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Transoesophageal echocardiography (TOE) is a well-established imaging modality, providing more accurate and of higher quality information than transthoracic echocardiography (TTE) for a wide spectrum cardiac and extra-cardiac diseases. The present paper represents an effort by the Echocardiography Working Group (WG) of the Hellenic Cardiology Society to state the essential steps of the typical TOE exam performed in echo lab. This is an educational text, describing the minimal requirements and the preparation of a meticulous TOE examination. Most importantly, it gives practical instructions to obtain and optimize TOE views and analyses the implementation of a combined two-and multi-dimensional protocol for the imaging of the most common cardiac structures during a TOE. In the second part of the article a comprehensive review of the contemporary use of TOE in a wide spectrum of valvular and non-valvular cardiac diseases is provided, based on the current guidelines and the experience of the WG members., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024. Published by Elsevier Inc.)

Vascular toxicity caused by cancer treatment can present as vasospasm, arterial thrombosis, and accelerated atherosclerosis. We report a case of a 60-year-old man with metastatic renal cell carcinoma under cabozantinib treatment for 3 years who presented to the hospital with relapsing episodes of rest angina. Due to the presence of ST depression in the 12-lead electrocardiogram and elevated troponin, a non-ST-segment elevation myocardial infarction was suspected. The patient underwent invasive coronary angiography, which revealed extended coronary artery spasm, and it subsided totally after nitrate administration. One year later, the patient presented again at the cardio-oncology outpatient clinic, reporting relapsing episodes of angina during the previous month. Coronary computed tomography angiography was performed, and it revealed 2 subsequent 70%-99% stenosis in OM1. To our knowledge, this is the first case of a patient treated with cabozantinib presenting with coronary artery spasm and accelerated atherosclerosis, in which a multimodality imaging approach was followed., (© 2023 The Authors. Published by Elsevier Inc. on behalf of University of Washington.)

Introduction: Dance for Parkinson's Disease® (DfPD®) is a structured dance program that has never been evaluated in Greek PD population. This study assesses for the first time the efficacy, safety and feasibility of DfPD® program in Greek PD patients., Material and Methods: A total of 16 early-to-mid-stage PD patients (50% men, aged 56 ± 12) underwent a total of 16 60-min classes of adjusted to Greek music and dance culture DfPD®, twice weekly, over 8 weeks. Assessments were performed at baseline and at the end of the study period and included quality of life (PDQ-8), depressive symptoms (BDI-II), fatigue (PFS-16), cognitive functions (MoCA), balance (BBS) and body mass index (BMI). Safety (possible falls, injuries, muscle soreness or excessive fatigue) and feasibility (technical and financial parameters, willingness for participation and continuation, recruitment rates) were also assessed., Results: Statistically significant improvements were found in quality of life (29 ± 47%, p = 0,020), depressive symptoms (26 ± 52%, p = 0,046), fatigue (13 ± 20%, p = 0,021), cognitive functions (17 ± 23%, p = 0,010), balance (5 ± 4%, p = 0,003) and BMI (2 ± 2%, p = 0,010). No adverse events, high adherence (93,75%) and low attrition (12,5%) rates were reported., Conclusion: A twice weekly 60-min DfPD® class for 8 weeks is a safe and feasible non-pharmacological complementary therapeutic intervention for Greek PD patients and may improve their quality of life, depressive symptoms, fatigue, cognitive functions, balance, and BMI. Further research on this intervention is warranted., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Background: The study of arterial properties in patients with aortic valve stenosis who undergo transcatheter aortic valve implantation (TAVI) remains challenging and results so far seem equivocal. We sought to investigate the acute and long-term effect of TAVI on arterial stiffness and wave reflections., Methods: We enrolled 90 patients (mean age 80.2 ± 8.1 years, 50% males) with severe symptomatic aortic stenosis undergoing TAVI. Arterial stiffness was assessed by carotid-femoral and brachial-ankle pulse wave velocity (cfPWV and baPWV). Augmentation index corrected for heart rate (AIx@75), central pressures and subendocardial viability ratio (SEVR) were assessed with arterial tonometry. Measurements were conducted at baseline, after TAVI and at 1 year., Results: Immediately after TAVI there was an increase in arterial stiffness (7.5 ± 1.5 m/s vs 8.4 ± 1.7 m/s, p = .001 for cfPWV and 1773 ± 459 vs 2383 ± 645 cm/s, p < .001 for baPWV) that was retained at 1 year (7.5 ± 1.5 m/s vs 8.7 ± 1.7 m/s, p < .001 and 1773 ± 459 cm/s vs 2286 ± 575, p < .001). Post-TAVI we also observed a decrease in AIx@75 (32.2 ± 12.9% vs 27.9 ± 8.4%, p = .016) that was attenuated 1 year later (32.2 ± 12.9% vs 29.8 ± 9.1%, p = .38), and an increase in SEVR (131.2 ± 30.0% vs 148.4 ± 36.1%, p = .002), which remained improved at 1 year (131.2 ± 30.0% vs 146.0 ± 32.2%, p = .01)., Conclusions: After TAVI the arterial system exhibits an increase of stiffness in response to the acute relief of the obstruction, which is retained in the long term., Competing Interests: Declaration of Competing Interest None., (Copyright © 2020. Published by Elsevier B.V.)

