Arteries Of Subjects Research Articles

P200 A POSITIVE CORRELATION BETWEEN THE OVERALL ECHOGENICITY OF CAROTID INTIMA MEDIA COMPLEX AND ARTERIAL STIFFNESS OF HYPERTENSIVE PATIENTS: BEYOND THE INTIMA MEDIA THICKNESS ASSESSMENT

Abstract According to the latest ESC guidelines on CVD prevention (2021) arterial stiffness (AS) still has a role in predicting future CVD risk and defining patients’ CVD risk level. However, significative measurement difficulties make a widespread evaluation of the AS problematic, especially in the ambulatorial outpatient setting. The IMT measurement is no longer recommended in the CVD risk assessment due to lack of standardization in measurement protocol and low power to reclassify patients toward higher CV risk. Understanding the correlation between the structure and function of the large arteries can lead to an optimization of cardiovascular disease prevention strategies. At present, indices of arterial stiffness have not been associated with qualitative morphological characteristics of intima–media complex. The IM GSM is a relatively simple measurement that can be acquired during a carotid color–Doppler ultrasound exam. The aim of this study was to investigate the relationship between indices of arterial stiffness and echogenicity of intima media complex (IM GSM) of the common carotid arteries in subjects with arterial hypertension. In our study population of 421 hypertensive patients, subjects with IM GSM > 30 showed a significantly increased arterial stiffness and LVMI (P < 0.001). A weak positive correlation was found between IM GSM and SBP (r =0.35, P< 0.001), and duration of hypertension (r = 0.31, P < 0.01). Our study suggests that increased stiffness observed in hypertensives is associated with qualitative changes in carotid arterial wall.

Renal Artery Caliber In Abdominal CT Scan With IV Contrast Based on Age and Gender

Introduction: CT scan provides several three-dimensional images when reconstructed, high speed, accurate, less invasive, and relatively low cost. The size of renal arteries varies based on influencing factors such as age, gender, and location. Several studies reported variations in the dimensions of the renal arteries based on sex, age, and variations of the arteries. The purpose of research objectives is to analyze factors affecting the caliber of the renal artery in patients with abdominal CT Scan with intravenous contrast procedure. Method: A case-control study in patients with abdominal CT Scan with intravenous contrast procedure. Data was secondary data obtained by medical records of patients who have undergone a CT scan of the Abdomen with intravenous contrast. Results: The caliber of the right renal artery in subjects ≤40 years (5.19±0.53 mm) was greater than those> 40 years (4.58±0.66 mm). Statistically, based on the Independent T-test, found that there was a significant difference in the mean caliber of the right renal artery (p <0.01) and the left renal artery (p=0.01). The mean of the caliber of the right and left renal arteries in male subjects (5.05±0.69 mm) was greater than women (4.7±0.60 mm). The results of the Independent T-test showed that there was a difference in male subjects than women with a p-value of the right renal artery caliber (p=0.04) and left (p=0.02). Conclusion: There was a difference in the mean caliber of the renal arteries by the CT scan of the abdomen with intravenous contrast based on age and gender.

567 BEYOND THE INTIMA MEDIA THICKNESS ASSESSMENT: THE MEASUREMENT OF OVERALL ECHOGENICITY (GSM) OF CAROTID INTIMA MEDIA COMPLEX SHOWS A POSITIVE CORRELATION WITH ARTERIAL STIFFNESS OF HYPERTENSIVE PATIENTS

Abstract Beyond the Intima Media Thickness assessment: the measurement of overall echogenicity (GSM) of Carotid Intima Media Complex shows a positive correlation with Arterial Stiffness of hypertensive patients. According to the latest ESC guidelines on CVD prevention (2021) arterial stiffness still has a role in predicting future CVD risk and defining patients’ CVD risk level. However, significative measurement difficulties make a widespread evaluation of the AS problematic, especially in the ambulatorial outpatient setting. The IMT measurement is no longer recommended in the CVD risk assessment due to lack of standardization in measurement protocol and low power to reclassify patients toward higher CV risk. Understanding the correlation between the structure and function of the large arteries can lead to an optimization of cardiovascular disease prevention strategies. At present, indices of arterial stiffness have not been associated with qualitative morphological characteristics of intima-media complex. The IM GSM is a relatively simple measurement that can be acquired during a carotid color-Doppler ultrasound exam. The aim of this study was to investigate the relationship between indices of arterial stiffness and echogenicity of intima media complex (IM GSM) of the common carotid arteries in subjects with arterial hypertension. In our study population of 421 hypertensive patients, subjects with IM GSM > 30 showed a significantly increased arterial stiffness and LVMI (P < 0.001). A weak positive correlation was found between IM GSM and SBP (r =0.35, < 0.001), and duration of hypertension (r = 0.31, < 0.01). Our study suggests that increased stiffness observed in hypertensives is associated with qualitative changes in carotid arterial wall.

