Assessment of left ventricular volumes and ejection fraction using ultra-low-dose thallium-201 SPECT on a CZT camera: a comparison with magnetic resonance imaging.

BACKGROUND: Cadmium-Zinc-Telluride (CZT) technology allows use of low activities of radiopharmaceuticals. The aim was to verify the values of left ventricular volume parameters, obtained via ultra-low-dose thallium Single Photon Emission Computed Tomography (SPECT) using a CZT camera. METHODS AND RESULTS: Forty-five patients referred for an assessment of myocardial perfusion or viability imaging were examined using CZT-SPECT and 1.5 T magnetic resonance (MRI) scanner. The ultra-low-dose protocol with 0.5 Mbq 201-Tl per kg of body weight was used. The values of end-systolic (ESV) and end-diastolic volumes (EDV), left ventricular ejection fraction (EF) and myocardial mass (MM) were assessed using both techniques. A very good correlation was found between the EF, ESV, and EDV values assessed with CZT-SPECT and cardiac magnetic resonance MRI; the Pearson coefficients were 0.86, 0.95, and 0.91, respectively. A moderate correlation was found for myocardial mass, r = 0.57. Compared to MRI, SPECT systematically overestimated ESV and MM, while it underestimates the EF, with P ≤ .001 in all cases. There was no difference in EDV estimation. CONCLUSIONS: Left ventricular volumes and ejection fraction assessed via ultra-low-dose CZT-SPECT showed very good correlation with the values obtained by MRI. A moderate correlation was found for myocardial mass.

Combination of myocardial perfusion imaging, left ventricle function parameters and coronary artery calcium score in risk evaluation in patients with diabetes mellitus.

OBJECTIVE: Myocardial perfusion imaging (MPI) can be challenging in some cases of multi vessel involvement. Our aim was to examine specific group of patients with diabetes mellitus (DM), who did not have significant reversible ischaemia diagnosed on perfusion study itself, and asses additional value of functional parameters obtained from gated acquisition and added information from coronary artery calcium score (CACS). SUBJECTS AND METHODS: One hundred and seventy eight patients with a history of DM, with summed difference score (SDS)≤1, were included in the study. All patients underwent gated acquisition with recording of functional parameters and CACS evaluation. During the follow-up, cardiac events (CE) were recorded. RESULTS: During the median follow-up of 20.3 months there were 23 CE encountered. Optimal cut-off value for CACS to predict CE was found at 1427, higher values were significantly related to CE (P<0.001). Low stress left ventricular ejection fraction (LVEF) <45% and induced stress LVEF drop for 5% were also more frequent in CE group (P=0.001, P=0.008). Multivariable Cox analysis revealed low stress LVEF (P=0.001, HR=4.48, 95%CI 1.79-11.22), stress induced LVEF drop (P=0.017, HR 3.13, 95%CI 1.22-8.01) and high CACS (P<0.001, HR 10.52, 95%CI 4.32-25.63) as significant predictors of CE. CONCLUSION: Low stress LVEF under 45%, post-stress LVEF drop for more than 5% and CACS more than or equal to 1427 are significant predictors of CE in patients with DM, who did not have reversible ischemia detected on MPI single photon emission computed tomography (SPECT).

Prognostic value of myocardial perfusion imaging and coronary artery calcium measurements in patients with end-stage renal disease.

OBJECTIVE: Coronary artery disease (CAD) is highly prevalent in patients with end-stage renal disease (ESRD), owing to clustering of traditional and uremic-specific risk factors. However, in this population asymptomatic course of CAD is common and it has been reported that myocardial perfusion imaging (MPI) with single-photon emission tomography (SPET) has lower sensitivity. In the current study, we assessed the value of MPI gated-SPET and its combination with coronary artery calcium (CAC) score measurements in risk stratification of ESRD patients. MATERIALS AND METHODS: MPI gated-SPET was performed with dual-headed SPET camera and CAC score measured by multi-detector computed tomography (MDCT) system.There were tested 77 ESRD individuals. During the follow-up study, cardiac events (CE) defined as cardiac death or nonfatal myocardial infarction (MI) or the necessity for coronary revascularization were recorded. Univariate and stepwise multivariable Cox proportional hazards-models were used to identify the predictors of CE. RESULTS: Eighteen CE were recorded during the follow-up. They were significantly associated with higher summed stress scores on MPI, higher percentage of ischaemic myocardium, higher occurrence of defects in multiple territories and higher CAC score (all with P<0.05). Univariate Cox proportional hazard-models showed that severe perfusion abnormalities as well as CAC score ≥1000 were significantly associated with cardiac events (P<0.0001, P=0.0056). In stepwise Cox proportional hazards-models considering age, gender, history of diabetes mellitus, post-stress left ventricular stunning, the degree of perfusion abnormality and CAC score, only severe perfusion abnormalities and CAC score ≥1000 were independent predictors of CE. There was no CE in patients with normal perfusion, normal function and zero CAC score. CONCLUSION: This study suggests that combined evaluation of MPI and CAC can predict the outcome in ESRD individuals, while severe perfusion abnormality on gated-SPET and high CAC score ≥1000 are predictors of future cardiac events.

