Greek adaptation and validation of the Patient-Rated Tennis Elbow Evaluation (PRTEE).

PURPOSE OF THE STUDY: To cross-culturally adapt and validate the Greek version of the Patient-Rated Tennis Elbow Evaluation (PRTEE-G) Questionnaire. METHODS: Four bi-lingual translators were involved in the translation and cultural adaptation procedures. Eighty-two patients (61 women and 21 men) with Lateral Elbow Tendinopathy (LET) participated in the study. To establish test - retest reliability, the patients were asked to complete the PRTEE-G Questionnaire before and after the first physiotherapy treatment. Internal consistency of the translated instrument was measured using Cronbach 'alpha'. An intraclass correlation coefficient was used to assess the test - retest reliability of the PRTEE-G Questionnaire. Concurrent validity was measured by correlating the PRTEE-G Questionnaire scores with the Greek version of the Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) scores using Pearson's correlation coefficient. RESULTS: The Greek PRTEE questionnaire has acceptable internal consistency (Cronbach 'alpha' = 0.95), excellent test - retest reliability (ICC = 0.94) and demonstrates expected concurrent validity (r > 0.72). CONCLUSION: The Greek version of PRTEE Questionnaire is a reliable and valid measure when administered to patients with LET.

Left atrium and the imaging of atrial fibrosis: catch it if you can!

Atrial fibrillation is a sustained arrhythmia commonly encountered in clinical practice. It has a high prevalence among the elderly and contributes significantly to the global socio-economic burden. Among many risk factors predisposing to atrial fibrillation is left atrial remodelling and wall fibrosis. Frequently, pathological left atrial wall remodelling and fibrosis results in low atrial compliance and elastance significantly increase the risk of developing permanent atrial fibrillation. We reviewed all literature which employs imaging and left atrial fibrosis and we present all available imaging modalities. Current imaging tools may play a role in the detection of atrial fibrosis, hence providing valuable information for risk stratification and management of patients with atrial fibrillation.

Grafts in Peyronie's surgery without the use of prostheses: a systematic review and meta-analysis.

Peyronie's disease (PD) is characterized by abnormal penile curvature, and various surgical methods have been developed using different graft materials. However, there is currently no universal agreement on which type of graft is the best. The objective of this review was to evaluate the available literature and identify the most effective graft material for penile curvature correction in PD. A literature search was conducted using electronic databases, including PubMed, Scopus, and the Cochrane Library. The patients, intervention, comparison, and outcome (PICO) approach was used to define the eligibility of studies. Two authors independently selected studies, evaluated them, and extracted data. Random-effect models using the DerSimonian-Laird method were used. Most studies were single-arm studies and had a high risk of bias. Buccal mucosa grafts (BMG) were found to result in the highest penile straightening rates and were associated with the least de novo erectile dysfunction. TachoSil grafts demonstrated a high success rate in straightening despite a higher mean preoperative curvature, while Tutoplast grafts had a higher incidence of postoperative erectile dysfunction. BMG had the highest percentage of postoperative penile straightening. Overall, the TachoSil graft showed the best performance when preoperative curvature is taken into account. Based on the available literature, BMG appear to be the most effective for penile curvature correction in PD, but this is offset by the requirement for low preoperative curvature. The TachoSil graft shows the best overall performance when preoperative curvature is considered. Comparative randomized clinical trials are still needed to determine graft superiority.

Using kinetic Monte Carlo simulations to design efficient magnetic nanoparticles for clinical hyperthermia.