Isolated diastolic hypertension is not associated with endothelial dysfunction.

Hypertension is associated with an impairment of endothelial function. However, it is unclear whether isolated diastolic hypertension is associated with endothelial dysfunction. The purpose of this study was to investigate the association of endothelial function with isolated diastolic hypertension diagnosed by using two major hypertension guidelines: systolic blood pressure (BP) < 130 mmHg and diastolic BP ≥ 80 mmHg according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) hypertension guideline and systolic BP < 140 mmHg and diastolic BP ≥ 90 mmHg according to the 2018 European Society of Cardiology/European Society of Hypertension (ESC/ESH) hypertension guideline. We measured the flow-mediated vasodilation (FMD) of the brachial artery in subjects without systolic hypertension who were not treated with antihypertensive drugs. Of 3727 subjects (2813 men; mean age: 41.3 ± 10.9 years), 749 (20.1%) had isolated diastolic hypertension according to the 2017 ACC/AHA definition. Multiple logistic regression analysis revealed that isolated diastolic hypertension was not associated with endothelial dysfunction, defined as FMD < 7.0% (OR, 1.15; 95% CI, 0.98-1.35; P = 0.09). Of 4747 subjects (3727 men; mean age: 45.1 ± 10.8 years), 314 subjects (6.6%) had isolated diastolic hypertension according to the ESC/ESH definition. Multiple logistic regression analysis revealed that isolated diastolic hypertension was not associated with endothelial dysfunction after adjusting for age and sex (OR, 1.04; 95% CI, 0.82-1.32; P = 0.76). Isolated diastolic hypertension was not associated with endothelial dysfunction in individuals who were not treated with antihypertensive drugs regardless of the major hypertension guideline definition used.

Epicardial adipose tissue volume is associated with low-attenuation plaque volume in subjects with or without increased visceral fat: a 3-vessel coronary artery analysis with CT angiography

Abstract Background Low-attenuation plaque (LAP) with a CT value of less than or equal 30 HU on coronary CT angiography (CCTA) is a marker of high-risk plaque features that leads to future acute coronary syndromes. Perivascular and epicardial adipose tissue (EAT) have been shown to be associated with progression of high-risk coronary plaques through metabolic and inflammatory mechanisms. However, association of EAT with LAP volume in three coronary arteries in subjects with or without visceral obesity remain unclear. Aims This study aimed to investigate the association of EAT volume (EAV) and coronary 3-vessel LAP volume in subjects with or without visceral obesity who underwent CCTA. Methods Patients who underwent CCTA without known coronary artery disease were included in the study (525 patients). Study subjects were classified as having non-obstructive or obstructive coronary artery disease according to the degree of coronary artery stenosis on CCTA. The plaque volume and EAV of the main vessel of the left anterior descending artery, left circumflex artery, and right coronary artery were measured with VINCENT software. Coronary plaque composition was classified as calcified plaque (CP, &amp;gt;150HU), noncalcified plaque (NCP, 30–150HU), and Lap (&amp;lt;30HU). The %LAP volume of the three coronary arteries was classified into quartiles. Multiple logistic regression analysis was used to analyze the factors associated with the %LAP volume. Results Compared with subjects without increase visceral fat, subjects with increased visceral fat had a significantly higher BMI, a greater total plaque volume, a greater total %LAP volume, a greater EAV, and a lower mean CT value of EAT. A significant correlation was observed between EAV and %LAP volume (R=0.24, p&amp;lt;0.001). EAV (odds ratio; 1.83, 95% confidence interval 1.071–3.141, p-value 0.027) and type 2 diabetes mellitus (odds ratio 1.76, 95%confidence interval 1.042–3.000, p-value 0.034) appeared to be independent predictors of %LAP volume (Q4), when adjusted by age, gender, BMI&amp;gt;25 kg/m2, visceral fat &amp;gt;100cm2, LogCRP, coronary artery calcium score&amp;gt;300, and obstructive coronary artery disease requiring revascularization. Conclusion This study suggests that LAP volume, which reflects the high-risk plaques in the three coronary arteries, is associated with EAV in subjects with or without increased visceral fat. Further research is needed whether pharmacological therapeutic intervention enables the prevention of coronary plaque progression and destabilization through the reduction of EAV in patients. Funding Acknowledgement Type of funding sources: None.