Diagnosis of high-risk patients with multivessel coronary artery disease by combined cardiac gated SPET imaging and coronary calcium score.

OBJECTIVE: The added value of coronary artery calcium (CAC) to SPET for identification of multivessel CAD has not been studied yet. The aim of this original study was to investigate CAC as an adjunct to gated single photon emission tomography (GSPET) in the detection of multivessel coronary artery disease (CAD). SUBJECTS AND METHODS: The study group consisted of 164 prospectively recruited patients without known CAD-123 (75%) men and 60 (37%) women, having diabetes type II, renal insufficiency, left ventricular dilatation and other cardiac problems (arrhythmia, necessity of pharmacological stress test, etc.). The mean age of these patients was 61±12 years (range 34-85 years). All these patients underwent GSPET imaging, CAC score measurement, and coronary angiography. The percentage of ischaemic myocardium, stress and rest left ventricular ejection fraction (LVEF), and transient ischaemic dilation (TID) ratio were measured. RESULTS: Patients with multivessel CAD had more frequently reversible defects in multiple territories, severe ischaemia ≥10% of the left ventricle, stress worsening of the LVEF ≥5%, TID ratio ≥1.17, and CAC score >1000. In the detection of multivessel CAD, the sensitivity of combined assessment of perfusion, function, and CAC (i.e., multiple and/or ≥10% ischaemia, and/or worsening of the LVEF ≥5%, and/or TID ratio ≥1.17, and/or CAC score >1000) was significantly higher than the sensitivity of perfusion alone or perfusion and function alone (81% vs. 55% and 65%, respectively, P<0.05). Sensitivity of only CAC was low (41%). CONCLUSION: Sensitivity of combined assessment of myocardial perfusion, function, and CAC was significantly higher than sensitivity of perfusion alone or perfusion and function alone, suggesting better identification of high-risk patients with CAD.

Nuclear medicine training and practice in the Czech Republic.

Nuclear medicine in the Czech Republic is a full specialty with an exclusive practice. Since the training program was organized and structured in recent years, residents have had access to the specialty of nuclear medicine, starting with a two-year general internship (in internal medicine or radiology). At present, nuclear medicine services are provided in 45 departments. In total, 119 nuclear medicine specialists are currently registered. In order to obtain the title of Nuclear Medicine Specialist, five years of training are necessary; the first two years consist of a general internship in internal medicine or radiology. The remaining three years consist of training in the nuclear medicine specialty itself, but includes three months of practice in radiology. Twenty-one physicians are currently in nuclear medicine training and a mean of three specialists pass the final exam per year. The syllabus is very similar to that of the European Union of Medical Specialists (UEMS), namely concerning the minimum recommended numbers for diagnostic and therapeutic procedures. In principle, the Czech law requires continuous medical education for all practicing doctors. The Czech Medical Chamber has provided a continuing medical education (CME) system. Other national CMEs are not accepted in Czech Republic.

Implant site development in the distal region of the mandible: bone formation and its stability over time.

INTRODUCTION: The purpose of this study was to determine the dimensional changes that occur in the alveolar ridge of patients upon distalization of the mandibular first premolars into the place of congenitally missing mandibular second premolars. The amount of bone formation that accompanied orthodontic treatment and the long-term stability of the new bone were assessed. METHODS: Fifty-five patients were included in the study, representing 71 congenitally missing mandibular second premolars. The dimensional changes were evaluated by comparing the dental stone casts and panoramic radiographs taken at treatment initiation (T1) and end (T2) and at follow-ups of 2 years (T3A) and 5 years (T3B). RESULTS: During the treatment period (T1-T2), the alveolar ridge width increased by an average of 28.5%, and the height increased by an average of 1.1 mm. During the retention periods (T2-T3A, T2-T3B), the alveolar ridge decreased by an average of 4.2%, but the height decreased only slightly (by an average of 0.07 mm). CONCLUSIONS: Orthodontic tooth movement created a significant amount of new bone that was stable in both the horizontal and vertical directions.

