceptual mappings of knowledge between mental spaces, using everyday knowledge to reason about more abstract concepts. Of all the templates for supernatural concepts, the ones that seriously matter to people are invariably person-like, because people are the most complex type of object that people know (Boyer 2001). WHY GOD AS AN EROTIC LOVER? - Diffusion and elaboration of religious memes: To reason about the ties between divine and human, man looks at his repertoire of human relationships, and the more significant ones are used to explain and speak of re-ligio. There are many metaphors used to represent the relationship between the divinity and the devotee (father/child, doctor/patient, teacher/pupil, etc.) The most significant relationship chosen by the mystic in terms of balance is Lover-Beloved. Blending between God and Lover: The idealized conceptual models of the Divinity/beloved and of a devotee/lover began to blend through composition, completion and elaboration. The concept of human love relationship of these ancient cultures probably needs to be re-evaluated by modern students if it had become such an entrenched concept to be used as a source for a cognitive input space. BLENDING THE EROTIC AND THE RELIGIOUS - Examples of erotic religious texts and emergent structure: Sir hassirim, or Song of Songs (Judeo-Christian); Jayadeva’s Gita Govinda (Hindu); Rumi’s Mathanawi (Islam). Strongly erotic in content, these are part of the canons of the respective religious traditions, and so have deeply influenced subsequent elaboration of the erotic symbolism The lover (the faithful) and the Beloved (the Divinity) are usually on a par, and the domination of one is hardly ever present. Poetic descriptions include psychological states of jealousy, passion, separation and reunion, and ultimate union. The time of reunion is spring and the place is nature. What emerges is a relationship that not only unilaterally satisfies the material and spiritual needs of the religious person, but is reciprocal. In other words, the needs of both parties are fulfilled (devotee: food, explanations; god: praise, sacrifice). Moreover, due to the blend, an emotional need is also fulfilled. The dignity of the woman is finding her place in society, like the devotee finds his/her place in his/her creator’s creation, and so their relationship must be lived in the same natural setting. Because of the fusion between counterpart input spaces, there is a completion that humanizes the divinity so it becomes a he, the Man, motivated by the dominating role. However the elaboration of the blend tends to eliminate any domination in the relationship, as the needs of both sides are equal, and only when they are united do they feel completely realized. Their place is in nature, at it’s most energetic and vibrant moment of springtime (ideally the time of life), and the time is eternal.