Is the intima-media thickness of temporal and axillary arteries influenced by cardiovascular risk?

To measure with US the intima-media thickness (IMT) of temporal (superficial, parietal and frontal branches) and axillary arteries in subjects without a diagnosis of GCA and/or PMR with different cardiovascular (CV) risk; and to assess the performance of previously proposed cut-off values for normal IMT. Subjects ≥ 50 years without a diagnosis of GCA or PMR were included. Bilateral US of the temporal arteries, including the frontal and parietal branches, and axillary arteries was performed by two sonographers using a 10-22 MHz and 6-18 MHz probe. The following previously proposed cut-offs were considered: superficial temporal artery: 0.42 mm; frontal branch: 0.34 mm; parietal branch: 0.29 mm; axillary artery: 1.0 mm. A total of 808 arteries in 101 subjects were evaluated; of these, 31 (30.7%) were classified as very high CV risk, seven (6.9%) as high, 34 (33.7%) as moderate and 29 (28.7%) as low risk. Subjects with very high or high risk showed higher IMT than those with moderate or low risk in the superficial temporal arteries [0.23 (s.d. 0.07) vs 0.20 (s.d. 0.04), P < 0.01] and in the axillary arteries [0.54 (s.d. 0.17) vs 0.48 (s.d. 0.10), P = 0.002] . The IMT was higher than the reference cut-off in 13/808 (1.6%) arteries, in ≥1 artery in 10/101 subjects (10.1%). Of these 10 subjects, 8 (80%) were classified as having very high or high risk. Our results suggest that CV risk might influence the US-determined IMT of the temporal and axillary arteries in subjects without GCA. Therefore, in patients with suspected GCA, particular attention should be paid when measuring the IMT in those patients with very high/high CV risk.

The Importance of Doppler Analysis of Uterine Circulation in Pregnancy for a Better Understanding of Preeclampsia.

Background:The etiology of preeclampsia has still not been completely explained. Early identification of women with the risk of developing preeclampsia is a key goal of antenatal care.Objective:To investigate risk factors for preeclampsia from the history, laboratory and ultrasound findings (Doppler).Methods:Pregnant women with normal Doppler sonography in the second trimester of pregnancy were classified as a control group, while pregnant women with impaired Doppler in the second trimester were considered as the investigated group with presumably increased risk for preeclampsia. A total number of 80 patients was included in the study (40 patients in each group).Results:The difference of urea, uric acid and lactate dehydrogenase (LDH) in the serum of the control and investigated group was statistically significant, while the differences were not statistically significant for creatinine, aspartate aminotransferase (AST) and alanine aminotransferase (ALT). The presence of a notch sign during assessment of blood flow in uterine arteries in subjects in the investigated group with the diagnosis of preeclampsia had the specificity of 47.62%, and sensitivity of 88.89%. The positive predictive value of a notch sign during assessment of blood flow in uterine arteries as a marker for diagnosis of preeclampsia in the second trimester of pregnancy was 90.91%, and its negative. Systolic and diastolic blood pressure are dependent variables which are predicting preeclampsia, whilst a notch sign in uterine arteries was designated as an independent variable predicting preeclampsia.Conclusion:From the laboratory tests the following parameters were considered as the risk factors for preeclampsia: increasing levels of urea, uric acid, and LDH. Notch sign was considered to be a very strong predictor of preeclampsia, especially if present bilaterally. Doppler sonography in the second trimester of pregnancy is a good predictor for early diagnosis of preeclampsia.

The Diagnostic Value of Radial and Carotid Intima Thickness Measured by High-Resolution Ultrasound for Ischemic Stroke

