Carotid Ultrasound Examination Research Articles

P121 Background of the Development of Carotid and Femoral Atherosclerotic Plaques in Twins

IntroductionDevelopment of carotid and femoral atherosclerotic plaques proved to be heritable in previous studies. However, no comprehensive ultrasonographic evaluation of the volume and types of plaque has been performed.MethodsComprehensive carotid and femoral arterial ultrasound examination (Samsung RS85, arterial analysis, 15 MHz probe) was performed in 92 Hungarian twins (54 monozygotic, MZ and 38 dizygotic, DZ twin pairs, mean age 54 ± 13 years). The volume of plaques was automatically measured, and the plaque type was grouped according to echogenicity. Raw heritability was evaluated using the Falconer formula.ResultsNo heritability of the total number of carotid and femoral plaques and total plaque volume was detected. Although the number of carotid plaques themselves has been found to be hereditary (h2 = 0.492), the volume of carotid and femoral plaques as well as the number of femoral plaques were not heritable. More MZ twin pairs were discordant in the presence of soft plaques in the carotid artery as DZ twin pairs, but greater similarity in femoral plaques was not detected between MZ twins, which does not indicate a genetic background. The presence of calcified and mixed echogenic carotid plaques in the MZ twins was more concordant as in DZ twins, indicating inheritance.ConclusionThe total number and volume of carotid and femoral plaques are influenced by the environment. Different plaque types have different backgrounds: while calcified and mixed echogenic carotid plaques are more affected by genetics, soft carotid and femoral plaques are more affected by the environment.

Standardization of the carotid ultrasound examination: a review of current recommendations

Objective – to review current recommendations and other publications on standardization of the neck ultrasound examination protocol.It was analyzed of published articles and recommendations for standardization of the ultrasound study protocol such organizations as: American Institute of Ultrasound in Medicine (AIUM), American College of Radiology (ACR), Society of Radiologists in Ultrasound (SRU), American Society of Echocardiography ( ASE), Society of Vascular Medicine and Biology, European Association for Cardiovascular Imagin (EACVI), Ukrainian Association of Ultrasound Specialists (UAFUD), Ukrainian Doppler Club and others.Carotid ultrasound is a rapid non-invasive method for the diagnosis of atherosclerotic vascular injury, which is the method of choice for screening and primary assessment of the degree of stenosis. This method of imaging is very commonly used by practitioners both in Ukraine and abroad. Today there are a number of performance techniques and approaches to interpreting the results of Doppler ultrasound. The question of standardization of the neck ultrasound examination protocol to optimize the interaction of different physicians is nowadays raised.The main indications for ultrasound examination were determined, the main stages of ultrasound diagnostics of vessels of the neck were identified. The presence of certain differences regarding the recommendations of different organizations. The main criteria of stenosis of arteries of the neck were described.

Asymptomatic carotid stenosis is associated with mobility and cognitive dysfunction and heightens falls in older adults

BackgroundAtherosclerosis of the carotid bifurcation with plaque formation causes asymptomatic carotid artery stenosis (ACAS), which may also be associated with cerebral hypoperfusion. Cerebral hypoperfusion adversely affects multiple aspects of mobility and cognition. This study tests the hypothesis that community-dwelling older adults with a 50% or greater diameter-reducing ACAS will have mobility and cognitive impairments that heighten their risk for falls. MethodsEighty community-dwelling adults completed a mobility assessment (Short Physical Performance Battery, Berg Balance Scale, Four Square Step Test, Dynamic Gait Index, Timed Up and Go, and gait speed), self-reported physical function (Activities-Specific Balance Confidence, SF-12 Physical Function Component), and cognitive tests (Mini-Mental State Examination). Falls were recorded for the past 6 months. Standardized carotid ultrasound examination classified participants into no stenosis (<50% diameter reduction) (n = 54), moderate stenosis (50%-69%) (n = 17), and high-grade stenosis (70%-99%) (n = 9) groups. Linear and logistic regression analyses determined the associations between these measures and the degree of stenosis (three groups). ResultsLogistic regression analysis showed their degree of stenosis was associated with reductions in mobility (Short Physical Performance Battery [P = .008], Berg Balance Scale [P = .0008], Four Square Step Test [P = .005], DGI [P = .0001], TUG [P = .0004], gait speed [P = .02]), perceived physical function (ABC [P < .0001], SF-12 Physical Function Component [P < .0001]), and cognition (MMSE [P = .003]). Adults with moderate- and high-grade stenosis had a greater incidence of falls compared with those without stenosis (relative risk, 2.86; P = .01). Results remained unchanged after adjustment for age, sex and cardiovascular risk factors. ConclusionsACAS is associated with impaired mobility and cognition that are accompanied with increased fall risk. These impairments increased with worsening severity.

