Duplex Scanning Of Carotid Arteries Research Articles

Atherosclerotic plaque in carotid arteries as a risk marker for cardiovascular events risk in middle aged population

Aim. To reveal the associations of carotid arteries atherosclerosis severity and cardiovascular events in mostly middle aged population. Material and methods . In the study, 1100 persons participated of the ATHEROGEN-Ivanovo trial (substudy of ESSE-RF), age 40-67 y. o. All participants underwent duplex scan of carotid arteries (Samsung Medison MySono U6) with assessment of the number of atherosclerotic plaques (AP), maximum stenosis and total stenosis with calculation of gender-specific quintiles. With the Cox regression model, risk was estimated for combinatory endpoint including all-cause death, myocardial infarction, novel onset of coronary heart disease, stroke, any area revascularization. Median follow-up 3,8 years. Results. The AP were found in 74,5% males and 58,0% females. In males atherosclerosis was more severe: maximum stenosis 27 (0-34)% in males vs 22 (0-58)% in females (р<0,001), total stenosis — 48 (0-90)% vs 22 (0-31)% (р<0,001) and plaques number — 2 (0-3) vs 1 (0-2) (р=0,000). There were 24 endpoints documented. 23 of 24 endpoints occurred in persons with at least any ultrasound marker value within quintile ≥3. Regression showed that if at least one ultrasound marker should have reached the quintile ≥3 (e. g., maximum stenosis ≥25% in men), than the risk of events from combinational endpoint would increase 8,5 times — 95% CI 1,12-64,76 (p=0,039). Also, coronary heart disease increases the risk 4,05 times — 95% CI 1,46-11,21 (p=0,007), acute stroke 3,49 times — 95% CI 1,19-10,23 (p=0,023). The number of males with AP <25% was 15%. Conclusion. The presence of AP in carotid arteries does 8,5 times increase the risk of cardiovascular events, and for 15% of males in population with AP in carotid arteries that narrow the lumen <25%, it is needed to clarify the risk.

Association between Carotid Wall Shear Rate and Arterial Stiffness in Patients with Hypertension and Atherosclerosis of Peripheral Arteries.

Aim To evaluate carotid wall shear rate (WSR) in association with local and regional vascular stiffness in patients with hypertension (HTN) and atherosclerosis of peripheral arteries and to study the pattern of change of WSR in patients with HTN with increasing severity of peripheral artery atherosclerosis. Materials and Methods Study involved 133 patients with HTN, 65 men and 48 women, aged in average 57.9±10.8 years. All patients were divided into four groups in accordance with ultrasound morphologic classification of vessel wall. Duplex scanning of carotid and lower limb arteries was performed. Carotid-femoral (cfPWV) and carotid-radial (crPWV) pulse wave velocity (PWV) were measured. Local carotid stiffness was evaluated by carotid ultrasound. Results WSR of patients with plaques without and with hemodynamic disturbance was 416±128 s−1 and 405±117 s−1, respectively, which was significantly less than the WSR in patients with intact peripheral arteries – 546±112 s−1. Decreased carotid WSR was associated with increased crPVW, cfPWV, Peterson's elastic modulus, decreased distensibility, and distensibility coefficient. Conclusion In patients with HTN and atherosclerotic lesions of peripheral arteries, it is registered that the carotid WSR decreased with increasing severity of atherosclerosis. Decreased carotid WSR is associated with increased local carotid stiffness, regional vascular stiffness of muscular, and elastic vessels.

RELATION OF COVERT VISCERAL ADIPOSITY AND SUBCLINICAL ATHEROSCLEROSIS PRESENTATION IN TYPE 2 DIABETES MALE PATIENTS

Aim. To evaluate the prevalence of covert visceral adiposity (CVA) in males with type 2 diabetes (DM2) and to assess its relation with subclinical atherosclerosis and food-related behavior. Material and methods. To the study, 72 middle age males included (54,1±0,7 y.o.). Mean duration of DM25,1±1,1 years. In 28 patients DM2 had been diagnosed first time in the study. Those with body mass index (BMI) >30 kg/m 2 and waist circumference >102 cm were excluded. All patients underwent standard clinical investigations and additionally, leptin levels measurement in blood serum, with bioelectrical impedance measurement of adipous tissue amount, duplex scan of carotid and femoral arteries; the EAT-26 questionnaire was applied. Results. In the group of participants, CVA prevalence was 31%. In this group of patients there were significantly higher BMI, waist circumference low density lipoproteides levels and leptin. At atherosclerosis assessment in carotid and femoral arteries, CVA associated with more significant and multifocal lesion. In regression analysis, the sum of plaques number correlated with the age, BMI, systolic blood pressure, low density lipoproteides levels. Conclusion. CVA might have significance in the increase of cardiovascular risk in middle aged males with normal BMI and with no obesity.