No study has examined intima thickness of the carotid artery and peripheral arteries in subjects with acute ischemic stroke due to large-artery atherosclerosis (LAAS). The aim of this study was to test whether carotid intima thickness (CIT), radial intima thickness (RIT), and dorsalis pedis intima thickness (PIT) are closely associated to atherosclerotic risk factors and whether they possess independent and additive value for differentiating LAAS stroke. One hundred and two patients with LAAS stroke and 104 age- and gender-matched control subjects were enrolled. CIT, RIT, and PIT were measured using a 24-MHz, high-resolution ultrasound system. Multivariate linear regression was performed to determine associations between ultrasonic parameters and risk factors. Binary logistic regression was used to evaluate the diagnostic value of different parameters. Receiver operating characteristic curves were plotted to compare the performance of several diagnostic models. CIT ([36.97±11.27]×10-2 vs [23.68±5.12]×10-2mm, P<.001) and RIT ([15.40±3.62]×10-2 vs [11.06±2.22]×10-2mm, P<.001) were significantly thicker in patients with LAAS stroke than in control subjects. CIT and RIT were associated with traditional risk factors for atherosclerosis, including age, systolic blood pressure, and serum levels of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, homocysteine, and glucose. CIT had incremental diagnostic value to traditional risk factors for LAAS stroke (area under the curve, 0.945 vs 0.860; P=.006). The addition of CIT and RIT to traditional risk factors had the best diagnostic performance (area under the curve, 0.961). Measurement of CIT, RIT, and PIT is feasible and reliable using newly developed ultrasound techniques. CIT and RIT were associated with traditional risk factors for atherosclerosis and exhibited incremental value to traditional risk factors for differentiating patients with LAAS stroke from control subjects.

Cerebral hemodynamics in the non-alcoholic fatty liver

Introduction and objectivesThe association between non-alcoholic fatty liver disease and cerebral hemodynamics arises from cardiovascular damage mechanisms such as endothelial dysfunction, arterial wall increased stiffness, high thickness of the intimate index of the internal carotid artery, left ventricular hypertrophy, left diastolic dysfunction, calcification coronary arteries and increased epicardial fat. The multidirectional relationship between systemic inflammation and lipid metabolism constitutes a common and simultaneous mechanism that causes vascular damage. This study aims to provide insight into the relationship between non-alcoholic fatty liver disease and the function of systemic circulation and cerebral circulation using Doppler ultrasound. Patients and methodsIs an observational, cross-sectional, prospective, comparative study conducted at Medica Sur Hospital. Thirty-five patients were selected consecutively. The patients consulted neurological service for various symptoms without severity criteria, such as vertigo, primary headache and balance disturbances. ResultsThere is a difference in the variables mean of the right MCA PI (p = 0.023), left MCA PI” (p = 0.004), and left VA PI (p = 0.036) between the control and NAFLD groups. The correlation analysis between these variables and the CAP showed a positive correlation of the three variables with the CAP, "right MCA PI" (r = 0.384), left MCA PI "(r = 0.509) and" left VA PI " (r = 0.551). ConclusionsThis study demonstrates a subclinical process of the middle cerebral artery in subjects with NAFLD, which suggests it may be involved in the disease development and points the need to make decisions for this liver manifestation prevention and treatment.

Doppler ultrasonographic evaluation of celiac and mesenteric arteries in subjects with sickle cell disease

Vasculopathy, as occurring in sickle cell disease (SCD), can affect celiac and mesenteric arteries and result in stenosis, with elevated peak systolic velocity (PSV) on Doppler ultrasonography. In six subjects with confirmed SCD in steady state, routine Doppler ultrasonographic examination discovered features of celiac artery (CA) or superior mesenteric artery (SMA) stenosis with CA PSV >200 cm/s (median = 222.8 cm/s; range = 201.5-427.1 cm/s) and/or SMA PSV >275 cm/s (median 183.2 cm/s; range = 87.8-289.3 cm/s). Among the six subjects, five had elevated soluble P-selectin values (median 72.55 ng/mL), while all six (100%) had elevated cystatin C levels (median 4.15 mg/L). Peripheral oxygen saturation was suboptimal in five subjects. All subjects had low hemoglobin concentration levels (median 8.5 g/dL) while four had elevated white blood cell count. Although vaso-occlusive crises result from microvessel occlusion, these findings at the macrovascular level suggest that SCD patients may also be vulnerable to mesenteric ischemic injury, especially in the setting of anemic heart failure from hemolysis.

Hypoglycemia does not affect the progression of preclinical atherosclerosis in subjects with type 2 diabetes