P3430Classification of pronounced subclinical atherosclerosis: deep learning approach of carotid intima media ultrasound images is superior to clinical risk factors

Abstract Background Carotid ultrasound measurements of subclinical atherosclerosis is extensively used in the research field of cardiovascular disease. Increased intima media thickness (IMT) and plaque detection have predictive value for cardiovascular events when added to traditional risk factors. However, among studies different protocols for measuring IMT (projections, mean or max values and sites) are used and methodological difficulties of plaque detection, together result in conflicting results. Recently, Deep Learning image driven classification methods, has been successfully applied in several medical imaging applications. Here we hypothesize that ultrasound image texture of the intima media complex accurately reflects the disease burden without the need to measure IMT values or detect plaques. Purpose To evaluate classification accuracy of ultrasound based deep learning approach of the intima media complex image compared to traditional risk factors for participants with no vs pronounced subclinical atherosclerosis. Methods Subjects from the VIPVIZA study (Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention, n: 3532, 40, 50 and 60 year old, 53% women) were selected for analysis. Bilateral carotid ultrasound examinations were performed according to a standardized protocol. Subjects were categorized in two groups as 1) pronounced subclinical atherosclerosis (n: 401) – bilateral plaques and estimated vascular age 10 years older, or 2) No subclinical atherosclerosis (n: 592) – no plaques and estimated ordinary vascular age. Traditional risk factors for the participants were estimated by the SCORE risk chart. A 1-cm wide region of the distal common carotid artery intima media complex was automatically segmented from the original B-mode images. The images were fed to a Deep Learning model, convolution neural network (CNN), trained using transfer learning model with 60% training data set and 40% evaluation data set. Classification performance was quantified using accuracy of ROC analysis. Results The mean age was 58 and 56 years in groups 1 and 2, respectively (with 43% and 56% women, respectively). The mean SCORE was 1.74 in group 1 and 1.09 in group 2. Classification based on SCORE had an area under the curve of 0.69 with an accuracy of 38%. The Deep learning approach had an area under the curve of 0.89 with an accuracy of 78%. Intima media image based classification Conclusion The results shows that ultrasound image texture of the intima media with Deep Learning approach can be used to detect pronounced disease without explicit measurement of IMT values or detection of plaques. With hard end-points, the approach could be used for risk stratification of subclinical atherosclerosis. Acknowledgement/Funding Västerbotten County Council, Swedish Research Council, Heart and Lung Foundation, Carl Bennet Ltd, Sweden.

P3416Bilateral carotid intima media thickness (cIMT) and plaque measurements was stronger associated with cardiovascular risk factors than unilateral measurements. Results from the VIPVIZA trial