PURPOSE: The purpose of this study was to identify the properties of magnetite nanoparticles that deliver optimal heating efficiency, predict the geometrical characteristics to get these target properties, and determine the concentrations of nanoparticles required to optimize thermotherapy. METHODS: Kinetic Monte Carlo simulations were employed to identify the properties of magnetic nanoparticles that deliver high Specific Absorption Rate (SAR) values. Optimal volumes were determined for anisotropies ranging between 11 and 40 kJ/m3 under clinically relevant magnetic field conditions. Atomistic spin simulations were employed to determine the aspect ratios of ellipsoidal magnetite nanoparticles that deliver the target properties. A numerical model was developed using the extended cardiac-torso (XCAT) phantom to simulate low-field (4 kA/m) and high-field (18 kA/m) prostate cancer thermotherapy. A stationary optimization study exploiting the Method of Moving Asymptotes (MMA) was carried out to calculate the concentration fields that deliver homogenous temperature distributions within target thermotherapy range constrained by the optimization objective function. A time-dependent study was used to compute the thermal dose of a 30-min session. RESULTS: Prolate ellipsoidal magnetite nanoparticles with a volume of 3922 ± 35 nm3 and aspect ratio of 1.56, which yields an effective anisotropy of 20 kJ/m3 , constituted the optimal design at current maximum clinical field properties (H0   = 18 kA/m, f = 100 kHz), with SAR = 342.0 ± 2.7 W/g, while nanoparticles with a volume of 4147 ± 36 nm3 , aspect ratio of 1.29, and effective anisotropy 11 kJ/m3 were optimal for low-field applications (H0   = 4 kA/m, f = 100 kHz), with SAR = 50.2 ± 0.5 W/g. The average concentration of 3.86 ± 0.10 and 0.57 ± 0.01 mg/cm3 at 4 and 18 kA/m, respectively, were sufficient to reach therapeutic temperatures of 42-44°C throughout the prostate volume. The thermal dose delivered during a 30-min session exceeded 5.8 Cumulative Equivalent Minutes at 43°C within 90% of the prostate volume (CEM43T90 ). CONCLUSION: The optimal properties and design specifications of magnetite nanoparticles vary with magnetic field properties. Application-specific magnetic nanoparticles or nanoparticles that are optimized at low fields are indicated for optimal thermal dose delivery at low concentrations.

The acute and long-term effects of a cardiac rehabilitation program on endothelial progenitor cells in chronic heart failure patients: Comparing two different exercise training protocols.

BACKGROUND: Vascular endothelial dysfunction is an underlying pathophysiological feature of chronic heart failure (CHF). Endothelial progenitor cells (EPCs) are also impaired. The purpose of the study was to assess the effect of a cardiac rehabilitation (CR) program on the increase of EPCs at rest and on the acute response after maximal exercise in patients with CHF and investigate whether there were differences between two exercise training protocols and patients of NYHA II and III classes. METHODS: Forty-four patients with stable CHF enrolled in a 36-session CR program and were randomized in one training protocol; either high-intensity interval training (HIIT) or HIIT combined with muscle strength (COM). All patients underwent maximum cardiopulmonary exercise testing (CPET) before and after the CR program and venous blood was drawn before and after each CPET. Five endothelial cellular populations, expressed as cells/106 enucleated cells, were quantified by flow cytometry. RESULTS: An increase in all endothelial cellular populations at rest was observed after the CR program (p < 0.01). The acute response after maximum exercise increased in 4 out of 5 endothelial cellular populations after rehabilitation. Although there was increase in EPCs at rest and the acute response after rehabilitation in each exercise training group and each NYHA class, there were no differences between HIIT and COM groups or NYHA II and NYHA III classes (p > 0.05). CONCLUSIONS: A 36-session CR program increases the acute response after maximum CPET and stimulates the long-term mobilization of EPCs at rest in patients with CHF. These benefits seem to be similar between HIIT and COM exercise training protocols and between patients of different functional classes.

Magnetic fluid hyperthermia simulations in evaluation of SAR calculation methods.

PURPOSE: The purpose of this study is to employ magnetic fluid hyperthermia simulations in the precise computation of Specific Absorption Rate functions -SAR(T)-, and in the evaluation of the predictive capacity of different SAR calculation methods. METHODS: Magnetic fluid hyperthermia experiments were carried out using magnetite-based nanofluids. The respective SAR values were estimated through four different calculation methods including the initial slope method, the Box-Lucas method, the corrected slope method and the incremental analysis method (INCAM). A novel numerical model combining the heat transfer equations and the Navier-Stokes equations was developed to reproduce the experimental heating process. To address variations in heating efficiency with temperature, the expression of the power dissipation as a Gaussian function of temperature was introduced and the Levenberg-Marquardt optimization algorithm was employed to compute the function parameters and determine the function's effective branch within each measurement's temperature range. The power dissipation function was then reduced to the respective SAR function. RESULTS: The INCAM exhibited the lowest relative errors ranging between 0.62 and 15.03% with respect to the simulations. SAR(T) functions exhibited significant variations, up to 45%, within the MFH-relevant temperature range. CONCLUSIONS: The examined calculation methods are not suitable to accurately quantify the heating efficiency of a magnetic fluid. Numerical models can be exploited to effectively compute SAR(T) and contribute to the development of robust hyperthermia treatment planning applications.