Objectives: The aim of this study was to compare the implantation of a self-expanding valve with or without balloon aortic valvuloplasty (BAV) in an open-label, noninferiority, randomized trial., Background: There are no randomized studies comparing the implantation of a self-expanding valve with (pre-BAV) or without BAV., Methods: Consecutive patients with severe aortic stenosis were randomly assigned to undergo transcatheter aortic valve replacement with the use of self-expanding prostheses with (pre-BAV) or without (no-BAV) pre-dilatation. The primary endpoint was device success according to the Valve Academic Research Consortium 2 criteria. Secondary endpoints included periprocedural mortality and stroke, new permanent pacemaker implantation, vascular complications, and 1-year mortality. The trial was scheduled to show noninferiority (Δ = 15%) of the direct versus the pre-BAV approach., Results: A total of 171 patients were randomized at 4 centers. Of these, 86 underwent transcatheter aortic valve replacement with pre-dilatation and 85 without. Device success was noninferior in the no-BAV group compared with the pre-BAV group (65 of 85 [76.5%] for no-BAV vs. 64 of 86 [74.4%] for pre-BAV; mean difference 2.1%; 90% confidence interval: -8.9% to 13%). In the no-BAV group, 25 patients (29.4%) underwent post-balloon dilatation, and in the pre-BAV group, 13 patients (15.1%) underwent post-balloon dilatation (p = 0.03). Regarding major vascular complications and permanent pacemaker implantation, there was no difference between the 2 groups (log-rank p = 0.49, log-rank p = 0.54). In 1-month completed follow-up for all patients, there was 1 periprocedural stroke (0.5%), without any deaths., Conclusions: Direct, without balloon pre-dilatation, transcatheter aortic valve replacement with a self-expanding prosthesis system is noninferior to the pre-dilatation procedure. Lower post-dilatation rates were encountered in the group with pre-dilatation. (The Predilatation in Transcatheter Aortic Valve Implantation Trial [DIRECT]; NCT02448927)., (Copyright © 2019 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: Familial dyslipidemias of either heterozygous (heFH) or combined (FCH) type lead to accelerated atherogenesis and increased cardiovascular risk., Objective: The aim of this study was to investigate in statin-naïve adult patients with familial dyslipidemias whether inflammatory activation and liver, spleen and bone marrow metabolic activity differ compared with normolipidemic subjects and between dyslipidemic groups., Methods: Fourteen patients with FCH, 14 with heFH, and 14 normolipidemic individuals were enrolled. Serum lipids, high-sensitivity C-reactive protein, and fibrinogen levels were measured, followed by 18 F-fluorodeoxyglucose positron-emission tomography/computed tomography imaging. Radiotracer uptake in the aortic wall, spleen, bone marrow, and liver was quantified as tissue-to-background ratio (TBR)., Results: Patients with heFH had significantly higher low-density lipoprotein levels compared with those with FCH and controls (P < .001). However, aortic TBRs were higher in FCH compared with heFH patients and controls (P = .02 and P < .001, respectively). FCH patients exhibited higher FDG uptake in the spleen compared with controls (P = .05). In addition, FCH exhibited higher bone marrow FDG uptake compared with heFH patients and controls (P = .03 and P = .02, respectively). FCH had higher liver uptake compared with heFH patients and controls (P < .001 for both). Significant correlations were observed between inflammatory biomarkers and imaging indices as well as between aortic TBR and FDG uptake of hematopoietic organs and liver., Conclusions: Systemic, as well as vascular inflammation and spleen, bone marrow, and hepatic metabolic activity are increased in patients with FCH despite lower levels of low-density lipoprotein., (Copyright © 2017 National Lipid Association. Published by Elsevier Inc. All rights reserved.)

