Post on 11-Apr-2017
transcript
NEW ADVANCES IN
THERMOGRAPHY
Christodoulos StefanadisProf. Of Cardiology
Athens medical School, Athens, Greece
Thermal Heterogeneity - Thermal Heterogeneity - AtherosclerosisAtherosclerosis
Prognosis of: • culprit lesion post
PCI• Non-culprit lesion
Epiphany Thermography System
• A mono-rail system. • One thermistor at the distal end
of 3-4 F catheter• Accuracy 0.05oC• Almost wedging at the
atherosclerotic plaque
• Safe, fast procedure • Wedging• Full contact in significant lesions
Epiphany Thermography System
35.5
35.7
35.9
36.1
36.3
36.5
Tem
pera
ture
(o C
)
Atherosclerotic Plaque TemperatureAtherosclerotic Plaque Temperature
Plaque Plaque
DistalProximal Proximal
38.5
38.3
38.1
37.9
37.7
37.5
Thermal Heterogeneity and Thermal Heterogeneity and Prognosis Post PCIPrognosis Post PCI
• Number: 86 pts
• Effort Angina: 30 pts
• Unstable Angina: 30 pts
• AMI: 26 pts
Study PopulationStudy Population
Demographic CharacteristicsDemographic Characteristics
Age (years) 61+ 9N 86Aspirin intake 24/86Statin intake 20/86Hypertension 39/86LV Dysfunction 26/86Diabetes 24/86Total cholesterol (mg/dl) 229 + 37Smoking 48/86Previous MI 22/86
ΔΤ - Clinical EventsΔΤ - Clinical Events
ΔΤ - Clinical Follow-upFV
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
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
Clinical Follow-up
Stefanadis C et al, JACC 2001 April
ΔΤ - Clinical EventsΔΤ - Clinical Events
Sensitivity: 86%Specificity: 79%
Cut-off point: 0.5 oC
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 72Treated pts 35Non-Treated pts 37Effort Angina 21Acute Coronary Syndromes
51
UA
32
AMI
19
StatinsNo statins
Tem
pera
ture
diff
eren
ces
(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)
Temperature measurements - coronary flow
Temperature measurements • At proximal vessel wall• At lesion• Flow interruption• At lesion• Balloon deflation
ΔTp
ΔTl
GW
D-GW
Th
Bl
Study Study ProtocolProtocol
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
Plaque
Vulnerable Patient
Myocardiu
mBlood
VulnerabilityVulnerabilityArter
y
Identification of Vulnerable Identification 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
Atherosclerosis and Atherosclerosis 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;July
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 curved (0o -180o ).
C
CS Th
In Vivo Coronary Sinus In Vivo Coronary Sinus ThermographyThermography
38.3
38.35
38.4
38.45
38.5
38.55
38.6
38.65
38.7
Tem
pera
ture
(o C)
Coronary Sinus Temperature
Right Atrium
Coronary Sinus
Right Atrium
ΔT = Difference of temperature between CS and right atrium
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) 62.19.8 59.99.4
60.09.5 0.57
BP (mmHg) 134.513.3 137.314.3 138.614.1
0.38
Chol (mg/dl) 214.113.1 218.214.1 199.514.4
0.47
Diabetes 3(11%) 1(10%) 1(4%)
0.67
Smoking 8(35%) 4(40%) 5(22%)
0.55
Family history 10(37%) 4(40%) 5(22%)
0.42
b-Blockers 20(74%) 8(80%) 13(56%)
0.28
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
Heart rate (1/min) 732 699 708
0.53
LV mass (g/m2) 9723 9520 9720
0.64
EF (%) 649 629 666
0.69
0
.1
.2
.3
.4Te
mpe
ratu
re D
iffer
ence
(oC
)
0 2 3
Control RCA LCA
Coronary Sinus Temperature Coronary Sinus Temperature MeasurementsMeasurements
0.090.07oC
0.150.08
0.270.10
The ‘Cooling Effect’ of Coronary Blood Flow on Heart in Patients With Coronary Artery Disease
Study Study ProtocolProtocol- Baseline
- Flow interruption- Balloon deflationTemperature recordings
- Recordings
DGW
Coronary Sinus and FlowCoronary Sinus and Flow
Temperature recordings
- Baseline
- Flow interruption- Balloon deflation
- Recordings
0
.05
.1
.15
.2
.25
.3
.35
.4
ƒ T
Δ Tl (
o C)
Coronary Sinus and FlowCoronary Sinus and Flow
Temperature difference (ΔΤ) between patients with CAD and controls
CADControls
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.
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.