Carotid Artery Intima-media Thickness Measurements Research Articles

Relationship of Dickkopf-1 With Atherosclerosis and Arterial Stiffness in Renal Transplant Recipients

IntroductionDickkopf wingless (Wnt) signaling pathway inhibitor-1 (DKK-1) is a potent antagonist of the WNT canonical signaling pathway. DKK-1 is a substance that exerts anabolic effects on bone and is also involved in vascular cell regulation. The study aimed to determine the relationship of DKK-1 with atherosclerosis as determined by carotid artery intima-media thickness (CA-IMT) and arterial stiffness (AS) as determined by brachial-ankle pulse wave velocity (baPWV) in renal transplant recipients (RTRs). MethodsA total of 62 (62%) male and 38 (438%) female RTRs with a mean age of 44.22 ± 10.88 years were included in the study. RTRs were compared with 65 healthy individuals. CA-IMT measurement with ultrasonography was used as a marker of atherosclerosis. The presence of AS was detected with the baPWV device. ResultsCreatinine, CA-IMT, and baPWV were higher in the RTRs compared to the healthy subjects. No difference was determined between the two groups regarding log10 DKK-1. No difference was noted in the levels of CA-IMT and baPWV in patients with log10 DKK-1 > 3.83 pg/mL compared to patients with ≤3.83 pg/mL. Correlation and multivariate analyses showed no correlation between log10 DKK-1 and CA-IMT and baPWV. DiscussionIn RTRs, an increased development of atherosclerosis and AS was observed compared to healthy individuals. There was no difference in DKK-1 between the groups based on improved renal function. DKK-1 was not correlated with atherosclerosis and AS.

Left versus right carotid artery IMT: differential impact of age, gender, and cardiovascular risk factors.

Carotid artery intima-media thickness (IMT), an important clinical marker of atherosclerosis, is used widely in screening for cardiovascular risk and prognosis. Measurements of carotid artery IMT are made on both the left and right sides of the body, however as per the Mannheim consensus, an average of these measurements is usually reported. Nevertheless, there is considerable debate whether there are side differences in the carotid artery IMT in terms of both measurements and determinants. In a large sample of Caucasian patients (n = 1888) referred for cardiovascular risk assessment, we compared the left and the right common carotid artery IMT measurements, and assessed whether age, gender and cardiovascular risk factors have differential effects. We found that the left common carotid artery IMT (0.7141 ± 0.1733mm) is larger than the right (0.6861 ± 0.1594, p < 0.0001), but not in the young (< 30years) or the elderly (> 69years), and that this side difference is less in women (0.019 ± 0.116mm) than in men (0.036 ± 0.148mm, p < 0.001). In addition to age (p < 0.0001) and gender (p < 0.0001), the left common carotid artery IMT was determined by dyslipidaemia (protective, p = 0.016) and diabetes mellitus (p = 0.022); whereas the right common carotid artery IMT was determined by hypertension (p = 0.0002). The differential determinants of left versus right common carotid artery IMT were similar in men and women, and in young and old. In conclusion, side differences in measurements of the common carotid artery IMT depend upon age and gender. In addition, cardiovascular risk factors have differential effects on the left and right common carotid artery IMT.

A study of carotid intima media thickness in patients with rheumatoid arthritis and its correlation with acute phase reactants and disease activity

