Background: Carotid artery temperature heterogeneity (ΔΤ) measured by microwave radiometry (MWR) has been associated with future cardiovascular events including acute coronary syndromes. The vulnerable plaques of the coronary arterial tree, that can be ideally depicted by intracoronary imaging such as optical coherence tomography (OCT) have anatomical characteristics such as the thin fibrous cap (TCFA), that make them vulnerable to rupture. The scope of the study was to assess the implication of the carotid artery temperature heterogeneity on the culprit coronary plaque morphology in patients presenting with acute myocardial infarction. Methods: 34 patients presented with an acute myocardial infarction were enrolled in the study. All patients underwent percutaneous coronary intervention (PCI) and OCT for the evaluation of the anatomical characteristics of the culprit lesion. After the completion of the PCI all patients underwent carotid ultrasound and MWR of both carotid arteries and thermal heterogeneity of the carotid arteries was assessed. Blood samples were collected for high sensitivity C-reactive protein (CRP) analysis. Results: Thirty four patients, 21 with STEMI (61.76%) and 13 (38.23%) with NSTEMI, were included in the study. Patients with ruptured plaques had significantly increased hsCRP compared to patients that did not have a ruptured plaque (14.41±4.02 vs 9.9±2.5, P<0.005). Thermal heterogeneity, was significantly increased in ruptured plaques compared to no ruptured ones (1.01±0.31 vs 0.51±0.14°C, P=0.001), and in plaques with TCFA compared to those without a TCFA (0.82±0.37 vs 0.60±0.05°C, P=0.001). Diabetes mellitus, ΔΤ and hsCRP, were entered in the multivariate analysis, from which DM (OR 4.12; 95% CI 0.77-22.07; P=0.07) and ΔΤ (OR for 0.1°C increase 1.43; 95% CI 1.03-1.98; P=0.03) remained in the final analysis, and only ΔΤ was independently associated with the presence of the TCFA. Regarding plaque rupture, STEMI, hsCRP, and ΔT were entered in the multivariate analysis from which hsCRP (OR 1.51; 95% CI 0.99-2.28; P=0.051) and ΔΤ (OR for 0.1°C increase 3.40; 95% CI 1.29-8.96; P=0.013) remained in the final analysis with the ΔT being the only variable.
Purpose: The development of atherosclerosis is partially controlled by systemic factors. Local factors, including local inflammation and shear stress, may also affect the progression of carotid plaques. The aim of this study was to evaluate in patients with coronary artery disease whether intra-subject left and right carotid arteries, have similar local inflammatory activation as determined non-invasively by microwave radiometry (MR). Methods: We examined 400 carotids from 200 consecutive patients with significant coronary artery disease, as documented by coronary angiography (stenosis ≥ 50%). All patients underwent carotid artery examination by basic ultrasound imaging and MR. Carotid artery disease was defined as intima-media thickness (IMT) ≥1.2 mm. During ultrasound study, plaque texture, surface and echogenicity were analyzed. Plaques were characterized as fatty, mixed and calcified according to previous classifications. Plaque surface was classified as regular and irregular. Thermal heterogeneity (ΔT) by MR was assigned as maximal temperature along the carotid artery minus minimum. Results: Mean IMT of all carotid arteries (n=400) was 2.04±1.09 mm. Mean ΔT of all carotid arteries was 0.80±0.49°C. In carotid arteries with carotid artery disease (n=313), fatty plaques (n=52) had higher ΔT compared to mixed (n=181) and calcified (n=80) (1.23±0.55°C versus 0.87±0.44°C versus 0.67±0.49°C respectively, p<0.01). Plaques with irregular surface (n=81) had higher ΔT compared to plaques with regular (n=232) (1.20±0.45°C versus 0.76±0.48°C, p<0.01). Heterogeneous plaques (n=71) had higher ΔT compared to homogenous (n=242) (1.22±0.56°C versus 0.77±0.44°C, p<0.01). Mean ΔT was similar between left and right carotid arteries (0.78±0.48°C versus 0.84±0.52°C, p=0.12). In all carotids, there was a correlation between left and right carotid plaque ΔT (p<0.001, R=0.38). In all lesions, there was a correlation between ΔT and IMT (p<0.001, R=0.25). Conclusions: Patients with coronary artery disease have similar inflammatory activation in the carotid plaques as detected by microwave radiometry. Thus, the systemic factors producing this diffuse inflammatory activation in patients with atherosclerosis need to be further investigated.
