Carotid Color Doppler Research Articles

Correlation analysis of serum miR-145 and miR-210 with carotid artery stenosis and their predictive value for cerebral ischemic events

Objective To analyze the significance of serum miR-145 and miR-210 expression levels in the diagnosis of carotid artery stenosis. Methods During the same period, 55 healthy individuals who received physical examination in the same hospital were recruited as controls and assigned to a non-stenosis group. Among the included patients, there were 45 cases of mild stenosis, 14 cases of moderate stenosis, and 6 cases of severe stenosis after carotid color Doppler ultrasonography. The expression levels of miR-145 and miR-210 in serum were measured using real-time fluorescence quantitative polymerase chain reaction (qPCR) technology. Results The expression levels of serum miR-145 and miR-210 in carotid artery stenosis group were significantly lower than those in non-stenosis group (p < 0.001). Multivariate Logistic regression analysis showed that smoking history, diabetes, hypertension and total cholesterol were positively correlated with the occurrence of carotid artery stenosis (p < 0.05). The expression levels of miR-145 and miR-210 were significantly negatively correlated with carotid artery stenosis (p < 0.001). In addition, patients with carotid artery stenosis and low expression levels of miR-145 and miR-210 had a greater risk of cerebral ischemia (p < 0.05). Cox regression analysis showed that the low expression of miR-145 and miR-210 were independent predictors of cerebral ischemic events. ROC analysis confirmed that miR-145 and miR-210 had good diagnostic efficacy in cerebral ischemia (p < 0.001). Conclusion The decreased expression of miR-145 and miR-210 in serum is closely related to the diagnostic significance of carotid artery stenosis, and may be used to predict the occurrence of cerebral ischemic events.

The value of Lp(a) and TG/HDLC in peripheral blood to assess the stability of carotid plaque in patients with ischemic stroke.

The objective of this study was to investigate the relationship between lipoprotein (a) (Lp(a)), triglyceride/high-density lipoprotein cholesterol (TG/HDL-C), and the stability of carotid atherosclerotic plaque in patients with acute ischemic stroke. A total of 142 patients with acute ischemic stroke were selected and divided into group A (59 cases of stable plaque formation) and group B (83 cases of unstable plaque formation) according to the characteristics of carotid artery plaque formation detected by carotid color Doppler ultrasound. The serum Lp(a), lipid metabolism indexes, peripheral blood routine indexes, and related serum inflammatory factors indexes were compared between the two groups. Receiver operating characteristic curve and multivariate logistic regression model were used to analyze the relationship between each index and the formation of carotid unstable plaque. There were no significant differences in serum total cholesterol (TC), HDL-C, and low-density lipoprotein cholesterol (LDL-C) between groups A and B (p > .05). The values of Lp(a), TG, and TG/HDL-C in group B were higher than those in group A, and the differences were statistically significant (p < .05). There were no significant differences in serum TC, HDL-C, and LDL-C between groups A and B (p > .05). The values of Lp(a), TG, and TG/HDL-C in group B were higher than those in group A, and the differences were statistically significant (p < .05). The values of HBA1C, Lp-PLA2, CRP, CysC, Hcy, TNF-α, neutrophils, and NLR in group B were higher than those in group A, and the differences were statistically significant (p < .05). There was no significant difference in FPG, systolic blood pressure, diastolic blood pressure, Hb, white blood cells, platelets, and lymphocytes between groups A and B (p > .05). The results of logistic regression model showed that the increase of Lp(a), TG/HDL-C, HBA1C, Lp-PLA2, CRP, CysC, Hcy, and NLR could increase the risk of carotid artery unstable plaque in patients with ischemic stroke (p < .05). Lp(a) and TG/HDL-C have certain value in evaluating the stability of carotid atherosclerotic plaque in patients with acute ischemic stroke, and the increased levels of LP (a) and TG/HDL-C will significantly increase the risk of carotid unstable plaque in patients.

Predictive stroke risk model with vision transformer-based Doppler features.

