Carotid Artery Intima Research Articles

Common carotid artery characteristics in patients with repaired aortic coarctation compared to other cardiovascular risk factors

AimsIncreased common carotid artery (CCA) intima media thickness (cIMT) is a well-known risk factor for cardiovascular morbidity and mortality. cIMT thickening has been described in patients with repaired aortic coarctation (CoA), but data on mechanism and clinical relevance in this population are scarce. Our aim was to gain mechanistic insights into cIMT thickening of patients with repaired CoA by comparing their wall architecture to patients with coronary artery disease (CAD), other congenital heart diseases (oCHD), and healthy controls. Methods and resultsA total of 310 subjects were included (CoA (n ​= ​58), oCHD (n ​= ​96), CAD (n ​= ​68) and healthy controls (n ​= ​88)). CIMT and lumen diameter (LD) were determined using semiautomated analysis software. Linear regression analyses were performed correcting for relevant covariates. While patients with repaired CoA and CAD both had significantly increased cIMT and cIMT/LD ratios, LD was increased only in CoA patients. Furthermore, patients with repaired CoA had decreased CCA stiffness. CCA characteristics in the oCHD group were not significantly different from controls. ConclusionThe mechanism of cIMT thickening in patients with repaired CoA may differ from CAD. While there is concentric remodeling in the latter, we see predominant eccentric remodeling in the CoA group, which could be due to increased flow as a result of compliance mismatch at the CoA repair site. We therefore suggest that the prognostic value of cIMT in post-CoA patients should be validated separately prior to using it to guide clinical management in this group.

Effect of Exercise on Carotid Artery Intima-Media Thickness in Adults: A Systematic Review and Meta-Analysis.

Carotid intima-media thickness (cIMT) is a validated surrogate marker of atherosclerosis that is independently associated with the risk for cardiovascular disease. Recent studies on the effect of exercise on cIMT have yielded conflicting results. Studies that were available up until October 30, 2021 from the PubMed, Cochrane Library, Embase, and Web of Science databases were included in the analysis. Subgroup analyses were performed to determine the effects of the type, intensity, and duration of exercise on cIMT. This review included 26 studies with 1370 participants. Compared with control participants, those who engaged in exercise showed a decline in cIMT (weighted mean difference [WMD] -0.02; 95% confidence interval [CI], -0.03 to -0.01; I2 = 90.1%). Participants who engaged in aerobic (WMD -0.02; 95% CI, -0.04 to -0.01; I2 = 52.7%) or resistance (WMD -0.01; 95% CI, -0.02 to -0.00; I2 = 38.5%) exercise showed lower cIMT compared with control participants. An exercise duration of >6months was associated with a 0.02mm reduction in cIMT. In participants with low cIMT at baseline (<0.7mm), exercise alone was not associated with a change in cIMT (WMD -0.01; 95% CI, -0.03 to 0.00; I2 = 93.9%). Exercise was associated with reduced cIMT in adults. Aerobic exercise is associated with a greater decline in cIMT than other forms of exercise. Large, multicenter, randomized controlled trials are required to establish optimal exercise protocols for improving the pathological process of atherosclerosis.

Carotid Intima Media Thickness and Comorbid Cardiometabolic Dysfunction in Women: The SWAN Study

Metabolic syndrome (MetS) and obesity are risk factors for atherosclerosis but their combined impact is unknown. The aim of this study was to quantify the added risk of obesity on carotid artery intima media thickness (cIMT), an early indicator for atherosclerosis, beyond MetS alone. The Study of Women’s Health Across the Nation (SWAN) is a multi-center, multi-ethnic cohort of women traversing the midlife into early late adulthood. cIMT was assessed between 2005-2007 and MetS, obesity and covariates were measured at the same time. This cross-sectional analysis is restricted to 1,433 women with a body mass index ≥18.5 kg/m2 and free of cardiovascular disease (CVD) when cIMT was measured. Mean maximum cIMT was related to obesity, MetS and their interaction using multivariable linear regression models. The average age was 60 years (standard deviation 2.7) and the prevalence of obesity and MetS were 44% and 35%, respectively. Both conditions occurred in 24% of women. After adjustment for age, race, smoking, family history of heart disease, and antilipemic medications, obese women had a 0.051mm (95% confidence interval (CI): 0.033,0.070; p<0.001) larger maximum cIMT versus women not obese and women with MetS had a 0.066mm (95%CI: 0.042,0.090; p<0.001) larger maximum cIMT versus women without MetS. There was a statistically significant antagonistic interaction between obesity and MetS; women with both had a mean cIMT of 0.972mm (95%CI: 0.955,0.989) and MetS alone a cIMT of 0.961mm (95%CI:0.938,0.983). This suggests that there is only a small risk of obesity on augmenting cIMT beyond MetS alone.

