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1591 Introduction: Molecular imaging of S1P1 expression in the brain provides an important biomarker for elucidating the pathophysiological roles of S1P1 in neuroinflammation and neurodegeneration. We previously reported the radiation dosimetry estimates for [11C]-CS1P1 using PET imaging and ex-vivo biodistribution in rodent. This report provides preliminary safety information from human whole-body biodistribution and dosimetry studies of [11C]-CS1P1 for its potential application in human brain imaging studies. 266.4 and 98.79 MBq of [11C]-CS1P1 was administered intravenously in two normal participants (one male and one female). Shortly after the administration of [11C]-CS1P1, whole body (WB) dynamic acquisition were initiated using Siemens Vision Biograph PET/CT (Siemens, Erlangen, Germany). The emission data were acquired for 180 minutes in 25 WB continuous bed motion sweeps from head to upper thighs. The time per sweeps were 120 s [for WB 1-10], 300 s [for WB 11-15], 600 s [for WB 16 and 20]) and 900 s [for WB 21 and 25]. A low-dose CT was performed before the PET emisision scan for PET attenuation correction and anatomical information. Scans were reconstructed using the ordered subset expectation maximization (OSEM) algorithm (4 iterations and 5 subsets) with a time of flight (TOF) and point spread function (PSF). Three-dimensional volumes of interest (VOIs) over entire organs were manually delineated on PET images using CT for anatomical localization. Eleven organs (lung, brain, kidney, gall bladder, spleen, liver, cardiac, stomach, urinary bladder, intestine and pancreas) were identified as source organs and remainder of the body that significantly took up the tracer and visually assessable amounts over the entire time frame of acquisition. Time-activity curves were obtained for each source organ by calculating the total activity (non decay corrected) in the VOIs and expressing them as the percentage of the total injected activity. Depending on the kinetics, different exponential models reflecting biodistribution and elimination of the tracer were used for different organs. The integrated-time-activity values were entered into a human biodistribution model Internal Dose Assessment by Computer (IDAC-Dose) (Ver. 2.1, Umea University, Sweden). The IDAC-Dose software calculates effective dose (ED) from the individual organ doses with radiation weighting factors and organ weighting factors for each of the source organs based on ICRP Publications 103 for male while ICRP Publications 60 for female. The residence time for all source organs are given in Table 1. The organ with the largest residence time was the liver with 0.064 h while the smallest was the urinary bladder with 0.00030 h. The organ total absorbed doses per MBq were largest for the liver (9.88 ± 0.03 µGy/ MBq), (Table 1). The total effective dose (ED) per MBq of injected activity of [11C]-CS1P1 in human is 1.60 ± 0.15 µSv/MBq. Based on the preliminary results, the radiation doses from PET studies are minimal and any biologically harmful effects on humans are unlikely. The total radiation burden depends largely on the initial organ perfusion and its retention until it clears out (larger effective half-life). Highly perfused organs such as heart, lung, liver, kidney, and brain receive a larger fraction of the absorbed dose due to larger effective half-life; whereas, less perfused organs such as muscle or fat receive a much smaller fraction. Most radiotracer molecules are likely to be cleared via either hepatobiliary (liver, gallbladder) or renal excretion (kidneys, urinary bladder). In our preliminary findings, the liver is a critical dose-limiting organ for [11C]-CS1P1. From our preliminary results, imaging with [11C]-CS1P1 for clinical PET studies is safe. Administration of 10 mCi (370 MBq) of [11C]-CS1P1 is expected to resulting in a total human effective dose of

We hypothesized that an accurate assessment of preoperative venography could be useful in predicting transvenous lead extraction (TLE) difficulty.A dedicated preoperative venogram was performed in consecutive patients with cardiac implantable electronic device who underwent TLE. The level of stenosis was classified as without significant stenosis, moderate, severe, and occlusion. The presence of extensive lead-venous wall adherence (≥50 mm) was also assessed. A total of 105 patients (median age: 71 years; 72% male) with a median of 2 (1-2) leads to extract were enrolled. Preoperative venography showed moderate to severe stenosis in 31 (30%), complete occlusion in 15 (14%), and extensive lead-venous wall adherence in 50 (48%) patients. Complete TLE success was achieved in 103 (98%) patients. A total of 55 (52%) were advanced extractions as they required a powered mechanical and/or laser sheath. They were more prevalent in the group with extensive lead-venous wall adherence (72% vs. 34%, p .001), while no differences were found between patients with and without venous occlusion. In multivariate analysis, the presence of adherence was a predictor of advanced extraction (odds ratio: 2.89 [1.14-7.32], p = .025). The fluoroscopy time was also significantly longer (14.0 [8.2-18.7] vs. 5.1 [2.1-10.0] min, p .001). The rate of complications did not differ based on the presence of venous lesions.Although procedural success and complication rates were similar, patients with extensive lead-venous wall adherence required a longer fluoroscopy time and were three times more likely to need advanced extraction tools. Conversely, the presence of total venous occlusion had no impact on the procedure complexity.