Endothelial progenitor cells mobilization after maximal exercise according to heart failure severity.

BACKGROUND: Vascular endothelial dysfunction is an underlying pathophysiological feature of chronic heart failure (CHF). Patients with CHF are characterized by impaired vasodilation and inflammation of the vascular endothelium. They also have low levels of endothelial progenitor cells (EPCs). EPCs are bone marrow derived cells involved in endothelium regeneration, homeostasis, and neovascularization. Exercise has been shown to improve vasodilation and stimulate the mobilization of EPCs in healthy people and patients with cardiovascular comorbidities. However, the effects of exercise on EPCs in different stages of CHF remain under investigation. AIM: To evaluate the effect of a symptom-limited maximal cardiopulmonary exercise testing (CPET) on EPCs in CHF patients of different severity. METHODS: Forty-nine consecutive patients (41 males) with stable CHF [mean age (years): 56 ± 10, ejection fraction (EF, %): 32 ± 8, peak oxygen uptake (VO2, mL/kg/min): 18.1 ± 4.4] underwent a CPET on a cycle ergometer. Venous blood was sampled before and after CPET. Five circulating endothelial populations were quantified by flow cytometry: Three subgroups of EPCs [CD34+/CD45-/CD133+, CD34+/CD45-/CD133+/VEGFR2 and CD34+/CD133+/vascular endothelial growth factor receptor 2 (VEGFR2)] and two subgroups of circulating endothelial cells (CD34+/CD45-/CD133- and CD34+/CD45-/CD133-/VEGFR2). Patients were divided in two groups of severity according to the median value of peak VO2 (18.0 mL/kg/min), predicted peak VO2 (65.5%), ventilation/carbon dioxide output slope (32.5) and EF (reduced and mid-ranged EF). EPCs values are expressed as median (25th-75th percentiles) in cells/106 enucleated cells. RESULTS: Patients with lower peak VO2 increased the mobilization of CD34+/CD45-/CD133+ [pre CPET: 60 (25-76) vs post CPET: 90 (70-103) cells/106 enucleated cells, P < 0.001], CD34+/CD45-/CD133+/VEGFR2 [pre CPET: 1 (1-4) vs post CPET: 5 (3-8) cells/106 enucleated cells, P < 0.001], CD34+/CD45-/CD133- [pre CPET: 186 (141-361) vs post CPET: 488 (247-658) cells/106 enucleated cells, P < 0.001] and CD34+/CD45-/CD133-/VEGFR2 [pre CPET: 2 (1-2) vs post CPET: 3 (2-5) cells/106 enucleated cells, P < 0.001], while patients with higher VO2 increased the mobilization of CD34+/CD45-/CD133+ [pre CPET: 42 (19-73) vs post CPET: 90 (39-118) cells/106 enucleated cells, P < 0.001], CD34+/CD45-/CD133+/VEGFR2 [pre CPET: 2 (1-3) vs post CPET: 6 (3-9) cells/106 enucleated cells, P < 0.001], CD34+/CD133+/VEGFR2 [pre CPET: 10 (7-18) vs post CPET: 14 (10-19) cells/106 enucleated cells, P < 0.01], CD34+/CD45-/CD133- [pre CPET: 218 (158-247) vs post CPET: 311 (254-569) cells/106 enucleated cells, P < 0.001] and CD34+/CD45-/CD133-/VEGFR2 [pre CPET: 1 (1-2) vs post CPET: 4 (2-6) cells/106 enucleated cells, P < 0.001]. A similar increase in the mobilization of at least four out of five cellular populations was observed after maximal exercise within each severity group regarding predicted peak, ventilation/carbon dioxide output slope and EF as well (P < 0.05). However, there were no statistically significant differences in the mobilization of endothelial cellular populations between severity groups in each comparison (P > 0.05). CONCLUSION: Our study has shown an increased EPCs and circulating endothelial cells mobilization after maximal exercise in CHF patients, but this increase was not associated with syndrome severity. Further investigation, however, is needed.