Abstract Background Clinical risk factors of cardiovascular diseases (CVD) are related to atherosclerosis and cIMT and plaque are signs of early atherosclerosis. However, associations between risk factors and ultrasound variables are not fully established and comparison between studies is hampered by different imaging protocols. There is limited data regarding study population characteristics and ultrasound measurements differ regarding arterial bed, projections, and plaque definitions and inclusion Purpose 1/ To describe the distribution of asymptomatic atherosclerosis as assessed by carotid ultrasound in a middle-aged population at low/intermediate risk of CVD. 2/ To investigate the associations between clinical risk factors and a set of ultrasound variables Method Bilateral carotid ultrasound examinations were performed according to a standardized protocol in 3532 healthy VIPVIZA-participants with at least one conventional CVD risk factor. CIMT was measured in the distal far wall of CCA, 240o and 210o left and 150o and 120o right side, based on Meijer arch. For each angle, mean and max IMT was measured in a 10 mm segment. Plaques were identified according to the Mannheim consensus. Socio-economic data was also recorded. Associations between the risk factors and the set of ultrasound variables were quantified by a partial least squares (PLS) regression. A new compound ultrasound variable was computed, PLS UL, bya combining all IMT variables and plaque using the weights of the first PLS component. In a second step, to estimate how much risk factors explained the variability of the ultrasound results, associations between risk factors and both PLS UL and single cIMT variables and plaque were determined using step-wise linear regression modelling Results Mean age was 55.6 and 55.8 years among men and women (52.7% women), 13% were smokers in both sexes, and 50.8% and 39.3%, respectively, had carotid plaque. Mean of mean cIMT was 0.68 mm vs 0.64 mm (p&lt;0.001), and max cIMT was 0.90 mm vs 0.82 mm (p&lt;0.001), respectively. Overall, cIMT was slightly higher in the left compared to the right carotid. All ultrasound variables had similar univariate associations with clinical risk factors, positive associations for all risk factors except physical activity, fruit and vegetable consumption, education and HDL-cholesterol. The strongest association between risk factors and ultrasound variables was found with PLS UL (R2=23%), compared to single cIMT variables (R2=14–18%) and plaque (R2=15%). The pattern was similar in both sexes with most risk factors shared between the sexes. The association with factors and PLS UL was stronger among 40-year olds (R2=22%) than among 50- and 60-year olds (R=12%) Conclusion A combination of ultrasound variables are stronger associated to CVD risk factors than plaque or a single CIMT measurement. The pattern is similar in men and women. These findings are relevant for development of a consensus for cIMT measurements Acknowledgement/Funding Västerbotten County Council, the Swedish Research Council, the Heart and Lung Foundation, the Swedish Society of Medicin, Carl Bennet Ltd, Sweden

Changes in carotid artery structure with smoking cessation.

Carotid artery grayscale ultrasound echogenicity and texture features predict cardiovascular disease events. We evaluated the longitudinal effects of smoking cessation on four grayscale ultrasound measures. This was a secondary analysis of data from 188 age, sex, and body mass index (BMI)-matched smokers (94 eventual abstainers [EA], 94 continued smokers [CS]) from a smoking cessation trial that had carotid ultrasound examinations at baseline and after 3 years. General linear models that included time, smoking group (EA or CS), and a time*smoking interaction term were used to examine the impact of smoking abstinence on carotid artery grayscale marker values at year 3. Participants were mean (SD) 50.3 (11.4) years old (57% female, 86% white). The baseline grayscale median value (GSM) was inversely correlated with age, BMI, insulin resistance, and smoking pack-years (r = -0.20 to -0.30, p < 0.007 for all). There was a significant time*smoking status interaction for predicting GSM at year 3: GSM decreased significantly in the EA group compared to the CS group (-3.63 [13.00] vs CS 0.39 [12.06] units; p = 0.029). BMI increased more in the EA than the CS group (2.42 [3.00] vs CS 0.35 [2.57] kg/m2; p < 0.001). After adjusting for changes in BMI, the time*smoking status interaction no longer was significant (p = 0.138). From baseline to year 3, contrast increased similarly in both groups. Entropy and angular second moment did not change significantly in either group. Changes in carotid ultrasound echogenicity and grayscale texture features during a smoking cessation attempt are modest and mostly related to weight gain. Clinicaltrials.gov Identifier: NCT01553084.

Subclinical left ventricular dysfunction assessed by two-dimensional speckle tracking echocardiography in asymptomatic patients with carotid stenosis.

The relationship between subclinical left ventricular (LV) dysfunction and atherosclerosis may have been underestimated in the past, which might be responsible for the high incidence of premature death in individuals with carotid stenosis. We sought to evaluate the underlying myocardial dysfunction in asymptomatic carotid stenosis patients using speckle tracking echocardiography (STE). Fifty patients with carotid stenosis ≥ 50% and a preserved LV ejection fraction (LVEF), and 45 controls without carotid stenosis who were matched in terms of vascular comorbidities were enrolled. All participants underwent carotid ultrasound and echocardiographic examination. The global LV longitudinal strain (GLS) was measured using STE. Compared with the control group, the e' of the mitral annular velocity and GLS were decreased in asymptomatic carotid stenosis patients (p < 0.05), however, the LVEF was well preserved. Based on a predefined cutoff for subclinical LV systolic dysfunction that was defined at a GLS < - 18%, this dysfunction was detected in 22 patients with carotid stenosis (44%) and in 10 patients in the control group (22%) (p < 0.05). The GLS was negatively correlated with the levels of low-density lipoprotein cholesterol (r = - 0.356, p < 0.05) and triglyceride (r = - 0.396, p < 0.05). In conclusion,LV diastolic and systolic functioning were significantly decreased in patients with asymptomatic carotid stenosis, and dyslipidemia likely contributed to the subclinical LV dysfunction in these patients. Our findings indicated the importance of detecting LV subclinical dysfunction and early intervention in this patient population.