Serum adipokine levels in patients with type 1 diabetes are associated with degree of obesity but only resistin is independently associated with atherosclerosis markers.

The role of adipokines in causing inflammation and insulin resistance in normal weight and obese patients is generally well studied. However, there are often conflicting results regarding their levels in type 1 diabetes mellitus (T1DM) patients and their relationship to micro- and macrovascular disease. We therefore investigated which serum adipokine levels are independently associated with markers of early atherosclerosis and microvascular complications in patients with T1DM. A cross-sectional study was performed in the Diabetes Outpatient Clinic of Hippokrateion General Hospital, Thessaloniki, Greece. Sixty T1DM patients (30 females, mean age 38.8 ± 10.6years, mean diabetes duration 17.4 ± 9.9years) were included. Plasma adiponectin, leptin, and resistin, carotid artery intima media thickness (cIMT), and arterial stiffness (pulse wave velocity, PWV/SpygmoCor CP System and Mobil-O-Graph 24h PWA) were assessed. Leptin and resistin levels were significantly higher in overweight and obese patients (p = 0.002 and p = 0.039, respectively). Adiponectin was the only adipokine negatively correlated with BMI (rs = - 0.41, p = 0.001). We report a bivariate association between serum adiponectin levels and retinopathy (p = 0.007). Resistin was the only adipokine that showed significant correlation with systolic (rs = 0.42, p = 0.001) and diastolic (rs = 0.29, p = 0.024) hypertension and PWV (p = 0.035). Serum adipokine levels demonstrate similar bivariate associations with anthropometric variables in patients with T1DM to those in normal weight subjects. Although microvascular complications are associated with serum adipokine levels by bivariate analysis, only resistin, an inflammatory marker, is independently associated with arterial stiffness in patients with T1DM.

Sex modifies the association between body mass index and carotid artery intima media thickness in the multi-ethnic Singapore population

Abstract Background and aims Globally cardiovascular disease (CVD) risk is higher in men than in women in the younger age group but the risk is attenuated in later life with an unexpected higher risk in women in some populations. A better understanding of sex differences in CVD is needed. Carotid artery intima-media thickness (CIMT) has been proposed for CVD risk assessment in individuals at intermediate risk. We study the gender interactions in the associations of the traditional cardiovascular risk factors with CIMT. Methods We performed carotid ultrasonography in the large population health study-HELIOS conducted in Singapore. Measurements were performed as per Mannheim consensus, at the far wall of bilateral common carotid artery at 8 sites in each participant. We report the average of all measurements (avgCIMT) and maximum value (maxCIMT). We analysed 2061 healthy participants recruited between 2018–2020. Inclusion criteria for this analysis: non-smokers, not known to have diabetes, hypertension, hyperlipidemia or ischemic heart disease. Individuals with systolic blood pressure &amp;gt;160 mm Hg or fasting glucose &amp;gt;7.0 mmol/L on recruitment were excluded. Multivariable linear regression analysis was performed to examine the association between CIMT and cardiovascular risk factors in the healthy population adjusting for age, sex and ethnicity. All analysis was performed using Stata version 16.0. Results After exclusion, 1407 healthy participants were included in the analysis. Median (IQR) avgCIMT: 0.56 (0.50, 0.65) in men; 0.54 (0.50, 0.58) in women. Median (IQR) maxCIMT: 0.64 (0.57, 0.76) in men; 0.61 (0.54, 0.70) in women. The avgCIMT and the maxCIMT were higher in males when compared to women and all traditional cardiovascular risk factors associated with CIMT after adjustment for age, sex and ethnicity (P&amp;lt;0.05) (Table 1). Interaction tests in multivariable model adjusted for age, ethnicity, pulse pressure, non HDL-C and HbA1c showed a significant interaction between sex and body mass index (BMI) with predicted effects on avgCIMT and maxCIMT being relatively higher in males at the same BMI when compared to females (P-interaction &amp;lt;0.01) (Figure 1). Conclusion Sex modifies the relationship between BMI and CIMT in Singapore's multi-ethnic population. Understanding the intermediary mechanisms involved will help in developing personalized preventive strategies. Funding Acknowledgement Type of funding sources: None. Figure 1

