Elias Sanidas

Standardized evaluation methodology and reference database for evaluating IVUS image segmentation

This paper describes an evaluation framework that allows a standardized and quantitative comparison of IVUS lumen and media segmentation algorithms. This framework has been introduced at the MICCAI 2011 Computing and Visualization for (Intra)Vascular Imaging (CVII) workshop, comparing the results of eight teams that participated. We describe the available data-base comprising of multi-center, multi-vendor and multi-frequency IVUS datasets, their acquisition, the creation of the reference standard and the evaluation measures. The approaches address segmentation of the lumen, the media, or both borders; semi- or fully-automatic operation; and 2-D vs. 3-D methodology. Three performance measures for quantitative analysis have been proposed. The results of the evaluation indicate that segmentation of the vessel lumen and media is possible with an accuracy that is comparable to manual annotation when semi-automatic methods are used, as well as encouraging results can be obtained also in case of fully-automatic segmentation. The analysis performed in this paper also highlights the challenges in IVUS segmentation that remains to be solved.

One-year outcomes after direct transcatheter aortic valve implantation with a self-expanding bioprosthesis. A two-center international experience.

BACKGROUNDnBalloon aortic valvuloplasty (BAV) is considered to be an essential part of the transcatheter aortic valve implantation (TAVI) procedure and is being performed routinely. At present there is insufficient long-term data as to the benefits of routine BAV prior to TAVI.nnnAIMnThe aim of this study was to evaluate the safety of direct TAVI and the mortality rate at 1-year in patients undergoing TAVI with or without BAV with a self-expanding bioprosthesis.nnnMETHODSnBetween January 2008 and September 2013 consecutive patients undergoing TAVI with the Medtronic CoreValve in two experienced centers in Athens, Greece and in Siegburg, Germany were studied. All data were prospectively collected and retrospectively analyzed. Primary endpoint was mortality at 1 year. Procedural data and clinical data (bleeding, vascular complications and echocardiographic parameters) were analyzed.nnnRESULTSnA total of 210 patients undergoing TAVI were evaluated (non-direct=120 patients, direct=90 patients). All-cause mortality at 30 days and at 1 year was similar in both groups (4% in non-direct versus 2% in direct, p=0.6 and 15% in non-direct versus 11% in direct, p=0.5, respectively). Device success rate was similar in both groups (77% in non-direct versus 83% in direct, p=0.2). Major vascular complications were comparable for both groups (5% in non-direct versus 3% in direct, p=0.5). The direct group had less moderate/severe paravalvular leakage than the non-direct group after the device implantation (7% versus 33%, p<0.01).nnnCONCLUSIONSnPerforming direct TAVI with the self-expanding bioprosthesis is safe and feasible showing similar mortality rates compared to patients undergoing non-direct TAVI at 30 days and at 1-year.

Detection of perivascular blood flow in vivo by contrast-enhanced intracoronary ultrasonography and image analysis: an animal study.

1 Acute coronary syndromes are mostly the result of coronary plaque rupture. Diagnostic techniques focusing on the early detection of those plaques that are prone to rupture are still limited. Increased neovascularization in the adventitia and within the atherosclerotic plaque have recently been identified as common features of inflammation and plaque vulnerability. Contrast‐enhanced intravascular imaging with microbubbles can be used to trace perfusion. 2 In the present study, we examined the perivascular network of the left anterior descending coronary arteries and left circumflex arteries of four domestic, clinically healthy pigs using intracoronary ultrasound after injection of microbubbles with a differential imaging technique (ACES™; Computational Biomedicine Laboratory, University of Houston, Houston, TX, USA). Our aim was to detect blood flow into the coronary lumen and perivascular flow in contrast‐enhanced images. Eleven regions of interest (ROI), including perivascular structures, were compared with regard to their grey scale level before and after the injection of SonoVue® (0.06 mL/kg; Bracco Diagnostics, Princeton, NJ, USA). 3 A statistically significant (P = 0.018) enhancement was found in the echogenicity of the total perivascular space (adventitial region and perivascular vessels), as indicated by an increase in grey level intensity from 8.33 ± 0.80 (before) to 10.11 ± 0.88 (after microbubble injection). A significant enhancement of the 11 selected ROI (perivascular structures) was also recorded after the injection of microbubbles (from 7.92 ± 2.14 to 14.03 ± 2.44; P = 0.008). 4 We believe that the detection of perivascular structures with contrast‐enhanced intracoronary ultrasonography combined with proper image processing may reinforce our future efforts in the detection of vasa vasorum, an active participant in the creation of acute coronary events.