Acute stroke is the leading cause of death and disability globally, with an estimated 16 million cases each year. The progression of carotid stenosis reduces blood flow to the intracranial vasculature, causing stroke. Early recognition of ischemic stroke is crucial for disease treatment and management. A computer-aided diagnosis (CAD) system was proposed in this study to rapidly evaluate ischemic stroke in carotid color Doppler (CCD). Based on the ground truth from the clinical examination report, the vision transformer (ViT) features extracted from all CCD images (513 stroke and 458 normal images) were combined in machine learning classifiers to generate the likelihood of ischemic stroke for each image. The pretrained weights from ImageNet reduced the time-consuming training process. The accuracy, sensitivity, specificity, and area under the receiver operating characteristic curve were calculated to evaluate the stroke prediction model. The chi-square test, DeLongtest, and Bonferroni correction for multiple comparisons were applied to deal with the type-I error. Only p values equal to or less than 0.00125 were considered to be statistically significant. The proposed CAD system achieved an accuracy of 89%, a sensitivity of 94%, a specificity of 84%, and an area under the receiver operating characteristic curve of 0.95, outperforming the convolutional neural networks AlexNet (82%, p<0.001), Inception-v3 (78%, p<0.001), ResNet101 (84%, p<0.001), and DenseNet201 (85%, p<0.01). The computational time in model training was only 30 s, which would be efficient and practical in clinical use. The experiment shows the promising use of CCD images in stroke estimation. Using the pretrained ViT architecture, the image features can be automatically and efficiently generated without human intervention. The proposed CAD system provides a rapid and reliable suggestion for diagnosing ischemic stroke.

Predicting coronary artery disease by carotid color doppler ultrasonography.

In this study, the color ultrasound indicators of carotid atherosclerosis (CAS) intima-media thickness (IMT) and atherosclerotic plaque (AP) were retrospectively analyzed for the prediction of CHD with the help of compressed speckle denoising. A total of 248 patients with suspected coronary atherosclerosis admitted to the Department of Cardiovascular Medicine of The First Affiliated Hospital of Harbin Medical University from August 2020 to January 2022 were retrospectively recruited as research subjects. The plaque detection rate (71.83%), IMT (1.26 ± 0.75) mm, and plaque index (PI) (2.31 ± 0.95) in the Obs group were greatly higher. The IMT and PI values in the patients with two CALs were superior to those in patients with a single CAL, and the IMT and PI values in the patients with three CALs were higher than those in patients with two CALs, illustrating considerable differences between the two groups (p < 0.05). The predictive sensitivity of IMT combined with AP was higher than that of IMT and AP (p < 0.05), and the predictive specificity of AP results was markedly inferior to that of IMT and IMT combined with AP (p < 0.05). The ultrasound examination of CAS had obvious predictive value for the occurrence and disease severity of CHD. The higher the IMT and AP, the higher the incidence and severity of CAD.

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

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

Incidental Detection of Thyroid Nodule on Carotid Color Doppler Ultrasound in Patients Presenting with Cerebrovascular Diseases

Background: Thyroid nodules are often detected in clinical practice, during physical examination, or accidentally during different imaging techniques. Most of these nodules are characterized as benign, and thyroid cancer is identified in only a small subclass. Ultrasonography is considered an important tool in thyroid nodule evaluation. Therefore, the study aimed to determine the frequency of incidental detection of a nodule of thyroid on carotid color Doppler ultrasound in patients presenting with cerebrovascular diseases. Methods: A cross-sectional descriptive study was carried out in the PNS Shifa hospital, Radiology department, from August 2017 to May 2018. Patients (n=110) underwent Color Doppler Ultrasound examinations with a scanner (Xario), furnished with a linear transducer operational at 10 MHz by the researcher. Incidental detection of thyroid nodule was labeled. Demographic detail including name, age, gender, and BMI was noted. Echogenicity and size of the thyroid gland was compared to that of encompassing glandular parenchyma. The data collected were analyzed and interpreted using SPSS version 20. Results: The patient’s mean age was 59.92 ± 11.03 years with the ratio being 1.2:1 between males and females respectively. Diabetes and hypertension were existent in 43(39.1%) and 54(49.1%) patients respectively. Family history of thyroid nodules was present in 31(28.2%) patients. Thyroid nodule was detected in 34(30.91%) patients. The Benign pattern of thyroid nodules on grayscale. However, the histologic pattern of a mildly differentiated follicular thyroid carcinoma was detected. Conclusion: The frequency of incidental detection of thyroid nodule on carotid color Doppler ultrasound was 30.91% in patients presenting with cerebrovascular diseases. Keywords: Carotid Color Doppler Ultrasound; Incidental Detection; Cerebrovascular; Thyroid Nodule.