Background: The aim of this study was to compare the predictive ability of clinical risk scores (ACEF, EuroSCORE and EuroSCORE II) to angiographic (SYNTAX score) and combined risk scores (Global Risk Score and Clinical SXscore) towards cardiovascular death and/or major adverse cardiac events (MACE) in patients with ST-segment elevation acute myocardial infarction (STEMI) managed with primary percutaneous coronary intervention (pPCI)., Methods: A total of 685 patients successfully treated with pPCI were evaluated and the risk scores were calculated. The primary endpoint was the 2-year incidence of fatal cardiac events. Secondary end points were target lesion failure (TLF), repeat revascularization (RR) and MACE., Results: Patients distributed in the highest tertile of EuroSCORE II presented increased rates of CV death (CVD), all-cause mortality and MACE (p<0.001 for all). EuroSCORE II was associated with increased C-statistics (0.873, 95% CIs: 0.784-0.962 and 0.825, 95% CIs: 0.752-0.898 respectively) for predicting CVD and MACE over competing risk scores (p<0.05). EuroSCORE II conferred incremental discrimination (Harrell's C, p<0.05 for all, apart from CSS for predicting CVD) and reclassification value (Net Reclassification Index, p<0.05 for all, apart from CSS for reclassifying MACE) over alternative risk scores for study's main endpoints. EuroSCORE II independently predicted CVD (HR=1.06, 95% CIs: 1.03-1.09, p<0.001) and MACE (HR=1.07, 95% CIs: 1.04-1.10, p<0.001)., Conclusion: EuroSCORE II has the best predictive ability of CVD and/or MACE after successful pPCI for the treatment of STEMI., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Limited are the data regarding the sex differences in functional carotid artery characteristics. Microwave Radiometry (MWR) is a new noninvasive method, which measures in vivo instantly the internal temperatures of tissues, reflecting inflammation. The aim of the present study was to investigate whether in patients with coronary artery disease (CAD), gender related differences apply in carotid plaque functional characteristics, as assessed by MWR., Methods: Consecutive patients with significant CAD were included in the study. All patients underwent evaluation of both carotid arteries by 1) ultrasound and 2) MWR. During ultrasound common carotid IMT and plaque thickness were assessed according to Mannheim consensus. During MWR measurements, temperature difference (ΔT) was assigned as maximal temperature along the carotid artery minus minimum. ΔT ≥0.90°C was assigned as high ΔT., Results: In total 364 patients with significant CAD were included in the study. Of these 54 were female and 310 were male. Max plaque thickness and ccIMT were similar between males and females (2.38±1.16 vs. 2.46±1.12mm, p=0.63 and 0.944±0.172 vs. 0.942±0.169mm, p=0.96). Carotid arteries of females showed higher ΔT values (1.16±0.48 vs 0.87±0.45°C, p<0.001). Interestingly, females had more commonly high ΔT values bilaterally (35.2% vs 15.5%, p=0.001). In multivariate analysis, female sex was independently associated with bilateral high ΔT, when adjusted to potential covariates (OR=2.78, 95% CI=1.42-5.45, p=0.003)., Conclusions: In patients with CAD, sex specific differences apply in functional but not in structural carotid artery characteristics. Whether this discrepancy has prognostic significance, remains to be clarified in future studies., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Background: Balloon aortic valvuloplasty (BAV) is considered to be an essential part of the transcatheter aortic valve implantation (TAVI) procedure and is being performed routinely. At present there is insufficient long-term data as to the benefits of routine BAV prior to TAVI., Aim: The aim of this study was to evaluate the safety of direct TAVI and the mortality rate at 1-year in patients undergoing TAVI with or without BAV with a self-expanding bioprosthesis., Methods: Between January 2008 and September 2013 consecutive patients undergoing TAVI with the Medtronic CoreValve in two experienced centers in Athens, Greece and in Siegburg, Germany were studied. All data were prospectively collected and retrospectively analyzed. Primary endpoint was mortality at 1 year. Procedural data and clinical data (bleeding, vascular complications and echocardiographic parameters) were analyzed., Results: A total of 210 patients undergoing TAVI were evaluated (non-direct=120 patients, direct=90 patients). All-cause mortality at 30 days and at 1 year was similar in both groups (4% in non-direct versus 2% in direct, p=0.6 and 15% in non-direct versus 11% in direct, p=0.5, respectively). Device success rate was similar in both groups (77% in non-direct versus 83% in direct, p=0.2). Major vascular complications were comparable for both groups (5% in non-direct versus 3% in direct, p=0.5). The direct group had less moderate/severe paravalvular leakage than the non-direct group after the device implantation (7% versus 33%, p<0.01)., Conclusions: Performing direct TAVI with the self-expanding bioprosthesis is safe and feasible showing similar mortality rates compared to patients undergoing non-direct TAVI at 30 days and at 1-year., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Objectives: This study sought to assess the diagnostic impact of stress echocardiography (SE) in patients with suspected low-flow, low-gradient aortic stenosis but normal resting transvalvular flow rate., Background: SE may help to distinguish between true severe aortic stenosis and pseudosevere aortic stenosis in patients with low aortic valve area (AVA) and mean gradient. However, if rest flow rate is normal, then SE may not confer any additional diagnostic value, irrespective of resting left ventricular ejection fraction (LVEF) and indexed stroke volume (SVi)., Methods: Sixty-seven patients with suspected low-flow, low-gradient aortic stenosis who underwent SE were retrospectively studied. Following stratification by rest LVEF, SVi, and flow rate-using cutoffs of 50%, 35 ml/m(2), and 200 ml/s, respectively-we tested for significant changes in AVA during SE., Results: Mean age was 77 ± 9 years and 60% of patients were male. Mean values for rest variables were as follows: AVA: 0.77 ± 0.12 cm(2); mean gradient: 27 ± 7 mm Hg; flow rate: 182 ± 37 ml/s; SVi: 32 ± 8 ml/m(2); and LVEF: 45 ± 15%. During SE, significant increases in AVA were observed regardless of resting LVEF and SVi state. In patients with rest flow rate ≥200 ml/s, AVA did not increase significantly during stress (rest AVA: 0.90 cm(2) vs. stress AVA: 0.97 cm(2); p = 0.11), and positive predictive value for confirming underlying true severe aortic stenosis was 84%. In adjusted analyses, rest flow rate was the only parameter associated with severe AS (odds ratio: 1.05, 95% confidence interval: 1.0 to 1.1; p = 0.002)., Conclusions: Rest AVA measured under normal flow rate conditions is likely to reflect the true severity of AS and unlikely to change significantly with SE. Flow normalization may only be required in patients with AVA <1 cm(2) and mean gradient <40 mm Hg when the rest flow rate is <200 ml/s., (Copyright © 2015 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Background: New-generation drug-eluting stents have demonstrated the mid-term efficacy and safety, but possible differences between stents may emerge in a long-term period. We compared long-term outcomes of patients with chronic stable angina and an isolated de-novo lesion in the proximal left anterior descending artery that underwent percutaneous coronary intervention with Endeavor-zotarolimus eluting stents (E-ZES) and everolimus eluting stents (EES)., Methods: We prospectively enrolled 600 patients. Of these, 180 underwent E-ZES and 420 underwent EES implantation. Clinical follow-up was performed up to 7 years (median follow-up 61 months). The evaluated clinical outcomes were Target Lesion Failure (TLF), a composite of cardiac death, myocardial infarction and Target Lesion Revascularization (TLR), the Patient-Related Outcome (PRO) and stent thrombosis. Differences between groups evaluated with the Kaplan-Meier method and possible independent predictors with Cox proportional hazard regression., Results: At 5 years, the cumulative probability for outcomes was: TLF: 13.8% versus 7.5%, p=0.025, cardiac death: 3.1% versus 2.5%, p=0.937, myocardial infarction: 1.2% versus 1.8%, p=0.829, TLR: 10% versus 3.3%, p=0.003, PRO: 19.6% versus 13.8%, p=0.528, ST: 2.5% versus 2.7%, p=0.965, for E-ZES and EES respectively. Differences between stents increased after 30 months. In multivariate analysis predictors of TLF adjusted for stent type were Diabetes mellitus and estimated Glomerular Filtration Rate (eGFR)., Conclusion: Both stents provided a favorable safety profile, with EES demonstrating better effectiveness. There was a late emergence in difference of endpoints after 30 months. Diabetes mellitus and eGFR predicted TLF., (Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.)