Primarna mitralna regurgitacija - ehokardiografska procena

In developed countries aortic stenosis (AS) is the most common acquired valvular heart disease in elder population. A 75 years old patient has been admitted to our institution due to symptomatic severe AS. Preoperative transthoracic echocardiography confirmed severe, calcified AS with a gradients of 95/49 mmHg, AVA 0.5 cm2 and moderate aortic regurgitation. Left ventricular ejection fraction was preserved. Preoperative coronary angiography and Duplex scan of carotid arteries excluded significant stenosis. Surgical risk assessed with EuroScore II was increased 5.9%. In the presence of restricted mobility, significant frailty and other circumstances that may affect the rehabilitation, TAVI as an intervention mode would have been more suitable. Since this was not available, our patient underwent successful surgical aortic valve replacement. The first postoperative echocardiogram revealed normal function of the bileaflet mechanical valve 29/14mmHg with mild transvalvular regurgitation. Without any prior psychiatric disorders, patient after the operation experienced complete lack of energy and willingness to cooperate or to perform any daily activity so she remained immobile. The antidepressives were ineffective. The rehabilitation process was complicated with decubitus and Acinetobacter and Proteus mirrabilis in wound culture. After antibiotic treatment we had the appearance of diarrhea, severe hypoalbuminaemia and the global edemas progressed to anasarca This three months long and costly struggle of all cardiovascular practitioners and family unfortunately was unsuccessful. This case is one more confirmation that we need objective frailty assessment, as one of major risk factors in elderly with AS, before making definitive decision of interventional, either surgical or transcatheter treatment.

POSSIBILITY OF USING THE AUGMENTATION INDEX AS A PREDICTOR OF ATHEROSCLEROTIC DISEASE OF CAROTID ARTERIES IN PATIENTS WITH ESSENTIAL HYPERTENSION

Objective. Study of the possibility of predicting atherosclerosis of carotid arteries on the basis of the augmentation index in patients with essential hypertension.Material and methods. A total of 155 patients with EH in the age range 30-70 years. A physical examination, identification of a number of biochemical parameters: glucose and creatinine and blood lipid (LDL, HDL and triglycerides), duplex scanning of carotid arteries, the definition of arterial stiffness by pulse wave contour analysis.Results. The augmentation index, along with age, was an independent risk factor for atherosclerosis carotid arteries in patients with EH, as well as the severity of its symptoms.

INNOVATION TECHNOLOGY OF SUBCLINICAL ATHEROSCLEROSIS VERIFICATION

This review article presents duplex scanning of carotid arteries as a key and the most informative modern noninvasive innovation technology for diagnostics of subclinical atherosclerosis. It was noted that during primary prophylaxis the values of intima-media complex of these arteries allow performing risk stratification of patients and selection of high-risk patients for aggressive lipid-lowering pharmacotherapy.

THE RELATIONSHIP OF KIDNEY FUNCTION WITH ARTERIAL WALL CONDITION IN INDIVIDUALS WITHOUT CHRONIC KIDNEY DISEASE AND CARDIOVASCULAR DISEASES

Background: Chronic kidney disease (CKD) is a known risk factor for cardiovascular disease (CVD). However, there is a small information about increased risk of CVD already with a slight decrease in kidney function. Substrate for CVD development is subclinical changes in the arterial wall, which can be accelerated by known risk factorsHypothesis: We have assumed that even an initial impairment of kidney function were capable of adversely affecting on the arterial wall.Objective: To examine the association of kidney function with the condition of the arterial wall in persons without CKD and CVD in different age groups.Materials and methods: The study group included 253 subjects free of known CVD and CKD. The average age of the subjects was 51.5 ± 13.3 g. There were 172 women and 81 men. The group of conditionally “older” (women> 55 years, men> 45 years) was 117 people, conditionally “younger” (women ≤ 55 years, men ≤ 45 years) - 136. 55 subjects had arterial hypertension 1-2 st. All subjects had a glomerular filtration rate (GFR) ≥60 ml / min / 1.73 m2, albuminuria <30 mg /24h. When assessing the condition of the arterial wall, the pulse wave velocity (PWV)> 10 m / s had 93 people, the complex intima-media thickness (CIMT)> 0.9 mm had 42 people, the presence of atherosclerotic plaques (AP) had 106 people, and a decrease in endothelium-dependent vasodilation (EDVD) <10% in 86 people. An elevated urea level> 8.3 mmol / l in the blood was detected in 10 people. Determination of creatinine, urea in the blood serum was carried out by routine methods. Measurement of PWV with the help of applanation tonometry. Measurement of CIMT and determination of AP was carried out by means of duplex scanning of carotid arteries. Measurement of EDVD - using a test with reactive hyperemia.Results: Statistical analysis of the results of this study was carried out using the SAS application statistical software package (StatisticalAnalysisSystem, SAS InstituteInc., USA). In the course of multivariate linear regression analysis, a statistically significant independent association of the urea level with CIMT (β = 0.023, p = 0.023) was detected in the “older” group taking into account the correction for sex, systolic blood pressure level, smoking, body mass index, fasting glucose level and albuminuria. Independent relationships of levels of GFR, creatinine and albuminuria with parameters of the vascular wall were not revealed.Conclusions: The level of urea had a direct independent relationship with CIMT in the older age group, which is more likely due to the ability of urea to enhance oxidative stress. Interrelations of the level of GFR, albuminuria, creatinine with the condition of the arterial wall were not obtained in the study group