THE ROLE OF NEUROHORMONAL FACTORS - GALECTIN-3 AND ALDOSTERONE IN THE FORMATION OF THE CLINICAL PROFILE OF THE PATIENT AND THE INFLUENCE ON THE STRUCTURAL REMODELING OF THE HEART AND VESSELS IN PATIENTS WITH HYPERTONIC DISEASE

The article is devoted to the study of the urgent problem of modern cardiology with regard to improving the prediction of the course of Essential arterial hypertension (AH), stage II, in patients of young and middle age based on the study of the role of age-related and neurohumoral factors - galectin-3 and aldosterone in the formation of the clinical profile and structural remodeling of the heart and vessels.&#x0D; The study was conducted according to the protocol of the current clinical and performed at the Department of Therapeutic Disciplines and Family Medicine of the Faculty of Postgraduate Education, Vinnytsya National Pirogov Memorial Medical University. The material was collected on the basis of the Khmelnytsky Regional Cardiovascular Center of the Khmelnytsky Regional Council in the period from January 2016 to April 2017.&#x0D; Patients with hypertension, who participated in the study, were divided into 4 groups depending on age: groups of young and middle age. The group of young patients included men and women (40 people), aged 18 to 44 years. The middle-aged groups included men and women (40 people), aged 45 to 60 years. The total number of the examined patients which we surveyed and were included in the study was 160 persons. The control group included 27 relatively healthy persons (male and female). The average age and the percentage of young and middle-aged patients did not differ significantly. Verification of the diagnosis of hypertension was carried out on the basis of the existing criteria and recommendations.&#x0D; In the course of study, all the patients have undergone laboratory tests (determination of the level of galectin-3 and aldosterone, glucose, creatinine, electrolytes (Na 2+, K +), total cholesterol, triglycerides, high, low and ultra-low density lipoprotein cholesterol), instrumental tests (electrocardiography (ECG ) in 12 leads, 24-hour ambulatory blood pressure monitoring (ABPM), echocardiographic (Echo CG) in M, B-, D modes, the structural state of the carotid arteries (CA) based on the assessment of the thickness of the intima-media (TIM) and statistical studies.&#x0D; Aldosterone level was determined by the enzyme-linked immunosorbent assay ELISA using reagents of IBL International GmbH (Canada). Aldosterone level of 40-160 pg/ml was considered as the reference values.&#x0D; The level of galectin-3 in serum was determined by the solid-phase enzyme linked immunosorbent assay using a set of reagents of Human Galectin-3 Platinum Elisa (Bender MedSystems GmbH, Austria).&#x0D; Scores reflect the prognostic value of indicators. The most valuable for predicting relatively high levels of galectin-3 are obesity, carotid artery Intima Media &gt; 0.91 mm and left atrial volume index &gt; 34 ml/m2 (echocardiography), while aldosterone is obesity, the presence of a non-dipper profile according to аverage blood pressure (24 hour blood pressure monitoring) &gt; 32 ml/m2 (еchocardiography) and nightly average heart rate &gt; 62 (24 hour blood pressure monitoring).&#x0D; When determining the IV level of galectin-3 and/or aldosterone, a more severe course of hypertension should be envisaged, and the patient should be referred to the group of high risk of complications from the heart and blood vessels and, possibly, an earlier indication of mineralocorticoids should be considered.

Evaluation of subclinical cardiovascular risk and cardiac function in children with vesicoureteral reflux: a prospective study.

Vesicoureteral reflux is a prominent congenital anomaly of the kidney and the urinary tract. Further, renal scarring is known to be related to chronic inflammation. However, there have been limited studies to date regarding the cardiovascular consequences of vesicoureteral reflux. The aim of this study is to evaluate the possible subclinical atherosclerosis and cardiovascular complications in children with vesicoureteral reflux. Patients with vesicoureteral reflux and age matched healthy controls were prospectively included in this case-control study. Patients were divided into two groups concerning renal scarring status. To assess cardiac functions, carotid artery intima media, epicardial adipose tissue, and periaortic adipose tissue thicknesses were evaluated. There were 50 patients with vesicoureteral reflux; 26 patients without renal scarring and 24 patients with renal scarring, as well as 40 healthy controls. Myocardial performance indexes (Tei indexes) measured by tissue Doppler echocardiography from septum and left ventricle were significantly increased in study group (for all, p < 0.001). Also, intima media, epicardial adipose tissue, and periaortic adipose tissue thicknesses of the study groups were significantly higher than the control group (for all, p < 0.001). However, no statistical difference was observed between renal scarring (-) and renal scarring (+) groups. Results of our study showed early deterioration of cardiac systolic and diastolic functions in children with vesicoureteral reflux regardless of renal scarring. Also, diagnosis of vesicoureteral reflux is an important risk factor for subclinical atherosclerosis, independent of renal scarring, which should be considered in the follow-up of these patients.