Left atrial thrombus after biventricular pacemaker implantation.

We report the case of a patient with ischaemic cardiomyopathy who was admitted to our hospital for an echocardiographic follow-up a few days after the implantation of a biventricular pacemaker/defibrillator. Transthoracic echocardiographic examination revealed an immobile echogenic mass attached to the left atrial side of the fossa ovalis which was not present a month before the biventricular pacemaker implantation. Because the images of the pre-operative echocardiogram were not available at the time of the examination, the differential diagnosis included a tumour or a thrombus formed on the left side of intra-atrial septum. The use of low myocardial infarction contrast echocardiography and power Doppler clarified the lack of microcirculation and blood flow within the mass, respectively, and confirmed the diagnosis of thrombus. After an episode acute renal failure, the thrombus was absent at a follow-up echocardiogram presumably because of peripheral embolization.

The role of myocardial contrast echocardiography to assess the origin of a mass in right cardiac cavities.

We report the case of a patient with hepatocellular carcinoma who was admitted to our hospital with fatigue and edema of lower extremities. Transthoracic echocardiographic examination revealed a mobile echogenic cavoatrial mass that infiltrated the inferior vena cava and extended along the vessel protruding into the right cardiac cavities. The differential diagnosis included a tumor mass originating from the liver and subsequently infiltrating the inferior vena cava and extending into the right cardiac cavities or a large thrombus formed on the tumor mass that infiltrated the inferior vena cava.

Incremental value of pulse wave velocity in the determination of coronary microcirculatory dysfunction in never-treated patients with essential hypertension.

BACKGROUND: Coronary microcirculation is disturbed in essential hypertension. We investigated whether arterial stiffness determines coronary flow reserve (CFR) in hypertensive patients. METHODS: We examined 100 never-treated hypertensives and 20 healthy controls. We measured (i) carotid-to-femoral pulse wave velocity (PWV); (ii) Systolic (V (s)) and diastolic (V (d)) coronary flow velocity, time integral (V (TI)-V (d)) of diastolic velocity and CFR after adenosine by transthoracic echocardiography; (iii) ratio of E wave from mitral inflow to Em of mitral annulus, as an index of left ventricular (LV) diastolic pressures using tissue Doppler; (iv) carotid intima-media thickness (IMT), as an index of vascular damage; and (v) 24-h blood pressure parameters using ambulatory blood pressure monitoring. RESULTS: Patients had abnormal PWV, IMT, E/Em, resting V (d)/V (s), and CFR than controls (P < 0.05). In hypertensives, PWV was related to abnormal IMT and E/Em which in turn were related to reduced CFR (P < 0.05). PWV and E/Em were independent determinants of CFR and V (d)/V (s) (P < 0.05) in hypertensives. When added to a model including age, sex, smoking, LV mass (LVM), heart rate, 24-h systolic blood pressure (SBP), and E/Em, PWV had an incremental value in the determination of CFR (r (2) change from 0.25 to 0.46, P < 0.01). PWV >10.7 m/s predicted a CFR <2 with 79 and 75% and a CFR <2.6 with 83 and 82% sensitivity and specificity, respectively, using adjusted-receiver operating characteristic curve (ROC) analysis. CONCLUSIONS: Elevated LV diastolic compressive forces on coronary microcirculation and the presence of generalized vascular damage may explain the association between PWV and CFR. PWV has an incremental value in the determination of impaired coronary microcirculation in hypertensive patients.

'Obstruction alternans' of a Sorin tilting disc prosthetic mitral valve: a case of emergency action.

We present a patient with a history of a Sorin tilting disc prosthetic mitral valve implanted 20 years ago who developed acute dyspnoea. Echocardiogram revealed a unique pattern of 'obstruction alternans' of mitral valve prosthesis due to pannus formation. We emphasize the need for urgent surgical treatment of this potentially fatal complication.