Assessment of the predictive value of carotid color Doppler ultrasound Crouse score combined with high‐sensitivity C‐reactive protein in elderly diabetics with cerebral infarction

Both the carotid Crouse score and high-sensitivity C-reactive protein (hs-CRP) levels are commonly used to evaluate atherosclerosis and vascular inflammatory response. This study was to investigate the correlation between the Crouse score and hs-CRP and cerebral infarction (CI) in elderly diabetics. We compared the carotid Crouse scores and hs-CRP levels between two groups of diabetic patients with and without CIs (n = 100 each) and the relationship between changes in these indices and CI. Between the four groups (control, diabetic with a large CI, diabetic with a small CI, and diabetic with a lacunar CI) there was a significant difference in the age, sex, Crouse scores and hs-CRP levels, as well as fasting blood glucose (FBG) and glycated haemoglobin (HbA1c) (all p < 0.05). Logistic regression analysis with CI as the dependent variable showed that the age (odds ratio [OR] = 1.114, 95% confidence interval [CFI]: 1.063-1.167, p = 0.000), FBG (OR = 1.260, 95% CFI: 1.102-1.570, p = 0.039), HbA1c (OR = 2.036, 95% CFI: 1.348-3.703, p = 0.001), Crouse score (OR = 2.721, 95% CFI: 1.800-4.114, p = 0.000) and hs-CRP level (OR = 3.364, 95% CFI: 2.185-5.180, p = 0.000) were risk factors for a CI in combination with diabetes mellitus. Significant differences were found in age, diastolic blood pressure, Crouse scores and hs-CRP levels between the male diabetic-non-CI subgroup, female diabetic-non-CI subgroup, male diabetic-CI subgroup and female diabetic-CI subgroup (All p < 0.05). The carotid Crouse score method has high reliability and reflects the severity of carotid atherosclerosis. The age, sex, fasting blood glucose, HbA1c, Crouse score, an elevated hs-CRP level, and the occurrence of CI in elderly with diabetes mellitus are closely related.

Computer-aided diagnosis of ischemic stroke using multi-dimensional image features in carotid color Doppler

PurposeStroke is one of the leading causes of disability and mortality. Carotid atherosclerosis is a crucial factor in the occurrence of ischemic stroke. To achieve timely recognition, a computer-aided diagnosis (CAD) system was proposed to evaluate the ischemic stroke patterns in carotid color Doppler (CCD). MethodsA total of 513 stroke and 458 normal CCD images were collected from 102 stroke and 75 normal patients, respectively. For each image, quantitative histogram, shape, and texture features were extracted to interpret the diagnostic information. In the experiment, a logistic regression classifier with backward elimination and leave-one-out cross validation was used to combine features as a prediction model. ResultsThe performance of the CAD system using histogram, shape, and texture features achieved accuracies of 87%, 60%, and 87%, respectively. With respect to the combined features, the CAD achieved an accuracy of 89%, a sensitivity of 89%, a specificity of 88%, a positive predictive value of 89%, a negative predictive value of 88%, and Kappa = 0.77, with an area under the receiver operating characteristic curve of 0.94. ConclusionsBased on the extracted quantitative features in the CCD images, the proposed CAD system provides valuable suggestions for assisting physicians in improving ischemic stroke diagnoses during carotid ultrasound examination.