Background Stent manufacturers always record stent shortening data while they do not record stent elongation data. The aim of this study is to identify both stent shortening and elongation occurring after deployment in the coronary arteries and know their percentage. Results The length of coronary stents was measured by intravascular ultrasound (IVUS) by (1) edge-to-edge (E-E) length, measured from the appearance of the first distal strut to the last proximal strut, and (2) area-to-area (A-A) length, measured from the first distal struts seen at more than one IVUS quadrant to the last proximal struts seen at more than one IVUS quadrant. Stent shortening was defined as both E-E and A-A lengths were shorter than the manufacturer box-stated length (shortened group). Stent elongation was defined as both E-E and A-A lengths were longer than the manufacturer box-stated length (elongated group), otherwise unchanged group. Consecutive 102 stents deployed in ischemic patients were included. Stent elongation was detected in 67.6% (69 stents), and shortening was detected in 15.7% (16 stents), while unchanged stents were detected in 16.7% (17 stents). Although the 3 groups had similar box-stated length and predicted foreshortened length, they had significantly different measurements by IVUS, p<0.001 for each comparison. Differences from box-stated length were 1.9±1.4mm, −1.4±0.4mm, and 0.4±0.3mm, respectively, p<0.001. The elongated group had significantly longer differences from the corresponding box-stated and predicted foreshortened lengths, while the shortened group had significantly shorter differences from the corresponding box-stated length and similar foreshortened length. By multinomial regression analysis, the plaque-media area and stent deployment pressure were the independent predictors of the stent length groups, p=0.015 and p=0.026, respectively. Conclusions Change in stent length is not only shortening—as mentioned in the manufacturer documents—but also stent elongation. Stent elongation is dominant, and the most important predictors of longitudinal stent changes are plaque-media area and stent deployment pressure.

Objectives: The new generation antiplatelets are generally recommended by the current US and European guidelines. This article aimed to address the efficacy and safety of using ticagrelor in patients with ST-elevated acute coronary syndromes.Methods: This was a prospective observational study on 120 patients admitted to the Cardiology Care Unit of Assiut University Hospital with ST-segment elevation acute coronary syndrome, who were admitted for urgent revascularization and received aspirin and the P2Y12 antagonist ticagrelor. The patients were followed for three months between May 2018 and September 2019. The primary efficacy end point was the incidence of major adverse cardiovascular events (MACE).Results: At three months, the primary efficacy endpoint, a composite of cardiovascular death, myocardial infarction, or stroke - occurred in 11/120 (9.2%) patients. The primary safety endpoint, the incidence of major bleeding, was observed in two patients (1.7%) with no fatal bleedings. Minor and minimal bleeding occurred in 2.5% and 20.8% of patients, respectively. Other efficacy endpoints were myocardial infarction 4.2% and stent thrombosis (1.7%). Severe dyspnea found in 5.0% of patients and led to 1.7% ticagrelor discontinuation. Multivariate regression analysis revealed no association between bleeding and patients’ age, sex nor IV administration of glycoprotein IIb/IIIa inhibitor. Conclusion: The MACE with ticagrelor was higher than previously reported in most studies. Dyspnea rate was higher and more pronounced than bleeding rate. The majority of bleeding cases were minimal with no fatal major bleeding and no bleeding led to comorbidity.