Air pollution and arterial hypertension. A new risk factor is in the air

Air pollution is one of the greatest environmental threats and has been implicated for several adverse cardiovascular effects including arterial hypertension (HTN). However, the exact relationship between air pollution exposure and HTN is still unclear. Air contamination provokes oxidative stress, systemic inflammation, and autonomic nervous system imbalance that subsequently induce endothelial dysfunction and vasoconstriction leading to increased blood pressure. The aim of this review was to describe the potential mechanisms by which air pollution contributes to HTN and to summarize the consequences of short- and long-term exposure.

The impact of financial crisis on coronary artery disease burden in Greece

BACKGROUNDnEconomic crisis poses an immense threat to public health worldwide and has been linked to cardiovascular morbidity and mortality. Greece is facing a distinctive recession over the recent years. However, the exact impact on coronary artery disease (CAD) burden has not been adequately addressed.nnnMETHODSnDemographic, clinical, and angiographic data of 3895 hospitalized patients were retrospectively studied. Patients were classified into two groups: those before crisis (2006-2007, nxa0=xa01228) and those during crisis (2011-2015, nxa0=xa02667).nnnRESULTSnAll data before and during crisis were compared. During crisis, patients presented with less acute coronary syndrome (ACS - 45.5% vs. 39.9%, pxa0<xa00.001). Subsequently, there were more patients without CAD (23.7% vs. 35.1%, pxa0<xa00.001) or one-vessel disease (20.5% vs. 23%, pxa0<xa00.001). The prevalence of traditional risk factors decreased significantly or remained stable except obesity (26.3% vs. 31.4%, pxa0=xa00.002). A significant increase in the examined females (23.6% vs. 26.7%, pxa0=xa00.04) was also observed.nnnCONCLUSIONSnThe burden of CAD in Greece was partially affected during the financial crisis. Even though the incidence of ACS was decreased, more women and more patients with no- or single-vessel disease were referredxa0for cardiac catheterization. In addition, the prevalence of traditional risk factors for CAD did not increase except obesity confirming the obesity paradox. It seems that the impact of traditional risk factors for CAD is not an immediate process and is somewhat related to living conditions or other exogenous and social factors.

Heart Rate and Blood Pressure: “Connecting the Dots” in Epidemiology and Pathophysiology

There is robust evidence from epidemiological and clinical studies showing that elevated heart rate (HR) constitutes a powerful predictor of morbidity and mortality in patients with hypertension, underlining the significance of HR measurement in them. Autonomous nervous system dysfunction and atherosclerosis are important features in the pathogenesis of the untoward events. However, the relationship between HR and blood pressure (BP) is complex and differs depending on the type of BP measurement which is considered. This differentiation implicates complex physiological mechanisms and is of clinical importance regarding the divergent effect of the different types of antihypertensive agents on these parameters. The aim of this review is to summarize the current evidence on the relationship between HR and BP based on epidemiological, clinical, and experimental studies.

Human Immunodeficiency Virus Infection And Hypertension. Is There a Connection

Data support that hypertension (HTN) is prevalent among human immunodeficiency virus (HIV) patients contributing to increased risk of cardiovascular disease. Immunodeficiency and prolonged antiretroviral treatment along with common risk factors including older age, male gender, and high body mass index might conduce to greater incidence of HTN. The purpose of this review was to summarize recent evidence of the increased cardiovascular risk in these patents linking HIV infection to HTN.

The Role of Angiogenesis Inhibitors in Hypertension: Following “Ariadne’s Thread”

Arterial hypertension (HT) is one of the most frequently recorded comorbidities among patients under antiangiogenic therapy. Inhibitors of vascular endothelial growth factor and vascular endothelial growth factor receptors are most commonly involved in new onset or exacerbation of pre-existing controlled HT. From the pathophysiology point of view, data support that reduced nitric oxide release and sodium and fluid retention, microvascular rarefaction, elevated vasoconstrictor levels, and globular injury might contribute to HT. The purpose of this review was to present recent evidence regarding the incidence of HT induced by antiangiogenic agents, to analyze the pathophysiological mechanisms, and to summarize current recommendations for the management of elevated blood pressure in this field.

