Obesity and adiponectin in acute myocardial infarction

Background: Low plasma concentration of adiponectin, a hormone-like peptide secreted by adipose tissue, is detected in obesity and in coronary artery disease. The aim of the study was to assess the impact of obesity on adiponectin and the relation of adiponectin to the anthropometric parameters and cardiovascular risk factors in men with acute myocardial infarction. Methods: Two groups of patients with first acute myocardial infarction were analyzed: 40 obese and 40 non-obese men. Waist and hip circumferences and waist-to-hip ratio, C-reactive protein (CRP), uric acid, fasting glucose, lipid profile and adiponectin were measured. Results: Mean level of adiponectin was significantly lower in obese than non-obese patients (6.80 &#956;g/ml &plusmn; 4.31 vs. 11.18 &#956;g/ml &plusmn; 7.19; p < 0.01). Adiponectin levels correlated negatively with all anthropometric measurements, the most significantly with waist circumference, with systolic blood pressure, fasting glucose, triglyceride levels, CRP, uric acid and positively with age and HDL-cholesterol. Adiponectin level was significantly associated with HDL-cholesterol, waist circumference and with trigliceryde levels and these independent variables explained 39% of the plasma adiponectin variability. Conclusions: In patients with acute myocardial infarction obesity is related to decreased adiponectin. Low adiponectin level is associated with atherogenic lipid profile and higher levels of inflammatory markers. (Cardiol J 2007; 14: 29&#8211;36

Evaluation of Sine Spin flat detector CT imaging compared with multidetector CT.

BACKGROUND Flat detector computed tomography (FDCT) is widely used for periprocedural imaging in the angiography suite. Sine Spin FDCT (SFDCT) is the latest generation of cone beam CT using a double oblique trajectory for image acquisition to reduce artefacts and improve soft tissue brain imaging. This study compared the effective dose, image quality and diagnostic performance of the latest generation of SFDCT with multidetector CT (MDCT). METHODS An anthropomorphic phantom equipped with MOSFET detectors was used to measure the effective dose of the new 7sDCT Sine Spin protocol on a latest generation biplane angiographic C-arm system. Diagnostic performance was evaluated on periprocedurally acquired SFDCT for depiction of anatomical details, detection of hemorrhage, and ischemia and was compared with preprocedurally acquired MDCT. Inter- and intra-rater correlation as well as sensitivity and specificity were calculated. RESULTS Both modalities showed equal diagnostic performance in the supratentorial ventricular system. SFDCT provided inferior image quality in grey-white matter differentiation and infratentorial structures. Intraventricular, subarachnoid and parenchymal hemorrhages were diagnosed with a sensitivity of 83.3%, 84.2% and 75% and a specificity of 97.3%, 80.0% and 100%, respectively; early ischemic lesions with a sensitivity of 73.3% and specificity 94.7%. The effective dose measured for the 7sDCT Sine Spin protocol was 2 mSv. CONCLUSIONS Our findings confirm the high diagnostic sensitivity and specificity of SFDCT in detecting intracranial hemorrhage and early ischemic lesions. The delineation of grey-white matter differentiation and infratentorial structures remains a limiting factor. In comparison to previous studies, the new 7sDCT Sine Spin protocol showed a lower effective dose

Przydatność doplerowskiego wskaźnika pracy serca oraz skurczowej amplitudy ruchu pierścienia trójdzielnego w ocenie czynności prawej komory u chorych z ostrym zawałem ściany dolnej lewej komory