Introduction: There is increased risk of cardiovascular morbidity and mortality in patients of rheumatoid arthritis (RA) due to accelerated atherosclerosis. In this study we measured Carotid artery intima media thickness (CIMT) as a surrogate marker for subclinical atherosclerosis in RA patients without pre-existing cardiovascular disease. This study also analyzed the correlation between CIMT, disease duration, Simplified Disease Activity Index (SDAI) and acute phase reactants. Methods: A cross-sectional study was conducted on 90 patients divided into two groups of 45 patients of RA and another 45 control subjects. Subjects with RA and age and sex matched healthy controls were included in the study without pre-existing CV risk factors. Complete clinical evaluation, hematological and biochemical profile done. ESR, CRP and platelet count were used as markers of acute phase reactants. All the RA patients included in the study were evaluated for their disease activity using Simplified Disease Activity Index (SDAI). All the subjects including the controls evaluated for carotid intima media thickness by using carotid ultrasonography. CIMT measured in common carotid artery bilaterally by examining throughout common carotid artery up to 2 cm proximal to bifurcation. CIMT measurement taken at the site of greatest thickness. All measurements taken in diastole, measured in phase when lumen diameter is at its smallest and IMT at its largest. Mean value of 6 readings (3 from each side) taken as final CIMT for evaluation. B mode (linear probe) USG was used to determine carotid IMT. Results: 45 cases and similar control subjects included in the study with mean age (SD) as 45.07 (14.81) years. We found female preponderance with 37 females out of 45 cases. Mean (SD) disease duration in male subjects was 5.38(2.40) years while in females was 5.09 (2.78) years. CRP was found to be significantly increased in cases group with mean (SD) of 5.75(8.85) mg/dl. ESR significantly raised to 35.22(13.55) mm/hour in cases group compared to control group where it was 16.16(5.71) mm/hr. Mean (SD) platelets (x10³/mm³) were 229.24(69.80) in cases while controls had 290.33(83.85), so platelets correlation with disease could not be established. CIMT was significantly raised in cases group. Mean (SD) CIMT in cases was 0.95(1.06) mm whereas in control group it was 0.60(0.16) mm with p value of 0.002. Moderate positive correlation was found between CIMT (mm) and SDAI and this correlation was statistically significant with p=0.001. For every 1 unit increase in CIMT, the SDAI increases by 2.92 units. A strong positive correlation between CIMT (mm) and Disease Duration (Years), and this correlation was statistically significant (rho = 0.9, p = &lt;0.001). For every 1 unit increase in CIMT (mm), the Disease Duration (Years) increases by 1.26 units. Conversely, for every 1 unit increase in Disease Duration (Years), the CIMT (mm) increases by 0.19 units. Conclusion: A strong correlation was observed between CIMT and disease duration in rheumatoid arthritis. Hence, CIMT can be a useful surrogate marker for detecting atherosclerosis in patients with RA. In view of the relation to duration of disease, established RA patients should regularly be screened to identify the evidence of atherosclerosis and manage it earlier. Prevention of cardiovascular disease in RA requires an integrated approach encompassing cardiovascular risk factors screening and management, effective and sustained control of RA disease activity, high index of suspicion and prompt investigation of suspected cardiac disease.

Reference intervals for carotid artery intima-media thickness measurements in the multi-ethnic Asian population: relationship with cardiometabolic risk factors

Abstract Background Carotid artery intima-media thickness (cIMT) is an intermediate surrogate marker for cardiovascular disease (CVD). It has been reported that although the distribution of cIMT values is very heterogeneous and values vary widely between different ethnicity, geographic location, and ultrasound protocol, the prediction of vascular events with study-specific cIMT values is consistent across all ethnicities and regions (1). Hence, Consensus Statement from the American Society of Echocardiography suggests that cIMT greater than or equal to 75th percentile for the patient’s age, sex, and ethnicity is indicative of increased CVD risk (2). Aims We aimed to establish age, sex, and ethnic-specific reference intervals in the multi-ethnic Asian population comprising Chinese, Malays, and Indians. Methods We analysed data from 8762 healthy individuals who had a 3D carotid ultrasonography done as part of the Health for Life in Singapore study. Carotid ultrasonography measurements were taken from the distal common carotid artery (CCA) at both the lateral and posterior angles bilaterally during the end-diastolic phase. The mean of all 4 measurements were taken as average cIMT (avgcIMT). For this analysis, we excluded individuals on treatment for diabetes, hypertension, hyperlipidemia, and ischemic heart disease to derive a healthy population subset comprising of 6522 individuals (Chinese: 69%, Malays: 14%, Indians: 17%). We then assessed the 75th percentile as a marker of cardiovascular risk in all individuals, by testing associations with Framingham risk scores (locally adapted) and with cardiometabolic risk factors (3). Results Ethnic- and sex-specific 75th percentiles (95% CI) of CIMT for our Asian populations are summarised in Table 1. Compared to reference intervals reported in European and African American populations, the 75th centiles are lower in all Asian ethnic subgroups (p&amp;lt;0.05). Framingham risk score, BMI, LDL-C, HbA1c and systolic blood pressure were higher in Asians with cIMT more than 75th percentile (p&amp;lt;0.001), compared to Asians with normal cIMT. Conclusions We estimated race- and sex-specific 75th percentiles of avgcIMT across age in the multi-ethnic Asian population. The thresholds for Asian populations are substantially lower than reported in European and African populations. The 75th centiles identify people with raised cardiovascular risk factors, supporting the validity of cIMT as marker of vascular risk in the population. The 75th centiles will be useful in interpretation of cIMT measures obtained both in research and clinical settings in different ethnic populations in Asia. Longitudinal evaluation is needed to determine the prediction of our Asian specific thresholds for predicting hard cardiovascular outcomes.