Background: Vascular calcification is an active process, sharing common molecular mechanisms with bone formation. Bisphosphonates are components, which inhibit calcification. The aim of the present study was to evaluate the safety and effectiveness of local delivery of the bisphosphonate zoledronate on inhibition of calcium formation in the arterial wall in an experimental animal model., Methods: Sixteen New Zealand rabbits were placed on vitamin D enriched atherogenic diet for 3 weeks. Subsequently, all animals underwent angiography of abdominal aorta and common iliac arteries. A mixture containing 500 μg/l zoledronate was delivered on the vascular wall of the target iliac artery, using a dedicated balloon catheter. A placebo mixture was administered on the contralateral iliac artery of each animal, which was used as control. At 28 days all animals were sacrificed. Histologic sections of each common iliac artery were stained with hematoxylin-eosin and von Kossa. Computer-assisted histomorphometry was performed for the calcium content quantification of each section from the target and the control iliac artery., Results: In all animals the local delivery of zoledronate and placebo mixtures was successful and uncomplicated. The mean percentage of the calcium content of the media was higher in the control artery segments compared to the target (2.66 ± 0.73 versus 1.08 ± 0.62 % of the area of the media, p<0.01)., Conclusions: Inhibition of vascular calcification by local catheter-based delivery of bisphosphonate zolendronic acid is effective without evident short-term complications. These finding and its potential clinical implication remain to be confirmed in human studies., (Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.)