The functional and molecular imaging characteristics of ischemic ventricular tachycardia (VT) substrate are incompletely understood. Our objective was to compare regional (18)F-FDG PET tracer uptake with detailed electroanatomic maps (EAMs) in a more extensive series of postinfarction VT patients to define the metabolic properties of VT substrate and successful ablation sites. Methods: Three-dimensional (3D) metabolic left ventricular reconstructions were created from perfusion-normalized (18)F-FDG PET images in consecutive patients undergoing VT ablation. PET defects were classified as severe (defined as 1.5 mV), or border zones (defined as voltage of 0.5–1.5 mV). Results: All 56 patients had ischemic cardiomyopathy (ejection fraction, 29% ± 12%). Severe PET defects were larger than dense scarring, at 63.0 ± 48.4 cm(2) versus 13.8 ± 33.1 cm(2) (P < 0.001). Similarly, moderate/severe PET defects (≤70%) were larger than areas with abnormal voltage (≤1.5 mV) measuring 105.1 ± 67.2 cm(2) versus 56.2 ± 62.6 cm(2) (P < 0.001). Analysis of bipolar voltage (23,389 mapping points) showed decreased voltage among severe PET defects (n = 10,364; 0.5 ± 0.3 mV) and moderate PET defects (n = 5,243; 1.5 ± 0.9 mV, P < 0.01), with normal voltage among normal PET areas (>70% uptake) (n = 7,782, 3.2 ± 1.3 mV, P < 0.001). Eighty-eight percent of VT channel or exit sites (n = 44) were metabolically abnormal (severe PET defect, 78%; moderate PET defect, 10%), whereas 12% (n = 6) were in PET-normal areas. Metabolic channels (n = 26) existed in 45% (n = 25) of patients, with an average length and width of 17.6 ± 12.5 mm and 10.3 ± 4.2 mm, respectively. Metabolic channels were oriented predominantly in the apex or base (86%), harboring VT channel or exit sites in 31%. Metabolic rapid-transition areas (>50% change in (18)F-FDG tracer uptake/15 mm) were detected in 59% of cases (n = 33), colocalizing to VT channels or exit sites (15%) or near these sites (85%, 12.8 ± 8.5 mm). Metabolism–voltage mismatches in which there was a severe PET defect but voltage indicating normal myocardium were seen in 21% of patients (n = 12), 41% of whom were harboring VT channel or exit sites. Conclusion: Abnormal (18)F-FDG uptake categories could be detected using incremental 3D step-up reconstructions. They predicted decreasing bipolar voltages and VT channel or exit sites in about 90% of cases. Additionally, functional imaging allowed detection of novel molecular tissue characteristics within the ischemic VT substrate such as metabolic channels, rapid-transition areas, and metabolism–voltage mismatches demonstrating intrasubstrate heterogeneity and providing possible targets for imaging-guided ablation.

Background: One of the risk factors of congestive heart failure that still under investigations is hyperuricemia. It's still debatable whether it's an independent risk factor or it's just a consequence of other disorders associated with cardiovascular diseases like hypertension, diabetes and dyslipidemia. Objective: The aim of our study is to elucidate whether in patients with heart failure serum uric acid level correlated with left ventricular ejection fraction supporting the possibility that the detection of progressive hyperuricemia in these patients may be an indicator of deteriorating cardiac function. Methods: We conducted a prospective study that included 124 studied patients and 26 apparently healthy persons at Coronary care unit and Internal Medicine Department at Sohag University Hospitals. All studied populations were classified into four groups; v Group "I" patients being newly diagnosed heart failure, v Group "II" patients decompensated heart failure on regular treatment, v Group "III" patients decompensated heart failure but stopped their treatment from three months, v Group "IV" control group selected to our study healthy and age-matched subjects from 30 to 70 years old . Then we studied the association between left ventricular ejection fraction, the severity of congestive heart failure and the serum uric acid levels and the well-known conventional risk factor that include age, sex, BMI, positive family history, smoking, hypertension, diabetes and dyslipidemia then through logistic regression analysis we tried to identify the independent predictors of coronary artery diseases. Results: The mean finding in our study is the significant higher mean ± SD serum uric acid levels in patients with congestive heart failure (8.43±2.95) versus apparently healthy persons (5.55±1.48) with "P value = .02". When we adjusted the serum uric acid with others significant factors in the univariate analysis which were age, gender and smoking, serum uric acid was an independent risk factor "P value = .04". Another interesting finding is significant correlation between serum uric acid level and the severity of congestive heart failure "P value

Background/objectives Systemic sclerosis (SSc) is an autoimmune disease associated with immune abnormalities and widespread vascular lesions, including increased intimal and medial thickness. These changes may be reflected in early atherosclerosis and cardiovascular risks. We aimed in this study to examine the carotid artery intima-media thickness and MRI brain findings in SSc patients and compared them to a group of normal controls. A relationship between these parameters and clinical measures in SSc was also sought. Methods Seventy-two SSc patients with no central nervous system (CNS) symptoms and 42 healthy controls were included. Clinical and laboratory measures, Medsger’s severity scale, and Doppler ultrasound common carotid artery intima-media thickness (CCA-IMT) were measured. Brain fluid-attenuated inversion recovery (FLAIR)-MRI and diffusion-weighted MRI (DWI) were also done. Results SSc patients had more CCA-IMT, higher CRP, and more brain MRI hyperintense lesions than controls (P