Relationship between hyperuricaemia and arterial stiffness

Milda Grigonytė1, Badarienė Jolita3, Alma Čypienė2,3, Jolanta Dadonienė1,2 1Vilnius University, Faculty of Medicine, Vilnius, Lithuania, LT – 03104, Ciurlionio 21 2 State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania, LT – 08406, Santariskiu 5 3 Clinic of Cardiac and Vascular Diseases, Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, LT – 08406, Santariskiu 2 Abstract Introduction. Hyperuricaemia has been classically associated with metabolic syndrome, however, association to cardiovascular health is still not well established. Aim. The aim of this study was to examine the differences of early atherosclerosis parameters between hyperuricaemic and non-hyperuricaemic patients and examine the associations between uric acid and arterial stiffness in a large group of patients with metabolic syndrome. Materials and methods. This cross-sectional study included 709 (445 women and 264 men) participants with previously diagnosed metabolic syndrome. We evaluated associations between uric acid and non-invasive vascular stiffness parameters of early artherosclerosis: mean blood pressure, augmentation index, pulse wave velocity, flow mediated dilatation and carotid artery intima media thickness. Results. 239 persons (33.71%) were found to be hyperuricaemic. Comparing the two groups dichotomized by uric acid level, carotid femoral pulse wave velocity was higher in group with elevated uric acid, while augmentation index was evidently lower. Significant but weak association was found between uric acid and augmentation index. The negative correlation showed the indirect relationship: with elevation of uric acid the augmentation index tended to decrease showing arteries being less responsive to pulse wave. Keywords: metabolic syndrome, arterial stiffness, uric acid, augmentation index.

Ischemic Stroke and its Association with Risk Factors at Nepalgunj Medical College Teaching Hospital Kohalpur

Introduction: Incidence of stroke increases with age and growing elderly population worldwide, the number of patients with stroke are likely to increase. It is the third most common cause of death in world in that 85% are ischemic in nature. Atherosclerosis is a major risk factor in cerebrovascular diseases. Carotid Intima Media thickness (CIMT) is a surrogate marker of atherosclerosis and provides a non-invasive method for the risk assessment of cerebrovascular diseases.&#x0D; Aims: To study the atherosclerotic risk profile of patients admitted with ischemic stroke in medical ward with study of the carotid artery intima-media thickness in patients with acute ischemic stroke.&#x0D; Methods: 92 patients with ischemic strokes were studied in this observational study. Carotid Doppler was performed in all patients with emphasis on carotid artery stenosis and intima thickening. Analysis of Association of various risk factors was done in detail. Study period was from June 2019 to May 2020.&#x0D; Results: Higher degree of stenosis was associated with hypoechoic plaques and cortical strokes. Hypertension was the most common and most significant risk factor. Multiple risk factors also appear to have synergistic actions.&#x0D; Conclusion: Various modifiable risk factors provide valuable target for primary and secondary prevention of stroke. Carotid Doppler is a very cheap and highly effective tool for further management of stroke patients. Most of the asymptomatic patients, risk factors may warrant precautionary carotid Doppler, and may result in significant reduction in disease burden on the families and the community and should be encouraged.

Liver-Specific Overexpression of Prostasin Attenuates High-Fat Diet-Induced Metabolic Dysregulation in Mice.

The liver has a most indispensable role in glucose and lipid metabolism where we see some of the most serious worldwide health problems. The serine protease prostasin (PRSS8) cleaves toll-like receptor 4 (TLR4) and regulates hepatic insulin sensitivity under PRSS8 knockout condition. However, liver substrate proteins of PRSS8 other than TLR4 and the effect to glucose and lipid metabolism remain unclarified with hepatic elevation of PRSS8 expression. Here we show that high-fat-diet-fed liver-specific PRSS8 transgenic mice improved glucose tolerance and hepatic steatosis independent of body weight. PRSS8 amplified extracellular signal-regulated kinase phosphorylation associated with matrix metalloproteinase 14 activation in vivo and in vitro. Moreover, in humans, serum PRSS8 levels reduced more in type 2 diabetes mellitus (T2DM) patients than healthy controls and were lower in T2DM patients with increased maximum carotid artery intima media thickness (>1.1 mm). These results identify the regulatory mechanisms of PRSS8 overexpression over glucose and lipid metabolism, as well as excessive hepatic fat storage.

