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Stefanadis

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Stefanadis

  1. 1. NEW ADVANCES IN THERMOGRAPHY Christodoulos Stefanadis Prof. Of Cardiology Athens medical School, Athens, Greece
  2. 2. Thermal Heterogeneity -Thermal Heterogeneity - AtherosclerosisAtherosclerosis Prognosis of: • culprit lesion post PCI • Non-culprit lesion
  3. 3. Epiphany Thermography System • A mono-rail system. • One thermistor at the distal end of 3-4 F catheter • Accuracy 0.05o C • Almost wedging at the atherosclerotic plaque • Safe, fast procedure • Wedging • Full contact in significant lesions
  4. 4. Epiphany Thermography System
  5. 5. 35.5 35.7 35.9 36.1 36.3 36.5 Temperature(o C) Atherosclerotic Plaque TemperatureAtherosclerotic Plaque Temperature PlaquePlaque PlaquePlaque DistalDistalProximalProximal ProximalProximal 38.5 38.3 38.1 37.9 37.7 37.5
  6. 6. Thermal Heterogeneity andThermal Heterogeneity and Prognosis Post PCIPrognosis Post PCI • Number: 86 pts • Effort Angina: 30 pts • Unstable Angina: 30 pts • AMI: 26 pts Study PopulationStudy Population
  7. 7. Demographic CharacteristicsDemographic Characteristics Age (years) 61+ 9 N 86 Aspirin intake 24/86 Statin intake 20/86 Hypertension 39/86 LV Dysfunction 26/86 Diabetes 24/86 Total cholesterol (mg/dl) 229 + 37 Smoking 48/86 Previous MI 22/86
  8. 8. ΔΤ - Clinical EventsΔΤ - Clinical Events
  9. 9. ΔΤ - Clinical Follow-up FV EventNo Event 2.0 1.5 1.0 0.5 0 -0.5 P < 0.01 ΔΤ(o C) Stefanadis C et al, JACC 2001 April
  10. 10. AMIUAEA 2.0 1.5 1.0 0.5 0 -0.5 P < 0.10 P < 0.01 P < 0.001 ΔΤ(o C) ΔΤ - Clinical Follow-up Stefanadis C et al, JACC 2001 April
  11. 11. Clinical Follow-up Stefanadis C et al, JACC 2001 April
  12. 12. ΔΤ - Clinical EventsΔΤ - Clinical Events Sensitivity: 86% Specificity: 79% Cut-off point: 0.5 o C
  13. 13. StatinsNo statins ΔΤ(ο C) 2.5 2.0 1.5 1.0 .5 0.0 -.5 Statins and Temperature Stefanadis C, et al. Eur Heart J (in press) Study PopulationStudy Population 72 Treated pts 35 Non-Treated pts 37 Effort Angina 21 Acute Coronary Syndromes 51 UA 32 AMI 19
  14. 14. StatinsNo statins Temperaturedifferences(oC) 2.5 2.0 1.5 1.0 .5 0.0 -.5 SYNDROME SA UA AMI Statins and Temperature Stefanadis C, et al. Eur Heart J (in press)
  15. 15. Temperature measurements - coronary flow Temperature measurements • At proximal vessel wall • At lesion • Flow interruption • At lesion • Balloon deflation ΔTp ΔTl
  16. 16. GW D-GW Th Bl StudyStudy ProtocolProtocol
  17. 17. 0 .03 .05 .08 .1 .13 .15 .17 .2 .23 .25 Lesion DT Lesion DT+Balloon DT in hyperemiaBaseline Occlusion After deflation ΔTl(o C) Plaque Temperature and Coronary FlowPlaque Temperature and Coronary Flow
  18. 18. Plaque Vulnerable Patient Myocardiu m Blood VulnerabilityVulnerability Arter y
  19. 19. Identification of VulnerableIdentification of Vulnerable PatientPatient Coronary SinusCoronary Sinus • In coronary sinus blood is drained mainly from the left coronary artery • An emerging technique is the measurement of the trans-coronary gradient of various variables such as cytokines, matrix metalloproteinases, etc.. • Measurement of blood temperature in coronary sinus may provide significant iformation regarding the inflammatory process within the myocardium