Cinnamon and Aspirin for Mild Ischemic Stroke or Transient Ischemic Attack: A Pilot Trial

Cinnamon can reduce levels of blood lipids, blood glucose, and inflammation, which are risk factors for ischemic stroke and transient ischemic attack (TIA).The goal of this study was to observe the safety and efficacy of aspirin combined with cinnamon in the treatment of patients with mild stroke or TIA. This pilot study included patients with mild stroke or TIA treated at Guangdong Provincial People's Hospital-Nanhai Hospital between January 2014 and December 2016. The primary end point was recurrent stroke (within 90 days after the first attack; intention-to-treat analysis). The secondary end points included biochemical indices, carotid color Doppler ultrasound, safety indices, and adverse reactions. A total of 122 patients were included, including 62 in the aspirin-cinnamon group (41 men and 21 women; mean age, 62.0 [3.5] years) and 60 in the aspirin-placebo group (40 men and 20 women; mean age, 63.0 [3.2] years). The number of participants with recurrent stroke was two (3.2%) and nine (15.0%) in the aspirin-cinnamon group and the aspirin-placebo group, respectively (P=0.002). Compared with aspirin-cinnamon, aspirin-placebo rates of unstable plaque and severe vascular stenosis were higher, whereas the rate of mild vascular stenosis with aspirin-cinnamon was higher than with aspirin-placebo (P < 0.05). One case of mild to moderate upper gastrointestinal bleeding in each group was observed. Among patients with TIA or mild ischemic stroke, the combination of cinnamon and aspirin could be superior to aspirin alone for reducing the risk of 90-day recurrent stroke.

Assessment of acetylsalicylic acid and clopidogrel resistance results of the patients with significant stenosis on carotid color Doppler ultrasonography

Assessment of acetylsalicylic acid and clopidogrel resistance results of the patients with significant stenosis on carotid color Doppler ultrasonography

Assessing Ischemic Stroke with Convolutional Image Features in Carotid Color Doppler

Stroke is a leading cause of disability and death worldwide. Early and accurate recognition of acute stroke is critical for achieving a good prognosis. The novel automated system proposed in this study was based on convolutional neural networks (CNNs), which were used to identify lesion findings on carotid color Doppler (CCD) images in patients with acute ischemic stroke. An image database composed of 1032 CCD images from 106 patients with acute ischemic stroke (549 images) and from 79 normal controls (483 images) was retrospectively analyzed. Taking the consensus of two neuroradiologists as the gold standard, different CNN models with and without transfer learning were evaluated with 10-fold cross-validation. The diagnostic information provided from individual color channels was also explored. AlexNet, which was trained from scratch, achieved an accuracy of 91.67%, a sensitivity of 93.33%, a specificity of 90.20% and an area under the receiver operating characteristic curves (AUC) of 0.9432. Other transferred models achieved accuracies between 77.69% and 83.94%. In channel comparisons, the green channel had the best performance, with an accuracy of 87.50%, a sensitivity of 97.78%, a specificity of 78.43% and an AUC of 0.9507. The proposed CNN architecture, as a computer-aided diagnosis system, suggests using automatic feature extraction from CCD images to predict ischemic stroke. The developed scheme has the potential to provide diagnostic suggestions in clinical use.

Effects of Neck Radiation on Result of Doppler Sonography of Carotid Arteries in Head and Neck Cancer Patients

PurposeThe aim of this study was to assess the effects of neck radiation on the results of Doppler sonography of carotid arteries in head and neck cancer patients. MethodsIn this prospective, cross-sectional study, 25 consecutive patients with head and neck cancers were assessed for carotid artery stenosis (CAS) by carotid color Doppler sonography before external radiotherapy and six months after external radiotherapy. Main outcome measures were peak systolic velocity (PSVs), end-diastolic velocities (EDVs) of the internal carotid artery (ICA), ICA/common carotid (CCA) ratios, and degree of stenosis. ResultsThe age of the enrolled patients at the initiation of radiotherapy was 57.9±11.8 years (mean±SD; range, 43–91 years), and only 4 (16%) of the 25 patients were female. The findings showed significant changes in the plaque degree and stenosis degree, and plaque size before and after external radiotherapy (P<0.05). Changes in degree of stenosis were significantly correlated with age (p=0.021). ConclusionAfter neck irradiation changes in the carotid artery may occur and cause subsequent neurologic events.

Silent brain infarcts and white matter lesions in patients with asymptomatic carotid stenosis.