Associations between cumulative biological risk and subclinical atherosclerosis in middle- and older-aged South Asian immigrants in the United States

Introduction&#x0D; The aim of this study was to investigate associations between cumulative biological risk and subclinical atherosclerosis in South Asian immigrants.&#x0D; Methods&#x0D; Data from the Mediators of Atherosclerosis in South Asians Living in America (MASALA) study, including 844 participants at baseline (mean age=56 [standard deviation=9] years, 46% women). A cumulative biological risk score was derived using 9 biomarkers across cardiovascular, immune and metabolic systems with possible score range 0-9. Common and internal carotid artery intima media thickness (CIMT) and coronary artery calcium (CAC) were used as indicators of subclinical atherosclerosis.&#x0D; Results&#x0D; Higher cumulative biological risk score were significantly associated with higher common and internal CIMT and higher odds of CAC at baseline. The odds of new CAC after 5 years of follow-up was 31% higher per 1 point increase in cumulative biological risk score, and higher cumulative biological risk was also associated with CAC progression.&#x0D; Conclusions&#x0D; Among South Asian immigrants, cumulative biological risk was directly associated with subclinical atherosclerosis and its progression.&#x0D;

Body Fat, Cardiorespiratory Fitness, Carotid Artery Thickness Among Older Adults Participating in the Senior Games

Abstract Objectives To determine the relationship among body fat, cardiorespiratory fitness, and carotid artery thickness in a large group of older adults. Methods Data were collected at the Huntsman World Senior Games held in St. George, Utah between 2016–2019. Participants visited the Dixie Convention Center (St. George, UT) for free health screenings associated with the Games. The data were cross-sectional; for repeat participants only the most recent results were analyzed. The measures of interest for this study included: body fat, body mass index (BMI), cardiorespiratory fitness (predicted VO2max), and carotid artery intima media thickness (CIMT). Body fat percentage was measured using bioelectrical impedance. BMI was calculated via weight (kg) and height (m2). Predicted VO2max was calculated at rest using a heart rate monitor and the validated Polar fitness test. CIMT was obtained via images of the right and left carotid arteries, visualized and captured with a portable diagnostic ultrasound system. Differences by sex were determined using independent t-tests. Multiple regression was used to examine associations between measures. Results For this analysis, 649 participants (232 women; 326 men; 68.13 ± 8.71 y, 25.15 ± 4.92 kg/m2) were included. Women had a higher body fat percentage than men (32.00 vs. 22.42%) (t &amp;lt; 0.0001). However, men had a significantly higher BMI (26.28 vs. 24.01 kg/m2) and cardiorespiratory fitness (40.22 vs. 38.82 ml/kg/min) (t &amp;lt; 0.05) than women. Accounting for age and sex, body fat % significantly predicted CIMT thickness (P &amp;lt; 0.05) but BMI (P = 0.0853) and cardiorespiratory fitness did not predict CIMT thickness (P &amp;gt; 0.05). Conclusions CIMT thickness appears to be related to body fat percentage among older adults. Subsequent studies could examine how reduction in body fat changes CIMT thickness and how that influences risk of chronic disease, such as stroke. Funding Sources There was no funding for this project.

Plasma osteopontin versus intima media thickness of the common carotid arteries in well-characterised patients with systemic lupus erythematosus.