Prevalence of Microalbuminuria in Patients of Essential Hypertension and its Correlation with Left Ventricular Hypertrophy and Carotid Artery Intima‑media Thickness

Background Urinary albumin excretion has been associated to cardiovascular events and increased mortality in hypertensive patients. There is limited information among Nepalese patients about the implications of microalbuminuria (MA) in the setting of hypertension and potential cardiovascular morbidity.&#x0D; Objective To investigate the prevalence of microalbuminuria in patients with essential hypertension and its connection with left ventricular hypertrophy (LVH) and carotid artery intima-media thickness (cIMT).&#x0D; Method The study involved 80 hypertension individuals in total. All patients in the study had basic biochemical tests, routine urine evaluations, echocardiography, and carotid artery intima-media thickness measurements performed, and the data were analyzed.&#x0D; Result The prevalence of microalbuminuria was present in 37.5% cases of essential hypertension. The mean left ventricular mass index (LVMI) was significantly higher in patients with increased microalbuminuria as compared to patient with normal microalbuminuria. In addition, a significant positive correlation between microalbuminuria and left ventricular hypertrophy was also observed. Furthermore, mean carotid artery intima-media thickness was found to be higher in patients with microalbuminuria (p &lt; 0.001), with 76.7% of the patients with microalbuminuria having elevated mean carotid artery intima-media thickness. The carotid artery intima-media thickness had a positive correlation with both microalbuminuria and left ventricular hypertrophy.&#x0D; Conclusion Microalbuminuria assessment in hypertensive patients is an important test for the evaluation of target organ damage. This study shows that microalbuminuria is common in hypertension patients, particularly those with left ventricular hypertrophy. Microalbuminuria was found to be associated with left ventricular hypertrophy and carotid artery intima-media thickness.

The Role of The Spleen in Atherosclerosis

Objective: Atherosclerosis is a chronic inflammatory process characterized by the accumulation of lipid and inflammatory cells in the walls of medium and large arteries. Metabolic effects of splenectomy are less known, especially the effects on lipid metabolism is a debate. In this study, we aimed to investigate the effects of splenectomy on atherosclerosis in humans. Methods: The data of 280 patients who underwent a splenectomy at a tertiary center between 2009-2016 were analyzed. The 50 patients were included in the study as a splenectomy group. In addition, 50 patients who applied to our outpatient clinic between January 2021 and August 2021 with similar characteristics to those in the splenectomy group except for splenectomy were included in the study as a non-splenectomy group. Atherosclerosis was evaluated by measuring the right, left, and the mean carotid artery intima-media thickness (CAIMT). Results: All measurements were significantly higher in the splenectomy group (p=0.010 for left CAIMT, p=0.011 for right CAIMT and p=0.008 for mean CAIMT). Conclusion: The CAIMT measurements were higher and therefore atherosclerosis risk was increased in patients with splenectomy. For this reason, it should be kept in mind that these patients may develop cardiovascular and cerebrovascular problems due to atherosclerosis and should be followed up in this respect.

Uterine arcuate artery calcification as a potential marker of cardiovascular risk-a preliminary study.

Atherosclerotic cardiovascular disease is the most common cause of death in postmenopausal women. As this is a progressive disease, it is important to identify markers at an early stage during the subclinical period. Arterial calcifications are an indicator of overall atherosclerotic disease and therefore may be used as a marker for the estimation of future atherosclerotic cardiovascular events. The aims of this study are to investigate the relationship between uterine myometrial calcification (UMC) and carotid artery intima-media thickness (CIMT) and to evaluate whether UMC can be a predictive marker for the estimation of future atherosclerotic cardiovascular risk in asymptomatic postmenopausal women. In this cross-sectional study, we assessed 81 postmenopausal women without gynecological complaints for cardiovascular risk factors, UMC, and CIMT. Participants were divided into two risk groups according to their cardiovascular risk factors. The level of UMC was determined using a new scoring system, which was based on transvaginal ultrasonography. Demographic, clinical, and laboratory parameters, UMC scores, and measurements of CIMT were evaluated. A moderately positive correlation was detected between CIMT and UMC scores ( r = 0.62). There was a significant relationship between UMC scores and atherosclerotic cardiovascular risk; the risk of atherosclerosis was 15.4 times higher (OR: 15.4, 95% CI: 5.1-46.8; P = 0.001) in participants with a high UMC score (≥2). According to the multivariable logistic regression model adjusted by age and duration of menopause, the risk of cardiovascular atherosclerosis increased 27.8 fold for those with CIMT of 0.075 or greater (OR: 27.8, 95% CI: 5.3-147.1; P = 0.001) and 9.2 fold for those with a UMC score of 2 or greater (OR: 9.2, CI: 1.22-69.3; P = 0.032). The presence of UMC has been identified as an independent predictive factor for atherosclerotic risk. Accordingly, considering UMC as an atherosclerotic cardiovascular risk factor may provide an opportunity to identify cardiovascular disease in asymptomatic postmenopausal women. When UMC is detected, women should be assessed for cardiovascular risk.