Myocardial perfusion imaging parameters: IQ-SPECT and conventional SPET system comparison.

Technological advancement in hardware and software development in myocardial perfusion imaging (MPI) leads to the shortening of acquisition time and reduction of the radiation burden to patients. We compared semiquantitative perfusion results and functional parameters of the left ventricle between new dedicated cardiac system with astigmatic collimators called IQ-SPECT (Siemens Medical Solutions, USA) and conventional single photon emission tomography (SPET) system equipped with standard low energy high resolution collimators. A group of randomly selected 81 patients underwent consecutively the MPI procedure on IQ-SPECT and on conventional SPET systen, both without attenuation correction. The summed scores and the values of the functional parameters of the left ventricle: ejection fraction (EF), end-systolic and end-diastolic volumes (ESV, EDV) received from the automatic analysis software were compared and statistically analyzed. Our results showed that summed scores values were significantly higher for the IQ-SPECT system in comparison to the conventional one. Calculated EF were significantly lower for IQ-SPECT, whereas evaluated left ventricular volumes (LVV) were significantly higher for this system. In conclusion, we recorded significant differences in automatically calculated semiquantitative perfusion and functional parameters when compared uncorrected studies obtained by the IQ-SPECT with the conventional SPET system.

Comparison of myocardial perfusion study and invasive hemodynamic measurement of the significance of non-infarct-related residual stenoses in ST elevation myocardial infarction patients.

BACKGROUND: Nearly 50% of ST elevation myocardial infarction (STEMI) patients have multivessel coronary artery disease. The optimal selection of non-culprit lesions for complete revascularization is a matter of current debate. Little is known about the predictive value of myocardial perfusion study (MPS) in this scenario. METHODS: We enrolled 49 STEMI patients (61.5 ± 10.3 years) with at least one major non-culprit lesion (50-90%) other than left main coronary artery lesions. Overall 63 non-infarct- related artery (IRA) stenoses (65.2 ± 11.9%) were recommended for further evaluation using Fractional Flow Reserve (FFR) measurement as is standard in our institution. Prior to FFR, all patients were scheduled for non-invasive MPS using single-photon emission computed tomography (SPECT). Both FFR and MPS were performed 4-8 weeks after STEMI with MPS preceding FFR within no more than 48 hours. An FFR value of ≤0.80 was considered significant and guided the final revascularization strategy. The results of MPS were correlated to FFR as well as to the clinical and angiographic characteristics of both culprit and non-infarct-related lesions. RESULTS: Based on FFR, 30 out of 63 stenoses (47.6%) in 27 patients were considered hemodynamically significant (FFR 0.69 ± 0.08, range 0.51-0.79) compared to residual 33 stenoses considered negative (FFR 0.87 ± 0.04, range 0.81-0.96). The MPS revealed abnormal myocardium (23.6% average, range 5-56%) in 21 patients (42.8%). Among those patients, only 9 showed the evidence of ischemic myocardium (average 10.8%, range 4-18%) with low sensitivity of MPS in predicting positive FFR. Besides that, higher proportion of patients (71.4% vs. 42.9%, P=0.047) with overall lower FFR values (0.73 vs. 0.80, P=0.014, resp.) in non-IRAs as well as higher proportion of patients with more severely compromised flow in IRAs (P=0.048) during STEMI had MPS-detected abnormal myocardium. CONCLUSION: In STEMI patients with multivessel coronary artery disease, we observed rather weak correlation between MPS using SPECT and invasive hemodynamic measurement using FFR in ischemia detection.

Comparison of angiographic estimation and invasive hemodynamic measurement of the significance of non-infarct-related residual stenoses in ST-elevation myocardial infarction patients.