Examination of hemodynamic environments of carotid stenosis with computational fluid dynamics

IntroductionCarotid arterial geometry is an independent risk factor for carotid stenosis, in which hemodynamics, classically low oscillatory shear stress, is thought to be involved. However, there are few reports indicating quantitative analyses of hemodynamic environments in carotid stenosis. Thus, we are conducting a prospective clinical study with computational fluid dynamic techniques, and 454 cases of carotid stenosis have been registered to date. Here, we focused on unilateral stenotic cases among them and compared hemodynamic distributions between stenotic and non‐stenotic sides. We also examined hemodynamic distributions of carotid arteries after releasing stenosis by carotid endarterectomy.MethodsHemodynamic distributions were examined using ANSYS‐CFX software. Patient‐specific arterial geometries and inflow velocities were obtained from 3‐dimensional computed tomographic angiography and carotid ultrasound Doppler examinations, respectively.ResultsIn both the stenotic area and the area proximal to the stenotic area, hemodynamic metrics indicating the magnitude of time‐averaged wall shear stress (TAWSS) were significantly higher compared with the non‐stenotic side (p=0.0027 and 0.0007, rspectively), whereas WSS disturbance‐based metrics, i.e. oscillating shear index (OSI, p=0.0006 and 0.0008) and normalized transverse WSS (NtransWSS, p&lt;0.0001 and p=0.0029), were rather lower. However, in the region distal to the stenotic area, OSI (p=0.0009) and NtransWSS (p=0.0021), but not TAWSS (p=0.4564), were significantly higher as compared with the same area of non‐stenotic side (Figure). WSS gradient on carotid bulb after carotid endarterectomy was significantly higher compared with controls (p=0.037), suggesting that the carotid arteries may primarily have geometric risks for stronger hemodynamic stress.ConclusionsThe results suggested that hemodynamic environments in carotid stenosis are more complex than previously thought. High WSS in the stenotic area and enhanced WSS disturbance downstream of the stenotic area may be associated with progression of stenosis and plaque rupture.Support or Funding InformationThis study is supported by the Grant‐in‐Aid for the Japanese National Hospital Organization Multi‐Center Clinical Research, AMED under Grant Number JP15gm0810006h0301, and JSPS KAKENHI Grant Number 15K10323.This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.

Matrix Metalloproteinases in COPD and atherosclerosis with emphasis on the effects of smoking.

BackgroundMatrix metalloproteinases (MMP´s) are known biomarkers of atherosclerosis. MMP´s are also involved in the pathophysiological processes underlying chronic obstructive pulmonary disease (COPD). Cigarette smoking plays an important role in both disease states and is also known to affect the concentration and activity of MMP´s systemically. Unfortunately, the epidemiological data concerning the value of MMP´s as biomarkers of COPD and atherosclerosis with special regards to smoking habits are limited.Methods450 middle-aged subjects with records of smoking habits and tobacco consumption were examined with comprehensive spirometry, carotid ultrasound examination and biomarker analysis of MMP-1, -3, -7, -10 and -12. Due to missing data 33 subjects were excluded.ResultsThe remaining 417 participants were divided into 4 different groups. Group I (n = 157, no plaque and no COPD), group II (n = 136, plaque but no COPD), group III (n = 43, COPD but no plaque) and group IV (n = 81, plaque and COPD). Serum levels of MMP-1,-7,-10-12 were significantly influenced by smoking, and MMP-1, -3, -7 and-12 were elevated in subjects with COPD and carotid plaque. This remained statistically significant for MMP-1 and-12 after adjusting for traditional risk factors.ConclusionCOPD and concomitant plaque in the carotid artery were associated with elevated levels of MMP-1 and -MMP-12 even when adjusting for risk factors. Further studies are needed to elucidate if these two MMP´s could be useful as biomarkers in a clinical setting. Smoking was associated with increased serum levels of MMP´s (except for MMP-3) and should be taken into account when interpreting serum MMP results.

