Validation of the echocardiographic assessment of epicardial adipose tissue thickness at the Rindfleisch fold for the prediction of coronary artery disease.

BACKGROUND AND AIM: Echocardiography is a promising technique for the assessment of epicardial adipose tissue (EAT). Increased EAT thickness is associated with different cardiac diseases, including; coronary artery disease (CAD). Since several different echocardiographic approaches have been proposed to measure EAT, the identification of a standardized method is needed. We propose the assessment of EAT maximal thickness at the Rindfleisch fold, the reproducibility of this measurement and its correlation with EAT thickness and volume assessed at cardiac magnetic resonance (CMR). Finally, we will test the predictive role of this measurement on the presence of significant CAD. METHODS AND RESULTS: In 1061 patients undergoing echocardiography, EAT thickness was measured at the level of the Rindfleisch fold. In 70 patients, we tested the relationship between echo-EAT thickness and EAT thickness and volume assessed at CMR. In 499 patients with suspected CAD, undergoing coronary artery angiography, we tested the predictive value of EAT on the presence of significant CAD. Echo-EAT thickness measurements had an excellent reliability as indicated by the inter-observer (ICC:0.97; 95% C.I. 0.96 to 0.98) and intra-observer (ICC:0.99; 95% C.I. 0.98 to 0.99) reliability rates. Echo-EAT thickness significantly correlated with CMR-EAT thickness and volume (p < 0.001). An EAT thickness value >10 mm discriminated patients with significant CAD at coronary angiography (p < 0.001). At multivariable analysis, including demographic data and cardiovascular risk factors, EAT thickness was an independent predictor of significant CAD and showed an additive predictive value over common atherosclerotic risk factors. CONCLUSIONS: Echocardiographic assessment of EAT thickness at the level of the Rindfleisch fold represents a simple and trustworthy method. An increased EAT thickness shows an additive predictive value on CAD over common atherosclerotic risk factors, thus suggesting its potential clinical use for CAD risk stratification.

Device closure of 'complex' postinfarction ventricular septal defect.

Ventricular septal defect (VSD) is a life-threatening complication of acute myocardial infarction (MI), resulting in high mortality rate even in the case of a timely approach by surgical repair. Transcatheter closure is nowadays a reliable alternative to surgery, although currently deemed challenging or unsuitable in large and complex VSD. This article reports on a successful transcatheter approach in a critically ill patient with subacute right coronary-related, complex postinfarction VSD. In this patient, two sequentially deployed Amplatzer Septal Occluder devices stabilized the clinical conditions and hemodynamic parameters.

An enhanced photocatalytic response of nanometric TiO2 wrapping of Au nanoparticles for eco-friendly water applications.

We propose a ground-breaking approach by an upside-down vision of the Au/TiO2 nano-system in order to obtain an enhanced photocatalytic response. The system was synthesized by wrapping Au nanoparticles (∼8 nm mean diameter) with a thin layer of TiO2 (∼4 nm thick). The novel idea of embedding Au nanoparticles with titanium dioxide takes advantage of the presence of metal nanoparticles, in terms of electron trapping, without losing any of the TiO2 exposed surface, so as to favor the photocatalytic performance of titanium dioxide. A complete structural characterization was made by scanning electron microscopy, transmission electron microscopy and X-ray diffraction. The remarkable photocatalytic performance together with the stability of the nano-system was demonstrated by degradation of the methylene blue dye in water. The non-toxicity of the nano-system was established by testing the effect of the material on the reproductive cycle of Mytilus galloprovincialis in an aquatic environment. The originally synthesized material was also compared to conventional TiO2 with Au nanoparticles on top. The latter system showed a dispersion of Au nanoparticles in the liquid environment, due to their instability in the aqueous solution that clearly represents an environmental contamination issue. Thus, the results show that nanometric TiO2 wrapping of Au nanoparticles has great potential in eco-friendly water/wastewater purification.