Wstęp: Zawał prawej komory (RVI) towarzyszy zawałowi ściany dolnej lewej komory (IMI) w 30-55% przypadków, a tętnicą odpowiedzialną za zawał (IRA) jest zazwyczaj proksymalny odcinek prawej tętnicy wieńcowej (RCA). Skuteczna reperfuzja uzyskiwana metodą pierwotnej interwencji wieńcowej (pPCI) poprawia niekorzystne, wczesne rokowanie u chorych z RVI. Ocena echokardiograficzna (TTE) prawej komory (RV) jest cennym uzupełnieniem badania elektrokardiograficznego (EKG). Amplituda ruchu pierścienia trójdzielnego (TAM) oraz wskaźnik pracy serca (MPIR) opisują czynność RV bez konieczności odnoszenia się do zasad geometrycznych. Celem pracy była ocena przydatności MPIR i TAM w rozpoznaniu zaburzeń czynności RV u chorych z pierwszym IMI. Metody: W 2.-3. dobie IMI wykonano TTE u 111 chorych z IMI. Oceniano funkcję skurczową lewej komory oraz zaburzenia czynności RV z określeniem obecności odcinkowych zaburzeń kurczliwości (w jakiejkolwiek dostępnej projekcji), wskaźnika kurczliwości wolnej ściany RV (WMSIR), MPIR i TAM. Na podstawie kryteriów elektrokardiograficznych chorych podzielono na dwie grupy: grupa I - 33 osób z RVI i grupa II - 78 pacjentów bez RVI. Wydzielono również dwie podgrupy, w zależności od IRA: grupa A - IRA w proksymalnym odcinku RCA (proxRCA) i grupa B - IRA w dalszym odcinku RCA lub w tętnicy okalającej. W grupie kontrolnej liczącej 24 zdrowych osób określono prawidłowe wartości wskaźnika TAM i MPIR. W modelu wieloczynnikowej regresji logistycznej stwierdzono, że MPIR i TAM w podobnym stopniu zwiększają prawdopodobieństwo rozpoznania RVI. Wyniki: Grupy I i II nie różniły się istotnie pod względem wieku, płci, występowaniem choroby wielonaczyniowej i stopniem dysfunkcji skurczowej lewej komory. W grupie I częściej rejestrowano odcinkowe zaburzenia kurczliwości RV niż w grupie II (88% vs. 11%, p < 0,001) oraz stwierdzano istotne różnice w zakresie: WMSIR (1,42 &plusmn; 0,28 vs. 1,04 &plusmn; 0,21, p < 0,0001), TAM (16,9 &plusmn; 1,5 vs. 21,4 &plusmn; 1,8, p < 0,001) i MPIR (0,42 &plusmn; 0,05 vs. 0,29 &plusmn; 0,06, p < 0,0001). Wskaźniki TAM i MPIR istotnie różniły się między grupą kontrolną a grupami I i II (p < 0,01). Zarówno w grupie I, jak i w grupie II średnia wartość TAM była istotnie niższa, a MPIR wyższa w podgrupie A niż w podgrupie B. Wykazano, że MPIR &#8805; 0,36 i TAM &#8804; 19,5 mm wskazują na RVI. W grupie I przynajmniej jeden z wymienionych nieprawidłowych wyników rejestrowano u wszystkich chorych z RVI, a współistnienie obu istotnie częściej w grupie IA niż w grupie IB (91% vs. 73%, p < 0,05). Podobnie, w grupie chorych bez RVI (grupie II) nieprawidłowe wartości MPIR i TAM wiązały się z lokalizacją IRA w proksymalnym odcinku RCA. W modelu wieloczynnikowej regresji logistycznej stwierdzono, że MPIR i TAM w podobnym stopniu zwiększają prawdopodobieństwo rozpoznania RVI (odpowiednio 15,3- i 15,6-krotnie). Wnioski: U chorych z zawałem ściany dolnej MPIR i TAM są łatwymi do określenia, niegeometrycznymi wskaźnikami oceny funkcji RV i stanowią cenne uzupełnienie danych klinicznych i elektrokardiograficznych. U pacjentów z IMI zaburzenia czynności RV zależą od lokalizacji IRA. (TAM (16,9 &plusmn; 1,5 vs. 21,4 &plusmn; 1,8, p < 0,001) i MPIR (0,42 &plusmn; 0,05 vs. 0,29 &plusmn; 0,06, p < 0,0001). Wskaźniki TAM i MPIR istotnie różniły się między grupą kontrolną a grupami I i II (p < 0,01). Zarówno w grupie I, jak i w grupie II średnia wartość TAM była istotnie niższa, a MPIR wyższa w podgrupie A niż w podgrupie B. Wykazano, że MPIR &#8805; 0,36 i TAM &#8804; 19,5 mm wskazują na RVI. W grupie I przynajmniej jeden z wymienionych nieprawidłowych wyników rejestrowano u wszystkich chorych z RVI, a współistnienie obu istotnie częściej w grupie IA niż w grupie IB (91% vs. 73%, p < 0,05). Podobnie, w grupie chorych bez RVI (grupie II) nieprawidłowe wartości MPIR i TAM wiązały się z lokalizacją IRA w proksymalnym odcinku RCA. W modelu wieloczynnikowej regresji logistycznej stwierdzono, że MPIR i TAM w podobnym stopniu zwiększają prawdopodobieństwo rozpoznania RVI (odpowiednio 15,3- i 15,6-krotnie). Wnioski: U chorych z zawałem ściany dolnej MPIR i TAM są łatwymi do określenia, niegeometrycznymi wskaźnikami oceny funkcji RV i stanowią cenne uzupełnienie danych klinicznych i elektrokardiograficznych. U pacjentów z IMI zaburzenia czynności RV zależą od lokalizacji IRA

