Background Stereotactic arrhythmia radioablation (STAR) may represent an alternative to standard catheter ablation (CA) for treatment of refractory ventricular arrhythmias (VA). Most STAR treatments performed to date have used photon radiotherapy. However, protons have advantageous ballistic properties suitable for this application, potentially improving sparing of organs at risk (OARs). Methods ECG-gated CT scans and electroanatomical mapping were performed to reconstruct a 3D bipolar voltage map and identify ablation targets in a cohort of patients with VA candidates for CA. Three radiation treatment modalities were investigated/compared using the breath-hold technique: photon volumetric modulated arc therapy (VMAT) and proton active pencil beam scanning delivered with/without cardiac gating. When cardiac gating was applied, the diastolic phase—longer and more stable than the systolic one—was selected as the reference. Results Twenty-three patients were enrolled, and three presented multifocal ventricular arrhythmias, resulting in a total of 27 treatment targets. Both photon and proton plans achieved adequate target coverage. Compared with photon plans, proton therapy showed a statistically significant reduction in the mean maximum dose to several OARs and to important non-target cardiac structures (coronary arteries, valvular apparatus and right atrium) while maintaining comparable target coverage. These findings were consistent for proton plans with and without cardiac gating. In a subset of 14 patients, cardiac gating provided additional reductions in dose to healthy cardiac tissue. Conclusions This in-silico study suggests that STAR using proton beams may significantly reduce radiation exposure to non-target cardiac substructures and surrounding extracardiac OARs, regardless of the cardiac motion management strategy adopted.
Background As people living with HIV (PWH) age, the prevalence of comorbidities such as cardiovascular disease, diabetes, and dyslipidemia is increasing, leading to greater polypharmacy. Lifelong antiretroviral therapy (ART) therefore requires regimens that are not only virologically effective and well tolerated, with a high genetic barrier and minimal drug–drug interactions, but also metabolically neutral. Since antiretroviral drugs may influence metabolic parameters, the selection of regimens with a favorable cardiovascular and metabolic profile is of growing importance. This study evaluated the efficacy, safety, tolerability, and metabolic impact of switching from TAF/FTC/RPV to BIC/TAF/FTC in a single-center real-life cohort. Methods We conducted a retrospective analysis of 126 PLWH who switched from TAF/FTC/RPV to BIC/TAF/FTC between June 2020 and January 2025. Virological efficacy, safety, and tolerability were assessed over 48 weeks. Metabolic and cardiovascular effects were evaluated by changes in FINDRISC and ASCVD risk scores at week 48, as well as by variations in lipid profile, glucose levels, body weight, body mass index (BMI), and renal function. Results The cohort included 126 patients, 82% male, with a median age of 57 years (IQR 52–65) and a median of three prior ART regimens. At baseline, all participants had HIV-RNA < 20 copies/mL and a median CD4 + T-cell count of 872 cells/µL (IQR 646–1093). At least one comorbidity was present in 89.7% of patients, most commonly cardiovascular (36.3%), bone (32.3%), central nervous system (18.6%), liver (16.2%), lipid disorders (25.7%), and glucose metabolism alterations (10.9%); 16% had HBV coinfection. No virological failures were observed during follow-up. Treatment discontinuation occurred in four patients due to death (one prostate cancer) or intolerance (three cases: insomnia, gastrointestinal disorder, headache). No significant changes were observed in FINDRISC or ASCVD scores at week 48. Lipid parameters, glucose levels, and creatinine remained stable over time. Conclusions Switching from TAF/FTC/RPV to BIC/TAF/FTC maintained virological suppression and demonstrated good safety and tolerability, with no clinically significant impact on metabolic or cardiovascular risk over 48 weeks
Background: Cardiac calcified amorphous tumours (CATs) are rare non-neoplastic intracardiac masses characterized by calcified nodules within an amorphous fibrinous matrix and may clinically mimic thrombi or cardiac neoplasms. We report two uncommon cases of right atrial CAT occurring in young women and provide a narrative review of the literature. Methods: Two patients with right atrial CAT underwent multimodality imaging evaluation, including echocardiography, computed tomography, and cardiac magnetic resonance, followed by surgical excision and histopathological examination. A narrative review of published cases identified through PubMed and Embase between 1972 and 2025 was also performed. Results: The first patient presented with a calcified right atrial mass extending into the superior vena cava, associated with superior vena cava syndrome and autoimmune disease. The second patient, affected by end-stage renal disease on hemodialysis and thrombophilia, presented with a large calcified right atrial mass associated with a retained dialysis catheter fragment. Histopathological examination confirmed CAT in both cases. The literature review identified 112 published reports comprising 143 patients, including the two cases presented herein, highlighting frequent associations with end-stage renal disease, mitral annular calcification, and embolic complications. Conclusions: Cardiac CAT remains a rare and likely underrecognized entity with heterogeneous clinical presentation and significant embolic potential. Multimodality imaging is essential for diagnosis and surgical planning, while early surgical excision should be considered in symptomatic or high-risk patients.
Background Immune checkpoint inhibitor doublet (ICI–ICI) and ICI plus tyrosine kinase inhibitor (ICI–TKI) regimens are the cornerstone of treatment for metastatic renal cell carcinoma (mRCC), although no head-to-head comparisons are currently available. This study aimed to compare the real-world effectiveness of ICI-ICI vs ICI-TKI combinations in patients with intermediate- and poor-risk mRCC according to International Metastatic RCC Database Consortium (IMDC). Methods The Meet-URO 33 study is a multicentre retrospective-prospective registry collecting real-world data on patients with mRCC. Multivariable logistic and Cox models were built for objective response rate (ORR), PFS and OS, with a propensity score (PS) adjustment for baseline imbalances. Results Among 1497 patients, 755 were intermediate-risk (199 ICI-ICI, 556 ICI-TKI) and 312 poor-risk (77 ICI-ICI, 212 ICI-TKI). Median follow-up was 14.2 months (8.0 months and 14.5 months in poor- and intermediate-risk subgroups, respectively). In poor-risk patients, median OS was 20.3 vs 12.9 months (HR 0.87, 95% CI: 0.59–1.28, p = 0.49), and median PFS was 6.7 vs 8.7 months (HR 1.10, 95% CI: 0.79–1.54, p = 0.53), for ICI–ICI vs ICI–TKI, respectively. In the intermediate-risk patients treated with ICI-ICI vs ICI-TKI, median OS was 37.8 vs 35.5 months (HR: 1.08; 95% CI: 0.77–1.50; p = 0.65), and median PFS was 17.8 vs 18.6 months (HR 1.29, 95% CI: 1.00–1.66, p = 0.050). ORR was 42.9% vs 45.8% in poor-risk patients (OR 0.72, 95% CI: 0.39–1.34, p = 0.303) and 48.1% vs 54.3% in intermediate-risk patients (OR 0.71, 95% CI: 0.48–1.04, p = 0.075). Conclusions No statistically significant differences in survival or response were observed between ICI-ICI and ICI-TKI combinations in patients with IMDC intermediate- and poor-risk mRCC.