The association of carotid atherosclerosis with silent brain infarcts (SBIs) and white matter lesions (WMLs) currently remains unknown. This study aims to compare SBIs, deep white matter lesions (DWMLs), and periventricular white matter lesions (PWMLs) in ipsilateral and contralateral hemispheres to internal carotid artery (ICA) stenosis, and investigate their association with stenosis grade in patients with asymptomatic ≥ 50% unilateral extracranial ICA stenosis. Patients without previous history of stroke and/or transient ischemic attack who had ≥ 50% stenosis in unilateral ICA on carotid color Doppler ultrasound were enrolled in the study. Patient demographics, vascular risk factors and ICA stenosis grades; number, location, and size of SBIs, DWMLs, and PWMLs in ICA territory were evaluated in both hemispheres using magnetic resonance imaging of the brain. Of the 69 patients, 53 had 50-69% (76.8%) and 16 had ≥ 70% (23.2%) unilateral ICA stenosis. There was no statistically significant difference in SBIs between ipsilateral and contralateral hemispheres to ≥ 50% ICA stenosis. Comparison of ICA stenoses as 50-69% and ≥ 70% revealed a greater number of patients with SBI in ipsilateral hemisphere to ≥ 70% stenosis compared to contralateral (p = 0.025). The number of SBIs was also higher in ipsilateral hemisphere to ≥ 70% stenosis compared to contralateral (p = 0.022). While DWMLs and PWMLs did not differ between hemispheres, frequency of Fazekas grade1 DWMLs was lower in ipsilateral hemisphere to either 50-69% or ≥ 70% ICA stenosis compared to contralateral (p = 0.035 and p = 0.025, respectively). Results of the present study indicate that stenosis grade may be relevant in the association between asymptomatic carotid stenosis and SBIs, and ≥ 70% stenosis may pose a risk of SBI development.

Clinical Applications of Ultrasonography in Neurocritically Ill Patients.

Ultrasonography is part of the multimodal monitoring of the neurocritical patient. Through transcranial color Doppler ultrasound, carotid-color Doppler ultrasound, and ocular ultrasound it is possible to diagnose and monitor a multitude of pathological conditions, such as cerebrovascular events, vasospasm, Terson syndrome, carotid atheromatosis, and brain death. Furthermore, these techniques enable the monitoring of the intracranial pressure, the cerebral perfusion pressure, and the midline deviation, which allows us to understand the patient's neurocritical pathology at their bedside, in a noninvasive way. Although none of these tools have yet been shown to improve patient prognosis, the dissemination of knowledge and management of neurovascular ultrasonography could significantly improve the comprehensive management of neurocritical patients.

Correlation between vestibular neuritis and cerebrovascular risk factors

PurposeTo investigate the relationship between cerebrovascular risk factors, including carotid plaques, and vestibular neuritis (VN). Materials and methodsAccording to the inclusion and exclusion criteria, this retrospective study included 90 VN patients and 74 age- and sex-matched healthy controls from January 2016 to December 2017. All subjects' records of cerebrovascular risk factors, such as age, sex, height, weight, history of hypertension and diabetes mellitus, living habits, serum levels of glucose, lipids, glycosylated haemoglobin (HbA1c), creatinine (CR), albumin (ALB), haemoglobin (HGB); and results of carotid colour Doppler ultrasound, were obtained and compared. ResultsNo significant differences in age; sex ratio; body mass index; history of hypertension or diabetes mellitus; or mean serum lipids, glucose, creatinine, haemoglobin or HbA1c were found between patients with VN and healthy controls (all P > 0.05). The mean serum ALB level was significantly lower in VN patients than in healthy controls (40.65 ± 3.77 vs 42.84 ± 4.32, P = 0.001).The prevalence of carotid plaques was significantly higher in VN patients than in healthy controls (36.67% vs. 16.22%, P = 0.003). Regression analyses demonstrated that a high frequency of carotid plaques was associated with VN with an odds ratio of 2.252 (95% CI 1.165–5.458, P = 0.019). ConclusionA high frequency of carotid plaques may be a risk factor for VN.

A cynomolgus monkey model of carotid atherosclerosis induced by puncturing and scratching of the carotid artery combined with a high-fat diet.