Safety and Efficacy of Carotid Artery Stenting with the CGuard Double-layer Stent in Acute Ischemic Stroke.

BACKGROUND Double-layer stents show promising results in preventing periinterventional and postinterventional embolic events in elective settings of carotid artery stenting (CAS). We report a single-center experience with the CGuard stent in the treatment of acute ischemic stroke (AIS) due to symptomatic internal carotid artery (ICA) stenosis or occlusion with or without intracranial occlusion. METHODS We retrospectively analyzed all patients who received a CGuard stent in the setting of AIS at our institution. Neuroimaging and clinical data were analyzed with the following primary endpoints: technical feasibility, acute and delayed stent occlusion or thrombosis, distal embolism, symptomatic intracranial hemorrhage (sICH) and functional outcome at 3 months. RESULTS In 33 patients, stenting with the CGuard was performed. Stent deployment was successful in all patients (28 with tandem occlusions, 5 with isolated ICA occlusion). Transient acute in-stent thrombus formation occurred in three patients (9%) without early stent occlusion. Delayed, asymptomatic stent occlusion was seen in 1 patient (3%) after 49 days. Asymptomatic periinterventional distal emboli occurred in 2 patients (6%), 1 patient experienced a transient ischemic attack 79 days after the procedure and 1 patient (3%) developed sICH. Favorable clinical outcome (mRS 0-2) at 3 months was achieved in 12 patients (36%) and the mortality rate was 24%. CONCLUSION The CGuard use in emergencies was technically feasible, the safety has to be confirmed by further multicentric studies

Epidural Blood Patching in Spontaneous Intracranial Hypotension-Do we Really Seal the Leak?

PURPOSE Epidural blood patch (EBP) is a minimally invasive treatment for spontaneous intracranial hypotension (SIH). Follow-up after EBP primarily relies on clinical presentation and data demonstrating successful sealing of the underlying spinal cerebrospinal fluid (CSF) leak are lacking. Our aim was to evaluate the rate of successfully sealed spinal CSF leaks in SIH patients after non-targeted EBP. METHODS Patients with SIH and a confirmed spinal CSF leak who had been treated with non-targeted EBP were retrospectively analyzed. Primary outcome was persistence of CSF leak on spine MRI or intraoperatively. Secondary outcome was change in clinical symptoms after EBP. RESULTS In this study 51 SIH patients (mean age, 47 ± 13 years; 33/51, 65% female) treated with non-targeted EBP (mean, 1.3 EBPs per person; range, 1-4) were analyzed. Overall, 36/51 (71%) patients had a persistent spinal CSF leak after EBP on postinterventional imaging and/or intraoperatively. In a best-case scenario accounting for missing data, the success rate of sealing a spinal CSF leak with an EBP was 29%. Complete or substantial symptom improvement in the short term was reported in 45/51 (88%), and in the long term in 17/51 (33%) patients. CONCLUSION Non-targeted EBP is an effective symptomatic treatment providing short-term relief in a substantial number of SIH patients; however, successful sealing of the underlying spinal CSF leak by EBP is rare, which might explain the high rate of delayed symptom recurrence. The potentially irreversible and severe morbidity associated with long-standing intracranial hypotension supports permanent closure of the leak

Casper Versus Precise Stent for the Treatment of Patients with Idiopathic Intracranial Hypertension.