Background: The majority of cardiovascular events in patients undergoing PCI arise from the progression of NCL during the long-term follow-up period. The purpose of the study was to investigate the clinical and angiographic factors related to the progression of non-culprit lesions (NCL) of patients undergoing percutaneous coronary interventions (PCI)., Methods: One hundred and seventeen patients that underwent two coronary angiograms with a time interval greater than 3 months were enrolled. All patients underwent PCI as a treatment for the culprit lesion. In the second coronary angiography we investigated whether they had a new culprit lesion clearly differentiated from the one of the first angiogram. The demographic characteristics, the clinical syndrome responsible for the first PCI and the procedural characteristics were recorded. Quantitative coronary angiography was performed at the culprit lesion of the second angiography and in the same lesion in the first angiography., Results: Multivariate analysis showed that the independent variables for the development of a significant lesion at the follow-up requiring intervention were: the presence of complex lesion (53.78% vs 36.22%, p<0.001, OR=39.42), acute myocardial infarction (AMI) at the initial diagnosis (36.3% vs 32.4%, p<0.001, OR=3.9), and smoking (46.15% vs 53.84%, p=0.03, OR=0.29)., Conclusions: Patients with AMI and complex morphology of NCL have increased risk for a new intervention after successful PCI. Smoking at the time of the follow up, was associated with fewer coronary interventions., (Copyright (c) 2008 Elsevier Ireland Ltd. All rights reserved.)