Weight loss after bariatric surgery improves aortic elastic properties and left ventricular function in individuals with morbid obesity: a 3-year follow-up study.

OBJECTIVE: To investigate whether weight loss after bariatric surgery (gastric bypass) is associated with changes in aortic function (an important determinant of left ventricular function) and in left ventricular function, in morbidly obese individuals 3 and 36 months after surgery. METHODS: We used echocardiography to evaluate 60 obese individuals [body mass index (BMI) > 40 kg/m2] who underwent surgery and 20 obese individuals who neither underwent surgery nor lost weight, at baseline and at 3 and 36 months of follow-up, and 40 lean individuals (BMI < 25 kg/m2) of similar age, sex and risk factors, at baseline. We measured aortic strain, distensibility, stiffness index, pressure-strain modulus and Doppler indices of left ventricular diastolic dysfunction (ratio of peak early to peak atrial flow velocities, isovolumic relaxation time and deceleration time). RESULTS: Baseline aortic function and Doppler diastolic indices were impaired in obese individuals compared with those who were lean (P < 0.05). During 3 and 36 months of follow-up, BMI and left ventricular diastolic diameter, volume, mass and wall thickness were reduced, and indices of aortic function and left ventricular diastolic function were normalized, in obese individuals after surgery [aortic distensibility (cm2 x dyn(-1) x 10(-6)): 1.9 before surgery, 3.4 at 3 months after surgery and 4.3 at 3 years after surgery, compared with 3.36 in lean controls; P < 0.01], but not in those who did not lose weight. The reduction in BMI after surgery was related to the concomitant improvement in indices of aortic function (P < 0.01) and isovolumic relaxation time (P < 0.05) after adjustment for age, sex and concomitant reduction in blood pressure, lipids and glucose concentrations. CONCLUSION: Weight reduction after bariatric surgery normalizes aortic function, reduces left ventricular hypertrophy and, thus, improves left ventricular diastolic function in morbidly obese individuals over a 3-year period of follow-up.

Greek cultural adaption and validation of the Kujala anterior knee pain scale in patients with patellofemoral pain syndrome.

PURPOSE: To cross-culturally adapt and validate the Greek version of the Kujala anterior knee pain scale (KAKPS). METHODS: The Greek KAKPS was translated from the original English version following standard forward and backward translation procedures. The survey was then conducted in clinical settings by a questionnaire comprising the Greek KAKPS and patellofemoral pain syndrome (PFPS) severity scale. A total of 130 (62 women and 68 men) Greek-reading patients between 18 and 45 years old with anterior knee pain (AKP) for at least four weeks were recruited from physical therapy clinics. To establish test-retest reliability, the patients were asked to complete the KAKPS at initial visit and 2-3 days after the initial visit. The Greek version of the PFPS severity scale was also administered once at initial visit. Internal consistency of the translated instrument was measured using Cronbach's α. An intraclass correlation coefficient was used to assess the test-retest reliability of the KAKPS. Concurrent validity was measured by correlating the KAKPS with the PFPS severity scale using Pearson's correlation coefficient. RESULTS: The results showed that the Greek KAKPS has good internal consistency (Cronbach's α = 0.942), test-retest reliability (ICC = 0.921) and concurrent validity (r > 0.7). CONCLUSIONS: This study has shown that the Greek KAKPS has good internal consistency, test-retest reliability and concurrent validity when correlated with the PFPS severity scale in adult patients with AKP for at least four weeks. Implications for rehabilitation The Greek version of the KAKPS has been found to be reliable and valid when used in adult patients with AKP for at least four weeks. The results of the psychometric characteristics were compatible with those of the original English version. The KAKPS could be applied in a Greek-speaking population to assess functional limitations and symptoms in patients aged 18-45 years old with AKP for at least four weeks.

The use of Bioptron light (polarized, polychromatic, non-coherent) therapy for the treatment of acute ankle sprains.