Markers of arterial health could serve as accurate non-invasive predictors of human biological and chronological age.

The decline in functional capacity is unavoidable consequence of the process of aging. While many anti-aging interventions have been proposed, clinical investigations into anti-aging medicine are limited by lack of reliable techniques for evaluating the rate of ageing. Here we present simple, accurate and cost-efficient techniques for estimation of human biological age, Male and Female Arterial Indices. We started with developing a model which accurately predicts chronological age. Using machine learning, we arrived on a set of four predictors, all of which reflect the functioning of the cardiovascular system. In Arterial Indices models, results of carotid artery duplex scan that show the thickness of the intima media complex and quantitatively describe the degree of stenosis are combined with pulse wave velocity and augmentation index measurements performed by applanation tonometry. In our cohort, the age of men was determined with MAE = 6.91 years (adjusted R-squared = 0.55), and the age of women with MAE = 5.87 years (adjusted R2 = 0.69). The Epsilon-accuracies of age-predicting models were at 86.5% and 80% for women and men, respectively. Substantially higher differences between the predicted age and the calendar age were noted for patients with Type 2 Diabetes Mellitus (T2D) as compared to non-T2D controls, indicating that the model could serve as a good approximation for an elusive biological age. Notably, in females with chronological and biological ages mismatching by 5 or more years, significant increases in in Framingham CVD scores and lower levels of IGF-1 were observed.Proposed Male and Female Arterial Indices derive biological age from the results of functional tests which do not require specialized laboratory equipment and, therefore, could be performed in hospitals and community health clinics.

Признаки нестабильности атеросклеротической бляшки в сонных артериях у больных с острым коронарным синдромом по данным ультразвукового дуплексного сканирования

to study carotid plaques structure in patients with acute coronary syndrome by ultrasound duplex scanning. We included in this study143 patients with acute coronary syndrome (ACS) aged 32-83 years and 28 patients with documented coronary heart disease (CHD) aged 46-83 years. Duplex scanning of carotid arteries was carried out with Philips iU22 ultrasound system and L9-3 linear array transducer. Atherosclerotic plaques in CCA, CCA bifurcation, and ICA from right and left side were investigated. Off-line analysis of B-mode images and plaque gray scale median (GSM) was performed with computer semiautomated workstation MultiVox. 378 plaques of ACS and 59 plaques of CHD patients were studied. We assessed traditional (heterogenous structure, hypoechogenic component, irregular plaque surface) as well as additional (positive remodeling, "layered" structure of plaque, local calcification) criteria of plaque instability. In ACS compared with CHD group there were more plaques with hypoechogenic component (43.4 and 28.8%, p=0.0459), heterogenous structure (77.8 and 64.4%, p=0.0327), irregular surface including irregularities more than 2.0 mm (22.5 and 6.8%, p=0.0048, respectively). There was significant difference in "layered" structure (55.7 and 35.8%, p=0.0011) and insignificant difference in positive remodeling (16.3 and 7.5%, p=0.06, respectively). There were no differences of GSM value (53.1 and 57.2, p=0.24) and local calcification (23.2 and 24.5%, p=0.23, respectively). In our study ultrasound duplex scanning revealed that signs of plaque instability in carotid arteries in patients with ACS were more frequent than in patients with stable CHD. The newly introduced parameter "layered" structure of atherosclerotic plaque was found to be most significant.