ObjectiveThe progress of accelerated atherosclerosis in systemic lupus erythematosus (SLE) is incompletely understood. Circulating osteopontin (OPN) is increased in autoimmune conditions, e.g. SLE, and its serum concentration was recently reported to associate with subclinical atherosclerosis in SLE, as measured by carotid intima-media thickness. The aim of this study was to investigate whether OPN may be used as a surrogate biomarker of subclinical atherosclerosis in SLE patients with different disease phenotypes.MethodsWe recruited 60 well-characterised SLE cases and 60 age- and sex-matched healthy controls. The SLE cases were divided into three different disease phenotypes: SLE with antiphospholipid syndrome (APS), lupus nephritis, and isolated skin and joint involvement. Plasma OPN was detected by ELISA (Quantikine®, R&D Systems). Common carotid arteries intima media thickness was compared between the studied groups in relation to OPN levels and risk factors for vascular changes. Intima media thickness of common carotid arteries was measured by using a sensitive ultrasound technique (LOGIQ™ E9 ultrasound, GE Healthcare).ResultsOPN levels were significantly higher among the entire SLE group (n = 60) compared to the healthy controls (P = 0.03). SLE cases with concomitant APS (n = 20) showed higher OPN levels than the controls (P = 0.004), whereas none of the other two subgroups differed significantly from the healthy controls. OPN and intima media thickness were correlated to several traditional risk factors of atherosclerosis, as well as to SLE-related factors. Yet, no significant correlation was observed between OPN levels and ultrasound findings of the common carotid arteries.ConclusionsIn line with previous studies, we observed increased OPN levels among SLE patients as compared to matched controls. However, the OPN concentrations did not correlate with intima media thickness of the common carotid arteries. Based on our findings, the use of OPN as a surrogate biomarker of subclinical atherosclerosis in SLE subjects, regardless of clinical phenotypes, cannot be recommended.

Subclinical atherosclerosis in patients with relapsing-remitting multiple sclerosis.

Multiple sclerosis is an inflammatory disorder of the central nervous system. Inflammation may create high susceptibility to subclinical atherosclerosis. The purpose of this study was to compare subclinical atherosclerosis and the role of inflammatory cytokines between the group of patients with relapsing-remitting multiple sclerosis (RRMS) and healthy controls matched for age and sex. The study group consisted of 112non-diabetic and non-hypertensive RRMS patients treated with disease modifying drugs (DMD) and the control group was composed of 51healthy subjects. The common carotid artery (CCA) intima media thickness (IMT) was investigated. Serum levels of risk factors for atherosclerosis and inflammatory cytokines were also determined. The mean CCA IMT (0.572 ± 0.131 mm vs. 0.571 ± 0.114 mm) did not differ (p > 0.05) between patients and controls. The RRMS patients' CCA IMT was significantly correlated with serum interleukin6 (IL-6) (p = 0.027), high-sensitivity C-reactive protein (hs-CRP) (p = 0.027), cystatinC (p < 0.0005), glucose (p = 0.031), cholesterol (p = 0.008), LDL (p = 0.021), erythrocyte sedimentation rate (p = 0.001) and triglyceride (p = 0.018) level. We fitted generalized linear models in order to assess the relationship between CCA IMT and IL‑6 with adjustment for sex and age. The obtained results showed that adjusted for age (p < 0.001) and sex (p = 0.048) IL‑6 serum levels statistically significantly (p = 0.009) predict CCA IMT only in the RRMS group. The findings of the present study suggest that when treated with DMD RRMS might not be an independent risk factor for early atherosclerosis presenting with arterial wall thickening; however, the results suggest a significant association of IL‑6 serum levels with CCA IMT only in the RRMS group.

The severity of acute ischemic stroke is associated with the decrease in peak systolic velocity in the common carotid arteries