Serum irisin and apelin levels and markers of atherosclerosis in patients with subclinical hypothyroidism.

In this study, we aimed to evaluate serum irisin and apelin levels in patients with subclinical hypothyroidism (SCH) when they were subclinical hypothyroid and become euthyroid after levothyroxine therapy and association of these adipokines with markers of atherosclerosis such as serum homocysteine levels and carotid intima-media thickness (IMT). The study included 160 patients with newly diagnosed subclinical hypothyroidism due to Hashimoto's thyroiditis and 86 euthyroid healty subjects. Serum glucose and lipid profile, insulin, HOMA, TSH, free T3, free T4, anti-thyroperoxidase and anti-thyroglobulin antibodies, homocysteine, apelin and irisin levels were measured in all study subjects. Thyroid and carotid ultrasound examinations were performed. The subclinical hypothyroid group was reevaluated after 12-weeks of levothyroxine therapy when they became euthyroid. Clinical characteristics of the patient and control group were similar. Glucose, insulin and HOMA levels, lipid parameters and free T3 were similar between the two groups.. Serum homocystein was higher and apelin was lower in patients with SCH, but irisin levels were similar between the two groups. While thyroid volume was lower, carotid IMT was significantly greater in patients with SCH (pCarotidIMT:0,01). After 12-weeks of levothyroxine therapy, all the studied parameters remained unchanged except, serum freeT4, TSH, homocystein and apelin. While homocystein decreased (p: 0,001), apelin increased significantly (p = 0,049). In multivariate analysis, low apelin levels significantly contributed to carotid IMT (p = 0,041). Apelin-APJ system may play a role in vascular and cardiac dysfunction in patients with SCH and treatment of this condition may improve the risk of cardiovascular disease.

Consideration of stringlike artifacts detected during carotid ultrasound examination

Consideration of stringlike artifacts detected during carotid ultrasound examination

Brief Report: Hyperbilirubinemia Is Associated With a Decreased Risk of Carotid Atherosclerosis in HIV-Infected Patients on Virological Suppression.

To investigate the association between total, direct, and indirect bilirubin and the presence of carotid lesions in a large sample of HIV-1-infected patients on virological suppression. Retrospective study on adult HIV-1-infected patients, with a carotid ultrasound (CUS) examination performed between January 2008 and August 2016, with HIV-RNA <50 copies per milliliter at CUS and without previous cardiovascular events. Intima media thickness was measured in 4 segments: carotid common artery and bifurcation on the left and right sides. Carotid lesion was defined as an intima media thickness ≥1.5 mm in ≥1 region at CUS. Patients were classified as: normal if all bilirubin values before CUS were below the upper normal limit and with hyperbilirubinemia if ≥1 bilirubin value above upper normal limit before CUS was recorded. Multivariate logistic regression was used to determine whether hyperbilirubinemia showed association with the presence of ≥1 carotid lesion, after adjusting for confounding factors. Overall, 903 patients were evaluated, 511 with ≥1 and 392 without carotid lesions. At multivariate analysis, total [adjusted odds ratio (95% confidence interval) 0.57 (0.36 to 0.90), P = 0.016] and indirect hyperbilirubinemia before CUS [adjusted odds ratio (95% confidence interval) 0.62 (0.40 to 0.97), P = 0.036] were associated with a lower risk of carotid lesions in addition to younger age, negative hepatitis C virus antibodies, higher nadir CD4, lower low-density lipoprotein cholesterol, higher high-density lipoprotein cholesterol, lower triglycerides, and no use of statin; no effect of atazanavir treatment on carotid lesions was detected. In HIV-1-treated patients, total or indirect hyperbilirubinemia was likely associated with the absence of carotid lesions.

Subclinical parameters of arterial stiffness and arteriosclerosis correlate with QRISK3 in systemic lupus erythematosus.

