Validation of the echocardiographic assessment of epicardial adipose tissue thickness at the Rindfleisch fold for the prediction of coronary artery disease.

BACKGROUND AND AIM: Echocardiography is a promising technique for the assessment of epicardial adipose tissue (EAT). Increased EAT thickness is associated with different cardiac diseases, including; coronary artery disease (CAD). Since several different echocardiographic approaches have been proposed to measure EAT, the identification of a standardized method is needed. We propose the assessment of EAT maximal thickness at the Rindfleisch fold, the reproducibility of this measurement and its correlation with EAT thickness and volume assessed at cardiac magnetic resonance (CMR). Finally, we will test the predictive role of this measurement on the presence of significant CAD. METHODS AND RESULTS: In 1061 patients undergoing echocardiography, EAT thickness was measured at the level of the Rindfleisch fold. In 70 patients, we tested the relationship between echo-EAT thickness and EAT thickness and volume assessed at CMR. In 499 patients with suspected CAD, undergoing coronary artery angiography, we tested the predictive value of EAT on the presence of significant CAD. Echo-EAT thickness measurements had an excellent reliability as indicated by the inter-observer (ICC:0.97; 95% C.I. 0.96 to 0.98) and intra-observer (ICC:0.99; 95% C.I. 0.98 to 0.99) reliability rates. Echo-EAT thickness significantly correlated with CMR-EAT thickness and volume (p < 0.001). An EAT thickness value >10 mm discriminated patients with significant CAD at coronary angiography (p < 0.001). At multivariable analysis, including demographic data and cardiovascular risk factors, EAT thickness was an independent predictor of significant CAD and showed an additive predictive value over common atherosclerotic risk factors. CONCLUSIONS: Echocardiographic assessment of EAT thickness at the level of the Rindfleisch fold represents a simple and trustworthy method. An increased EAT thickness shows an additive predictive value on CAD over common atherosclerotic risk factors, thus suggesting its potential clinical use for CAD risk stratification.

C-reactive protein levels are associated with paraoxonase polymorphism L55M in patients undergoing cardiac SPECT imaging.

BACKGROUND: Oxidation and inflammation are linked processes playing an important role in the development and progression of coronary artery disease (CAD). The relation between oxidation and inflammation markers with myocardial ischemia is still controversial. We assessed the association between paraoxonase (PON) polymorphisms (rs854560, rs662, rs7493) and high sensitivity C-reactive protein levels with stress-induced ischemia in patients with suspected CAD. MATERIALS AND METHODS: Patients (n = 203; 78 men; mean age 59 ± 10 years), with suspected CAD underwent on the same day stress/rest Tc-99m sestamibi cardiac single-photon emission computed tomography and venous blood samples collection, to assess PON polymorphisms, lipid profile and high sensitivity C-reactive protein levels. RESULTS: At cardiac tomography, 43 (21%) patients had stress-induced myocardial ischemia and 160 (79%) did not. At logistic regression analysis, diabetes (p < 0.005), sex (p = 0.020) and high-density lipoprotein (HDL)-cholesterol levels (p < 0.050) were independently associated with stress-induced ischemia. No differences of PON1 and PON2 genotype frequencies were observed between patients with and without stress-induced ischemia. Multiple linear regression analysis showed that LL genotype for PON1 (p < 0.03), high body mass index (BMI) values (p < 0.001) and low HDL-cholesterol levels (p < 0.05) are associated with high C-reactive protein levels independently from presence of stress-induced ischemia, age, sex, diabetes, hypertension, statin therapy, smoking and total cholesterol levels. CONCLUSIONS: The results of this study identified a weak association between the M55L polymorphism in PON1 gene and C-reactive protein levels. BMI showed a major role in the determination of C-reactive protein levels. No association between PON polymorphisms and stress-induced ischemia was found.

Do rebreathing manoeuvres for non-invasive measurement of cardiac output during maximum exercise test alter the main cardiopulmonary parameters?

BACKGROUND: Inert gas rebreathing has been recently described as an emergent reliable non-invasive method for cardiac output determination during exercise, allowing a relevant improvement of cardiopulmonary exercise test clinical relevance. For cardiac output measurements by inert gas rebreathing, specific respiratory manoeuvres are needed which might affect pivotal cardiopulmonary exercise test parameters, such as exercise tolerance, oxygen uptake and ventilation vs carbon dioxide output (VE/VCO2) relationship slope. METHOD: We retrospectively analysed cardiopulmonary exercise testing of 181 heart failure patients who underwent both cardiopulmonary exercise testing and cardiopulmonary exercise test+cardiac output within two months (average 16 ± 15 days). All patients were in stable clinical conditions (New York Heart Association I-III) and on optimal medical therapy. RESULTS: The majority of patients were in New York Heart Association Class I and II (78.8%), with a mean left ventricular ejection fraction of 31 ± 10%. No difference was found between the two tests in oxygen uptake at peak exercise (1101 (interquartile range 870-1418) ml/min at cardiopulmonary exercise test vs 1103 (844-1389) at cardiopulmonary exercise test-cardiac output) and at anaerobic threshold. However, anaerobic threshold and peak heart rate, peak workload (75 (58-101) watts and 64 (42-90), p < 0.01) and carbon dioxide output were significantly higher at cardiopulmonary exercise testing than at cardiopulmonary exercise test+cardiac output, whereas VE/VCO2 slope was higher at cardiopulmonary exercise test+cardiac output (30 (27-35) vs 33 (28-37), p < 0.01). CONCLUSION: The similar anaerobic threshold and peak oxygen uptake in the two tests with a lower peak workload and higher VE/VCO2 slope at cardiopulmonary exercise test+cardiac output suggest a higher respiratory work and consequent demand for respiratory muscle blood flow secondary to the ventilatory manoeuvres. Accordingly, VE/VCO2 slope and peak workload must be evaluated with caution during cardiopulmonary exercise test+cardiac output.

NSAIDs and cardiovascular risk.

NSAIDs are the most largely used class of drugs in the world, due to their large use in many diseases, in particular for the systemic inflammatory diseases. Nevertheless, today NSAIDs are less used for some of these diseases, due to several side-effects correlated to these drugs. The antiinflammatory mechanism of NSAIDs consist in the inibhition of two forms of cyclooxygenase, namely COX-1 (its block contributes to an antiplatelet effect) and COX-2 (its block has a greater antiinflammatory, antipyretic and analgesic effect). The COX-2 inhibition might reduce the risk of gastrointestinal toxicity, but several studies have shown the cardiovascular side effects of this inhibition. Mechanisms of the cardiovascular side effects are controversial yet, so the aim of this document is to review side-effects profile of NSAIDs and, specifically, to investigate cardiovascular consequences of NSAIDs use in clinical practice.