  20. 20. Atherosclerosis andAtherosclerosis and Widespread InflammationWidespread Inflammation • In this study the authors showed that inflammation is widespread • Even if lesions are found only in RCA, the inflammatory markers (activated leukocytes) are found also in great cardiac vein Buffon and Maseri, N Engl J Med 2002;
  21. 21. Th Shaft Coronary Sinus Thermography Catheter A 7F thermography catheter Proximal part: A steering arm with a connector for the thermistor lead-wires Distal part: The distal 7 cm of the shaft of the catheter consist of a soft material. A thermistor probe is positioned at the tip of the catheter. Manipulation of the steering arm proximally enables the distal end of the catheter to be C
  22. 22. CS Th In Vivo Coronary SinusIn Vivo Coronary Sinus ThermographyThermography
  23. 23. 38.3 38.35 38.4 38.45 38.5 38.55 38.6 38.65 38.7 Temperature(o C) Coronary Sinus Temperature Right AtriumRight Atrium Coronary SinusCoronary Sinus Right AtriumRight Atrium ΔT = Difference of temperature between CS and right atrium
  24. 24. Baseline Characteristics IBaseline Characteristics I LCA RCA Controls P- value N 27 10 23 Males 24(89%) 10(100%) 21(91%) 0.55 Age (years) 62.1±9.8 59.9±9.4 60.0±9.5 0.57 BP (mmHg) 134.5±13.3 137.3±14.3 138.6±14.1 0.38 Chol (mg/dl) 214.1±13.1 218.2±14.1 199.5±14.4 0.47 Diabetes 3(11%) 1(10%) 1(4%)
  25. 25. Baseline Characteristics IIBaseline Characteristics II    LCA RCA Controls P- value   N 27 10              23  Aspirin     22(81%) 9(90%)      17(74%)       0.55 Nitrates     18(67%) 7(70%)            11(49%)       0.31 Statin 14(52%) 6(60%)       7(30%)       0.18 ACE inhibitors 8(29%) 3(30%)       3(13%)       0.33
  26. 26. 0 .1 .2 .3 .4TemperatureDifference(oC) 0 2 3 Control RCA LCA Coronary Sinus TemperatureCoronary Sinus Temperature MeasurementsMeasurements 0.09±0.07o C 0.15±0.08 0.27±0.10
  27. 27. The ‘Cooling Effect’ of Coronary Blood Flow on Heart in Patients With Coronary Artery Disease 
  28. 28.     StudyStudy ProtocolProtocol - Baseline - Flow interruption - Balloon deflationTemperature recordings - Recordings
  29. 29. DGW Coronary Sinus and FlowCoronary Sinus and Flow Temperature  recordings - Baseline - Flow interruption - Balloon deflation - Recordings
  30. 30. 0 .05 .1 .15 .2 .25 .3 .35 .4 ƒ T ΔTl(o C) Coronary Sinus and FlowCoronary Sinus and Flow Temperature difference (ΔΤ) between patients with CAD and controls  CADControls
  31. 31. 0 .05 .1 .15 .2 .25 ƒT ƒT-B ΔT(o C) Baseline Balloon Inflation Coronary Sinus and FlowCoronary Sinus and Flow Temperature difference (ΔΤ) in control subjects at baseline  and during interruption of coronary flow. 
  32. 32. Conclusions •Today’s  challenge  is  to  identify  and  treat  the  vulnerable  plaques. •Thermography  is  a  new  promising  method  for  the  early  detection of vulnerable plaques. •  Aggressive  lipid  therapy,  antiplatelet  agents  and  medications have favorable results in thermal heterogeneity. •Clinical studies are required to investigate whether there is  clinical benefit from lowering thermal heterogeneity locally  at the culprit or non-culprit lesions.

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