IntroductionIntensive treatment aimed at achieving optimal metabolic control to prevent the development of chronic diabetic complications is often associated with an increased rate of hypoglycemic events. Hypoglycemia is believed to be responsible for acute fatal and nonfatal cardiovascular events likely as a consequence of the activation of pro-inflammatory and pro-atherothrombotic pathways. Hypoglycemia has been reported to influence the development of preclinical atherosclerosis. The present study was designed to prospectively evaluate whether hypoglycemia influences the function and the morphology of the arteries in subjects with type 2 diabetes without complications and uncontrolled diabetes.Material and methodsSeventy-six subjects underwent a noninvasive evaluation of carotid wall thickness and brachial artery function at baseline and after one year of treatment with the intent of obtaining optimal glycemic control. At the end of the observation time, subjects were divided in two groups: with hypoglycemia (H-group) or without hypoglycemia (C-group).ResultsBaseline characteristic were comparable between groups. HbA1c significantly decreased in both groups, and fasting plasma glucose was only significant in the H-group. Subjects with hypoglycemia showed a significant reduction of carotid wall thickness after one-year of treatment (H-groups: right baseline 834±141 vs. 1-year 770±132 μ p<0.05; C-group: 757±162 vs. 767±135 μ p = ns). Endothelial function remained unchanged during the study for both groups.DiscussionThe present findings demonstrate that hypoglycemia does not affect endothelial function. Furthermore, subjects who experience more hypoglycemia show significant reduction of carotid wall thickness. Optimal metabolic control should be pursued as soon as possible.

Histopathologic Characterization of Peripheral Arteries in Subjects With Abundant Risk Factors: Correlating Imaging With Pathology

ObjectivesThe aim of this study was to comprehensively evaluate the pathology of the lower extremity arteries across their entire length in subjects dying with abundant risk factors and to evaluate the clinical and imaging implications of the pathological characteristics. BackgroundLower extremity peripheral arterial disease is a major cause of cardiovascular morbidity, but a systematic characterization of the pathology has never been undertaken. MethodsTwelve legs were obtained from 8 cadavers with histories of coronary risk factors (median age 82 years, 6 men); 8 of 12 legs were evaluated using computed tomography before the major peripheral arteries were dissected along their entire length. Dissected arteries were cut serially at 3 to 4 mm, and a total of 2,987 sections were examined. ResultsLuminal irregularities and stenosis were more commonly seen in computed tomography images of above-the-knee (AK) arteries. Atherosclerotic lesions were histologically confirmed and were more common in AK (95.7%) than below-the-knee (BK) (56.8%) arteries. Occluded vessels were observed at 18 sites, including 8 AK and 10 BK arteries. Pathologically, acute thrombus was observed in all 8 AK sites, of which 3 were associated with plaque rupture and 5 were related to calcified nodules. The 10 occluded BK arteries revealed chronic total occlusions, of which one-half were embolic in origin and one-half were associated with atherosclerotic lesions. Intimal (75.3%) and medial (86.2%) calcifications were commonly encountered. Proportionate to the neointimal atherosclerosis, intimal calcification was more severe in AK arteries; the severity of medial calcification was no different between AK and BK arteries. Calcification was significantly greater in arteries excised from subjects with compared with those without diabetes. ConclusionsAtherosclerosis occurs more commonly in AK arteries and luminal occlusion from acute thrombosis secondary to rupture or calcified nodules. BK occlusion was chronic in nature, and at least one-half of lesions were embolic in origin. Medial calcification was similarly common in AK and BK arteries but more prevalent in subjects with diabetes.

β-amyloid wall deposit of temporal artery in subjects with spontaneous intracerebral haemorrhage.

BackgroundCerebral Amyloid Angiopathy has been indicated as an important cause of spontaneous non-hypertensive intracerebral haemorrhage (ICH).Aimsto analyze the presence of β-amyloid deposit in the temporal artery of consecutive patients with ICH in comparison to control subjects and its relation to APO-E haplotype frequency.MethodsWe enrolled consecutive patients admitted to Neurosurgery Ward of University Hospital “P. Giaccone” of Palermo with a diagnosis of spontaneous non hypertensive ICH and as control 12 subjects without brain haemorrhage. Biopsy of superficial temporal artery has been performed and β-amyloid deposit was quantified.ResultsAmong 25 subjects with ICH, 10 (40%) had APOE epsilon 2 allele and among these subjects 7 (70%) showed amyloid accumulation on temporal artery specimens, 8 (32%) subjects had APOE epsilon 3 allele and among these subjects only 2 (25%) showed amyloid accumulation on temporal artery specimens, whereas 7 (28%) had APOE epsilon 4 allele and of these, 7 (100%) showed amyloid accumulation on temporal artery specimens. At multivariable logistic regression analysis for the presence of amyloid, predictive factors for the presence of amyloid in temporal artery biopsies were: age, hypertension, intralobar site of haemorrhage, APOE epsilon 2 and APOE epsilon 4 alleles.DiscussionOur findings of a higher frequency of amyloid deposition in temporal artery specimens in subjects with spontaneous intracerebral haemorrhage indicate a possible role of temporal artery as a possible diagnostic site of biopsy in subjects at high risk to develop intracranial haemorrhage related to Cerebral Amyloid Angiopathy.