The estimated annual incidence of out-of-hospital cardiac arrest (OHCA) is approximately 120 cases per 100000 inhabitants in western countries. Although the rates of bystander cardiopulmonary resuscitation (CPR) and use of automated external defibrillator are increasing, the likelihood of survival to hospital discharge is no more than 8%. To date, various devices and methods have been utilized in the initial CPR approach targeting to improve survival and neurological outcomes in OHCA patients. The aim of this review is to discuss strategies that facilitate resuscitation, increase the chance to achieve return to spontaneous circulation and improve survival to hospital discharge and neurological outcomes in the pre-hospital setting.
Abstract Introduction Vulnerable plaques of the coronary arteries, share common characteristics such as the thin cap fibrous cap, that make the prone to rupture in the presence of stimulus such as shear stress or inflammation. Optical coherence tomography (OCT) is an imaging method, by which the fibrous cap and the presence of plaque rupture can be accurately in vivo visualized. Recent studies have shown an association between increased carotid temperature heterogeneity (ΔT) detected by microwave radiometry (MWR) and cardiovascular events. Purpose To evaluate the impact of carotid temperature heterogeneity on the culprit plaque morphology on patients presenting with acute myocardial infarction. Method A total of 37 patients undergoing percutaneous coronary intervention (PCI) for an acute myocardial infarction who had an identifiable de novo culprit lesion in a native coronary artery, were enrolled in this study. All patients underwent PCI and Optical Coherence Study (OCT) within 12 hours since symptom onset. The culprit lesion of the angiogram was clearly identified by a combination of ECG, wall motion abnormalities seen in cardiac ultrasound, and coronary angiogram. The OCT study was performed using the LightLab OCT wire, and acquired images were analyzed by 2 independent investigators using previously validated criteria for OCT plaque characterization. After the completion of the PCI all patients underwent MWR of both carotid arteries and ΔT was defined as maximal temperature detected along each carotid artery minus minimum. Results Thirty four patients with acute myocardial infarction 21 with STEMI (61.76%) and 13 (38.23%) with NSTEMI were included in the study. STEMI patients had more ruptured plaques compared to NSTEMI patients (71.41 versus 38.46%, p=0.053). Thin cap fibroatheroma (TCFA) was present in 31 patients (91.1%), while all ruptured plaques had a TCFA compared to 11 TCFA (78.57%) observed in plaques that had no rupture (p=0.03). HsCRP was significantly increased in ruptured plaques compared to non ruptured ones (14.41±4.02 versus 9.9±2,5, p<0.005). Mean ΔT was significantly increased in ruptured plaques compared to no ruptured ones (1.01±0.31 versus 0.51±0.14°C, p<0.005), as well as in plaques with TCFA compared to those without a TCFA (0.82±0.37 versus 0.60±0.05°C, p=0.001). In the multivariate analysis, STEMI, hsCRP, and ΔT were entered from which hsCRP (OR 1.51; 95% CI 0.99–2.28; P=0.051) and ΔT ((OR for 0.1°C increase 3.40; 95% CI 1.29–8.96; P=0.013) remained in the final model, with ΔT being the only variable independently associated with the presence of rupture. Conclusions Carotid thermal heterogeneity is associated with the presence of plaque rupture in patients with acute myocardial infarction. Further studies are needed in order to assess the possible prognostic impact of carotid ΔT on such population. Funding Acknowledgement Type of funding source: None
Abstract Microwave radiometry (MWR) has been applied successfully in the evaluation of carotid atherosclerosis, measuring reliably temperature heterogeneity of atherosclerotic plaques. Recent studies have shown an association between increased carotid temperature heterogeneity (ΔT) detected by MWR and cardiovascular events. Vulnerable plaques of the coronary arteries, share common characteristics such as the thin cap fibrous cap, that make the prone to rupture in the presence of stimulus such as shear stress or inflammation. Optical coherence tomography (OCT) is an imaging method, by which the fibrous cap and the presence of plaque rupture can be accurately in vivo visualized. Purpose To evaluate the impact of carotid temperature heterogeneity on the culprit plaque morphology on patients presenting with acute myocardial infarction. Method A total of 37 patients undergoing percutaneous coronary intervention (PCI) for an acute myocardial infarction who had an identifiable de novo culprit lesion in a native coronary artery, were enrolled in this study. All patients underwent PCI and Optical Coherence Study (OCT) within 12 hours since symptom onset. The OCT study was performed according to the standard techniques and acquired images were analyzed by 2 independent investigators., After the completion of the PCI all patients underwent MWR of both carotid arteries and ΔT was defined as maximal temperature detected along each carotid artery minus minimum. Results Thirty four patients with acute myocardial infarction 21 with STEMI (61.76%) and 13 (38.23%) with NSTEMI were included in the study. Thin cap fibroatheroma (TCFA) was present in 31 patients (91.1%), while all ruptured plaques had a TCFA compared to 11 TCFA (78.57%) observed in plaques that had no rupture (p=0.03). HsCRP was significantly increased in ruptured plaques compared to non ruptured ones (14.41±4.02 versus 9.9±2.5, p<0.005). Mean ΔT was significantly increased in ruptured plaques compared to no ruptured ones (1.01±0.31 versus 0.51±0.14°C, p<0.005), as well as in plaques with TCFA compared to those without a TCFA (0.82±0.37 versus 0.60±0.05°C, p=0.001). In the multivariate analysis DM, hsCRP, and ΔT were entered from which DM (OR 4.12; 95% CI 0.77–22.07; P=0.07) and ΔTau ((OR for 0.1°C increase 1.43; 95% CI 1.03–1.98; P=0.03) remained in the final model, with ΔT being the only variable independently associated with the presence of TCFA. Similarly regarding plaque rupture, STEMI, hsCRP, and ΔT were entered in the multivariate analysis from which hsCRP (OR 1.51; 95% CI 0.99–2.28; P=0.051) and ΔTau ((OR for 0.1°C increase 3.40; 95% CI 1.29–8.96; P=0.013) remained in the final model, with ΔT being the only variable independently associated with the presence of rupture. Conclusions Carotid thermal heterogeneity is associated with TCFA and plaque rupture in patients with acute myocardial infarction. Funding Acknowledgement Type of funding source: None
Running evidence supports a prognostic value of an exaggerated blood pressure response to exercise (EBPR). The impact of the metabolic syndrome (MS) on EBPR in hypertensive patients has not been investigated.A cross-sectional study in the setting of an outpatient hypertension clinic.In total, 325 non-diabetic patients with newly diagnosed hypertension were divided into two groups based on the presence (n = 95) or absence (n = 230) of the MS as defined with NCEP-ATP III criteria. All subjects underwent ambulatory blood pressure monitoring, echocardiography and exercise treadmill testing.Hypertensive patients with MS exhibited higher prevalence of EBPR (by 17%, p = 0.002) and peak exercise systolic BP (by 10.4 mmHg, p = 0.001) irrespectively of confounders. Metabolic equivalents were higher in hypertensives with MS (by 0.6 ml/kg/min, p = 0.048), but the difference lost significance after adjusting for confounders, including body mass index. Logistic regression analysis identified the MS as an independent predictor of an EBPR (p = 0.016). Hypertensive patients with MS had a 2.3-fold risk of exhibiting EBPR compared to those without MS. However, individual components of MS altogether as well as each one separately failed to predict EBPR.Presence of MS in newly diagnosed hypertensive patients is associated with increased peak exercise BP and a higher frequency of EBPR over and above its separate elements.
Mechanical automated compression devices are being used in cardiopulmonary resuscitation instead of manual, "hands-on", rescuer-delivered chest compressions. The -theoretical- advantages include high-quality non-stop compressions, thus freeing the rescuer performing the compressions and additionally the ability of the rescuer to stand reasonably away from a potentially "hazardous" victim, or from hazardous and/or difficult resuscitation conditions. Such circumstances involve cardiopulmonary resuscitation (CPR) in the Cardiac Catheterization Laboratory, especially directly under the fluoroscopy panel, where radiation is well known to cause detrimental effects to the rescuer, and CPR during/after land or air transportation of cardiac arrest victims. Lastly, CPR in a coronavirus disease 2019 patient/ward, where the danger of contamination and further serious illness of the health provider is very existent. The scope of this review is to review and present literature and current guidelines regarding the use of mechanical compressions in these "hostile" and dangerous settings, while comparing them to manual compressions.