THE ROLE OF GLYCEMIA VARIABILITY IN THE PROCESSES OF CELLULAR AND VASCULAR AGEING IN PATIENTS WITH TYPE 2 DIABETES

Aim. To investigate on the presence and relation characteristics of glycemia variability (GV) and vascular wall parameters, chronic inflammation, oxidation status, telomere biology in type 2 diabetes patients (DM2). Material and methods . Into the single-movement study, 50 DM2 patients included, with no signs of cardiovascular diseases. All participants were evaluated on the carbohydrate metabolism, glycemia variablity, underwent duplex scan of carotid arteries with intima-media complex (IMC) measurement, and assessment for atherosclerotic plaques; underwent carotid-femoral pulse wave velocity measurement, endothelium dependent vasodialtion, telomere length measurement and telomerase activity (TA). Results. The parameters of vessel wall, together with the classical CVD risk factors, independently related with the various carbohydrate metabolism parameters: glycated hemoglobin, fasting glucose plasma, HOMA-IR index, C-peptide, immune reactive insulin. The GV of moderate amplitude of glycemia (MAGE) was related to IMC increase in DM2 patients. There was significant relation of telomere length (TL) not just with a chronic hyperglycemia, but with glucose level fluctuations as well, e.g. with GV standard deviation (SD), MAGE, CONGA (continuous overall net glycemic action), and such relation is higher in the analysis of “the longest” telomeres. Relation of TL and GV is not dependent on the cardiovascular risk factors, chronic inflammation and TA, but depends on fasting plasma glucose. There was no significant relation of TA with GV in DM2. There was direct correlation of GV CONGA and oxidative stress marker malonic dialdehyde, and independent negative correlation of GV (MAGE, SD, CONGA) with TL. Conclusion. GV is related with subclinical atherosclerosis (IMC) and shorter TL in DM2 patients, which is mediated by activated oxidation stress under glycemia fluctuations.

Circadian CLOCK Gene Variants, Parameters of Arterial Stiffness and Blood Pressure Levels in Subjects Without Arterial Hypertension

CLOCK gene polymorphic variants, parameters of arterial stiffness and blood pressure (BP) variability were studied in 115 normotensive Russian patients without cardiovascular diseases (62 men, 53 women; mean age 36.4+/-1.01 years). Examination included ECG, 24h BP monitoring, duplex scan of carotid arteries, registration of vascular stiffness parameters, and genotyping of the following polymorphic markers of CLOCK: 3111T>C (3-untranslated region), 862T>C (exon 9) and 257T>G (promoter region) by PCR-RFLP method. Pulse wave velocity was not significantly different among carriers of various 257T>G, 862T>C, 3111T>C genotypes. Augmentation index (Aix night, Aix max) values were lower in individuals with genotypes allegedly associated with essential hypertension and ischemic heart disease (257GG, 862CC, 3111CC). Arterial stiffness index (ASI) was significantly higher in men having CC genotype of 862T>C. Polymorphic variants 257T>G and 862T>C SNPs of CLOCK gene were found to be associated with parameters reflecting BP variability (morning rise of diastolic BP and rate of BP rise). These results provide a basis for suggestion that the CLOCK gene polymorphism is one of factors determining elastic properties of vascular wall. The suggestion is supported by discussion of possible molecular mechanisms of circadian genes impact on elasticity and rigidity of vessel.

Ultrasonic indicators of the heart and carotid arteries in arterial hypertension development in patients with chronic obstructive pulmonary disease

Aim. To specify the sequence of changes in the functional parameters of arterial hypertension in patients with chronic obstructive pulmonary disease and asthma according to the results of echocardiography, carotid arteries duplex scan and ambulatory blood pressure monitoring.Methods. Ambulatory blood pressure monitoring, tissue Doppler echocardiography and carotid artery duplex scan were performed in 160 patients with chronic obstructive pulmonary disease, arterial hypertension, asthma, and 33 apparently healthy volunteers of both sexes aged 39-70 years.Results. In patients with chronic obstructive pulmonary disease, an increase in hypertensive indices of time and area with the development of non-dipper or inverse-dipper 24-hour blood pressure profile disturbances is registered only at night hours. In chronic obstructive pulmonary disease, unlike asthma, carotid arteries thickening, combined hypertrophy and diastolic dysfunction of both ventricles develop. The prevalence of the thickening of «intima-media» complex and atherosclerotic plaques among patients with comorbid pathology (chronic obstructive pulmonary disease + arterial hypertension) occurs significantly more frequently than in the groups with hypertension or chronic obstructive pulmonary disease, confirming the synergistic effect of the considered nosologies on the atherosclerotic process.Conclusion. In patients with chronic obstructive pulmonary disease changes of the ultrasonic and functional indicators of the cardiovascular system, typical for arterial hypertension are registered starting with stage I and amplified with increase in the disease severity, leading to the need of diagnostic and therapeutic management correction.