It is well known that cardiovascular diseases (CVD) are a major contributor of death in systemic lupus erythematosus (SLE) as well in other rheumatic illness. In the last decades, there has been a growing development of different methodologies with the purpose of early detection of CVD. Objective: The aim of this study is to correlate the usefulness of subclinical parameters of vascular aging and QRISK 3–2017 score for early detection of CVD in SLE. Methods: Clinical assessment including systemic lupus erythematosus disease activity index (SLEDAI) and systemic lupus international collaborating clinics / american college of rheumatology damage index (SLICC/ACR DI), laboratory measurements, carotid ultrasound examination, carotid intima media thickness (cIMT) measurement, carotid distention and diameter analysis, arterial stiffness measurement measured by tonometry and QRISK 3–2017 were done. All results were analyzed by SPSS 24 software. Results: We observed correlation between QRISK3 and mean cIMT (rs = 0.534, P < 0.001), PWV (rs = 0.474, P < 0.001), cfPWV (rs = 0.569, P < 0.001) and distensibility (rs = -0.420, P = 0.006). Consistent with above, SLE patients in middle and high risk QRISK 3–2017 showed increased arterial stiffness versus low risk group. Conclusions: We encourage to the rheumatology community to assess cardiovascular risk in SLE patients with QRISK 3–2017 risk calculator as an alternative method at the outpatient clinic along a complete cardiovascular evaluation when appropriate.

Handheld versus conventional vascular ultrasound for assessing carotid artery plaque

BackgroundCoronary Artery Disease (CAD) is the leading cause of death worldwide. Ultrasound-detected carotid plaque has been previously shown to predict significant CAD. Despite this evidence, carotid plaque assessment has not been implemented in cardiac risk screening, likely due to the cost associated with a formal carotid ultrasound examination. This study sought to determine whether a handheld vascular ultrasound device could be used as an accurate point-of-care imaging tool for the assessment of carotid artery plaque. MethodsWe performed a focused vascular ultrasound of the carotid arteries of 200 patients referred for coronary angiography using a handheld ultrasound device as well as a full-size conventional ultrasound system. For each participant, the maximum plaque height (MPH) and total plaque area (TPA) of the carotid artery bulbs were measured. ResultsCarotid plaque assessment using the handheld device was comparable to that of the conventional ultrasound system. We found a good correlation and no relevant bias between handheld and conventional ultrasound systems in measuring MPH (r = 0.84, p < 0.0001) and TPA (r = 0.94, p < 0.0001). Furthermore, there was good inter-rater reliability for online and offline measurements of MPH and offline measurements of TPA by handheld ultrasound (0.79, 0.76 and 0.85, respectively). ConclusionsThis study demonstrates that a focused ultrasound of the carotid artery using a handheld device can be used to accurately measure MPH and TPA. This protocol has the potential to provide an expedited point-of-care assessment of carotid plaque.

Evaluation of spatial distribution and characterization of wall shear stress in carotid sinus based on two-dimensional color Doppler imaging

ObjectiveThis study aims to use a wall shear stress (WSS) quantitative analysis software to analyze and evaluate the carotid sinus WSS spatial distribution and characteristics in intima-media thickness (IMT) normal and thickening group by using two-dimensional color doppler flow imaging (CDFI) so as to assist clinicians to predict the location and risk of plaque formation.MethodsAccording to IMT, 50 subjects was selected as IMT thickening group and 50 subjects as IMT normal group from subjects who had a carotid ultrasound examination in Shanghai East hospital during October 2016 to October 2017. This study presents the spatial distribution of the carotid sinus WSS based on the WSS quantitative analysis software and compared the spatial distribution and characteristics of the carotid sinus WSS between IMT thickening group and IMT normal group through two- and three-dimensional WSS maps and a fused WSS image.ResultsThe distributional regularity of WSS in both two group was: carotid sinus < common carotid artery (CCA) < internal carotid artery (ICA) and posterior-interior wall of the carotid sinus < the anterior-lateral wall of the carotid sinus. Furthermore, the WSS of CCA, ICA, the anterior-lateral proximal wall of the carotid sinus, the anterior-lateral distal wall of the carotid sinus, the posterior-interior proximal wall of the carotid sinus, and the posterior-interior distal wall of the carotid sinus in IMT thickening group was lower than the corresponding part of IMT normal group (P < 0.05).ConclusionIn summary, this WSS quantitative analysis framework by two-dimensional CDFI can measure and reflect the carotid sinus WSS spatial distribution and characteristics more accurately and visually. As a convenient tool, it may be used for clinical prediction of the plaque formation in carotid sinus in the future.