Subclinical carotid artery atherosclerosis and cognitive function in older adults

BackgroundThe combined effects of increased life expectancy and the considerable number of persons reaching old age will magnify the dementia epidemic in the USA. Demonstration that subclinical atherosclerosis precedes and is associated with cognitive impairment suggests a modifiable risk factor for age-associated cognitive impairment and dementia. The purpose of this study is to determine whether subclinical atherosclerosis as measured by carotid artery intima-media thickness (CIMT) is associated with changes in cognitive function over time in older adults.MethodsThis study combined longitudinal data from three clinical trials conducted between 2000 and 2013: the B-Vitamin Atherosclerosis Intervention Trial (BVAIT), the Women’s Isoflavone Soy Health (WISH) trial, and the Early versus Late Intervention Trial with Estradiol (ELITE). Participants were recruited from the general population in the Greater Los Angeles area and were free of cardiovascular disease and diabetes; no cognitive or psychiatric exclusion criteria were specified. The same standardized protocol for ultrasound image acquisition and measurement of CIMT was used in all trials. CIMT measurements performed at baseline and 2.5 years were used in these analyses. Cognitive function was assessed at baseline and 2.5 years using a battery of 14 standardized cognitive tests. All clinical trials were conducted at the University of Southern California Atherosclerosis Research Unit, Los Angeles, and had at least 2.5 years of cognitive follow-up.ResultsA total of 308 men and 1187 women, mean age of 61 years, were included in the combined longitudinal dataset for the primary analysis. No associations were found between CIMT and cognitive function at baseline or at 2.5 years. There was a weak inverse association between CIMT measured at baseline and change in global cognition assessed over 2.5 years (β (SE) = − 0.056 (0.028) units per 0.1 mm CIMT, 95% CI − 0.110, − 0.001, p = 0.046). No associations between CIMT at baseline and changes in executive function, verbal memory, or visual memory were found.ConclusionsIn this sample of healthy older adults, our findings suggest an association between subclinical atherosclerosis and change in global cognitive function over 2.5 years. Stronger associations were observed longitudinally over 2.5 years than cross-sectionally. When analysis was stratified by age group (<65 and ≥65 years old), the inverse association remained statistically significant for participants in the older age group. Subclinical atherosclerosis of the carotid artery may be a modifiable correlate of cognitive decline in middle and older age.Trial registrationBVAIT, NCT00114400. WISH, NCT00118846. ELITE, NCT00114517.

Association of Glycated Haemoglobin levels, LDL levels, Systolic blood pressure, and BMI with carotid artery intima-media thickness (CIMT) in patients with type 2 diabetes mellitus

Background : Glycated haemoglobin in type 2 diabetes mellitus (DM) patients together with other modifiable major risk factors are potentially increase oxidative stress and decreasing nitric oxide activity which triggers atherosclerosis. Atheroslerosis can be detected using B-mode ultrasound to measure carotid artery intima-media thickness (CIMT). The aim of this study is to analyze the association between glycated haemoglobin levels (Hb A1c), LDL levels, systolic blood pressure (SBP), and BMI to CIMT in type 2 DM patients.&#x0D; Methods : This was an observational analytic study with a cross-sectional approach. There were 30 study subjects from Endocrine Clinic at Saiful Anwar Hospital, Malang, Started in September 2018 to December 2019. The subjects were examined using B-mode ultrasound for CIMT measurement, as well as examination to evaluate Hb A1c levels, LDL levels of SBP and BMI. All collected data were statistically analyzed.&#x0D; Results : The correlation between CIMT and Hb-A1c satitistically shows significant association (P = 0.015) with negative correlation coefficient (P = - 0.441), while others variable showed insignificant result. The linear regression between Hb-A1c and CIMT showed 18.3% effectiveness.&#x0D; Conclusion : There was a significant association in the predictor variable levels of Hb-A1C and CIMT with inverse corellation with effectiveness 18.3%

Association of Glycated Haemoglobin levels, LDL levels, Systolic blood pressure, and BMI with carotid artery intima-media thickness (CIMT) in patients with type 2 diabetes mellitus