Effect of organic and inorganic nitrates on cerebrovascular pulsatile power transmission in patients with heart failure and preserved ejection fraction

Objective: Increased penetration of pulsatile power to the brain has been implicated in the pathogenesis of age-related cognitive dysfunction and dementia, a common comorbidity in patients with heart failure and preserved ejection fraction (HFpEF). However, there is a lack of knowledge on the effects of organic and inorganic nitrates administration in this population on the power carried by pressure and flow waves traveling through the proximal aorta and penetrating the carotid artery into the brain microvasculature. Approach: We assessed aortic and carotid hemodynamics non-invasively in two sub-studies: (1) at baseline and after administration of 0.4 mg of sublingual nitroglycerine (an organic nitrate; n = 26); and (2) in a randomized controlled trial of placebo (PB) versus inorganic nitrate administration (beetroot-juice (BR), 12.9 mmol NO3; n = 16). Main results: Wave and hydraulic power analysis demonstrated that NTG increased total hydraulic power (from 5.68% at baseline to 8.62%, P = 0.001) and energy penetration (from 8.69% to 11.63%; P = 0.01) from the aorta to the carotid, while inorganic nitrate administration did not induce significant changes in aortic and carotid wave power (power: 5.49%PB versus 6.25%BR, P = 0.49; energy: 8.89%PB versus 10.65%BR, P = 0.27). Significance: Organic nitrates, but not inorganic nitrates, increase the amount of hydraulic energy transmitted into the carotid artery in subjects with HFpEF. These findings may have implications for the adverse effect profiles of these agents (such as the differential incidence of headaches) and for the pulsatile hemodynamic stress of the brain microvasculature in this patient population.

Endothelial dysfunction of coronary arteries in subjects without diabetes: An association with both insulin resistance and impaired insulin secretion response

AimsThis study was aimed to compare insulin sensitivity and secretion response, lipoprotein and plasminogen activator inhibitor 1 (PAI-1) levels between the subjects with and without coronary artery endothelial dysfunction (ED). MethodsED was detected by intracoronary injection of acetylcholine (ACh) in 47 nondiabetes subjects without stenotic coronary arteries, selected from 316 consecutive patients with coronary angiography performed for suspected coronary artery disease. The subjects were divided into two groups: presence of ACh-induced coronary spasm (group ED+, N = 30) and absence of ACh-induced coronary spasm (group ED−, N = 17). Insulin sensitivity (Si) was evaluated by frequently sampled intravenous glucose tolerance test (FSIGTT) with minimal model analysis and by HOMA-IR, insulin secretion by acute insulin response (AIR) (calculated from the first 8 min of FSIGTT) and by disposition index (DI) (Si × AIR). Lipids and PAI-1 levels were determined enzymatically, and LDL particle size by gradient gel electrophoresis. ResultsSi was significantly lower (4.22 ± 0.62 vs 6.98 ± 1.47 min−1/mU/l × 104; p < 0.05) while HOMA-IR was significantly higher in ED + group vs ED− group (2.8 ± 0.3 vs 1.7 ± 0.2; p < 0.05). Simultaneously, AIR and DI was significantly lower in ED + vs ED− groups (p < 0.05 and p < 0.01, respectively). Investigated groups did not differ in fasting lipid levels but ED+ group had significantly smaller LDL particles (p < 0.01) and higher PAI-1 levels (p < 0.05). Regression analysis shown that DI was a strong independent predictor of appearance of ED, together with PAI-1 and LDL particle size. ConclusionsBoth insulin resistance and impairment in insulin secretion response strongly correlate with coronary ED in subjects without diabetes.

Evidence for congruent impairment in micro and macrovascular function in type 1 diabetes.

Diabetes affects large and small vessels through mechanisms only partially known. In the present study, we evaluated the function of capillaries and large arteries in subjects with type 1 diabetes mellitus (T1DM) to study the effect of chronic hyperglycemia in the absence of other cardiovascular risk factors. Twenty-five subjects with T1DM and 12 healthy age-matched controls were enrolled. Nine patients had mild or moderate retinopathy. Contrast enhanced ultrasound was used to measure perfusion of the deep forearm flexor muscle of the non-dominant arm at rest (baseline) and after an ischemic stimulus (reactive hyperemia). Perfusion was expressed as Video Intensity (VI) in arbitrary unit (a.u.)/mm2. The time to reach peak VI after ischemia was also recorded. The function of large arteries was evaluated using flow-mediated vasodilation (FMD). VI was significantly lower in T1DM compared to control subjects both at baseline (0.22±0.16 vs 0.44±0.35 a.u./mm2, p<0.05), and after ischemia (0.33±0.24 vs 0.68±0.46 a.u./mm2, p<0.05). The time to reach peak VI after ischemia was markedly longer in T1DM (5.6±2.2 vs 4.0±1.7 seconds, p<0.02). These differences were more marked in T1DM subjects with retinopathy. FMD was lower in TIDM patients compared to controls (5.4±6.4 vs 10.7±4.5%, p<0.01). The present findings demonstrate that T1DM patients have defective peripheral skeletal muscle perfusion both at rest and after ischemia compared with control subjects. Low muscle perfusion associates with low FMD of the brachial artery. Furthermore, T1DM subjects with retinopathy have the least muscle perfusion and blunted response to hyperemia compared to T1DM without retinopathy.