A17161 Carotid intimomedial thickness as a primary marker of atherosclerosis in 100 patients of chronic kidney disease aged above 50 years

Objectives: Atherosclerosis is a slowly progressive diffuse degenerative disease of arteries which can lead to various metabolic and cardiovascular complications. However, it can cause early and significant morbidity in patients with chronic kidney disease (ckd) when compared to general population. Indirect evidence of accelerated atherosclerosis in CKD comes from studies measuring carotid artery intima media thickness and clinical and metabolic features in CKD patients Methods: In this prospective case control study, 100 patients with CKD having a disease duration of more than 5 years were compared to 100 healthy matched controls. All the patients and controls were asymptomatic for atherosclerosis and had no traditional risk factors for atherosclerosis. Both groups underwent high frequency carotid ultrasound and Doppler examination for CIMT in addition to detailed history, physical examination and measurement of other metabolic parameters. Results: The mean ages of CKD group and the control group were 56 ± 14.4 and 54.6 ± 14.0 respectively. The groups were comparable for atherogenic biochemical risk indices such as body mass index (BMI), systolic and diastolic blood pressure, random blood sugar, and lipid profile. The CKD group had a significant elevation of CRP as compared to the control group (88% vs 15%). The mean CIMT of the CKD group was 0.86 ± 0.18 and that of the control group was 0.53 ± 0.15, a difference which was statistically significant (p < 0.0001). Conclusion: CKD is a chronic disease associated with chronic subclinical inflammation. In view of the consequent high risk of atherosclerosis seen in these patients CIMT may serve as an early surrogate marker of atherosclerosis. We can identify these high risk subgroups of patients with a simple, reliable, inexpensive, and non-invasive bedside carotid Doppler

Gut Microbiota in Patients with Different Metabolic Statuses: Moscow Study.

The aim of this paper was to study gut microbiota composition in patients with different metabolic statuses. Methods: 92 participants aged 25–76 years (26 of whom were men), with confirmed absence of cardiovascular and other chronic diseases (but with the possible presence of cardiovascular risk factors) were included. Carotid ultrasound examinations, 16S rRNA sequencing of stool samples and diet assessments were performed. Statistical analysis was performed using R programming language, 3.1.0. Results: Enterotyping yielded two clusters differentiated by alpha-diversity. Intima-media thickness was higher in the cluster with lower diversity (adj. p < 0.001). Obesity was associated with higher Serratia (adj. p = 0.003) and Prevotella (adj. p < 0.0003) in relative abundance. Abdominal obesity was associated with higher abundance of Serratia (adj. p = 0.004) and Prevotella (adj. p = 0.0008) and lower levels of Oscillospira (adj. p = 0.0005). Glucose metabolism disturbances were associated with higher Blautia (adj. p = 0.0007) and Serratia (adj. p = 0.003) prevalence. Arterial hypertension was associated with high Blautia levels (adj. p = 0.002). The Blautia genus strongly correlated with low resistant starch consumption (adj. p = 0.007). A combination of high-fat diet and elevated Blautia levels was very common for diabetes mellitus type 2 patients (adj. p = 0.0001). Conclusion: The results show that there is a relationship between metabolic changes and higher representation of opportunistic pathogens and low diversity of gut microbiota even in apparently healthy participants.

NESVS16. Carotid Duplex Velocity Criteria Recommended by the Society of Radiologists in Ultrasound and Endorsed by the Intersocietal Accreditation Commission Lack Predictive Ability for Identifying High-Grade Carotid Artery Stenosis