Introduction: Up to 50% of patients with ST elevation myocardial infarction (STEMI) have ≥ 50% stenosis in a major non-infarct-related artery. Several studies have evaluated the prognostic value of the completion of revascularization with overall inconclusive results. Selection of the stenoses was based on the angiographic evaluation, invasive hemodynamic measurement or the combined approach. It is unknown whether such a selection provides correlation of comparable patient groups. Material and methods: We enrolled 51 patients (62.7 ±10.2 years) with acute STEMI and at least one residual (50-90%) stenosis in a non-infarct-related major coronary artery (excluding left main coronary artery). Overall 65 stenoses (67.9 ±10.7%) were evaluated angiographically following primary percutaneous coronary intervention and the hemodynamic significance was estimated with respect to the stenosis severity, caliber of the arterial segment, localization of the stenosis (proximity) as well as the estimated size of the supplied vascular territory. During subsequent hospitalization, invasive measurement of the hemodynamic significance using fractional flow reserve (FFR) was performed to guide the final revascularization strategy (FFR value of ≤ 0.80 considered significant). Results: Based on angiographic evaluation, a total of 44 stenoses would be recommended for treatment, whereas only 31 stenoses were revascularized based on FFR measurement. Moreover, visual evaluation and hemodynamic measurement were discrepant in 27 of 65 (41.5%) stenoses. Conclusions: We observed a weak correlation between visual angiographic evaluation and invasive hemodynamic measurement. More stents would be implanted based on angiographic evaluation compared to FFR measurement.

Orthodontic tooth movement: bone formation and its stability over time.

INTRODUCTION: Orthodontic tooth movement can lead to the creation of bone. The purposes of the study were to investigate the amount of bone formed in orthodontic patients during treatment (maxillary canine distalization) and retention and to assess the long-term stability of the new bone. METHODS: The sample consisted of 80 patients with 128 missing lateral incisors who were treated with distalization of the maxillary canines. They were examined at the beginning of orthodontic treatment (T1), at the end of treatment (T2), 2 years after treatment (T3A), and 5 years after treatment (T3B). The influence of the canine's inclination and its distance from the central incisor at T1 on the amount of bone created and the bone mass stability over time were assessed. Vestibular width of the alveolus was measured on casts at the level of the bone ridge and 5 mm apically from the alveolar ridge. Canine inclination to the alveolar ridge was recorded, as well as the height of the alveolar ridge. RESULTS: During treatment, T1 to T2, the alveolar ridge width was reduced by 4%, and the height decreased by 0.26 mm; during the retention periods (T2-T3A, T2-T3B), the alveolar ridge reduction was 2% on average, with individual variances, and height decreased by 0.38 mm on average. No correlation was found between canine inclination or between the canine distance from the central incisor at T1 and the amount and stability of the bone created by the orthodontic movement. CONCLUSIONS: The bone created through orthodontic tooth movement was stable in both the horizontal and vertical directions. Changes in the width of the alveolus were not related to the amount of bone at the place of agenesis at T1. When the canine erupts next to the central incisor, favorable conditions affect the formation of the bone mass through distalization of the canine at the site of the missing lateral incisor.

[Preoperative diagnosis of prosthetic joint infection]. / Predoperacní diagnostika infekcí kloubních náhrad.

Making pre-operative diagnosis of intermediate and low-grade infections of prosthetic joint infection (PJI) is demanding and requires both clinical experience and good knowledge of diagnostic test performance. It is also necessary to know the rules of working with diagnostic tests based on the expected change in pre-test probability of PJI or the diagnostic odds ratio. This also requires a multi-modal approach with a rational combination of relevant tests because none of them can have both 100% sensitivity and 100% specificity. Suspicion of a developing PJI should be aroused by relevant information present in the patient s medical history and confirmed by clinical examination. Patients with an increased starting PJI probability, i.e. after taking the medical history and clinical examination, should be examined for the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels (screening tests). When both of these tests are positive and no other alternative explanation for their increase is plausible, then the post-test probability of PJI is significantly increased (up to 70%). Under such conditions the diagnosis is made definitive by positive results of synovial fluid analysis (leukocyte count, percentage of neutrophils and lymphocytes, IL-1, IL-6) or an increased IL-6 serum levels. On the other hand, when both ESR and CRP are negative, the post-test probability of PJI is significantly decreased and no further examination for the presence of infection is usually necessary. In case of inconsistent results of ESR and CRP or if there is a high suspicion of joint infection regardless of these test results, joint fluid aspiration (cytology, IL-1, IL-6) and IL-6 serum levels should be assessed. In this situation scintigraphy imaging (three-phase bone scan combined with labelled leukocytes or anti-granulocyte antibodies) can also support or exclude the diagnosis. In low-grade infections or after previous administration of antibiotics it is recommended to repeat the above-mentioned laboratory tests and joint aspiration after at least a two-week interval without antibiotics. Key words: Total joint arthroplasty, prosthetic joint infection, preoperative diagnosis, pre-test probability, post-test probability, algorithm.