Although the therapeutic advantage of percutaneous coronary intervention in acute coronary syndromes have been proved in numerous studies, its position in the treatment of stable angina remains a controversial issue. The results of the recent studies did not lead into definite answers for the proper treatment of chronic coronary artery disease. The identification of the patients that will benefit from the interventional approach is necessary and is probably based on the proper screening for myocardial ischemia with noninvasive diagnostic techniques. In this review article, we mention the most recent studies for the treatment of chronic stable angina with respect to clinical outcome and economical consequences.

Objectives: This study investigated the association between morphological characteristics of culprit atheromatic lesions as assessed by optical coherence tomography and Thrombolysis In Myocardial Infarction (TIMI) flow grade after thrombolysis in patients with ST-segment elevation myocardial infarction (STEMI)., Background: Although several variables have been found to predict coronary flow after thrombolysis in patients with STEMI, the impact of culprit lesion morphology has not been studied., Methods: Fifty-five patients with STEMI from 3 tertiary centers that were treated with thrombolysis and underwent optical coherence tomography examination in the culprit lesion between 24 and 48 h after thrombolysis were included in the study. Patients were categorized on the basis of TIMI flow grade into patients with TIMI flow grade 3 versus TIMI flow grade < or =2., Results: Patients with TIMI flow grade < or =2 had plaques with more lipid quadrants than patients with TIMI flow grade 3 (p < 0.001), and presented with greater incidence of plaque rupture (p = 0.001). Mean minimal cap thickness was greater in patients with patent arteries than in patients with impaired flow (87 +/- 26 microm vs. 48 +/- 18 microm, p < 0.0001). Minimal cap thickness was independently associated with TIMI flow grade., Conclusions: The morphological characteristics of the culprit atheromatic lesion in patients with STEMI are associated with coronary flow after thrombolysis. The lipid content, the existence of rupture, and mainly the thickness of the fibrous cap are associated with the outcome of thrombolysis., (Copyright 2010 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.)

Atrial fibrillation (AF) is the most common sustained rhythm disturbance resulting in substantial morbidity and mortality as well as increased medical costs in general population. The possible association between AF and inflammation is suggested by several studies that are based on the identification of inflammatory serum biomarkers that are elevated in patients with AF. In this population, the successfulness of maintenance of sinus rhythm after cardioversion and the risk of cardioembolic stroke are related to the inflammatory burden. Furthermore, the positive effect of the antiinflammatory agents on the prevention and modulation of AF further supports this hypothesis.

Inflammatory processes play a pivotal role in the pathogenesis of atherosclerosis and mediate many of the stages of atheroma development, from initial leukocyte recruitment to eventual rupture of the unstable atherosclerotic plaque. Several systemic inflammatory markers reflect different degrees of inflammation and have been indicated as independent risk factors in cardiovascular disease, especially in unstable coronary syndromes. However, whether elevated levels of circulating inflammatory markers play a role in the extent and severity of atherosclerosis remains controversial. The present review summarizes our current understanding of the relationship between inflammatory markers and the presence and extent of coronary atherosclerosis, in order to assess the potential utility of these markers in identifying patients with higher levels of atherosclerotic burden.