Flow Patterns in the Carotid Arteries of Patients with Left Ventricular Assist Devices

The aim of this study is to evaluate and define the expected flow pattern changes of carotid artery duplex ultrasound after left ventricular assist device (LVAD) placement. Retrospective review of Henry Ford Hospital database of patients who had undergone LVAD placement between March 2008 and July 2012 was performed. All patients who had carotid artery duplex scanning before and after LVAD placement within 2 years of each other and showed <50% stenosis were included in this study. Type of waveform, carotid peak systolic velocity, and end-diastolic velocities were analyzed, and the values were compared before and after LVAD placement. A total of 13 patients with LVAD had at least 2 carotid duplex studies before and after LVAD placement within 2 years of each other. Of those, 92% (n=12) were men, and 61% (n=8) were Caucasian. Mean age was 61years old. The HeartWare ventricular assist device was implanted in 4 patients and the HeartMate II left ventricular assist device was implanted in 9 patients. Post-LVAD Doppler imaging demonstrated parvus tardus waveform. Analysis of flow velocities revealed that peak systolic velocity was diminished after LVAD placement in both the internal and common carotid arteries (P=0.006 and P<0.0001, respectively). End-diastolic velocity, however, increased post-LVAD (P<0.0001). Interestingly, mean flow velocities in both the common and internal carotid arteries remained stable after LVAD placement. This study reveals changes in waveform morphology and peak systolic and diastolic velocities in the common and internal carotid arteries on carotid duplex after LVAD placement. Additionally, it shows that despite changes in post-LVAD pulse pressure in the carotid arteries, the mean flow velocity remained unchanged.

Evaluation of arterial stiffness and possibility to predict carotid atherosclerosis in patients with essential hypertension based on an outpatient facility

To estimate the possibility of predicting the presence and severity of coronary atherosclerosis from arterial stiffness characteristics and augmentation index (AIx) in patients with essential hypertension (EH) obtained under outpatient conditions. The general clinical examination of 15 patients aged 30-70 yr with EH was supplemented by measuring blood glucose and creatinine levels, the lipid status (LWLP, HDLP, TG), duplex scanning of carotid arteries, and evaluation of arterial stiffness by pulsed wave contour analysis. AIx and age were independent risk factors of coronary atherosclerosis in patients with EH and severity of its manifestations. AIx values over 25% were with high specificity (over 85%) associated with atherosclerotic lesions.

Arterial stiffness and carotid arteries: correlation with daily blood pressure profile in essential hypertension

Objective. To study the relationship between arterial stiffness, augmentation index and the structure of the carotid arteries with daily blood pressure (BP) profile in patients with essential hypertension (HTN). Design and methods. Altogether 155 patients with HTN aged 30–70 years were examined. A physical examination, glucose, creatinin level and lipid profile (low- and high-density lipoproteins, and triglycerides) (biochemical analyzer Sinсhron SX‑4 DELTA, Beckman, USA), duplex scanning of carotid arteries (Sequoia‑512, Acuson, USA), and arterial stiffness assessment by pulse wave contour analysis (Angioscan‑01, Angioscan, Russia) were performed. Results . Augmentation index was associated with the nocturnal BP reduction in hypertensive males, but not females. In males, augmentation index was 6,8 ± 11,5 %, 12,7 ± 10,9 % and 14,5 ± 7,7 % for the dippers, nondippers and night-peakers, respectively (p 0,05). The lowest values of augmentation index (15,6 ± 14,8 % versus 21,6 ± 13,4 % for non-dippers, p < 0,02) were found in patients with normal circadian BP profile. In addition, more severe carotid atherosclerotic lesions were found in non-dippers (23,2 ± 18,8 %) compared to dippers (13,7 ± 14,5 %, p < 0,01). Conclusions . Patients with HTN and abnormal circadian BP profile show higher augmentation index and more severe atherosclerotic lesions in carotid arteries.

SPECIFICS OF SUBFRACTIONAL SPECTRUM OF APOLIPOPROTEIN B RELATED LIPOPROTEINES IN CAROTID OR CORONARY ATHEROSCLEROSIS PATIENTS