Background : Glycated haemoglobin in type 2 diabetes mellitus (DM) patients together with other modifiable major risk factors are potentially increase oxidative stress and decreasing nitric oxide activity which triggers atherosclerosis. Atheroslerosis can be detected using B-mode ultrasound to measure carotid artery intima-media thickness (CIMT). The aim of this study is to analyze the association between glycated haemoglobin levels (Hb A1c), LDL levels, systolic blood pressure (SBP), and BMI to CIMT in type 2 DM patients.&#x0D; Methods : This was an observational analytic study with a cross-sectional approach. There were 30 study subjects from Endocrine Clinic at Saiful Anwar Hospital, Malang, Started in September 2018 to December 2019. The subjects were examined using B-mode ultrasound for CIMT measurement, as well as examination to evaluate Hb A1c levels, LDL levels of SBP and BMI. All collected data were statistically analyzed.&#x0D; Results : The correlation between CIMT and Hb-A1c satitistically shows significant association (P = 0.015) with negative correlation coefficient (P = - 0.441), while others variable showed insignificant result. The linear regression between Hb-A1c and CIMT showed 18.3% effectiveness.&#x0D; Conclusion : There was a significant association in the predictor variable levels of Hb-A1C and CIMT with inverse corellation with effectiveness 18.3%

ASSESSMENT OF SUBCLINICAL ATHEROSCLEROSIS IN PATIENTS WITH HIDRADENITIS SUPPURATIVA AND ITS RELATION TO C-REACTIVE PROTEIN

Background: Hidradenitis suppurativa (HS) is a chronic, inflammatory, recurring dermatosis of the hair follicle. Some studies have revealed relation between HS and other diseases as metabolic syndrome, multifaceted disorder associated with increased risk for subclinical atherosclerosis and cardiovascular disease (CVD). Objective: To measure carotid artery intima-media thickness (CIMT) as predictors of cardiovascular risk in HS patients and its relation to inflammatory serum marker especially C-reactive protein (CRP). Patients and Method: This was a prospective case-control performed on 20 patients with HS and compared to 20 healthy volunteers matched in sex, mean of the age and BMI. Participants were recruited from Outpatient clinic of Al-Zahra’a University Hospital during the period from March 2017 to December 2018. The following investigations were done to all the participants including CRP, ESR, neutrophils count, HDL, total cholesterol, triglycerides and glucose. Carotid intima media thickness with B-mode ultrasound. Conclusion: CIMT measurement was not significantly different between patients and controls but differed significantly according to stage of the disease, so HS potentially increased the risk of cardiovascular. The thickness of CIMT related directly to inflammatory serum markers especially CRP, so CRP was considered marker of disease severity and can be used for monitoring the response of treatment.

Latent atherosclerosis as a risk factor in chemotherapy-induced cardiomyopathy.

e12525 Background: Anthracyclines and monoclonal antibodies targeting HER2/neu receptors are widely used antineoplastic agents in breast cancer treatment. Both therapies have been known to cause cardiovascular adverse effects, notably chemotherapy-induced congestive heart failure, especially if used in combination. Multiple factors have been postulated to increase the risk of doxorubicin and trastuzumab-associated cardiotoxicity, including a pre-existing coronary artery disease, but the role of latent atherosclerosis has not been widely studied. Methods: We retrospectively reviewed health records of female breast cancer patients at our institution treated with doxorubicin or trastuzumab between 2012 and 2017. Using echocardiography, we identified patients with underlying atherosclerotic lesions at the start of the treatment and those who subsequently developed cardiotoxicity. Chemotherapy-induced cardiomyopathy was defined as a drop in the ejection fraction (EF) to &lt; 50% from the normal EF of &gt; 53% pre-therapy. We used a χ2 test to search for the relationship between atherosclerosis and subsequent cardiotoxicity. Results: A total of 518 patient records were reviewed. Of 518 patients with breast cancer, 93 (18%) received doxorubicin or trastuzumab-based chemotherapy. The median age for breast cancer diagnosis was 58. Sixty-one patients (66%) were identified to have atherosclerosis on echocardiography at the time of the first chemotherapy cycle. The most common location for atherosclerotic lesions was in the aortic arch and proximal upper abdominal aorta. Of 61 patients with atherosclerosis, ten (16.4%) subsequently developed chemotherapy-induced cardiomyopathy (p = 0.77). A post hoc analysis was performed to compare the two cohorts aged 40 to 50 (p = 0.49) and 51 to 75 (p = 1.00) as they represented the majority of breast cancer cases. Conclusions: The role of atherosclerosis in doxorubicin and trastuzumab-induced toxicity remains unclear. We did not observe any statistical correlation between atherosclerosis at the start of chemotherapy and increased rates of cardiac injury. A younger population may be more susceptible to cardiotoxicity, but further research is needed as the study has limitations. Although we identified patients with latent atherosclerosis, additional evaluation via carotid artery intima-media thickness measurements would yield more precision. Other methods such as the use of computed tomography and coronary artery calcium scores would also allow for assessing atherosclerotic plaque burden. Still, not all patients were subjected to these techniques. Furthermore, the study was challenged by the small sample size and its retrospective nature. Larger prospective studies are essential to explore this area further. Identifying the means of reducing cardiovascular complications remains a priority as heart disease is currently the leading cause of death among breast cancer survivors.

