Constantina Aggeli

First In Vivo Application of Microwave Radiometry in Human Carotids: A New Noninvasive Method for Detection of Local Inflammatory Activation

OBJECTIVES This study investigated whether temperature differences: 1) can be measured in vivo noninvasively by microwave radiometry (MR); and 2) are associated with ultrasound and histological findings. BACKGROUND Studies of human carotid artery samples showed increased heat production. MR allows in vivo noninvasive measurement of internal temperature of tissues. METHODS Thirty-four patients undergoing carotid endarterectomy underwent screening of carotid atherosclerosis by ultrasound and MR. Healthy volunteers were enrolled as a control group. During ultrasound study, plaque texture, plaque surface, and plaque echogenicity were analyzed. Temperature difference (ΔT) was assigned as maximal minus minimum temperature. Association of thermographic with ultrasound and histological findings was performed. RESULTS ΔT was higher in atherosclerotic carotid arteries compared with the carotid arteries of controls (p < 0.01). Fatty plaques had higher ΔT compared with mixed and calcified (p < 0.01) plaques. Plaques with ulcerated surface had higher ΔT compared with plaques with irregular and regular surface (p < 0.01). Heterogeneous plaques had higher ΔT compared with homogenous (p < 0.01). Specimens with thin fibrous cap and intense expression of CD3, CD68, and vascular endothelial growth factor (VEGF) had higher ΔT compared with specimens with thick cap and low expression of CD3, CD68, and VEGF (p < 0.01). CONCLUSIONS MR provides in vivo noninvasive temperature measurements of carotid plaques, reflecting plaque inflammatory activation.

Myocardial ischaemia without obstructive coronary artery disease in rheumatoid arthritis: hypothesis-generating insights from a cross-sectional study

OBJECTIVE RA is associated with increased cardiovascular events, reportedly to equal diabetes mellitus (DM). The presence of myocardial ischaemia was assessed in asymptomatic high-risk RA patients and compared with patients with DM and a healthy control group. METHODS Eighteen consecutive non-diabetic RA patients without known cardiovascular disease who developed a new carotid atheromatic plaque during the last 3 years were matched 1:1 for traditional cardiovascular risk factors with asymptomatic type 2 DM patients and 1:2 with asymptomatic non-RA, non-DM control subjects. After dobutamine stress contrast echocardiography with wall-motion and perfusion evaluation, coronary angiography was performed in those with positive stress tests. RESULTS Ischaemia by echocardiography was found in 67% of RA patients; this was significantly higher than controls (31%, P = 0.019) but comparable to those with DM (78%, P = 0.71). Angiography performed in eight consenting RA patients was normal in four, revealed non-flow-limiting coronary atheromatic lesions in two and significant lesions in two patients. RA patients with ischaemia had CRP serum levels significantly higher by six-fold compared with those with normal stress echocardiography. CONCLUSION Asymptomatic RA patients may display myocardial ischaemia at similar levels to DM patients but with low prevalence of obstructive coronary artery disease. Microvascular abnormalities associated with increased inflammatory response may account for these findings. Their exact nature and significance require further evaluation.

Myocardial mechanics for the early detection of cardiac sarcoidosis

Background: Speckle tracking has emerged as valuable tool for comprehensive assessment of regional myocardial function, providing angle-independent measurements of ventricular strain. Aim of this study was to evaluate left ventricular (LV) function in patients with newly diagnosed sarcoidosis, utilizing the novel method of 2D speckle tracking. Methods: Forty one patients with sarcoidosis and unremarkable medical history of cardiovascular disease, as well as 20 healthy age- and gender-matched controls underwent echocardiographic study. Apical 4-,2-,3- chamber as well as short axis acquisitions were made. In addition to conventional 2D, Doppler and TDI measurements, speckle tracking echocardiography was applied and LV global longitudinal strain was derived from the obtained images. Moreover, LV base and apex rotation angles were assessed from which LV twist was derived. Results: The mean age of patients (17 men) was 41 ± 6.5 years old. Compared with controls, patients had similar conventional 2D and Doppler measurements. TDI revealed increased E/E9 in the patient group vs control group (8.72 ± 1.65 vs 4.6 ± 1.32, p Conclusions: Speckle tracking echocardiography revealed impaired strain and rotational indices, implying elevated filling pressures of the left ventricle. This may represent a sign of myocardial involvement in patients with sarcoidosis. Therefore deformation imaging could be valuable adjunct for screening.

