Epicardial Adipose Tissue Thickness and Carotid Intima-Media Thickness in Hemodialysis Patients.

BACKGROUND: It is well-known that cardiovascular risk and all-cause mortality is increased in hemodialysis patients. Epicardial fat thickness (EFT), which reflects visceral adiposity, has been suggested as a new cardiometabolic risk factor. The purpose of this study was to investigate EFT in hemodialysis patients. METHODS: A total of 144 consecutive patients (60 hemodialysis patients and 84 controls) were enrolled into the study, and patients with diabetes mellitus and cardiovascular diseases (CVD) were excluded. EFT was measured on the free wall of the right ventricle at end-diastole from the parasternal long-axis view by standard transthorasic 2D echocardiography. RESULTS: The groups were similar in terms of sex distribution, age, blood pressure, heart rate and frequencies of CAD risk factors including smoking status, family history of CAD and hypertension. There were no significant differences between the hemodialysis patients and controls in 2D echocardiographic parameters, including ejection fraction and biochemical parameters except low-density lipoprotein, high-density lipoprotein and c- reactive protein. Despite having lower body mass index, EFT levels were significantly higher in hemodialysis patients compared to the controls (8.0 ± 2.2 mm vs. 5.8 ± 1.9 mm; p < 0.01). In multivariate linear regression analysis we determined that hemodialysis patient status was found to be an independent predictor for both EFT (ß = 0. 700, p = 0.014) and carotid intima-media thickness (CIMT, ß = 0. 614, p = 0.047). CONCLUSIONS: Hemodialysis patients are independently associated with high EFT and CIMT.

Three-dimensional transoesophageal echocardiography: how to use and when to use-a clinical consensus statement from the European Association of Cardiovascular Imaging of the European Society of Cardiology.

Three-dimensional transoesophageal echocardiography (3D TOE) has been rapidly developed in the last 15 years. Currently, 3D TOE is particularly useful as an additional imaging modality for the cardiac echocardiographers in the echo-lab, for cardiac interventionalists as a tool to guide complex catheter-based procedures cardiac, for surgeons to plan surgical strategies, and for cardiac anaesthesiologists and/or cardiologists, to assess intra-operative results. The authors of this document believe that acquiring 3D data set should become a 'standard part' of the TOE examination. This document provides (i) a basic understanding of the physic of 3D TOE technology which enables the echocardiographer to obtain new skills necessary to acquire, manipulate, and interpret 3D data sets, (ii) a description of valvular pathologies, and (iii) a description of non-valvular pathologies in which 3D TOE has shown to be a diagnostic tool particularly valuable. This document has a new format: instead of figures randomly positioned through the text, it has been organized in tables which include figures. We believe that this arrangement makes easier the lecture by clinical cardiologists and practising echocardiographers.

Serum levels of C-reactive protein and uric acid in patients with cardiac syndrome X.

OBJECTIVES: Angina-like chest pain, a positive result from a stress test, and normal coronary arteries are characteristics of patients with cardiac syndrome X (CSX). Serum levels of C-reactive protein (CRP), which is a marker of a systemic inflammatory state, are associated with coronary atherosclerosis and endothelial dysfunction. Serum uric acid (UA) levels have also been implicated in the development of atherosclerotic cardiovascular disease. However, little is known about the association of serum UA and CRP levels with CSX. METHODS: In all, 250 subjects (100 patients with CSX, 100 with coronary artery disease (CAD), and 50 control subjects) were enrolled in the study. Coronary arteries were evaluated by conventional coronary angiography in the CSX and CAD groups. All patients underwent a noninvasive stress test. To determine whether they are potential risk factors for CSX, serum CRP and UA levels were compared among the 3 groups. RESULTS: Serum levels of CRP were higher in patients with CSX or CAD than in the control subjects (4.4 +/- 3.1 and 4.5 +/- 2.9 mg/L, respectively, vs. 1.9 +/- 1.6 mg/L; P < 0.001), but those levels were similar in patients with CSX or CAD. Uric acid levels were higher in patients with CSX or CAD than in the control subjects (5.5 +/- 1.1 mg/dl and 5.9 +/- 1.4 mg/dl, respectively, vs. 4.4 +/- 1.2 mg/dl; P < 0.00 1), but those levels were also similar in patients with CSX or CAD. CONCLUSIONS: In patients with CSX, serum CRP and UA levels were as high as those in patients with CAD. Elevated serum CRP and UA levels may contribute to the development of CSX.