Background and purpose: Human neuropathological studies indicate that the pontine nucleus Locus Coeruleus (LC) undergoes significant and early degeneration in Alzheimer's disease. This line of evidence alongside experimental data suggests that the LC functional/structural decay may represent a critical factor for Alzheimer's disease pathophysiological and clinical progression. In the present prospective study, we used Magnetic Resonance Imaging (MRI) with LC‐sensitive sequence (LC‐MRI) to investigate in vivo the LC involvement in Alzheimer's disease progression, and whether specific LC‐MRI features at baseline are associated with prognosis and cognitive performance in amnestic Mild Cognitive Impairment.Methods: LC‐MRI parameters were measured at baseline by a template‐based method on 3.0‐T magnetic resonance images in 34 patients with Alzheimer's disease dementia, 73 patients with amnestic Mild Cognitive Impairment, and 53 cognitively intact individuals. A thorough neurological and neuropsychological assessment was performed at baseline and 2.5‐year follow‐up.Results: In subjects with Mild Cognitive Impairment who converted to dementia (n = 32), the LC intensity and number of LC‐related voxels were significantly lower than in cognitively intact individuals, resembling those observed in demented patients. Such a reduction was not detected in Mild Cognitive Impairment individuals, who remained stable at follow‐up. In Mild Cognitive Impairment subjects converting to dementia, LC‐MRI parameter reduction was maximal in the rostral part of the left nucleus. Structural equation modeling analysis showed that LC‐MRI parameters positively correlate with cognitive performance.Conclusions: Our findings highlight a potential role of LC‐MRI for predicting clinical progression in Mild Cognitive Impairment and support the key role of LC degeneration in the Alzheimer clinical continuum.

BACKGROUND: The clinical significance and outcome predictors of anomalous aortic origin of a coronary artery (AAOCA) in adults remains unclear. Therefore, the aim of this study was to analyze the clinical and prognostic implications of AAOCA in a large cohort of patients undergoing coronary computed tomography angiography (CCTA) in an Italian tertiary referral center. METHODS: Consecutive adults with AAOCA identified through CCTA from September 2004 to September 2024 were included. Data on clinical indications of CCTA, AAOCA subtypes, evidence of inducible myocardial ischemia, and concomitant coronary atherosclerotic disease were collected. Patients were followed up for the end points of all-cause mortality and major adverse cardiac events (nonfatal acute coronary syndromes, revascularization procedures, and heart failure hospitalization). Outcomes were compared with matched controls with normal coronary artery anatomy. RESULTS: Among 17 454 CCTAs performed over a span of 20 years, AAOCA was detected in 173 patients (62±15 years of age, n=58 women [34%]). Chest pain (34%) was the most common indication of CCTA. Obstructive coronary atherosclerotic disease was present in 36 patients (21%), and myocardial ischemia was detected in 60% of those (n=62) who underwent functional imaging testing. AAOCA repair was performed in 9 patients (5%), whereas the majority of patients were treated conservatively. After a median 37-month follow-up (17 to 69 months), mortality ( P =0.321) and major adverse cardiac events ( P =0.392) were similar between patients with AAOCA and controls. Only obstructive coronary atherosclerotic disease was associated with a higher event rate during follow-up, whereas AAOCA subtype and ischemia were not. CONCLUSIONS: In adults with AAOCA, concomitant obstructive coronary atherosclerotic disease is the primary determinant of adverse events. Given the low prevalence of AAOCA and event rates, multicenter registries are needed to refine risk stratification and management of these patients.

The concept of vascular age (VA) was proposed to provide patients with an understandable explanation of cardiovascular (CV) risk and to improve the performance of prediction models. The present study compared risk-based VA derived from Framingham Risk Score (FRS) and Systematic Coronary Risk Estimation (SCORE) models with value-based VA derived from the measurement of the common carotid artery (CCA) distensibility coefficient (DC), and it assessed the impact of DC-based VA on risk reclassification. In 528 middle-aged individuals apparently free of CV disease, DC was measured by radiofrequency-based arterial wall tracking that was previously utilised to establish sex- and age-specific reference values in a healthy population. DC-based VA represented the median value (50th percentile) for given sex in the reference population. FRS-based and SCORE-based VA was calculated as recommended. We observed a good agreement between DC-based and FRS-based VA, with a mean difference of 0.46 ± 12.2 years (p = 0.29), while the mean difference between DC-based and SCORE-based VA was higher (3.07 ± 12.7 years, p < 0.0001). When only nondiabetic individuals free of antihypertensive therapy were considered (n = 341), the mean difference dropped to 0.70 ± 12.8 years (p = 0.24). Substitution of chronological age with DC-based VA in FRS and SCORE models led to a reclassification of 28% and 49% of individuals, respectively, to the higher risk category. Our data suggest that the SCORE prediction model, in which diabetes and antihypertensive treatment are not considered, should be used as a screening tool only in healthy individuals. The use of VA derived from CCA distensibility measurements could improve the performance of risk prediction models, even that of the FRS model, as it might integrate risk prediction with additional risk factors participating in vascular ageing, unique to each individual. Prospective studies are needed to validate the role of DC-based VA in risk prediction.

Background/Objectives: This study compares the power of the radiofrequency (RF) signal reflected from the media layer (media power) of the common carotid artery (CCA) and the CCA stiffness between individuals with and without type 2 diabetes mellitus (T2DM). It also evaluates the associations of CCA media power with plasma glucose and lipid levels, as well as carotid stiffness. Methods: A total of 540 individuals, 115 with and 425 without T2DM (273 males, mean age = 64 ± 8 years) were studied using RF-based tracking of the right CCA. The following parameters were measured: CCA media thickness, luminal diameter, wall tensile stress (WTS), local pulse wave velocity (PWV), and media power. Results: Compared to the non-diabetic individuals, the T2DM patients had significantly higher CCA media thickness (652 ± 122 vs. 721 ± 138 microns, p < 0.005), luminal diameter (6.12 ± 0.78 vs. 6.86 ± 0.96 mm, p < 0.0005), media power (36.1 ± 4.8 vs. 39.3 ± 4.6, p < 0.0001), and PWV (7.65 ± 1.32 vs. 8.40 ± 1.89 m/s; p < 0.01), but comparable WTS (32.7 ± 10.4 vs. 33.1 ± 10.7 kPa; p = 0.25). In the entire population, CCA media power was independently associated with male sex, pulse pressure, current smoking, and T2DM; when T2DM was not included in the model, triglycerides emerged as an independent determinant of media power. The CCA PWV was independently associated with age, pulse pressure, media power, and T2DM. Conclusions: Our findings suggest the presence of structural changes in the arterial media of T2DM patients, leading to carotid stiffening and remodeling, aiming to preserve WTS. T2DM-related changes in arterial wall composition may be driven by high plasma triglyceride levels, which have previously been associated with both arterial stiffening and the incidence of CV events.