PURPOSE We hypothesized that due to its specific characteristics, the CasperTM RX carotid stent (CP) might be particularly suitable for venous sinus stenting (VSS) in patients with idiopathic intracranial hypertension (IIH). To test this theory, we compared it to the commonly used Precise Pro RXTM stent (PP). METHODS A total of 15 patients with IIH (median age 28.7 years) were reviewed retrospectively. Technical aspects as well as periinterventional and postinterventional complication rates were examined in patients treated with CP (n = 10) and the PP (n = 5). Improvements in cerebrospinal fluid opening pressure (CSF OP), transstenotic pressure gradient (TSPG) and clinical symptoms were also assessed. Results are shown as percentages and respective P-values. RESULTS Stent delivery was easier and more successful with the CP than the PP (difficult/failed stent delivery 0.0% versus 57.1%). No severe peri- or postinterventional complications or instances of in-stent thrombosis and/or stenosis were observed during follow-up. Improvement of CSF OP and TSPG immediately after VSS as well as at 6‑month follow-up were comparable between the CP and PP groups. Both groups showed substantial and similar decreases in intensity and frequency of headache. Almost all patients with other IIH-related symptoms showed either improvement or complete resolution of the symptoms after VSS. All patients who were available for interview (n = 12/15) reported a substantial improvement in quality of life. CONCLUSION A VSS using the CP seems to be safe and effective. The CP may reduce the risk of difficult or failed stent delivery in patients with challenging intracranial venous anatomy

Benefit of Advanced 3D DSA and MRI/CT Fusion in Neurovascular Pathology.

Digital subtraction angiography provides excellent spatial and temporal resolution; however, it lacks the capability to depict the nonvascular anatomy of the brain and spinal cord.A review of the institutional database identified five patients in whom a new integrated fusion workflow of cross-sectional imaging and 3D rotational angiography (3DRA) provided important diagnostic information and assisted in treatment planning. These included two acutely ruptured brain arteriovenous malformations (AVM), a small superficial brainstem AVM after radiosurgery, a thalamic microaneurysm, and a spine AVM, and fusion was crucial for diagnosis and influenced further treatment.Fusion of 3DRA and cross-sectional imaging may help to gain a deeper understanding of neurovascular diseases. This is advantageous for planning and providing treatment and, most importantly, may harbor the potential to minimize complication rates. Integrating image fusion in the work-up of cerebrovascular diseases is likely to have a major impact on the neurovascular field in the future

Heterogeneity of the Relative Benefits of TICI 2c/3 over TICI 2b50/2b67 : Are there Patients who are less Likely to Benefit?

PURPOSE Incomplete reperfusion after mechanical thrombectomy (MT) is associated with a poor outcome. Rescue therapy would potentially benefit some patients with an expanded treatment in cerebral ischemia score (eTICI) 2b50/2b67 reperfusion but also harbors increased risks. The relative benefits of eTICI 2c/3 over eTICI 2b50/67 in clinically important subpopulations were analyzed. METHODS Retrospective analysis of our institutional database for all patients with occlusion of the intracranial internal carotid artery (ICA) or the M1/M2 segment undergoing MT and final reperfusion of ≥eTICI 2b50 (903 patients). The heterogeneity in subgroups of different time metrics, age, National Institutes of Health Stroke Scale (NIHSS), number of retrieval attempts, Alberta Stroke Programme Early CT Score (ASPECTS) and site of occlusion using interaction terms (pi) was analyzed. RESULTS The presence of eTICI 2c/3 was associated with better outcomes in most subgroups. Time metrics showed no interaction of eTICI 2c/3 over eTICI 2b50/2b67 and clinical outcomes (onset to reperfusion pi = 0.77, puncture to reperfusion pi = 0.65, onset to puncture pi = 0.63). An eTICI 2c/3 had less consistent association with mRS ≤2 in older patients (>82 years, pi = 0.038) and patients with either lower NIHSS (≤9) or very high NIHSS (>19, pi = 0.01). Regarding occlusion sites, the beneficial effect of eTICI 2c/3 was absent for occlusions in the M2 segments (aOR 0.73, 95% confidence interval [CI] 0.33-1.59, pi = 0.018). CONCLUSION Beneficial effect of eTICI 2c/3 over eTICI 2b50/2b67 only decreased in older patients, M2-occlusions and patients with either low or very high NIHSS. Improving eTICI 2b50/2b67 to eTICI 2c/3 in those subgroups may be more often futile