Purpose The purpose of this study was to investigate the efficacy of Bioptron light therapy for the treatment of acute ankle sprains. Method A parallel group, single-blind, controlled study was carried out in patients with grade II acute ankle sprains. Patients were randomly allocated into two treatment groups (n = 25 for each). Both groups received cryotherapy, and the test group also received Bioptron light therapy. All treatments were performed daily for 5 d. Evaluations included self-reported pain via a visual analogue scale, degree of ankle edema, and ankle range of motion via goniometry carried out before the treatment and at the end of the treatment. Results The test group showed the largest magnitude of improvement for all evaluations at treatment five, and the between-group differences observed were statistically significant (p < 0.0005 for each). Conclusions These data provide preliminary evidence of the efficacy of Bioptron light therapy supplemented with cryotherapy for the treatment of acute ankle sprains; however, larger studies are required to confirm these results. Implications for Rehabilitation Ankle sprains are common acute injuries among professional and recreational sports players but also among people in general. Cryotherapy is the first-standard treatment of acute ankle sprains. Phototherapy such as Bioptron light has been recommended supplement to cryotherapy to reduce the symptoms of ankle sprains. The results of the present trial showed that using BIOPTRON LIGHT and cryotherapy the rehabilitation period of acute ankle sprains can be reduced.

Sonochemical degradation of ethyl paraben in environmental samples: Statistically important parameters determining kinetics, by-products and pathways.

The sonochemical degradation of ethyl paraben (EP), a representative of the parabens family, was investigated. Experiments were conducted at constant ultrasound frequency of 20 kHz and liquid bulk temperature of 30 °C in the following range of experimental conditions: EP concentration 250-1250 µg/L, ultrasound (US) density 20-60 W/L, reaction time up to 120 min, initial pH 3-8 and sodium persulfate 0-100mg/L, either in ultrapure water or secondary treated wastewater. A factorial design methodology was adopted to elucidate the statistically important effects and their interactions and a full empirical model comprising seventeen terms was originally developed. Omitting several terms of lower significance, a reduced model that can reliably simulate the process was finally proposed; this includes EP concentration, reaction time, power density and initial pH, as well as the interactions (EP concentration)×(US density), (EP concentration)×(pHo) and (EP concentration)×(time). Experiments at an increased EP concentration of 3.5mg/L were also performed to identify degradation by-products. LC-TOF-MS analysis revealed that EP sonochemical degradation occurs through dealkylation of the ethyl chain to form methyl paraben, while successive hydroxylation of the aromatic ring yields 4-hydroxybenzoic, 2,4-dihydroxybenzoic and 3,4-dihydroxybenzoic acids. By-products are less toxic to bacterium V. fischeri than the parent compound.

Association of impaired left ventricular twisting-untwisting with vascular dysfunction, neurohumoral activation and impaired exercise capacity in hypertensive heart disease.

AIMS: We investigated the association between left ventricular (LV) torsional deformation and vascular dysfunction, fibrosis, neurohumoral activation, and exercise capacity in patients with normal ejection fraction METHODS AND RESULTS: In 320 newly-diagnosed untreated hypertensive patients and 160 controls, we measured: pulse wave velocity (PWV); coronary flow reserve (CFR) by Doppler echocardiography; global longitudinal strain and strain rate, peak twisting, the percentage changes between peak twisting, and untwisting at mitral valve opening (%dpTw - UtwMVO ), at peak (%dpTw - UtwPEF ), and the end of early LV diastolic filling (%dpTw - UtwEDF ) by speckle tracking imaging; transforming growth factor (TGFb-1), metalloproteinase-9 (MMP-9), tissue inhibitor of matrix metalloptoteinase-1(TIMP-1), markers of collagen synthesis, and N-terminal pro-brain natriuretic peptide (NT-proBNP). Oxygen consumption (VO2 ), measured by means of cardiopulmonary exercise test, was assessed in a subset of 80 patients. The PWV, CFR, longitudinal strain and strain rate, %dpTw-UtwMVO , %dpTw-UtwPEF , and %dpTw-UtwEDF were impaired in hypertensive patients compared with controls. In multivariable analysis, CFR, PWV, LV mass, and systolic blood pressure were independent determinants of longitudinal strain, strain rate, and untwisting markers (P < 0.05). Increased TGFb-1 was related with increased collagen synthesis markers, TIMP-1 and MMP-9 and these biomarkers were associated with impaired longitudinal systolic strain rate, untwisting markers, CFR and PWV (P < 0.05). Delayed untwisting as assessed by reduced %dpTw - UtwEDF was related with increased NT-proBNP and reduced VO2 (P < 0.05). CONCLUSIONS: Impaired LV untwisting is associated with increased arterial stiffness and coronary microcirculatory dysfunction, and is linked to reduced exercise capacity and neurohumoral activation in hypertensive heart disease. A fibrotic process may be the common link between vascular dysfunction and abnormal myocardial deformation.