Background Ischemic heart disease represents nearly 1.8 million annual deaths or 20% of all Europe deaths. Reperfusion of the ischemic myocardium decreases infarct's size and improves left ventricular function and clinical outcome in patients with acute myocardial infarction. Objective The study evaluated the outcome of revascularization strategies [primary percutaneous coronary intervention (PPCI) and fibrinolytic] for patients who presented with ST-segment elevation myocardial infarction (STEMI). Patients and methods This is an observational retrospective study that was conducted during March 1, 2018 and August 31, 2018. The study included 232 patients divided into group A (186 patients of them underwent PPCI) and group B (66 patients who received streptokinase). Results In group A, 76.9% of them were males, 33.9% were diabetic, 30.1% were hypertensive, 55.4% were smokers, and 17.7% were addicts, whereas in group B, 77.3% were males, 59.1% were smokers, and 16% were addict, and it was found that diabetes mellitus and hypertension presented in 54.5% and 50 of patients, respectively. Anterior myocardial infarction and KILLIP I presentation were nearly the same in both groups. In-hospital mortality was statistically higher in group B than group A (18.18 vs 8.6%; P = 0.03). Moreover, the mean of ejection fraction by Simpsons during admission at the PPCI patient was found higher in group A than that in the group B (51.20 ± 9.19 vs 46.7 ± 7.61; P = 0.001). Conclusion The implementation of PPCI service is beneficial in patients with STEMI in the form of lower in-hospital mortality and better ejection fraction, so primary PCI is preferred as a strategy in patients with STEMI.

Background: Adipo¬cytokines may play role in pathogenesis of atherosclerosis. The association of the novel adipocytokines, vaspin and visfatin, with atherosclerosis coronary artery disease (CAD) is still obscure. Objectives: To investigate the relationship of vaspin and visfatin adipocytokines with the existence as well as the severity of CAD. Patients and Methods: A total of 87 patients who underwent coronary angiography due to symptoms of stable angina were enrolled in the study. They were divided into two groups; CAD group who have at least single vessel disease and normal group who have normal coronary arteries. The severity of CAD was assessed using coronary angiography by estimation the number of vessels affected and Gensini score. Results: Serum levels of vaspin were significantly lower and inversely, serum levels of visfatin were significantly higher in CAD group than normal (1.51 ± 0.99 μg/L versus 4.54 ± 0.69 μg/L for the former and 22.86 ± 4.68 μg/L versus 13.43 ± 1.1 μg/L for the later; p

Background The treatment of patients with repeated drug-eluting stent–in stent restenosis (DES-ISR) remains a challenge and a burdensome clinical problem. Methods Over a 3-year period, 130 lesions in 123 patients who underwent target lesion revascularization (TLR) for DES restenosis were included in the study. They were classified into two main groups: the first group having first-time DES-ISR ( n =84), and the second group having rerestenosis of DES-treated DES-ISR ( n =39). Further classification according to the treatment strategy yielded four subgroups: balloon angioplasty (BA) in first-time DES-ISR ( n =66), re-DES in the same group ( n =22), BA in rerestenosis of DES-treated DES-ISR ( n =30), and re-DES in the same group ( n =10). Angiographic follow-up was planned at 1year, and clinical follow-up for re-TLR up to 2years later. Results The mean duration of clinical follow-up was 24.8±9.7months. The angiographic follow-up data were obtained for 108 patients (87.8%) at 1year. Among patients treated for first-time DES-ISR, late lumen loss (0.65±0.83mm and 1.02±0.52mm, p =0.02) and binary restenosis rates (25% and 49.1%, p =0.05) were significantly less in those undergoing re-DES compared with BA. This benefit was not evident in patients having rerestenosis of DES-treated DES-ISR. Re-TLR at 2years was significantly less in the re-DES group compared with BA (log rank p =0.038) in first-time DES-ISR patients, while no significant difference (log rank p =0.58) was observed in those having rerestenosis of DES-treated DES-ISR. Conclusion While a strategy of re-DES would be better than BA in first-time DES-ISR, this could not be extrapolated to rerestenosis cases.

The current studyAimed: to identify the impact of implementing an educational nursing program on reducing the level of anxiety and complications among patients undergoing cardiac catheterization.Design: quasi-experimental design was used in this study. Setting: the Current study was conducted atAssiutUniversityHospital in the cardiac catheterization unit.Subjects: 60 adult patients, age between 20 – 65 years, male and female, thirty for each group (study and control). The group of patients who received educational nursing program was considered a study group, while who received a routine care was the control group. Tools: four.Tools: Structure Interview Questionnaire sheet, Hamilton Anxiety Rating Scale, Assessment of complications, & educational nursing program.Results: there was the statistically significant difference between both groups regarding the level of anxiety and incidence of local complications.Conclusion: giving written nursing program for patients more effective in decreasing level of anxiety for patients in the study group than the control group patients.Recommendations: Permanent attendance of a specialized nurse in the cardiac catheterization unit is of great importance to instruct and apply the guidelines of the patients. Simple illustration booklet and pamphlets must be adequate and available for patients with Arabic explanation that helps the patient how to live safely.