In vivo measurement of plaque neovascularisation and thermal heterogeneity in intermediate lesions of human carotid arteries

Objectives Both neoangiogenesis and inflammation contribute in atherosclerosis progression. Contrast-enhanced ultrasound (CEUS) provides visualisation of plaque neovascularisation. Microwave radiometry (MR) allows in vivo non-invasive measurement of temperature of tissues, reflecting inflammatory activation. We assessed the association of carotid plaque temperature, measured by MR, with plaque neovascularisation assessed by CEUS in intermediate lesions. Methods Consecutive patients with coronary artery disease and carotid atherosclerosis underwent carotid ultrasound imaging, CEUS and MR. Plaque texture, plaque surface and plaque echogenicity were analysed. Contrast enhancement (CE) by CEUS was defined as the % percentage of signal intensity difference, prior and post contrast infusion. Thermal heterogeneity (ΔT) was assigned as maximal temperature along the carotid artery minus minimum. Results Eighty-six carotid arteries of 48 patients were included. Fatty plaques had higher CE% and ΔT compared with mixed and calcified (p<0.01 for all comparisons). Heterogeneous plaques had higher CE% and ΔT compared with homogenous (p<0.01 for all comparisons). Plaques with irregular surface had higher CE% and ΔT compared with plaques with regular (p<0.01 for all comparisons). There was a good correlation between ΔT and CE (R=0.60, p<0.001). Conclusions Carotid plaque neovascularisation on CEUS examination is associated with increased thermal heterogeneity and ultrasound characteristics of plaque vulnerability in intermediate lesions.

Echocardiographic and signal averaged ECG indices associated with non-sustained ventricular tachycardia after repair of tetralogy of Fallot

OBJECTIVE To identify any possible association between different readily available non-invasive indices and potential malignant ventricular arrhythmias in patients with repaired tetralogy of Fallot. DESIGN 27 consecutive patients, mean (SD) age 27.3 (11.7) years, were studied 15.7 (6.7) years after corrective surgery for tetralogy of Fallot, using 12 lead ECG, 24 hour Holter recordings, signal averaged ECG, and echocardiography. The following variables were measured: standard QRS duration, filtered QRS duration (fltQRS), low amplitude signal duration, and root mean square voltage of the last 40 ms of the fltQRS (RMS-40), as well as right ventricular systolic pressure, right ventricular ejection fraction, and the ratio of the maximum short axis diameters of the right and left ventricles (RD:LD). RESULTS All patients had right bundle branch block, with a mean QRS duration of 137.1 (14.9) ms. There were no patients with sustained arrhythmia. Five patients had runs of non-sustained ventricular tachycardia (group A) and the other 22 patients did not (group B). Univariate analysis showed that fltQRS and RD:LD ratio were significantly associated with non-sustained ventricular tachycardia. In addition, a fltQRS ⩾ 148 ms, low amplitude signal ⩾ 32.5 ms, RMS-40 ⩽ 23 μV, and RD:LD ratio ⩾ 1.05 were cut off points with a high sensitivity for detecting patients with non-sustained ventricular tachycardia. CONCLUSIONS Abnormal signal averaged ECG and echocardiographic variables are associated with potentially malignant ventricular arrhythmias on the Holter recordings in asymptomatic patients with repaired tetralogy of Fallot.

Morphological and Functional Assessment of Carotid Plaques Have Similar Predictive Accuracy for Coronary Artery Disease

Background and Purpose— Microwave radiometry allows noninvasive in vivo measuring of internal temperature of tissues reflecting inflammation. In the present study, we evaluated the predictive accuracy of this method for the diagnosis of coronary artery disease (CAD). Methods— Consecutive patients (n=287) scheduled for coronary angiography were included in the study. In carotid arteries of both groups, the following measurements were performed: (1) intima-media thickness (IMTmax) and (2) temperature measurements by microwave radiometry (&Dgr;Tmax). C-statistic and net reclassification improvement were used to compare the prediction ability of the markers IMTmax and &Dgr;Tmax for the presence of CAD and multivessel CAD. Results— Of 287 patients, 239 had stenoses ≥50% (CAD group), and 48 did not have significant stenoses (NO-CAD group). &Dgr;Tmax was an independent predictor for the presence of CAD and multivessel CAD, showing similar predictive accuracy to intima-media thickness, as assessed by c-statistic and net reclassification improvement. Conclusions— Local inflammatory activation, as detected by microwave radiometry, has similar predictive accuracy to intima-media thickness for the presence and extent of CAD.

Comparison of Frequency of Left Atrial Thrombus in Patients With Mechanical Prosthetic Cardiac Valves and Stroke Versus Transient Ischemic Attacks

Transesophageal echocardiography performed in a group of 36 patients who had a first cerebral embolic event after implantation of a mechanical cardiac valvular prosthesis revealed that stroke is associated with the presence of left atrial thrombi more frequently than transient ischemic attacks. Intracardiac embolic sources other than thrombi are possibly related more often to the latter type of cerebral embolism in this patient population.