Pulmonary artery wave propagation and reservoir function in conscious man: impact of pulmonary vascular disease, respiration and dynamic stress tests.

Wave travel plays an important role in cardiovascular physiology. However, many aspects of pulmonary arterial wave behaviour remain unclear. Wave intensity and reservoir-excess pressure analyses were applied in the pulmonary artery in subjects with and without pulmonary hypertension during spontaneous respiration and dynamic stress tests. Arterial wave energy decreased during expiration and Valsalva manoeuvre due to decreased ventricular preload. Wave energy also decreased during handgrip exercise due to increased heart rate. In pulmonary hypertension patients, the asymptotic pressure at which the microvascular flow ceases, the reservoir pressure related to arterial compliance and the excess pressure caused by waves increased. The reservoir and excess pressures decreased during Valsalva manoeuvre but remained unchanged during handgrip exercise. This study provides insights into the influence of pulmonary vascular disease, spontaneous respiration and dynamic stress tests on pulmonary artery wave propagation and reservoir function. Detailed haemodynamic analysis may provide novel insights into the pulmonary circulation. Therefore, wave intensity and reservoir-excess pressure analyses were applied in the pulmonary artery to characterize changes in wave propagation and reservoir function during spontaneous respiration and dynamic stress tests. Right heart catheterization was performed using a pressure and Doppler flow sensor tipped guidewire to obtain simultaneous pressure and flow velocity measurements in the pulmonary artery in control subjects and patients with pulmonary arterial hypertension (PAH) at rest. In controls, recordings were also obtained during Valsalva manoeuvre and handgrip exercise. The asymptotic pressure at which the flow through the microcirculation ceases, the reservoir pressure related to arterial compliance and the excess pressure caused by arterial waves increased in PAH patients compared to controls. The systolic and diastolic rate constants also increased, while the diastolic time constant decreased. The forward compression wave energy decreased by ∼8% in controls and ∼6% in PAH patients during expiration compared to inspiration, while the wave speed remained unchanged throughout the respiratory cycle. Wave energy decreased during Valsalva manoeuvre (by ∼45%) and handgrip exercise (by ∼27%) with unaffected wave speed. Moreover, the reservoir and excess pressures decreased during Valsalva manoeuvre but remained unaltered during handgrip exercise. In conclusion, reservoir-excess pressure analysis applied to the pulmonary artery revealed distinctive differences between controls and PAH patients. Variations in the ventricular preload and afterload influence pulmonary arterial wave propagation as demonstrated by changes in wave energy during spontaneous respiration and dynamic stress tests.

A two center 320 slice CT study for evaluating coronary arteries in subjects with chronic atrial fibrillation: A comparison of prospective and retrospective ECG-gating acquisition

PurposeTo compare diagnostic-accuracy of prospective and retrospective-ECG-gated acquisition in 320-slice-CT for detecting coronary-artery stenosis in subjects with chronic-atrial-fibrillation (CAF) in a two-center study. Materials and methods53 CAF subjects who underwent 320-slice-CT, and invasive-coronary-angiogram (ICA) within 6-months (43 male; 69±9years; CHADS2 score 2.2±1.3; CHA2DS2-VASc score 3.5±1.6) in the two institutes were analyzed. In Institute-1, prospective-ECG-gated acquisition was routinely performed (N=33). In Institute-2, retrospective-ECG-gated acquisition was routinely performed (N=20). CT and ICA data were transferred to the analysis center and were analyzed by cardiologists blinded to the clinical-data. ResultsPrevalence of >50 and >75% on ICA was 79 and 61% in Institute-1, and 30 and 15% in Institute-2, respectively. In a patient-by-patient analysis, Institute-2 had higher negative-predictive-value (NPV) and accuracy of >75% stenosis on CT in predicting >75% stenosis on ICA. In a vessel-by-vessel analysis, there were no significant-differences of sensitivity, specificity, positive-predictive-value (PPV) and NPV of >50% stenosis on CT in predicting >50% stenosis on ICA between both institutes. But sensitivity, specificity, and NPV of >75% stenosis on CT in predicting >75% stenosis on ICA were significantly higher in Institute-2 than in Institute-1. This is mainly because of more severe coronary-artery disease including calcification in Institute-1; there might also have been an influence of differences in scanning and reconstruction methods. Conclusions320-slice-CT shows relatively high diagnostic-accuracy for the detection of significant coronary-artery stenosis compared with ICA even in CAF subjects, in a two-center analysis. Retrospective-ECG-gated acquisition in 320-slice-CT shows significantly higher diagnostic-accuracy than prospective-ECG-gated acquisition for detection of >75% coronary-artery stenosis.

