SHAPE Society

1. Thermography
early clinical correlations
R Erbel, A Schmermund, M.
Katz, F. Chwallek, D. Baumgart
Department of Cardiology
University Essen
Germany

2. Thermography Catheter
Basket
Over the wire catheter system
Pull back device with 0.5 mm/s
1 central blood
thermo couple
5 thermo couples
3.3 F catheter
0.02 o
C accuracy

4. 0.2 o
C
0.1 10
mm

5. distal
proximal
mm
100.1
0.2 o
C

6. Temperature
36,4
36,6
36,8
37
37,2
37,4
37,6
37,8
Blood TC
TC1
TC2
TC3
TC4
TC5
Scan Distance

7. Study Aim
Assessment of
• Temperature recording
• Steerability of catheter system
• QCA of coronary arteries
• Pull back recording, Endosonics device
• Practicability
• Safety

8. Clinical History of
Patients
• 12 patients included
• 9 male, 3 female
• 43 – 73 years
• 8 stable angina
• 4 unstable angina IIIb/IIIc
• 4 diabetes melitus
• 3 previous myocardial infarction
• 9 on aspirin, 9 on statine

9. Unstable Angina, LAD stenosis
Advancing the thermography catheter

10. Unstable Angina, LAD stenosis
Positioning the thermography catheter

11. Unstable Angina, LAD stenosis
Opening the basket

12. Unstable Angina
Advancing the thermography catheter
RCx
lesionAmplatz
catheter

13. Thermography
Catheterization
Technical
Considerations
• High 92% success rate
• Over the wire catheter
• Good steerability even with regular
wires
• Easy opening of thermography
basket
• Accurate pull back device

14. Patient Scan B2
35
35,2
35,4
35,6
35,8
36
36,2
36,4
36,6
36,8
37
1
10
19
28
37
46
55
64
73
82
91
100
109
118
Scan Distance (mm)
Temperature(C)
Blood TC
TC1
TC2
TC3
TC4
TC5
Patient 2

15. Patient Scan B4
35,8
36
36,2
36,4
36,6
36,8
37
1
9
17
25
33
41
49
57
65
73
81
89
97
105
113
121
129
137
145
153
Scan Distance (mm)
Temperature(C)
Blood TC
TC1
TC2
TC3
TC4
TC5
Distal Proximal
Patient 4

16. Patient Scan B7
34,8
35
35,2
35,4
35,6
35,8
36
36,2
36,4
36,6
36,8
37
37,2
1
10
19
28
37
46
55
64
73
82
91
100
109
118
127
Scan Distance (mm)
Temperature(C)
Blood TC
TC1
TC2
TC3
TC4
TC5
Patient 7

17. Patient 10
• 65 year old man
• Unstable angina, Braunwald IIIB
• Previous RCx PTCA and stenting 1996
• Risk factors
arterial hypertension
hypercholesterinemia
smoking, diabetes mellitus
• 175 cm, 88 kg, 2 m 2
BSA
• 0.1 mg/dl CRP

18. Unstable Angina, LAD stenosis
Angio

19. LAD Segment 7 Lesion
79%
stenosis
14 mm length
16.1 mm 2
plaque area
KH K

20. LAD Segment 7 lesion
KH K 10

21. LAD Segment 7 lesion
KH K 10

22. LAD Segment 7 lesion
KH K

23. LAD Segment 7 lesion
KH K

24. Unstable Angina, LAD stenosis
Thermography

25. Patient 10
Patient Scan B10
35,6
35,8
36
36,2
36,4
36,6
36,8
37
1
9
17
25
33
41
49
57
65
73
81
89
97
105
113
121
129
137
145
153
Scan Distance (mm)
Temperature(C)
Blood TC
TC1
TC2
TC3
TC4
TC5

26. Unstable Angina
After stent implantation

27. LAD segment 7 lesion
After drug-
eluting stent
Implantation
29% stenosis
3 mm length
2.7 mm 2
pla-
que area

28. Patient 10
• Follow-up
no troponin elevation
o.o2 and o.o4 ng/ml (ref < 0.1)
myoglobin stable
57 and 59 ug/dl (ref < 90)
C-reactive protein
0.1 and 0.1 mg/dl (ref < 0.5)

29. Patient 11
• 43 years old man
• Anterior AMI August 29
peak CK 3286 U/l
treatment 50 mg tenecteplase
(Prof Jansen, Leverkusen)
• previous TIA April 01
• RF: hypercholesterinemia
smoking
190 cm, 98 kg, 2.3 m 2
BSA
• 2.1 mg/dl CRP