Diagnostic Value of Carotid Artery Intima-media Thickness in Patients with Type 2 Diabetes and Its Correlation with HbA1c Levels

Objectives: This study aimed to assess the role of carotid ultrasonography and measure the carotid artery intima-media thickness (CIMT) and its correlation with hemoglobin A1c (HbA1c) to observe cardiovascular disease (CVD) risks in patients with type 2 diabetes mellitus (T2DM). Methods: In this observational study, 205 consecutive patients with T2DM from Golestan Hospital, Ahvaz, Iran, were included. We performed HbA1c measurements using high-pressure liquid chromatography (HPLC) with a thermo-system. Carotid arteries ultrasonography was performed with an Aloka SSD 5500 apparatus with a 7.5 MHz transducer. The CIMT was measured in the supine position with a slight neck extension. Results: There was no statistically significant difference between the two study groups in the duration of diabetes with CIMT (P = 0.425), while the differences in creatinine, HbA1c, and urine albumin were statistically significant (P = 0.020, P = 0.041, and P = 0.016, respectively). There was no correlation between CIMT and age (r = 0.19, P = 0.792) and duration of diabetes (r = 0.125, P = 0.081). Furthermore, there was no remarkable association between CIMT and weight (r = 0.12, P = 0.881) and FBS ( r = 0.062, P = 0.405). There was also a non-significant negative correlation between HbA1c% and CIMT (r = -0.127, P = 0.127). Conclusions: Ultrasound measurement of CIMT is a safe and relatively cost-effective way of diagnosing atherosclerosis. Thus, the ultrasound's predictive value as a safe and non-invasive examination may alert the related field experts early enough to intervene to prevent major cardiovascular complications.

STUDY OF NON-ALCOHOLIC FATTY LIVER IN PATIENTS WITH TYPE 2 DIABETES AND ITS CORRELATION WITH SUBCLINICALATHEROSCLEROSIS, IN A HOSPITAL BASED CROSS-SECTIONAL OBSERVATIONAL STUDY

Aim: To assess the prevalence of NAFLD among type 2 diabetics and assess its correlation with risk factors for atherosclerosis and presence of Sub-clinical atherosclerosis on the basis of Carotid Artery Intima-Media Thickness (CIMT). Materials and methods: This was a hospital based observational cross-sectional study conducted in M.L.B. Medical College, Jhansi (U.P.) It comprised of a total of 100 patients coming to OPD and IPD of Department of General Medicine, MLB Medical College, Jhansi during the period of May 2019 to October 2020. Result: The most common risk factor for subclinical atherosclerosis in our study was Metabolic Syndrome (61%). Prevalence of NAFLD among patients of DM 2 was 73%. The prevalence of sub clinical atherosclerosis increased with increasing number of risk factors and the correlation was statistically signicant (p=0.000632). Prevalence of sub-clinical atherosclerosis increased with increasing duration of diabetes mellitus and the relation was statistically signicant (p=0.00001). Conclusion: Our study found that NAFLD is related to atherosclerosis and may lead to an increased risk of developing CAD in future. Hence, measurement of CIMT in patients of NAFLD can serve as an early marker of atherosclerosis, allowing physicians to plan early interventions to decrease future cardiovascular disease risk

APRIL: Anatomical prior-guided reinforcement learning for accurate carotid lumen diameter and intima-media thickness measurement