Low-density lipoprotein cholesterol and radiotherapy-induced carotid atherosclerosis in subjects with head and neck cancer.

BackgroundRadiotherapy (RT) is a risk factor for accelerated carotid artery atherosclerotic disease in subjects with head and neck cancer. However, the risk factors of RT-induced carotid artery remodeling are not established. This study aimed to investigate the effects of RT on carotid and popliteal arteries in subjects with head and neck cancer and to evaluate the relationship between baseline clinical and laboratory features and the progression of RT-induced atherosclerosis.FindingsEleven men (age = 57.9 ± 6.2years) with head and neck cancer who underwent cervical bilateral irradiation were prospectively examined by clinical and laboratory analysis and by carotid and popliteal ultrasound before and after treatment (mean interval between the end of RT and the post-RT assessment = 181 ± 47 days). No studied subject used hypocholesterolemic medications. Significant increases in carotid intima-media thickness (IMT) (0.95 ± 0.08 vs. 0.87 ± 0.05 mm; p < 0.0001) and carotid IMT/diameter ratio (0.138 ± 0.013 vs. 0.129 ± 0.014; p = 0.001) were observed after RT, while no changes in popliteal structural features were detected. In addition, baseline low-density lipoprotein cholesterol levels showed a direct correlation with RT-induced carotid IMT change (r = 0.66; p = 0.027), while no other studied variable exhibited a significant relationship with carotid IMT change.ConclusionsThese results indicate that RT-induced atherosclerosis is limited to the irradiated area and also suggest that it may be predicted by low-density lipoprotein cholesterol levels in subjects with head and neck cancer.

Abstract W P55: The Degree of Cerebral Blood Flow Augmentation by External Counterpulsation Correlates With Clinical Outcome After Acute Ischemic Stroke

Background and Purpose: External counterpulsation (ECP) is a novel noninvasive method used to augment cerebral blood flow which may benefit ischemic stroke patients. We aimed to explore the association between the degree of cerebral blood flow augmentation by ECP and clinical outcome after acute ischemic stroke. Methods: Acute ischemic stroke patients within 7 days of symptom onset were recruited into this study. On admission, bilateral middle cerebral arteries of subjects were monitored using transcranial Doppler (TCD). Flow velocity changes before, during, and after ECP were, respectively, recorded for 3 minutes. Cerebral augmentation index (CAI) was the increase in percentage of middle cerebral artery mean flow velocity during ECP compared with baseline. TCD data were analyzed based on ipsilateral or contralateral to the infarct side. Modified Rankin Scale (mRS) was evaluated 3 months, 6 months and 1 year after ischemic stroke onset. We stratified the patients into two groups (good outcome: mRS 0~2; poor outcome: mRS 3~6) at each measurement time point. Results: 72 patients were recruited (mean age, 63.8±10.7 years; 87.5% males). At month 6 and year 1 after stroke onset, univariate analysis showed that admission National Institutes of Health Stroke Scale (NIHSS) was significantly lower and ECP therapy duration was longer in good outcome group; while the ipsilateral CAI was significantly lower in good outcome group than those in poor outcome group (3.71±4.94 versus 7.73±7.66, P=0.044; 3.50±4.73 versus 8.58±7.72, P=0.015 respectively). Multivariate logistic regression showed that ipsilateral CAI and baseline NIHSS were independent predictors for a favourable outcome at these two measurement points. Conclusions: The degree of cerebral augmentation on ipsilateral to the infarct side by ECP is found to be an important predictor for long-term good outcome in acute ischemic stroke patients, in addition to the well-known prognostic factors such as NIHSS.