Cardio-cerebrovascular disease is one of the three major causes of mortality in humans and constitutes a major socioeconomic burden. Carotid atherosclerosis (CAS) is a very common lesion of the arterial walls, which leads to narrowing of the arteries, in some cases occluding them entirely, increasing the risk of cardiovascular events. The aim of the present study was to evaluate a cynomolgus monkey model of carotid atherosclerosis (CAS) induced by puncturing and scratching combined with a high-fat diet. A total of 12 cynomolgus monkeys were randomly divided into four groups: A, puncturing and scratching carotid artery intimas + high-fat diet (n=3); B, puncturing and scratching carotid artery intimas + regular diet (n=3); C, high-fat diet only (n=3); and D, regular diet only (n=3). Blood was harvested at weeks 4, 6 and 8 and plasma lipid levels were assessed. At week 8, monkeys were sacrificed and carotid arteries were harvested for hematoxylin and eosin (H&E) staining to observe pathological changes. The results revealed that a high-fat diet led to increased plasma lipid levels and accelerated plaque formation. Carotid color Doppler ultrasonography was performed and, along with H&E staining, revealed plaque formation in group A. In summary, the results of the present study suggest that a cynomolgus monkey model of CAS model may be successfully constructed by puncturing and scratching of the carotid artery intimas in combination with a high-fat diet.

Uniaxial Tensile Properties of Atherosclerotic Carotid Artery After Mobilization of Pushing on Qiao-Gong: A Safety Study Using an Animal Model of Carotid Atherosclerosis

ObjectivesThis study aimed to preliminarily explore the effects of the soft tissue mobilization of pushing on Qiao-Gong (MPQ) on biomechanical properties of the carotid artery using an animal model of carotid atherosclerosis (CAS). MethodsFifty rabbits were randomly divided into 4 groups: animals with CAS treated with MPQ (CAS-MPQ [n = 15]); animals with CAS treated without MPQ (CAS [n = 15]); normal animals treated with MPQ (normal-MPQ [n = 10]); and a blank control group (n = 10). The MPQ procedure consisted of soft tissue mobilization of the Qiao-Gong acupoint on the front edge of the sternocleidomastoid muscle applied from top to bottom, by flat pushing with the thumb repeatedly for 20 times. Disease in the CAS models was induced by carotid artery balloon injury combined with a high-fat diet for 12 weeks. At the end of modeling, carotid color Doppler ultrasonography examination was performed to confirm which animal models were successfully induced with CAS, excluding model rabbits without typical CAS at the same time. Then, MPQ was applied on rabbits in the CAS-MPQ and the normal-MPQ groups for 3 weeks. By contrast, rabbits in the other 2 groups were fed normally without MPQ. Uniaxial failure tests were later performed on carotid arteries in all 4 groups, and at the end of the study, a 2-way factorial analysis of variance of the results was conducted. Results(1) At the end of modeling, 10 rabbits in the CAS-MPQ group and 9 in the CAS group were included with typical carotid atherosclerotic characteristics. (2) Young’s elastic modulus of the rabbit carotid artery increased more significantly in the CAS-MPQ group than the CAS group. (3) Compared with normal rabbit carotid arteries, atherosclerotic carotid arteries had lower levels of ultimate stress and ultimate strain but higher levels of ultimate load. ConclusionsThe uniaxial tensile mechanical properties of the rabbit atherosclerotic carotid artery were impaired after MPQ.