Apolipoprotein (apo)B-containing lipoproteines of low density are heterogeneous by their nature, and differ by their lipid and protein contents, charge, particle size and functional activity. High blood level of small dense particles of low-density lipoproteines (LDL) is related to higher risk of coronary heart disease 3-5 times irrelevant to cholesterol level they contain. Aim. To evaluate and describe the specifics of subfraction spectrum of apo-Bcontaining lipoproteines in patients with lesions in carotid and/or coronary circulation. Material and methods . Totally, 310 patients included (62,5±9,3 year old), underwent duplex scanning of carotid arteries and coronary arteriography (M/F 203/107). Sub fraction spectrum of lipoproteines was assessed with electrophoresis on 3% polyacrylamide gel (Lipoprint system, Quantimetrix Lipoprint LDL System, USA). The level of severity of coronary atherosclerosis lesion was assessed with the Gensini Score (GS). Results. Evaluation of subfractional spread of lipoproteines according to the results of duplex scan showed that in the group of patients with intima-media thickness (IMT) >0,9 mm part of intermediate density lipoproteides (IDL) C is higher (11,0±3,6 vs 9,1±2,8%, р=0,002), and the part of low density lipoproteides (LDL) 1 is lower (16,7±4,1 vs 18,1±3,7%, р=0,047) comparing to the patients with normal IMT. Assessment of the spread of LDL subfractions according to the number of atherosclerotic plaques (AP) and/or lesion of carotid arteries showed that among the patients with ≥3 AP and/or involved carotid arteries for >45%, the part of LDL C decreased (9,9±3,2 vs 11,4±3,7%, р=0,003), but there is increase of intermediate density lipoproteides A (IDL A) (9,3±2,6 vs 8,4±2,5%, р=0,013) and large particles of IDL 1 (17,8±4,0 vs 16,2±4,0%, р=0,005) and comparing to those having 0, n=242). Coronary patients were selected to subgroups with minimal or mild (GS 0 part of very low density lipoproteines (VLDL) (21,0±4,1 vs 19,3±4,1%, р=0,004) and IDL (11,4±3,4 vs 10,5±3,3%, р=0,047) were higher, and part of IDL A (8,4±2,5 vs 9,4±2,6%, р=0,006) and large particles IDL 1 (16,8±4,2 vs 18,2±4,2%, р=0,013) lower than group GS =0. In the group GS ≥35 the part of IDL C was significantly higher comparing to those from GS <35 (11,8±3,7 vs 10,8±3,0%, р=0,008). According to multifactor regression, the risk of coronary atherosclerosis is related to higher part of VLDL (OR =1,1, 95% CI 1,0-1,2, р=0,039), small dense particles of LDL 3-6 (OR =1,3, 95% CI 1,0-1,6, р=0,049), and higher part of LDL 2 is associated with the risk of coronary atherosclerosis by 10% GS score (OR =0,9, 95% CI 0,8-1,0, р=0,014). Conclusion. Combination of carotid and coronary arteries is related to the changes of subfractional lipoproteides spectrum (lower part of IDL A and large particles of LDL 1 and higher part of VLDL), characteristic for isolated lesion of coronary arteries regardless its prominence, which probably might be regarded as additional markers of atherogenity of lipid profile in earlier stage carotid and any coronary atherosclerosis.

RELATIONSHIP OF LIPOPROTEINE-ASSOCIATED PHOSPHOLIPASE A2 WITH CORONARY AND CAROTID ATHEROSCLEROSIS IN KIRGIZ ETHNIC GROUP

Aim. To study the association of the level (mass) of lipoproteine-associated phospholipase A2 with coronary and carotid atherosclerosis in the patients with essential arterial hypertension in Kirgiz ethnic group. Material and methods. Totally 52 patients studied with arterial hypertension (AH); mean age — 54,9±6,7, of those 26 men and 26 women. CHD, confirmed by exercise tests or coronary arteriography, had 19 patients, atherosclerosis of carotid arteries – 28. All patients underwent height measurement, weight and waist circumference, BP and HR measurement, also measurement of some biochemical values: fibrinogene level, sugar, creatinine of the blood and lipid profile (levels of total cholesterol, LDL, HDL and triglycerides). Measurement of LP-PLA2 was done using “PLAC” test by “DiaDexus” (USA) with immuneturbodimetry method “ELISA”. Duplex scanning of carotid arteries was done with Sequoia-512 by “Accuson” (USA). Results. There was direct correlation of LP-PLA2 correlation with the age (r=0,27; p&lt;0,05), HDL concentration (r=0,30; p&lt;0,05) and LDL (r=0,28; p&lt;0,05) and negative association with triglycerides (r=-0,28; p&lt;0,05). Significant differences by gender in LP-PLA2 were not found (p&gt;0,05). Patients with CHD had higher level oftotal cholesterol (5,64±0,97 mmol/l vs. 5,23±1,33 mmol/l, р=0,057), LDL (3,63±0,89 mmol/l vs. 3,16±0,98 mmol/l, p&lt;0,01), and the mass of LP-PLA2 (296±70 ng/ml vs. 237±76 ng/ml, p&lt;0,005) comparing to the patients with EH and CHD. In multifactorial regression analysis it was shown that only concentration of LP-PLA2 independently associated with CHD among native inhabitants of the Republic (β=0,66; p&lt;0,001). We did not found association of LP-PLA2 with presence and prominence of carotid atherosclerosis and carotid intima-media thickness (p&gt;0,05). Conclusion. In Kirgiz ethnic group there is association of LP-PLA2 with CHD, but not with carotid atherosclerosis.