Olmesartan worsening known thrombocytopenia. A rare side effect of antihypertensive drugs

tp://dx.doi.org/10.1016/j.hjc.2017 09-9666/a 2017 Hellenic Society of ense (http://creativecommons.org/ Drug induced thrombocytopenia (DIT) is a relatively frequent condition with increasing diagnostic and clinical concerns requiring specific treatment. DIT disorders can be a consequence of decreased platelet production mainly due to bone marrow suppression or accelerated platelet immune-mediated destruction. Clinically, these patients present with moderate to severe thrombocytopenia (defined as a platelet count of less than 50 10/L), and spontaneous bleeding varying from simple ecchymoses, petechiae and mucosal bleeding to life-threatening spontaneous intracranial hemorrhage. A wide variety of medications including thiazide diuretics have proven to cause thrombocytopenia. Conversely, other common antihypertensive medications such as angiotensin receptor blockers (ARBs) are safe and well tolerated drugs with limited contraindications. Only few case reports have presented the development of thrombocytopenia in patients receiving ARBs however, robust data to support this statement are still lacking. We present here one such case.

Triglyceride blood levels and metalloproteinases activity in acute myocardial infarction patients

s / Atherosclerosis 263 (2017) e111ee282 e203 1924/2006 IN THE FRAMEWORK OF PREVENTION OF DYSLIPIDAEMIA AND CARDIOVASCULAR DISEASES Daniela Martini, Beatrice Biasini, Alessandra Dei Cas, Giorgio Bedogni, Stefano Rossi, Carlo Pruneti, Giovanni Passeri, Marilena Musci, Ivana Zavaroni, Marco Ventura, Marco Vitale, Riccardo C. Bonadonna, Daniele Del Rio. 1 The Laboratory of Phytochemicals in Physiology, Department of Food Science, University of Parma, Parma, Italy; Department of Clinical and Experimental Medicine, Division of Endocrinology, University of Parma, Parma, Italy; Azienda Ospedaliera Universitaria of Parma, Parma, Italy; Clinical Epidemiology Unit, Liver Research Center, Basovizza, Trieste, Italy; Department of Clinical and Experimental Medicine, Clinical Psychology Unit, University of Parma, Medical School Building, Parma, Italy; Department of Clinical and Experimental Medicine, Building Clinica Medica Generale, University of Parma, Parma, Italy; Department of Food Science, University of Parma, Parma, Italy; Department of Life Sciences, Laboratory of Probiogenomics, University of Parma, Parma, Italy; Department of Biomedical, Biotechnological and Translational Sciences (SBiBiT), Sport and Exercise Medicine Center(SEM), Parma, Italy Aim: To date a high number of requests for authorisation of health claims pursuant to Article 13(5) and 14 of Regulation (EC) No 1924/2006 has received a negative opinion from the European Food Safety Authority (EFSA). One of the most critical limitations is the choice of inappropriate outcome variables (OVs) and of their methods of measurement (MMs) in the studies supporting the substantiation of health claims. The present work reports the results of a critical evaluation of OV and MM used for the substantiation of health claims in the framework of prevention of dyslipidaemia and cardiovascular diseases. Methods: OVs and MMs were extracted from EFSA’s Guidance documents and Scientific Opinions on claim applications. Databases of references were created on PubMed to allow a specific critical analysis of all OVs and MMs. Results: Each OV and related MM was critically classified in one of the following categories: (i) appropriate alone; (ii) appropriate only in combination with other OV/MM; (iii) not appropriate per se; (iv) not appropriate in relation to the specific claimed effect, (v) not appropriate but useful as supportive evidence. Conclusions: The information provided in this document could serve as basis for EFSA to develop further guidance to applicants in the preparation of applications for authorization of health claims proposed under Regulation 1924/2006 in the framework of prevention of dyslipidaemia and cardiovascular diseases. In addition, it could be useful for applicants during the selection/design of human intervention studies aimed to substantiate such health claims. This project has received financial support from EFSA, Grant GP/EFSA/NUTRI/2014/01. PO302. CYSTATIN C AS PROGNOSTIC MARKER OF CORONARY ARTERY DISEASE S. Panakala, K. Kalyan Kumar, K. Rambabu, S. Venkata Rao, M. Vijaya Bhaskar, P. Jagannadha Rao. Dept of Biochemistry, Mamata medical college, Khammam, India; Dept of Biochemistry Varun Arjun Medical college, Lucknow, India; Dept of Biochemistry Parul Medical College, Vadodara, India; Dept