Carotid artery lumen diameter (CALD) and carotid artery intima-media thickness (CIMT) are essential factors for estimating the risk of many cardiovascular diseases. The automatic measurement of them in ultrasound (US) images is an efficient assisting diagnostic procedure. Despite the advances, existing methods still suffer the issue of low measuring accuracy and poor prediction stability, mainly due to the following disadvantages: (1) ignore anatomical prior and prone to give anatomically inaccurate estimation; (2) require carefully designed post-processing, which may introduce more estimation errors; (3) rely on massive pixel-wise annotations during training; (4) can not estimate the uncertainty of the predictions. In this study, we propose the Anatomical Prior-guided ReInforcement Learning model (APRIL), which innovatively formulate the measurement of CALD & CIMT as an RL problem and dynamically incorporate anatomical prior (AP) into the system through a novel reward. With the guidance of AP, the designed keypoints in APRIL can avoid various anatomy impossible mis-locations, and accurately measure the CALD & CIMT based on their corresponding locations. Moreover, this formulation significantly reduces human annotation effort by only using several keypoints and can help to eliminate the extra post-processing steps. Further, we introduce an uncertainty module for measuring the prediction variance, which can guide us to adaptively rectify the estimation of those frames with considerable uncertainty. Experiments on a challenging carotid US dataset show that APRIL can achieve MAE (in pixel/mm) of 3.02±2.23 / 0.18±0.13 for CALD, and 0.96±0.70 / 0.06±0.04 for CIMT, which significantly surpass popular approaches that use more annotations.

Effects of Long-term Antiepileptic Therapy on Carotid Artery Intima- Media Thickness.

ABSTRACTBackground:Common first-line antiepileptic drugs (AEDs) used in children are valproate, phenytoin, and levetiracetam. Many side effects for these AEDs are reported including obesity, atherosclerosis, and metabolic syndrome. The aim of our study was to evaluate changes in carotid artery intima-media thickness (CIMT) in epileptic children and to correlate with lipid profile of those who are on long-term antiepileptic therapy.Materials and Methods:This case–control study was done over 18 months in department of pediatrics. Sample size was 84 with equal number of cases and controls. Epileptic children between 1 and 18 years of age receiving monotherapy with valproate, phenytoin, or levetiracetam for at least 6 months were included in the study. Measurement of CIMT was done by B mode ultrasonography. Lipid profile was analyzed. Statistical analysis was performed using one-way analysis of variance (ANOVA) test and Pearson correlation.Results:Among 42 cases of epilepsy, 30 were on valproate, 9 on phenytoin, and 3 on levetiracetam monotherapy. No significant difference was noted in body mass index (BMI) among children receiving AED compared with that of controls (P = 0.82). Mean value for CIMT was significantly higher among valproate (0.43 ± 0.04, P ≤ 0.001), phenytoin (0.44 ± 0.04, P ≤ 0.001), and levetiracetam group (0.43 ± 0.03, P = 0.01) compared to controls (0.39 ± 0.01). Significant correlation was noted between CIMT and total cholesterol (P = 0.034), triglyceride (P = 0.011), low-density lipoprotein (P = 0.008), and very low-density lipoprotein (P = 0.011).Conclusion:Children on long-term monotherapy with valproate, phenytoin, and levetiracetam have significantly abnormal CIMT. This might be associated with atherosclerotic changes, and these children may require close follow-up to prevent cardiovascular and cerebrovascular risks.

Pulse wave velocity, carotid intima media thickness and flow-mediated dilation in Takayasu arteritis: a systematic review.

IntroductionTakayasu arteritis (TA) is a chronic vasculitis associated with an increased cardiovascular risk. The measurement of pulse wave velocity (PWV), carotid artery intima-media thickness (CIMT) and flow-mediated dilatation (FMD) are generally used for evaluating the cardiovascular risk. The application of these measurements to TA patients remains undetermined.Material and methodsClinical studies that reported the PWV, CIMT and FMD levels in TA patients, which were published prior to 2021, were summarized using PubMed.ResultsFifteen studies were eligible. Overall, in TA patients, the PWV and CIMT levels were significantly higher and the FMD levels were significantly lower compared to controls. Part of the studies showed that the disease activity of TA was significantly associated with the PWV, CIMT or FMD levels.ConclusionsThe PWV, CIMT and FMD measurements could be useful for evaluating the cardiovascular risk in TA patients. Further studies to determine the proper use of these measurements are warranted.

Early-onset subclinical cardiovascular damage assessed by non-invasive methods in children with Juvenile Idiopathic Arthritis: analytical cross-sectional study.

Chronic inflammation starting early in life and continuing into adulthood may predispose children with Juvenile Idiopathic Arthritis (JIA) to cardiovascular (CV) complications. To compare non-invasive CV risk markers- left ventricular mass index (LVMi), brachial artery flow mediated dilatation (FMD) and carotid artery intima-media thickness (CIMT) between patients with JIA and healthy controls. Measurements of LVMi, CIMT and FMD and lipid profile were compared between 4 and 18year old 81 patients with JIA and 78 age and sex matched healthy controls. Among 81, 20 had systemic onset, 19 enthesitis related arthritis, 9 polyarticular rheumatoid factor (RF) + ve, 19 polyarticular RF -ve, 11 oligo-articular, and 3 un-differentiated JIA. FMD was significantly lower (p < 0.001), CIMT and LVMi significantly higher in patients (p ≤ 0.001). CIMT showed positive correlation with blood pressure (p = 0.001), disease duration (p ≤ 0.001) and negative correlation with high density lipoprotein (HDL) (p ≤ 0.001). FMD correlated positively with HDL (p = 0.006) and negatively with disease duration (p ≤ 0.001). CIMT (p = 0.017) and FMD (p = 0.04) were significantly worse in active than inactive disease. Children with JIA have worse lipid profile, increased LVMi, CIMT, and reduced brachial artery FMD, suggestive of early cardiovascular dysfunction.