Additional value of the coronary artery calcium score in patients for whom myocardial perfusion imaging is challenging.

BACKGROUND Determination of prognosis based on ischemia detection, using single­photon emission computed tomography myocardial perfusion imaging (SPECT­MPI), can be challenging in patients with multiple affected coronary arteries. AIMS The aim of the study was to examine the outcomes of SPECT­MPI combined with the coronary artery calcium score (CACS) to identify predictors of adverse cardiac events (ACEs) in patients for whom ischemia detection may be difficult using SPECT­MPI. METHODS The study group included 195 patients with a history of chronic kidney disease, suspected ischemic cardiomyopathy, or left bundle branch block. All patients underwent SPECT­MPI and CACS evaluation. During the follow­up, ACEs were recorded. Perfusion and functional parameters as well as the CACS were analyzed to find the predictors of ACEs. RESULTS The ACEs were recorded in 58 individuals (29.7%) and were significantly associated with ischemia (P <0.001), abnormal functional parameters (P = 0.04), and higher CACSs (P <0.001). The optimal cutoff value of the CACS to predict an ACE was 530. Cox proportional hazards models revealed that age, mild and severe ischemia, functional abnormalities, and a CACS of 530 or higher were significant predictors of ACEs. In the subgroup of individuals without ischemia, a CACS of 530 or higher was significantly associated with poor outcome, while we recorded only 3 ACEs in these patients when the CACS was lower than 530. CONCLUSIONS The addition of the CACS to SPECT­MPI improves the identification of patients at higher risk for ACEs, even in individuals for whom SPECT­MPI is challenging.

The prognostic value of ultra low-dose thallium myocardial perfusion protocol using CZT SPECT.

The purpose of this study was to assess the prognostic value of ultra-low dose thallium myocardial perfusion imaging. Three hundred and sixty-six patients (245 men) underwent ultra-low dose stress-redistribution imaging on CZT SPECT camera GE Discovery NM 530c. The stress test was performed by bicycle ergometry or regadenoson injection. The activity of 0.5 MBq (0.014 mCi) Tl-201 chloride per kilogram of body weight was administered. The stress images were acquired immediately and redistribution images were taken after 3 h. Patient follow-up was focused on combined end-point (death, myocardial infarction, unstable angina, revascularization and hospitalization for heart failure). Data analysis was performed from hospital database, with a mean period 23 months. Patients with revascularization within 1 month after SPECT was excluded as revascularization for diagnosis. Ischaemia on SPECT was found in 72 patients, 294 patients were without ischaemia. In patients with ischaemia there were 21 (29.2%) subjects with cardiac events, and 23 (7.9%) in patients without ischaemia (HR 4.15, 95% CI 2.30-7.51, p < 0.0001). Ultra-low dose thallium perfusion imaging using CZT camera provides very good prognostic results in assessment of myocardial ischaemia.

Individual differences in the effectiveness of intracoronary bone marrow cell transplantation assessed by gated sestamibi SPECT/FDG PET imaging.

BACKGROUND: The impact of different levels of tracer uptake on improvements of left-ventricular (LV) function was analyzed in patients treated by intracoronary bone marrow cell (BMC) transplantation. METHODS AND RESULTS: Thirty-one patients with irreversible damage after their first acute myocardial infarction (MI), as confirmed by sestamibi single-photon emission computed tomography (MIBI SPECT)/fluorodeoxyglucose positron emission tomography (FDG PET), underwent high-dose (1 x 10(8) cells) BMC transplantation, whereas 31 similar patients were randomly integrated into a control group. In 11 BMC-treated patients with very low sestamibi uptake at less than 30% of maximum in the infarcted area, the mean left-ventricular ejection fraction (LVEF) improved after 3 months of follow-up by 3% only, and mean end-diastolic/end-systolic volumes (EDV/ESV) enlarged by 10/1 mL (P = NS vs controls). In 20 BMC-treated patients with higher sestamibi uptake in the range of 31% to 50% of maximum, LVEF improved by 7%, and EDV/ESV decreased by 5/12 mL (P < .05 vs BMC-treated subgroup with low MIBI uptake and controls). No similar categorization was seen in the control group: in patients with higher sestamibi uptake or very low uptake, the LVEF increased by 2% and 3% only, and the EDV/ESV enlarged in both subgroups by 12/4 mL and 12/2 mL, respectively (P = NS). CONCLUSIONS: Our results suggest the capability of SPECT/PET imaging to select patients who will receive the maximum benefit from BMC therapy.