Carotid duplex ultrasound is the first-line imaging modality for characterizing degree of carotid artery stenosis. The Intersocietal Accreditation Commission, in published guideline documents, has endorsed use of the Society of Radiologists in Ultrasound (SRU) criteria to characterize ≥70% stenosis: peak systolic velocity (PSV) ≥230 cm/s. We sought to perform a validation of the SRU criteria using computed tomography (CT) angiography as a “gold standard” imaging modality and to perform a sensitivity analysis to determine optimal velocity criteria for identifying ≥80% stenosis. We queried all carotid duplex ultrasound examinations performed at our institution between 2008 and 2017. Patients with ≥70% carotid stenosis, based on previous criteria, and further narrowed to those with minimum PSV ≥300 cm/s or end-diastolic velocity (EDV) ≥100 cm/s were identified. Of these patients, those who also had CT angiography of the neck within 1 year formed the study cohort. Patients who underwent carotid revascularization between the two imaging dates were excluded. Degree of stenosis, as reported from the CT angiogram, was considered the true degree of stenosis. Receiver operating characteristic curves were generated to evaluate the SRU criteria and to identify the optimal discrimination threshold for high-grade carotid stenosis. Of 37,204 carotid duplex ultrasound examinations, 3478 arteries met criteria for ≥70% stenosis. Of these, 344 patients had CT angiography within 1 year of the carotid duplex ultrasound examination (mean time between studies, 55 days; standard deviation, 6.5), and 240 (69.8%) were consistent with ≥80% carotid stenosis. The predictive ability of the SRU criteria to identify ≥70% stenosis was poor, with an area under the curve of 0.51. A sensitivity analysis to identify ≥80% stenosis demonstrated the optimal discrimination threshold to be PSV ≥450 cm/s or EDV ≥120 cm/s, with an area under the curve of 0.66 (Fig). In this validation study, the SRU criteria, endorsed by the Intersocietal Accreditation Commission, to identify ≥70% carotid stenosis have no predictive value. For detection of ≥80% stenosis, the optimal criteria are PSV ≥450 cm/s and EDV ≥120 cm/s. This study demonstrates the critical importance of carotid duplex ultrasound examination validation.

Carotid Ultrasound Examinations: Indications Correlated With Abnormal Findings.

Our purpose was to evaluate the clinical indications for carotid duplex ultrasonography and determine for each indication how often carotid artery disease was identified.We retrospectively reviewed the consecutive reports for 3191 carotid ultrasound examinations. We tracked 14 indications to determine how often examinations were requested for each indication and correlated each indication with the finding of carotid artery disease.We found 26.5% of all examinations were abnormal; 17.5% of patients showed internal carotid artery disease; 10.9%, a moderate stenosis; 5.2%, a severe stenosis; and 1.4%, a total occlusion. For each of the 14 individual indications, with 1 exception, carotid ultrasound examination showed a 19.7% or greater chance of an abnormal result and an 11.6% or greater chance of finding a flow-limiting stenosis of an internal carotid artery.Our results validate the collaborative position of the American College of Radiology, the American Institute of Ultrasound in Medicine, the Society for Pediatric Radiology, and the Society of Radiologists in Ultrasound that, overall and for almost all indications they enumerate, carotid ultrasound examinations are a proven and useful procedure for evaluating extracranial carotid artery disease.

Acute Cardiovascular Adaptation to Strenuous Exercise: An Integrative Ultrasound Study.

The aim of this study was to evaluate the acute effects of participation in an Ironman distance triathlon competition on arterial function by ultrasound, in relation to cardiac function and body water content. Twenty-eight male triathletes participating in an Ironman distance competition underwent carotid, femoral, and cardiac ultrasound examinations. Moreover, the presence of extravascular lung water was identified by lung echo B-lines (echogenic coherent wedge-shaped signal with a narrow origin from the hyperechoic pleural line) at rest and within 20 minutes of arrival. At the end of the competition, athletes showed an increased heart rate (mean ± SD, from 60.2 ± 13.1 to 82.8 ± 15.6 beats/min; P < .0001) and unchanged mean blood pressure (from 93 ± 14 to 91 ± 10 mm Hg; P > .05) in the presence of negligible dehydration (total body water from 48.0 ± 4.0 to 46.5 ± 3.9 kg; P > .05). Cardiac output increased (from 5.5 ± 1.2 to 6.7 ± 2.4 L/min; P < .05) in the presence of an unchanged stroke volume (from 64 ± 14 to 59 ± 16 mL; P > .05) and unchanged left ventricular elastance (from 1.52 ± 0.48 to 1.39 ± 0.48 mm Hg/mL/m2 ; P > .05). The mean carotid diameter increased (from 7.19 ± 0.65 to 7.61 ± 0.76 mm; P < .05), whereas the mean femoral diameter was unchanged at the end of the competition (from 10.41 ± 0.83 to 10.49 ± 0.82 mm; P > .05). Carotid intima-media thickness was significantly reduced (from 537 ± 70 to 495 ± 70 μm; P < .05), whereas B-lines increased significantly after the competition (from 1 [0-4] to 12 [5-23]; P < .0001). These data suggest different acute functional adaptation in central arteries with respect to peripheral leg vessels.