Olivia Manfrini

Consensus standards for acquisition, measurement, and reporting of intravascular optical coherence tomography studies: a report from the International Working Group for Intravascular Optical Coherence Tomography Standardization and Validation.

OBJECTIVESnThe purpose of this document is to make the output of the International Working Group for Intravascular Optical Coherence Tomography (IWG-IVOCT) Standardization and Validation available to medical and scientific communities, through a peer-reviewed publication, in the interest of improving the diagnosis and treatment of patients with atherosclerosis, including coronary artery disease.nnnBACKGROUNDnIntravascular optical coherence tomography (IVOCT) is a catheter-based modality that acquires images at a resolution of ~10 μm, enabling visualization of blood vessel wall microstructure in vivo at an unprecedented level of detail. IVOCT devices are now commercially available worldwide, there is an active user base, and the interest in using this technology is growing. Incorporation of IVOCT in research and daily clinical practice can be facilitated by the development of uniform terminology and consensus-based standards on use of the technology, interpretation of the images, and reporting of IVOCT results.nnnMETHODSnThe IWG-IVOCT, comprising more than 260 academic and industry members from Asia, Europe, and the United States, formed in 2008 and convened on the topic of IVOCT standardization through a series of 9 national and international meetings.nnnRESULTSnKnowledge and recommendations from this group on key areas within the IVOCT field were assembled to generate this consensus document, authored by the Writing Committee, composed of academicians who have participated in meetings and/or writing of the text.nnnCONCLUSIONSnThis document may be broadly used as a standard reference regarding the current state of the IVOCT imaging modality, intended for researchers and clinicians who use IVOCT and analyze IVOCT data.

Heart Rate Variability Today

Heart rate variability (HRV) non-invasively assesses the activity of the autonomic nervous system. During the past 30 years, an increasing number of studies have related the imbalance of the autonomic nervous system (as assessed by HRV) to several pathophysiogical conditions, particularly in the setting of cardiovascular disease. Sudden death, coronary artery disease, heart failure, or merely cardiovascular risk factors (smoking, diabetes, hyperlipidemia, and hypertension) are the best-known clinical circumstances that can affect and/or be affected by the autonomic nervous system. Analyses of HRV variables have been proposed as a component of the clinical evaluation for patient risk stratification due to its independent prognostic information. Yet the potential for HRV to be used widely in clinical practice remains to be established.

Presentation, management, and outcomes of ischaemic heart disease in women

Scientific interest in ischaemic heart disease (IHD) in women has grown considerably over the past 2 decades. A substantial amount of the literature on this subject is centred on sex differences in clinical aspects of IHD. Many reports have documented sex-related differences in presentation, risk profiles, and outcomes among patients with IHD, particularly acute myocardial infarction. Such differences have often been attributed to inequalities between men and women in the referral and treatment of IHD, but data are insufficient to support this assessment. The determinants of sex differences in presentation are unclear, and few clues are available as to why young, premenopausal women paradoxically have a greater incidence of adverse outcomes after acute myocardial infarction than men, despite having less-severe coronary artery disease. Although differential treatment on the basis of patient sex continues to be described, the extent to which such inequalities persist and whether they reflect true disparity is unclear. Additionally, much uncertainty surrounds possible sex-related differences in response to cardiovascular therapies, partly because of a persistent lack of female-specific data from cardiovascular clinical trials. In this Review, we assess the evidence for sex-related differences in the clinical presentation, treatment, and outcome of IHD, and identify gaps in the literature that need to be addressed in future research efforts.

Acute coronary syndrome and Behçet's disease.

Results In his past medical history, aged 72-years, the patient started to report recurrent superficial migratory thrombophlebitis of the right leg, followed by severe painful oral ulcers and decreased visual acuity. Ophthalmologic evaluation revealed retinal vasculitis, the human leukocyte antigen B51 allele and a positive skin pathergy test were detected. According to the International Study Group criteria, the diagnosis was Behçet’s syndrome. Colchicine and steroid therapy achieved remission of symptoms.

[Ischemic heart disease and depression: an underestimated clinical association].