Study on Correlation of Carotid Artery Intima–Media Thickness and Dyslipidemia in Chronic Kidney Disease in a Bangladeshi Population

Background: In chronic kidney disease (CKD) patients,measuring carotid artery intima– media thickness (CIMT) canpredict coronary heart disease and stroke, resulting from systemic atherosclerosis.Objective: To find out correlation of carotid artery intima–media thickness and dyslipidemia in chronic kidney disease in a Bangladesh population.Methods: A cross-sectional analytic study was conducted in the Department of Nephrology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladeshi, between July 2014 and June 2015, on 80 CKD patients. Standard laboratory techniques were followed to estimate all biochemical parameters. CIMT measurement was done by duplex study of carotid vessels through high resolution B-mode ultrasound technique.Results: Among 80 patients, 29 (36%) were in 18-30 age group, 18 were (23%) 31-40 age group and 33 (41%) were between 41-50 age group; mean age was 36.1±9.5 years. 51 (64%) patients were male and 29 (36%) were female. Though mean CIMT was found markedly increased in all CKD patients, the differences among stage 3, 4 and 5 was not significant. Mean CIMT was found more in dyslipidemic patients in comparison those with normal lipid profile, which was statistically significant (p&lt;0.05). Positive correlations were found between total cholesterol (TC) and CIMT (r=+0.295; p=0.008), triglyceride (TG) and CIMT (r=+0.238; p=0.034), and lowdensity lipoprotein (LDL) and CIMT (r=+0.231; p=0.039). However, there was negative correlation between high-density lipoprotein (HDL) and CIMT (r=–0.242; p=0.030).Conclusion: Our data suggest that the mean carotid intima-media thickness was markedly high in patients with CKD in comparison to normal expected value; however, there was no significant difference in thickness among CKD stages 3, 4 and 5. It was also observed that carotid artery intima-media thickness showed significant positive correlation with total cholesterol, triglyceride and LDL, but negative correlation with HDL.International Journal of Human and Health Sciences Vol. 04 No. 04 October’20 Page : 271-276

Early detection of premature atherosclerosis in β-thalassemia patients by measuring carotid intima-media thickness

Abstract Background Beta-thalassemia patients still suffer from many complications. Transfused patients may develop complications related to iron overload including growth retardation and failure or delay of sexual maturation, cardiac involvement (dilated cardiomyopathy or rarely arrhythmia), liver (fibrosis and cirrhosis), endocrine glands (diabetes mellitus, hypogonadism, insufficiency of parathyroid, thyroid, pituitary and less commonly, adrenal glands). Purpose The present study was undertaken to evaluate the role of Carotid artery intima media thickness (CIMT) measurement as an early detector of premature atherosclerosis in beta-thalassemia children and early adolescents and its relation to biochemical risk factors as iron overload and lipid profile. Patients and Method Twenty-two β-thalassemia major (TM), 8 β-thalassemia intermedia (TI) with confirmed diagnosis of beta-thalassemia (major and intermedia) proved by clinical and laboratory investigations, frequent blood transfusion, chelation therapy with their age ranging from 10 to18 years old and 30 age-and sex matched healthy controls were included. Lipid profile (by colorimetric assay), serum ferritin, and CIMT measurements using high-resolution B-mode ultrasonography were estimated. Results CIMT of thalassemic patients (major and intermedia) was highly significantly increased compared to controls with no significant difference between β-thalassemia major and β thalassemia intermedia groups could be detected. CIMT was positively correlated with serum ferritin, TG, Total cholesterol level in both diseased groups and LDL level in B-TM group only. This provides a good evidence of the presence of premature atherosclerosis in vascular-free TM and TI patients and its relation to increased body iron and dyslipidemia. Conclusion Carotid artery intima media thickness represented a simple, accurate and non-invasive method for early detection of premature atherosclerosis which started early in β- thalassemia patients This study identified a relationship between body iron status, dyslipidemia and increased carotid IMT..