Abstract Funding Acknowledgements Type of funding sources: None. Introduction A negative effect on the prognosis of ischemic stroke of the aggressive decrease in blood pressure, leading to a decrease in cerebral blood flow, is known. On the other side, increased blood pressure can be a compensatory mechanism. Currently, however, it is difficult to assess the adequacy of cerebral blood flow, one of the indicators of which is the blood flow velocity in the common carotid artery. Purpose The aim of this study was to estimate the peak systolic velocity in the common carotid arteries (CCA PSV) depending on the severity of acute ischemic stroke (IS). Methods 180 patients with acute ischemic stroke (70 females and 110 males, mean age was 66.3 ± 12.3 years) were studied. Including 46 (25.6%) patients with cardioembolic stroke, 25 (13.9%) - with a thrombotic stroke, 27 (15.0%) – with a lacunar stroke and 82 (45.5%) – with undifferentiated stroke. Most of them 173 (96.1%) had grade 3 of arterial hypertension according to ESH/ESC Guidelines for the management of arterial hypertension, 2018. 59 (32.8%) patients had coronary artery disease, 52 (28.9%) - had atrial fibrillation. Patients were categorized according to National Institutes of Health Stroke Scale (NIHSS) severity in mild NIHSS (&amp;lt;9) - 122 (67.8%) patients, moderate NIHSS (9–15) - 35 (19.4%) patients, and severe stroke NIHSS (&amp;gt;16) - 23 (12.8%) patients. Median NIHSS score was 9.2 ± 0.9. All patients underwent a transthoracic echocardiography and a carotid ultrasound examination. A comparative assessment of echographic parameters was performed in patients of lower (NIHSS score ≤ 4.0) and upper (NIHSS score≥11.0) quartile according to the NIHSS score. Results It is shown a decrease of peak systolic velocity in the common carotid arteries with an increase in the severity of IS on the NIHSS scale: in mild stroke, it was 73.9 ± 18.7 cm/s, in moderate stroke - 66.3 ± 19.2 cm/s (p = 0.04), in severe stroke - 62.1 ± 17,4 cm/sec (p = 0.006 and p = 0.4, respectively). Peak systolic velocity in patients with the lower quartile of stroke severity was 73.8 ± 19.1 cm/sec, in the group of patients with the upper quartile – 64.3 ± 19.2 cm/sec (р=0.02). There were no differences in the resistance index of common carotid arteries: 0.75 ± 0.05, 0.76 ± 0.06 and 0.75 ± 0.07 for mild, moderate and severe severity, respectively, p &amp;gt; 0.5). A multiple linear regression analysis in which the severity of ischemic stroke on the NIHSS scale was a dependent variable and age, CCA PSV, common carotid artery intima–media thickness and systolic, diastolic and pulse blood pressure were independent variables, showed that the severity of ischemic stroke was independently correlated with the CCA PSV (β =-0.13, p = 0.009). Conclusions.1. It is shown the decrease of peak systolic velocity in the common carotid arteries with an increase in the severity of ischemic stroke on the NIHSS scale. 2. The reduction of CCA PSV exacerbates brain ischemia and reflecting disorders of autoregulation of cerebral blood flow.

Arterial Function after a 246 km Ultra-marathon Running Race.

There is little research about the effects of ultra-endurance exercise on arterial morphological and functional properties. The aim was to assess the acute changes of the carotid-femoral pulse wave velocity and carotid doppler-derived parameters following an ultra-marathon race as well as the intima-media thickness of the carotid artery in ultra-marathon runners. Twenty athletes were examined at baseline and within 10 mins after a 246 km running race. Measurements included carotid-femoral pulse wave velocity, peak-systolic and end-diastolic velocities of carotid artery blood flow, pulsatility and resistivity indices and blood biochemical parameters. The intima-media thickness of the right and left carotid artery was measured before the race. Arterial stiffness and carotid artery intima media thickness at rest remained within known normal limits. The ultra-marathon race significantly increased carotid-femoral pulse wave velocity by 22.6% and pulsatility index by 10.2%. There was a decrease in body weight by 3.35% and an increase of all biochemical markers of muscle damage after the race. Additionally, C-reactive protein was correlated with both pulsatility and resistivity indices post-race. This study shows that immediately after a 246 km ultra-marathon running race, acute increase of arterial stiffness and vascular resistance were evident. The carotid artery thickness of ultra-marathon runners was within normal range.

Lipidome association with vascular disease and inflammation in HIV+ Ugandan children.

HIV infection and antiretroviral therapy (ART) have both been linked to dyslipidemia and increased cardiovascular disease (CVD). The relationships among the lipidome, immune activation, and subclinical vascular disease in children with perinatally acquired HIV (PHIV) have not been investigated. Serum lipid composition, including 13 lipid classes constituting 850 different lipid species were measured by direct infusion-tandem mass spectrometry in samples from 20 ART-treated PHIV and 20 age-matched and sex-matched HIV- Ugandan children. All participants were between 10 and 18 years of age with no other known active infections. PHIVs had HIV-1 RNA level 50 copies/ml or less. In addition, common carotid artery intima--media thickness (IMT), as well as plasma marker of systemic inflammation (hsCRP, IL6, sTNFRa I), monocyte activation (soluble CD14 and CD163), and T-cell activation (expression of CD38 and HLA-DR on CD4+ and CD8+) were evaluated. Median age (Q1, Q3) of study participants was 13 years (11, 15), 37% were boys, 75% were on an NNRTI-based ART regimen. The concentrations of cholesterol ester, LCER, phosphatidylcholines, and sphingomyelin lipid classes were significantly increased in serum of PHIV compared with HIV (P≤0.04). Biomarkers associated with CVD risk including hsCRP, sCD163, and T-cell activation were directly correlated with lipid species in PHIV (P ≤ 0.04). Contents of free fatty acids including palmitic (16 : 0), stearic (18 : 0), and arachidic acid (20 : 0) were positively correlated with IMT in PHIV. Serum lipidome is altered in young virally suppressed PHIV on ART. A direct association between inflammation and lipid species known to be associated with CVD was observed.