of Biochemistry and Medical Genetics, St.Matthews University, Grand Cayman, Cayman Islands Aim: Introduction: Cystatin C is a 13 KD protein composed of 120 amino acid residues which produce in all nucleate cells of the body. Cystatin C was a recognized marker of renal dysfunction, is gaining importance in dysfunction of other organs as well. Preliminary studies indicated a role for cystatin C as a projecting marker in coronary artery disease (CAD). CAD is the primary cause of death and has emerged as major health burden worldwide. The prevalence is increasing as well and is affecting younger age group. By 2020, 60% of the worlds heart disease is expected to arise in India. The fundamental cause of CAD is atherosclerosis. There is a proof that both elastolytic cysteine proteases (cathepsins) and their inhibitors, an important one being cystatin C are implicated in the pathogenesis of atherosclerosis. Objectives: Aim to assess the of serum cystatin C levels in CAD and its clinical spectrum. The spectrum of CAD is Stable angina (SA), Unstable angina (UA) and Myocardial infarction (MI). Methods: Study group comprised of 145 patients diagnosed as having CAD based on clinical and bio-chemical criteria. Control group included 66 age and sex matched subjects (non CAD cases) using the above mentioned criteria. Results: In this study significant enhance of mean serum cystatin C levels were observed in CAD cases when compared with controls. Highest mean cystatin C values were observed in MI than UA and SA.Conclusion: Increased cystatin C levels may reflect CAD associated with inflammation and atherosclerosis. Serum cystatin C plays a significant role in the progress of CAD and it might have a role as a prognostic marker of CAD. Poster session: lipid and lipoprotein metabolism PO303. TRIGLYCERIDE BLOOD LEVELS ANDMETALLOPROTEINASES ACTIVITY IN ACUTE MYOCARDIAL INFARCTION PATIENTS Dimitrios Papadopoulos, Haralambos Grassos, Elias Sanidas, John Barbetseas. 1 Laiko Hospital, Athens, Greece; Kat Hospital, Athens, Greece Aim: Matrix Metalloproteinases MMPs and their inhibitors TIMPs are key enzymes for myocardial collagen degradation in patients (pts) with acute myocardial infarction (AMI). The aim of this study was to investigate the influence of triglyceride blood levels on collagenolytic activity in pts with AMI. Methods: We measured MMP-1, TIMP-1, MMP-1/TIMP-1, plasma levels in 24 pts mean age (58,46+-13,9) yrs with AMI and classified them in two groups according to serum level of triglyceride in TRGL >150 mg%(TRIGL1) and in TRGL <150mg%(TRIGL-2) Plasma samples were collected at the time of admission in the hospital (0 hours) as well as 3h, 6h, 9h, 12h, 18h, 24h, 36h, 48h, 3days, 4d, 5d, 7d, 15d, 30d, thereafter and measured them by relevant ELISA kits. The mean latency between the onset of AMI and the admission in the hospital was 2.0+1.0 hours. All patients had no previous history of any other disease. For statistical analysis ANOVA rp.m.a and unpaired t-test were used. Data are expressed as mean values +-SD in ng/ml. p<0,05 was considered statistically signficant. Results: The mean blood values of collagenolytic enzymes in TRGL -1 group compared to the TRGL -2 were increased average by 10% for MMP-1 and reduced by -20% and by -4% for TIMP-1 and MMP-1/TIMP-1 complex respectively. Statistical significance was found by ANOVA rp.m.a within subjects alone for MMP-1, for TIMP-1 and for MMP-1/TIMP-1 complex respectively with 0,012>p>0,003. Conclusions: Hypertriglyceremia in pts with AMI increase MMP-1 activation and decrease expression of TIMP-1 leading to an imbalance between them making worse the ischemic injury. PO304. HYPERTRIGLYCERIDEMIA-INDUCED ACUTE PANCREATITIS IN THIRD TRIMESTER OF PREGNANCY: A CASE REPORT Ioanna Polypathelli, Christos Demosthenous, Maria Gavra, Eleni Matsaridou, Glykeria Tzatzagou. Papageorgiou General Hospital, Thessaloniki, Greece Aim: Hypertriglyceridemia-induced acute pancreatitis during pregnancy is a rare condition occurring in approximately 3 in 10000 pregnancies and carries a dismal prognosis. It is known to be associated with an increase in estrogen. The mainstay of treatment includes dietary restriction of fat and lipid-lowering medications. Plasmapheresis has also been described. Methods: A 38-year-old Caucasian woman, Gravida 2, Para 1, was presented at the emergency department at 30 weeks of gestation for acute abdominal pain. The patient had a history of type 2 diabetes mellitus and preeclampsia during her first pregnancy. As the patient showed lipemic in blood on emergency room, tests were performed after high-speed centrifuging.