PP.24.04

Objective: To study the relationship between changes in the content of estradiol and follicle-stimulating hormone (FSH), the restructuring process of the cardiovascular system in women with hypertension. Design and method: 64 women in the late reproductive age with hypertension not taking antihypertensive therapy. All determined by the level of estradiol and FSH. Depending on the degree of estradiol and FSH patients with hypertension were divided into groups. In group 1 (gr.) Included 34 hypertensive age 39,11 ± 4,3 years with the menstrual cycle and estrogen deficiency. In the 2nd c. - 30 with hypertension, age 39,14 ± 2,23 years, with the menstrual cycle and normal levels of estradiol and FSH. A comparison group of 20 healthy women, 38,45 ± 4,12 years with normal levels of estradiol and FSH without hypertension. Performed duplex scanning of the common carotid artery (CCA). Results: Observed expansion of the mean diameter of CCA in patients with hypertension and estrogen deficiency. Blood flow velocity in the CCA significantly lower in comparison with the control in patients with hypertension and gipoestrogeniya. Resistance index was higher in patients with hypertension 1 gr. in comparison with the control and patient 2 gr. The elastic properties of the wall of the carotid artery decreased: from 41,3 ± 10,8 x ∼ 3 / kPa in patients with hypertension and normal levels of estradiol to 36,4 ± 10,8 x Yu- 3 / kPa p = 0.034 for patients with hypertension with decreased levels of estradiol. The index of stiffness was higher in comparison with the control as in patients with hypertension estrogenodefitsitom, and without it. Conclusions: Duplex scanning of carotid arteries in women with hypertension shows expansion of the lumen of the CCA, reducing blood flow velocity, expressed against the backdrop of estrogen deficiency, indicating that the more significant changes in the vascular wall in hypertensive patients compared with having normal levels of estradiol.

Is temporal artery biopsy (TAB) always necessary in suspected giant cell arteritis (GCA)?