Background: In the clinical setting there are conflicting results regarding the role of inflammatory activation in atrial fibrillation (AF). Coronary sinus (CS) thermography assesses myocardial heat production and is correlated with inflammatory states. We investigated in patients with AF whether 1) there is increased CS blood temperature and 2) the correlation of heat production with systemic inflammation., Methods: We included patients with AF and subjects with sinus rhythm. C-reactive protein (CRP) levels were measured in all patients. CS and right atrium (RA) blood temperature measurements were performed by a dedicated 7F thermography catheter. DeltaT was calculated by subtracting RA from CS blood temperature., Results: We included 47 patients with AF and 23 subjects with sinus rhythm. We stratified patients with AF into two groups: normotensive (AFN) and hypertensive (AFH). DeltaT was lower in the RA compared with the CS in AFH (37.27+/-0.52 degrees C vs 37.47+/-0.54 degrees C, p<0.01), in AFN (37.13+/-0.53 degrees C vs 37.34+/-0.54 degrees C, p<0.01), and in controls (37.41+/-0.69 degrees C vs 37.55+/-0.68 degrees C, p<0.01). DeltaTau was greater in AFH, and AFN compared to controls (0.20+/-0.07 degrees C, 0.20+/-0.08 degrees C, vs 0.14+/-0.06 degrees C, p<0.01). DeltaT was similar between AFH and AFN (p=0.95). CRP was higher in AFH and AFN compared to controls (1.72+/-0.85 mg/Dl, 1.69+/-0.94 mg/dL, 0.98+/-0.71 mg/dL, p<0.01). CRP was similar between AFH and AFN (p=0.87). A correlation between CRP with DeltaT was observed in AFH and AFN (R=0.58, p<0.01, R=0.44, p=0.02)., Conclusions: Patients with AF have increased myocardial heat production, which is correlated to the systemic inflammation. CS blood temperature measurement may provide significant information for the pathogenesis of AF.

Sudden death or acute coronary syndromes are frequently the first manifestation of plaque rupture at non-culprit lesions. Thus, identification of high-risk non-culprit plaques may have significant impact on the prognosis of patients with coronary artery disease. At present a widely accepted diagnostic method to prospectively identify such 'high-risk' plaques is not available. Improved identification of high-risk plaques by novel imaging coronary modalities currently available is a goal of great importance since it will result in major decreases in coronary artery disease morbidity and mortality. Potential new treatments with systemic, regional, and local approaches have been proposed. In this review article we focus on common and different morphologic characteristics between culprit and non-culprit lesions, the natural history of non-culprit lesions, and potential methods to identify the high-risk lesions for future adverse cardiovascular events.

Background: In patients with acute coronary syndromes (ACS) increased systemic and local inflammatory activation in culprit lesions is observed. It is unknown, however, whether systemic inflammation is correlated with non-culprit lesion inflammatory activation. Moreover, the effect of statins on non-culprit lesion inflammation has not been extensively investigated. The aim of the present study was to investigate in non-culprit lesions 1) the correlation between plaque temperature measurements with the levels of C-reactive protein (CRP) and 2) whether statin administration is associated with reduced heat production., Methods: We included 71 patients with ACS or stable angina (SA) undergoing percutaneous coronary intervention in culprit lesions, having an intermediate non-culprit lesion. Forty patients were treated with statin and 31 patients were not treated. Systemic inflammatory status was assessed by CRP, and local inflammatory activation by measuring the temperature difference of non-culprit lesion (deltaT), assigned as the difference between the maximal temperature of the atherosclerotic plaque from the proximal vessel wall temperature., Results: Mean deltaT was 0.08+/-0.07 degrees C. Patients with ACS had higher deltaT compared to patients with SA (ACS: 0.10+/-0.07 degrees C vs SA: 0.05+/-0.06, p<0.01). deltaT was less in patients treated with statin in both groups (ACS: 0.07+/-0.04 degrees C vs 0.13+/-0.08 degrees C p=0.009; SA: 0.04+/-0.05 degrees C vs 0.09+/-0.07 degrees C, p=0.04). CRP was higher in patients with ACS compared to SA (1.18+/-1.12 vs 0.47+/-0.37 mg/dL, p=0.001). There was a positive correlation of deltaT and CRP values (R=0.46, p<0.001)., Conclusions: Local inflammatory activation in non-culprit lesions is correlated with systemic inflammation. Moreover, statins have a beneficial effect on non-culprit lesion heat production.