: Patients with acute or chronic ischemic heart disease have a high incidence of depression, and a variable proportion of patients (ranging from 14% to 47%) suffer from major or subclinical depression. In addition, chronic depression has been shown to be associated with the development or progression of coronary atherosclerosis. Besides a poor quality of life, depressive symptoms in patients with ischemic heart disease result in a poor prognosis, as cardiovascular event rates are 2-2.5 times higher than in their counterparts without depressive symptoms. A variety of pathogenetic mechanisms may play a role, including pathophysiological (dysfunction of the autonomic nervous system or hypothalamic-pituitary-adrenal axis, platelet hyperaggregability, inflammation, endothelial dysfunction and genetic predisposition) and behavioral mechanisms (inadequate therapy adherence, obesity, smoking, sedentary lifestyle). However, in patients with ischemic heart disease, depression often goes undiagnosed or untreated. Several screening procedures including questionnaires for patients with heart disease, along with the help of a psychiatrist, may facilitate not only the diagnosis of depressive symptoms but also the pharmacological and/or physiotherapeutic management. The use of tricyclic antidepressant agents should be avoided in patients with heart disease, whereas selective serotonin reuptake inhibitors have been shown to be safe in this patient population. However, no evidence is available to support that use of these drugs is associated with a reduced risk of cardiovascular events at follow-up. Psychotherapy proved to be effective in reducing depressive symptoms but ineffective in improving prognosis. In this review, epidemiology and pathophysiology of depression in patients with ischemic heart disease are described, with a focus on stratification of depressive symptoms and potential therapeutic strategies.Patients with acute or chronic ischemic heart disease have a high incidence of depression, and a variable proportion of patients (ranging from 14% to 47%) suffer from major or subclinical depression. In addition, chronic depression has been shown to be associated with the development or progression of coronary atherosclerosis. Besides a poor quality of life, depressive symptoms in patients with ischemic heart disease result in a poor prognosis, as cardiovascular event rates are 2-2.5 times higher than in their counterparts without depressive symptoms. A variety of pathogenetic mechanisms may play a role, including pathophysiological (dysfunction of the autonomic nervous system or hypothalamic-pituitary-adrenal axis, platelet hyperaggregability, inflammation, endothelial dysfunction and genetic predisposition) and behavioral mechanisms (inadequate therapy adherence, obesity, smoking, sedentary lifestyle). However, in patients with ischemic heart disease, depression often goes undiagnosed or untreated. Several screening procedures including questionnaires for patients with heart disease, along with the help of a psychiatrist, may facilitate not only the diagnosis of depressive symptoms but also the pharmacological and/or physiotherapeutic management. The use of tricyclic antidepressant agents should be avoided in patients with heart disease, whereas selective serotonin reuptake inhibitors have been shown to be safe in this patient population. However, no evidence is available to support that use of these drugs is associated with a reduced risk of cardiovascular events at follow-up. Psychotherapy proved to be effective in reducing depressive symptoms but ineffective in improving prognosis. In this review, epidemiology and pathophysiology of depression in patients with ischemic heart disease are described, with a focus on stratification of depressive symptoms and potential therapeutic strategies.

Coronary plaque quantification and composition in asymptomatic patients with type II diabetes mellitus.

Objective The aim of this study was to characterize the extent and morphology of coronary lesions in asymptomatic patients with type II diabetes mellitus. Methods We enrolled 102 asymptomatic patients with type II diabetes mellitus and 97 patients without diabetes as controls. All individuals had no history of ischemic heart disease. They underwent multidetector computed tomography (MDCT). Plaque density and plaque volume were calculated using specific software on axial images. Arterial remodeling was evaluated with semiquantitative assessment on image reconstructions. Results MDCT angiography revealed the presence of 124 coronary plaques in 46 patients with type II diabetes mellitus and 59 plaques in 21 controls (Pu200a<u200a0.01). Diabetic patients had a significantly higher proportion of lesions with impaired adaptive remodeling (56.5 versus 35.6%, Pu200a<u200a0.01), as compared with nondiabetic individuals. The volume of fibrofatty component was 0.1u200acm3 (0.01–0.72) in diabetic patients and 0.08u200acm3 (0.01–0.33) in controls (Pu200a=u200a0.14). The calcium volume was 0.082u200acm3 (0–0.558) in diabetic patients and 0.12u200acm3 (0–0.669) in controls (Pu200a=u200a0.21). Plaques with fibrofatty components had a significantly higher density in the diabetic cohort (58.76u200a±u200a9.55u200aHounsfield Units), as compared with the control group (47.31u200a±u200a5.42u200aHounsfield Units, Pu200a<u200a0.001). Plaque density correlated with the duration of type II diabetes mellitus (ru200a=u200a0.37, Pu200a=u200a0.044), but was independent of age, sex, hypertension and metabolic profile. In the control group, plaque density was independent of any covariate. Conclusion Coronary plaques in type II diabetes mellitus show a tendency to develop impaired adaptive remodeling and to have a higher tissue density.

Weight is an independent predictor of vascular injury in healthy volunteers with aspartate allele.

Background Endothelial dysfunction and carotid intima–media thickeness (IMT) are currently considered key early events in atherogenesis and markers of arterial damage. We investigated whether endothelial nitric oxide synthase (eNOS) glutamate (Glu)298–aspartate (Asp) polymorphism may influence the vascular response to weight, as measured by BMI, in young, healthy individuals. Methods One hundred young (30.6u200a±u200a5.9 years) healthy individuals, without concomitant traditional cardiovascular risk factors took part in the study. Brachial artery endothelial function was assessed by vascular response to reactive hyperemia [flow-mediated dilation (FMD) and sublingual nitroglycerin (GTN)-mediated dilation] using high-resolution ultrasound. Carotid IMT was also measured. Results Participants were grouped as Glu-homozygotes (nu200a=u200a38) and Asp-carriers (nu200a=u200a62). On univariate analysis, a higher response to GTN was associated with lower brachial baseline diameter (Pu200a<u200a0.001) and increasing value of high-density lipoprotein cholesterol (Pu200a=u200a0.04) in Asp-carriers, but not in Glu-homozygotes. Higher FMD correlated with lower brachial baseline diameter (Pu200a<u200a0.001), BMI (Pu200a=u200a0.03) and SBP (Pu200a=u200a0.03) in the Asp-carriers, but not in Glu-homozygotes. Higher IMT showed a similar Asp-genotype-dependent association with higher BMI (Pu200a=u200a0.001), SBP (Pu200a=u200a0.006) and DBP (Pu200a=u200a0.001). In individuals with Asp-alleles, the multivariate analysis showed that BMI was the only independent predictor of IMT. Conclusion Weight is independently associated with impaired arterial structure in healthy and genetically predisposed young individuals. The allelic variation (Asp298) of the eNOS gene polymorphism makes individuals vulnerable to the impact of weight on the development of atherosclerosis.