s / International Journal of Surgery 12 (2014) S13eS117 S114 Department of Surgery, University of Queensland, Queensland, Australia; Imperial College NHS Healthcare Trust, London, UK; Department of Vascular Surgery, Norfolk and Norwich, Norfolk and Norwich, UK. Introduction: Aortic aneurysms represent a significant burden of disease worldwide. Whilst some risk factors for rupture are well established, such as hypertension, smoking and female gender, the impact of season and meteorological variables is less clear. We systematically reviewed the literature in order to conclusively determine whether these variables are associated with aortic aneurysm rupture. Methods: Reviewmethodswereaccording to thePreferredReporting Items for Systematic Reviews and Meta-Analysis guidelines. Data was extracted from all identified studies with regard to study design, geographical location, aortic lesion, sample size, and meteorological variables including season, atmospheric pressure, temperature and daylight hours. Results: 27 studies representing 46,580 patients were investigated. Whilst there is no consensus within the literature, several large studies suggest a statistically significant seasonal variation in the incidence of aortic aneurysm rupture, with winter months broadly conferring a greater degree of risk. There is also some evidence for an association with atmospheric pressure. Associations with temperature and daylight hours, however, remain more controversial. Conclusions: Meteorological and seasonal variables may affect the haemodynamic stability of aortic aneurysms. This may have implications on the epidemiology of aneurysm rupture, and thus influence the provision of vascular services and timing of surgical intervention. 0803: IS TEMPORAL ARTERY BIOPSY (TAB) ALWAYS NECESSARY IN SUSPECTED GIANT CELL ARTERITIS (GCA)? Eva Andreotti, Nicholas Farkas *, Emma Rose McGlone, Aziz Anjum. Epsom and St Helier University Hospitals NHS Trust, Surrey, UK. Introduction: In the diagnosis of GCA, an American College of Rheumatology (ACR) criteria score of three or more has very high sensitivity and specificity. Current guidelines recommend early TAB of sufficient length in all cases of suspected GCA, however recent studies suggest that TAB does not change management in the majority of cases. This retrospective audit aimed to investigate the safety of restricting TAB to only those with indeterminate pre-biopsy ACR score. Methods: We identified 45 consecutive patients undergoing TAB from April 2012 onwards. Notes were analysed for indications for, timing, length and results of TAB, and subsequent patient management. Results: Of those started immediately on steroids, 8/40 (20%) underwent TAB within one week. 21/45 specimens (48%) were one centimetre or longer. Seven patients (16%) had their management changed following biopsy result; of these, 2/17 (11.7%) had pre-biopsy ACR score of 2, 4/19 (21%) of 3, and 1/9 (11%) of 4. Conclusions: In our trust, TAB changes management in patients with prebiopsy ACR score of 2, 3 or 4. Guidelines for specimen length and timing are poorly adhered to, which may influence interpretation of results. At present, TAB cannot be restricted to those with indeterminate pre-biopsy ACR score. 0830: LENGTH OF THE EXTRACRANIAL INTERNAL CAROTID ARTERY AND DEGREE OF STENOSIS: ARE THEY RELATED? Emma Wilton , Naomi Warner *, Patrick Lintott . Oxford University Hospitals NHS Trust, Oxford, UK; Buckinghamshire Healthcare NHS Trust, High Wycombe, Buckinghamshire, UK. Introduction: To determine if the degree of stenosis within the internal carotid artery (ICA) is related to the length of the extracranial ICA. Methods: Retrospective analysis of patients that underwent carotid endarterectomy between September 2009 and August 2013, in one institution, was carried out. Magnetic resonance angiography time-of-flight images were reviewed and the distance between the carotid bifurcation and the base of the skull was recorded bilaterally. The degree of internal carotid artery stenosis measured on preoperative carotid artery duplex scanning, according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria, was also recorded. The results were analysed using Pearson's product-moment correlation. Results: A total of 369 patients underwent carotid endarterectomy within the study period. 175 patients were excluded due to insufficient imaging. 194 patients were included (mean age ± SEM 1⁄4 73±1 year; 125 male, 69 female) and their images andcarotidduplex scan resultswere reviewed. 361 pairs of data were analysed using Pearson's correlation (r1⁄40.06, p1⁄40.23). Conclusions: We showed no significant correlation between the length of the extracranial ICA and the degree of stenosis that may develop within it. 0832: MORTALITY FOLLOWING ACUTE NATIVE ARTERY EMBOLECOTMY FOR ARTERIAL EMBOLISM UNRELATED TO PERIPHERAL ARTERIAL DISEASE (PAD): 18 YEAR REVIEW Joel Lambert *, Sobath Premaratne, Anthony Jaipersad, Andy Houghton, Anthony Fox, Kate Merriman. Shrewsbury & Telford NHS Trust, Shrewsbury,

Telomere length and vascular wall in patients with Type 2 Diabetes Mellitus

Aim. To study the relationship between changes in the artery structure and function and peripheral lymphocyte telomere length in patients with type 2 diabetes mellitus (DM2). Materials and methods. A total of 50 patients with T2DM and without clinical manifestations of cardiovascular disease (CVD) were included in the study; the control group consisted of 49 people. The following tests were conducted for all study participants: carbohydrate metabolism evaluation, carotid artery duplex scan to measure intima?media complex thickness (IMT) and to determine the presence of atherosclerotic plaques, carotid?femoral pulse wave velocity (PWV) measurement and lymphocyte telomere length measurement. Results. The vascular changes were more pronounced in patients with T2DM than in controls. The telomeres were shorter in patients with T2DM than in those without diabetes (9.53?0.1 vs 9.86?0.1, p=0.033). The participants were divided according to the telomere length. Among patients with T2DM, there were significant differences in the condition of the vascular wall [PWV: 10.58?0.1 m/s in patients with ?long? telomeres and 15.08?1.3 m/s in patients with ?short? telomeres; IMT: 0.80?0.09 mm in patients with ?long? telomeres and 0.87?0.05 mm in patients with ?short? telomeres (p=0.024)]. There were no significant differences in the arterial structure between the patient and control groups with ?long? telomeres [PWV: 10.58?0.1 m/s vs 10.5?0.5 m/s (p=0.913); IMT: 0.080?0.09 mm vs 0.73?0.03 mm (p=0.12). However, there were significant differences in the vascular wall condition between the patient and control groups with ?short? telomeres [PWV: 15.08?1.3 m/s vs, 10.7?0.5 m/s (p=0.015); IMT: 0.87?0.1 vs 0.78?0.1 (p=0.03)]. Conclusions. The signs of vascular ageing were more pronounced in patients with T2DM than in controls. However, despite diabetes, vascular changes were minimal in patients with ?long? lymphocyte telomeres, comparable with the state of the vascular walls in healthy individuals. Thus, enhanced lymphocyte telomere length may have a protective effect on the vascular wall and may prevent damage from carbohydrate metabolism disorders.