Markers of subclinical atherosclerotic disease in HIV-infected individuals

BackgroundWider access to antiretroviral treatment (ART) has resulted in a decline in the number of people dying due to AIDS-related causes. However, with this increased longevity, accelerated rates of cardiovascular and atherosclerotic diseases are on the rise. We hypothesised that the prevalence of atherosclerotic cardiovascular diseases is greater in HIV/AIDS patients as compared to the normal population. Thus, we aimed to study the predictors of subclinical atherosclerotic disease in HIV-infected individuals. MethodsIn total, 168 HIV-positive individuals below 45 years of age (124 [73.08%] on ART and 44 [26.2%] ART naive) along with 150 age- and sex-matched healthy controls were recruited for this cross-sectional observational study. Carotid intimal medial thickness (cIMT), a surrogate marker of atherosclerosis, was assessed by a carotid colour doppler ultrasound and a mean of four measurements (both sides) were taken. cIMT was correlated with the age of the individuals, duration and type of ART, duration of disease and the level of immunodeficiency (CD4 cell count) along with conventional cardiac risk markers. ResultsIn 168 HIV-positive individuals, the mean CD4 cell count was 332.41 ±17.1 cells/mm3. The mean cIMT of all HIV-positive individuals was 0.712 ±0.039mm (0.596–0.840 mm) as compared to 0.616 ±0.023mm (0.540–0.655 mm) in HIV-negative individuals (P>0.001). cIMT in HIV-positive individuals on ART (subgroup A) was 0.723 ±0.034mm as compared to 0.682 ±0.038mm in HIV-positive individuals not on ART (subgroup B) (P>0.01). Low CD4 cell counts, longer duration of HIV infection, exposure to ART and longer duration of ART were found to be independent predictors of a higher cIMT in HIV-positive subjects whereas age, diastolic blood pressure, low HDL, smoking and high BMI were predictors of high cIMT in HIV-negative controls. No difference was observed in cIMT among patients on different ART regimens but individuals who were on nevirapine had higher cIMT as compared to those who were on efavirenz, both non-nucleoside reverse transcriptase inhibitors (NNRTIs). ConclusionsIndividuals with HIV infection (whether on ART or ART naive) have higher cIMT, and therefore a higher atherosclerotic burden, as compared to HIV-negative individuals. HIV infection itself, along with ART, overshadows conventional cardiac risk markers as a predictor of atherosclerotic disease in these individuals.

Correlation of Carotid Colour Doppler and MRI Brain in Patients Suffering from Cerebrovascular Disease

Correlation of Carotid Colour Doppler and MRI Brain in Patients Suffering from Cerebrovascular Disease

Risk factors between intracranial–extracranial atherosclerosis and anterior–posterior circulation stroke in ischaemic stroke

Objectives: Atherosclerosis is an important cause of stroke and remains a challenge for stroke prevention. Risk factors involved in atherosclerotic stroke and anterior and posterior circulation strokes (ACS and PCS, respectively) are different. The purpose of this study is to investigate differences in risk factors between intracranial and extracranial atherosclerosis (ICAS and ECAS), ACS and PCS, and ICAS/ECAS with ACS/PCS in a Chinese acute ischaemic stroke population.Methods: We analysed 551 ischaemic stroke patients who had been enrolled between August 2005 and July 2008. First, risk factors were compared between non-atherosclerosis, ICAS, ECAS, and combined ICAS and ECAS groups. ICAS and ECAS were assessed with transcranial Doppler and carotid colour Doppler ultrasound, respectively. Second, risk factors were compared between ACS and PCS groups. Stroke lesion was assessed with magnetic resonance imaging. Third, risk factors were compared in ICAS/ECAS associated with ACS/PCS.Results: The risk factor for ICAS was high diastolic blood pressure (OR, 1.075; 95% CI, 1.016–1.138; p = 0.013), and the risk factors for ECAS were age (OR, 1.113; 95% CI, 1.046–1.183; p = 0.001) and low density lipoprotein (OR, 1.450; 95% CI, 1.087–1.935; p = 0.012). Hypertension (OR, 1.090; 95% CI, 1.001–1.109; p = 0.027) was associated with PCS. Age (OR, 1.026; 95% CI, 1.011–1.128; p = 0.003), male gender (OR, 2.278; 95% CI, 1.481–3.258; p = 0.003) and age (OR, 1.067; 95% CI, 1.013–1.123; p = 0.014), scores of NIHSS (OR, 1.069; 95% CI, 1.012–1.130; p = 0.018) were risk factors for ICAS and ECAS with ACS, respectively.Conclusion: Risk factors are different between ICAS and ECAS, ACS and PCS, and ICAS/ECAS with ACS/PCS. Thus, targeted strategies are needed to consider these differences to prevent, treat and manage these diseases.