Cell therapy in patients with left ventricular dysfunction due to myocardial infarction.

OBJECTIVES: The purpose of this study was to determine the impact of autologous transplantation of mononuclear bone marrow cells on myocardial function in patients with left ventricular (LV) dysfunction due to an acute myocardial infarction. METHODS: The randomized study included 82 patients with a first acute myocardial infarction treated with a stent implantation. This presentation is a subanalysis of 47 patients with left ventricular dysfunction-EF (ejection fraction)

Multiple myeloma: predictive value of Tc-99m MIBI scintigraphy and MRI in its diagnosis and therapy.

BACKGROUND: We assessed the validity of (99m)Tc-MIBI scintigraphy and MRI in the diagnosis and prediction of the effect of therapy in patients with multiple myeloma (MM) and monoclonal gammopathy of unknown significance (MGUS), in whom both examinations were performed within 14 days. MATERIAL AND METHODS: Forty-seven consecutive patients with MM and 5 with MGUS were enrolled in the study. Out of 47 MM patients, 6 were in Durie-Salmon stage I and 41 had active disease in stage II or III. Fifteen patients were examined before and within 2 months of intensive chemotherapy. Anterior and posterior whole-body scans were obtained 10 min after IV administration of 740 MBq (20 mCi) (99m)Tc-MIBI. MRI of Th and LS spine, T1 w.i. and STIR in the sagittal plane were performed. RESULTS: Bone marrow pathological changes in 41 MM patients with active disease were detected in 39 (95%) scintigraphic examinations and in 38 (94%) of MRI. Among 41 MM patients with active disease, 21 showed diffuse patterns of (99m)Tc-MIBI uptake, 8 showed focal patterns and 10 showed both focal and diffuse patterns, while 34 patients exhibited focal lesions in MRI and 4 both focal and diffuse findings. Moreover, 5 of 38 patients had epidural mass and 18 had vertebrae compression. Out of 15 patients after therapy, 13 reached complete remission and 2 had stable disease. Normal (99m)Tc-MIBI scintigraphy was found in 11 (85%) patients with complete remission, 2 presented both focal and diffuse patterns of (99m)Tc-MIBI uptake. Two patients with stable disease also had focal and diffuse radiotracer uptake. MRI findings were normal only in 3 (23%) patients in complete remission. Eight patients exhibited focal lesions and 2 showed partial conversion in MRI. CONCLUSIONS: (99m)Tc-MIBI scintigraphy and MRI are methods of equal sensitivity in detecting active MM and complement each other. The advantage of 99mTc-MIBI scintigraphy is the possibility of whole body examination, which allows superiority in detection of MM in appendicular skeleton and extramedular lesions, and faster response to therapy, while the advantage of MRI is the detection of epidural masses and vertebral compressions influencing the therapeutic strategy.

Possitive correlation between adipocyte fatty acid-binding protein and epicardial fat in patients with a family history of cardiovascular disesase.

BACKGROUND: Adipocyte fatty acid-binding protein (A-FABP) is a promising link between metabolic syndrome and atherosclerosis. Epicardial fat (EPI) is an independent risk factor for cardiovascular disease (CVD). OBJECTIVE: The aim of this pilot study was to evaluate the correlation between EPI and A-FABP in asymptomatic patients with a family history of CVD. METHODS: 59 subjects (39 males) (median = 54 years old) were enrolled in the study and their EPI thickness and A-FABP levels were assessed. RESULTS: EPI was found in 46 patients (77.9%). There were positive correlations between EPI and A-FABP (r=0.336; P=0.010), age (r=0.526; P<0.001), fibrinogen (r=0.304; P=0.023) and systolic blood pressure (r=0.279; P=0.034). A positive correlation was found between EPI and A-FABP in a subgroup of overweight and obese patients (0.389; P=0.041, 0.407; P=0.004) and in the subgroup of patients with excluded CVD (r=0.368; P=0.006). CONCLUSIONS: We found a positive correlation between EPI and A-FABP in a group of patients with a family history of CVD and in subgroups of overweight and obese patients.