30. Unstable Angina
Angio

31. LAD segment 6
lesion
73 % stenosis
12 mm length
9.7 mm 2
pla-
que area

32. Unstable Angina
Thermography
Position 2 cm
distal to segment
6 culprit lesion

33. Unstable Angina
Thermography
Position 69 mm
within the lesion

34. ThermographyMain stem hot spot 2 mm proximal to
stenotic segment 6 lesion, + 0.35 o
C

35. Unstable Angina
After stent
implantation

36. LAD segment 6 lesion
26% stenosis
11 mm length
0.7 mm 2
pla-
que area
Reperfusion
no - reflow
VT
UH

37. Patient 11
History of PCI
• Detection of hot spot pre PCI
• LAD 3.0 18 mm drug eluting stent
18 bar, post stent PTCA 4.0 mm 10 bar
• RCA 90% stenosis, additional PCI
3.0 13 mm drug eluting stent
• Lab tests: decline of CK, TnI and
myoglobin 69 to 123 and 86 ug/d (ref 90)
• CRP: 0.7 mg/dl (ref 0.5)
• Further course uneventful

38. Thermography Results
• 92 % success rate
• 35.91 – 36.95 o
C blood temperature
• Up to + 0.14 up to + 0.36 o
C in hot spots
• 4/ 11 temperature increase
• 4/ 11 focal hot spot
• 3/ 4 multifocal hot spots
• 1/ 4 MACE corresponding to CRP increase
• 3/ 4 hot spots but normal CRP

39. Future of Thermography
• Combination with IVUS
• Preinterventional scanning in order
to detect hot spots
for futher protective intervention
- aspiration systems or
- filter devices or
- graft stenting or
- cooling down

41. Patient 9
• 61 year old woman
• Unstable angina type IIIB
• troponin I in the gray zone 0.14 ng/ml
• C-reactive protein 0.1 and 0.2 mg/dl
(ref. 0.1)
• Risk factors: diabetes,
hypertension
hypercholesterinemia
• Dialysis 1992 – 2001
• Renal transplantation

42. RCx Segment 11 lesion
70 % stenosis
14 mm length
19 mm 2
pla-
que area
HS

43. Unstable Angina IIIB
Angio
Suspicion of plaque rupture in distal RCx

44. Unstable Angina IIIB
After thermography

45. RCx Segment 11
lesion
35%stenosis
15 mm length
6.8 mm 2 pla-
que area
HS

46. Patient
• PCI protocol:
• Heavily calcified vessels
• Guidewire steering with balloon
• Amplatz catheter AL 1 8F
• 3.5 16 mm bare stenting
• 16 bar
• TnI 0.87 ng/ml (ref 0.1)
CK, myoglobin remained stable

47. Patient 8
Patients History
• 66 year old man
• Unstable AP III after surgery by
urology
• Risk factors
diabetes
hypertension

48. Patient Scan B8
35,8
36
36,2
36,4
36,6
36,8
37
37,2
1
7
13
19
25
31
37
43
49
55
61
67
73
79
Scan Distance (mm)
Temperature(C)
Blood TC
TC1
TC2
TC3
TC4
TC5

49. Unstable Angina IIIB
Thermography

50. Thermography

51. Thermography

52. RCx lesion

53. RCx lesion

54. Patient 2

55. Patient 2

56. Patient 1

57. Patient 1

58. LAD segment 5 lesion
59 % stenosis
8 mm length
10 mm 2
pla-
que area
Patient 0

66. Thermography

67. Thermography

68. Thermography

69. Thermography

70. Thermography

71. Thermography

72. Unstable Angina, Circ lesion
Angio

73. Unstable Angina, Circ lesion
After thermography

75. LAD segment 6 lesion
UH

76. LAD segment 6 lesion
UH

77. LAD segment 6 lesion
UH

79. 35,8
36
36,2
36,4
36,6
36,8
37
37,2
Scan Distance
Blood TC
TC1
TC2
TC3
TC4
TC5
Temperature

80. Patient Scan B1
34
34,2
34,4
34,6
34,8
35
35,2
35,4
35,6
35,8
36
36,2
36,4
36,6
36,8
37
37,2
37,4
37,6
37,8
38
1
5
9
13
17
21
25
29
33
37
41
45
49
53
57
61
65
69
73
77
81
85
89
93
97
101
105
109
113
117
121
125
129
133
Scan Distance (mm)
Temperature(C)
Blood TC
TC1
TC2
TC3
TC4
TC5

81. Patient B0 Partial Scan
35,8
36
36,2
36,4
36,6
36,8
37
37,2
1
3
5
7
9
11
13
15
17
19
21
23
25
27
29
31
33
35
37
39
41
43
Scan Distance (mm)
Temperature(C)
Blood TC
TC1
TC2
TC3
TC4
TC5

82. Patient B6 - Scan
35
35,2
35,4
35,6
35,8
36
36,2
36,4
36,6
36,8
37
1
7
13
19
25
31
37
43
49
55
61
67
73
79
85
91
97
103
109
115
121
127
133
139
145
151
157
163
169
175
181
187
193
199
205
Scan Distance (mm)
Temperature(C)
Blood TC
TC1
TC2
TC3
TC4
TC5

83. Temperature
36,4
36,6
36,8
37
37,2
37,4
37,6
37,8
Blood TC
TC1
TC2
TC3
TC4
TC5
Scan Distance

84. Thermography
Catheterization