Assessment of carotid artery intima media thickness in prehypertension

Introduction and Aim: Increased carotid artery intima media thickness (CIMT) has been linked to the development of cardiovascular disease (CVD). CVD is a major cause of mortality and morbidity in India. Increased CIMT has been documented in Hypertension (HT), thus putting them at a higher risk of CVD. Early identification and awareness of risk factors leading to increased morbidity and mortality could help in reducing its incidence. The aim of the study was to measure CIMTin prehypertensive Indian population.&#x0D; &#x0D; Materials and Methods:In this analytical observational study, common carotid artery IMT was measured using B mode ultrasonography in 46 individuals having blood pressure in the prehypertensive range and 46 individuals with normal blood pressure. Cardiovascular risk factors like body mass index(BMI),fasting blood glucose (FBS), and lipid profile, which are known to influence CIMT,were also assessed and compared between the two groups.&#x0D; &#x0D; Results:CIMT was significantly higher in prehypertensives as compared to subjects having normal blood pressure. BMI, FBS, and lipid profile was found to be comparable between the two groups.&#x0D; &#x0D; Conclusions:The presence of increased CIMT in prehypertensives as compared to controls indicates an increased risk of adverse cardiovascular events.

FETUIN A DEFICIENCY IS ASSOCIATED WITH ARTERIAL DAMAGE IN PEDIATRIC PATIENTS WITH PRIMARY HYPERTENSION

Abstract Objective: Circulating calcification inhibitors: fetuin A (FA) and osteoprotegerin (OPG) together with soluble ligand of the receptor activator of nuclear factor kappa-B (sRANKL) have been linked to vascular calcifications and subclinical arterial damage. The aim of the study was to evaluate the relationship between FA, OPG, sRANKL and arterial damage in children with primary hypertension (PH). Design and method: We performed cross-sectional analysis of FA, OPG, sRANKL, peripheral and central blood pressure (BP), ambulatory blood pressure monitoring (ABPM), parameters of arterial damage including common carotid artery intima media thickness (cIMT), pulse wave velocity (PWV), augmentation index normalized to heart rate of 75 beats per minute (AIx75HR) and ECHO-tracking (ET) analysis of carotid artery stiffness in 60 patients with PH (age: 14.84 ± 3.05 years) and 20 healthy children (age 14.11 ± 2.99 years). Results: Children with PH had significantly higher peripheral and central BP, BP in ABPM, thicker cIMT, higher PWV, and AIx75HR. FA was significantly lower in patients with PH compared to healthy peers (340.57 ± 70.43 vs. 389.19 ± 99.22 [mg/mL], P = 0.019) without differences in OPG, sRANKL, and OPG/sRANKL and OPG/FA ratios. In children with PH, FA level correlated negatively with cIMT Z-score and ET AIx; sRANKL level correlated negatively with ABPM, systolic blood pressure (SBP), SBP load, diastolic BP load, and AIx75HR; OPG/sRANKL ratio correlated positively with SBP load, while OPG/FA ratio correlated positively with ET AIx. In multivariate analysis FA was a significant determinant of cIMT [mm] and cIMT Z-score (beta = -0.208, 95%CI (-0.407 - -0.009), P = 0.041 and beta = -0.224, 95%CI (-0.435 - -0.013), P = 0.038, respectively). Conclusions: In children with PH arterial damage is related to fetuin A deficiency.

Point-of-Care Ultrasound (POCUS) in the Field of Diabetology.

Ultrasound is increasingly used in daily clinical practice to improve the efficiency of the clinical examination. In this article, we reviewed its various possible uses in the field of diabetology. The ultrasonic evaluation of the carotid arteries (plaques and intima media thickness) allows improving the assessment of the cardiovascular risk. Steatosis can be detected relatively easily on liver ultrasound. Ultrasound also allows a more sensitive detection of lipohypertrophy resulting in glycemic fluctuations and thus increasing the risk of hypoglycemia than the clinical examination. Finally, muscle ultrasound appears to be a promising tool to assess the nutritional status and its consequences (e.g., falls).