Association of abnormal coronary microcirculatory function with impaired response of longitudinal left ventricular function during adenosine stress echocardiography in untreated hypertensive patients.

AIMS: Coronary microcirculation is disturbed in hypertensive patients. We investigated the association of coronary flow reserve (CFR) with the response of left ventricular (LV) function as assessed by tissue Doppler imaging (TDI) during adenosine stress echocardiography in never-treated hypertensive patients. METHODS AND RESULTS: We studied 90 hypertensive patients and 30 control subjects, matched for age and sex, by adenosine stress echocardiography. We measured: (i) CFR, E and A Doppler, S', E', A' mitral annulus velocities with TDI, as well as the E'/A' ratio and the E/E' ratio before and during adenosine infusion (ii) the %changes of the measured indices between baseline and adenosine infusion. After adenosine infusion, there was an increase in S', E', and A' in all patients and controls (P < 0.05). Compared with controls and patients with CFR ≥ 2.5, patients with CFR <2.5 showed a smaller increase in S' (28.6 vs. 30.0 vs. 11.1%, F for interaction = 14.592) and E' (33.3 vs. 33.3 vs.1.5%, F = 28.927) as well as a decrease in E'/A' (9.2 vs. 6.4% vs. -20.0%, F = 5.128) and an increase in E/E' (-6.1 vs. -1.6 vs. 30.5%. F = 12.780) after adenosine infusion (P < 0.05 for all comparisons). CFR was independently related to %changes of TDI parameters (regression coefficient b = 0.576 for S'; b = 0.517 for E'; b = 0.473 for E'/A'; b = -0.520 for E/E', respectively, P < 0.001). By the receiver operating curve, a CFR <2.5 predicted the median changes of all measured TDI markers, with a sensitivity and specificity over 70% (AUC >75%, P < 0.05). CONCLUSION: An abnormal response of the LV longitudinal function during adenosine stress echocardiography is related to impaired CFR in untreated hypertensive patients.

Mobile masses in the aortic arch in a patient with acute embolic event.

We describe a 45-year-old woman with peripheral embolism in whom echocardiography revealed mobile masses in the aortic arch that were characterized as atherothrombi. The masses were resected surgically 2 months later, since treatment with antiplatelets, anticoagulants and statins failed to resolve them.

Attainment of optional low-density lipoprotein cholesterol goal of less than 70 mg/dl and impact on prognosis of very high risk stable coronary patients: a 3-year follow-up.

OBJECTIVES: We aimed to investigate the proportion of very high-risk patients with coronary heart disease (CHD) who achieve the optional low-density lipoprotein cholesterol (LDL-C) target of <70 mg/dl (1.8 mmol/liter), the factors that influence the success rate and the impact on their prognosis. RESEARCH DESIGN AND METHODS: We enrolled 1337 consecutive patients with stable CHD. Fasting lipids were determined and all cardiovascular events were recorded during a median follow-up of 33 months. RESULTS: The majority (86.5%) of patients were taking lipid-lowering medication (95.5% statins), but only 50.6% had LDL-C levels of <100 mg/dl (2.6 mmol/liter). In total, 941 (70.4%) patients were considered very high risk and only 15.1% of them had LDL-C levels of <70 mg/dl. Τhe use of intensive lipid-lowering medication was associated with 12-fold (95% CI 6.98-20.76; p<0.001) higher possibility in achieving LDL-C levels of < 70 mg/dl. Attainment of LDL-C levels of < 70 mg/dl by patients at very high risk were independent predictors of all cardiovascular events (HR=0.34, 95% CI 0.17-0.70; p=0.003). CONCLUSIONS: The vast majority of very high-risk patients do not achieve the optional LDL-C goal; this is mainly due to the suboptimal uptitration of statin dose and is translated into loss of clinical benefits.