Tricuspid regurgitation after successful mitral valve surgery

The tricuspid valve (TV) is inseparably connected with the mitral valve (MV) in terms of function. Any pathophysiological condition concerning the MV is potentially a threat for the normal function of the TV as well. One of the most challenging cases is functional tricuspid regurgitation (TR) after surgical MV correction. In the past, TR was considered to progressively revert with time after left-sided valve restoration. Nevertheless, more recent studies showed that TR could develop and evolve postoperatively over time, as well as being closely associated with a poorer prognosis in terms of morbidity and mortality. Pressure and volume overload are usually the underlying pathophysiological mechanisms; structural alterations, like tricuspid annulus dilatation, increased leaflet tethering and right ventricular remodelling are almost always present when regurgitation develops. The most important risk factors associated with a higher probability of late TR development involve the elderly, female gender, larger left atrial size, atrial fibrillation, right chamber dilatation, higher pulmonary artery systolic pressures, longer times from the onset of MV disease to surgery, history of rheumatic heart disease, ischaemic heart disease and prosthetic valve malfunction. The time of TR manifestation can be up to 10 years or more after an MV surgery. Echocardiography, including the novel 3D Echo techniques, is crucial in the early diagnosis and prognosis of future TV disease development. Appropriate surgical technique and timing still need to be clarified.

Value of real-time three-dimensional adenosine stress contrast echocardiography in patients with known or suspected coronary artery disease

AIM The aim of this study was to evaluate the feasibility of myocardial wall-motion and perfusion assessment using contrast echocardiography during real-time three-dimensional (RT3D) adenosine stress test, and compare its diagnostic accuracy with the two-dimensional (2D) method using coronary angiography as reference. METHODS AND RESULTS Patients with known or suspected coronary artery disease (CAD) have been submitted to adenosine stress contrast echocardiography and coronary angiography, within a 1-month period. Two-dimensional apical four, two, and three chamber, as well as three-dimensional (3D) pyramidal full-volume data sets were acquired at rest and at peak stress. The 17-segment division of the left ventricle was used and each segment was evaluated based on wall motion and perfusion. Sixty patients (age: 60.1 ± 8.5 years, 38 men) were enrolled, i.e. 1020 segments were evaluated at rest and at peak stress. Wall-motion analysis per patient revealed that the sensitivity and specificity of 2D to detect CAD were 80 and 82% and of RT3D echocardiography were 82 and 64%, respectively, whereas in the per patient perfusion analysis the respective percentages were 88, 64% for 2D and 90, 73% for RT3D. Regarding left anterior descending artery and right coronary system, there seems to be no statistical significant difference in terms of wall-motion and perfusion evaluation between the two modalities. CONCLUSIONS Real-time 3D adenosine stress echocardiography is a feasible and valuable technique to evaluate myocardial wall motion and perfusion in patients with suspected CAD, despite existing problems concerning lower spatial and temporal resolution when compared with 2D echocardiography.

Left ventricular diastolic dysfunction: An old, known entity in a technologically modern era.

lease cite this article in press as: Ag ra, Hellenic Journal of Cardiology ( tp://dx.doi.org/10.1016/j.hjc.2016 09-9666/a 2016 Hellenic Cardiologi ense (http://creativecommons.org/ Left ventricular diastolic dysfunction (LVDD) manifests early and is a common pathophysiological pathway leading to many cardiovascular diseases. Diastolic dysfunction can present in a spectrum of diverse patterns, ranging from a simple delay of ventricular relaxation without significant hemodynamic changes, to pulmonary venous congestion due to ventricular diastolic pressure elevationwith displacement of the upper, left pressure-volume loop (Figure 1). Cardiac catheterization provides data on the left side of the heart, the right side of the heart, systemic and pulmonary arterial pressures, vascular resistances, cardiac output, and ejection fraction. These data are often used as markers of cardiac preload, afterload, and global function, although each of these parameters reflects additional complex interactions between the heart and loading conditions. Hemodynamic evaluation has long been considered to be the “gold-standard” method for characterizing load, contractility, diastole, and, ventricular-arterial interactions, but has not been adopted for clinical practice. Attaining a working understanding of each of these elements remains paramount to properly interpreting hemodynamic changes in patients who have heart failurewith preserved ejection fraction (HF-PEF). However, it is worth noting that recently, conventional and newer echocardiographic methods have been used to accurately evaluate patients with HF-PEF (Table 1). Recently, Kasner et al. reported that the quotient of simultaneously measured E/E’ and LV end-diastolic volumes