Carotid Ultrasound Measurements Research Articles

Questioning the Role of Carotid Artery Ultrasound in Assessing Fluid Responsiveness in Critical Illness: A Systematic Review and Meta-Analysis.

A noninvasive and accurate method of identifying fluid responsiveness in hemodynamically unstable patients has long been sought by physicians. Carotid ultrasound (US) is one such modality previously canvassed for this purpose. The aim of this novel systematic review and meta-analysis is to investigate whether critically unwell patients who are requiring intravenous (IV) fluid resuscitation (fluid responders) can be identified accurately with carotid US. The protocol was registered with PROSPERO on the 30/11/2022 (ID number: CRD42022380284). Studies investigating carotid ultrasound accuracy in assessing fluid responsiveness in hemodynamically unstable patients were included. Studies were identified through searches of six databases, all run on 4 November 2022, Medline, Embase, Emcare, APA PsycInfo, CINAHL, and Cochrane Library. Risk of bias was assessed using the QUADAS-2 and the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) guidelines. Results were pooled, meta-analysis was conducted where amenable, and hierarchical summary receiver operating characteristic models were established to compare carotid ultrasound measures. Seventeen studies were included (n = 842), with 1048 fluid challenges. 441 (42.1%) were fluid responsive. Four different carotid US measures were investigated, including change in carotid doppler peak velocity (∆CDPV), carotid blood flow (CBF), change in carotid artery velocity time integral (∆CAVTI), and carotid flow time (CFT). Pooled carotid US had a pooled sensitivity, specificity, and AUROC with 95% confidence intervals (CI) of 0.73 (0.66-0.78), 0.82 (0.72-0.90), and 0.81 (0.78-0.85), respectively. ∆CDPV had sensitivity, specificity, and AUROC with 95% CI of 0.72 (0.64-0.80), 0.87 (0.73-0.94), and 0.82 (0.78-0.85), respectively. CBF had sensitivity, specificity, and AUROC with 95% CI of 0.70 (0.56-0.80), 0.80 (0.50-0.94), and 0.77 (0.78-0.85), respectively. Risk of bias and assessment was undertaken using the QUADAS-2 and GRADE tools. The QUADAS-2 found that studies generally had an unclear or high risk of bias but with low applicability concerns. The GRADE assessment showed that ∆CDPV and CBF had low accuracy for sensitivity and specificity. It appears that carotid US has a limited ability to predict fluid responsiveness in critically unwell patients. ∆CDPV demonstrates the greatest accuracy of all measures analyzed. Further high-quality studies using consistent study design would help confirm this.

Quantitative assessment of carotid ultrasound diameter measurements in the operating room: a comparable analysis of long-axis versus rotated and tilted orientation

Objective. Carotid ultrasound (US) has been studied as a non-invasive alternative for hemodynamic monitoring. A long-axis (LA) view is traditionally employed but is difficult to maintain and operator experience may impact the diameter estimates, making it unsuitable for monitoring. Preliminary results show that a new, i.e. rotated and tilted (RT) view is more robust to motion and less operator-dependent. This study aimed to quantitatively assess common carotid diameter estimates obtained in a clinical setting from an RT view and compare those to corresponding estimates obtained using other views. Approach. Carotid US measurements were performed in 30 adult cardiac-surgery patients (26 males, 4 females) with short-axis (SA), LA, and RT probe orientations, the first being used as a reference for measuring the true vessel diameter. Per 30 s acquisition, the median and spread in diameter values were computed, the latter representing a measure of robustness, and were statistically compared between views. Main results. The median (IQR) over all the patients of the median diameter per 30 s acquisition was 7.15 (1.15) mm for the SA view, 7.03 (1.51) mm for the LA view, and 6.99 (1.72) mm for the RT view. The median spread in diameter values was 0.18 mm for the SA view, 0.16 mm for the LA view, and 0.18 mm for the RT view. There were no statistically significant differences between views in the median diameter values (p = 0.088) or spread (p = 0.122). Significance. The RT view results in comparable and equally robust median carotid diameter values compared to the reference. These findings open the path for future studies investigating the use of the RT view in new applications, such as in wearable ultrasound devices.

Correlation between intravascular pressure gradients and ultrasound velocities in carotid artery stenosis: An exploratory study.

Grading of carotid stenosis is routinely performed with non-invasive techniques, such as carotid ultrasound (CUS) and computerized tomography angiography (CTA), which have limitations in grading definition. Moreover, the actual hemodynamic impact of a stenosis remains poorly defined. Preliminary studies explored the application of the resting full-cycle ratio (RFR), measured with pressure wire (PW), but the correlation between RFR and morphological/hemodynamic parameters is still undefined. This study aims to test the correlation between RFR and CUS-CTA-DSA based degree of stenosis, to define the suitability of RFR as carotid stenosis index. We included patients with symptomatic carotid stenosis receiving carotid artery stenting (CAS), between November 2022 and May 2023. We performed CUS and PW measurements before and after stenting, at four different sites (trans-lesion, distal cervical, petrous and supraclinoid internal carotid artery [ICA] segments). We compared CUS and PW parameters by Pearson's or Spearman test for continuous variables. Among 15 patients included the mean stenosis degree was 81.3%. Trans-lesion RFR was significantly higher than other sites (0.72 ± 0.2 trans-lesion vs. 0.69 ± 0.18 distal cervical ICA vs. 0.66 ± 0.2 petrous ICA vs. 0.6 ± 0.2 intracranial ICA, p < 0.05). All RFR values significantly increased after treatment; the highest relative increase was registered at stenosis site (0.72 ± 0.2 pre-stent vs. 1.01 ± 0.1 post-stent, p < 0.01). Trans-lesion RFR was significantly associated with the CTA and DSA stenosis degree and CUS measurements. Pressure wire in carotid artery stenosis seems safe and suitable. Resting full-cycle ratio has a significant correlation with CUS values and stenosis degree and might be used as carotid stenosis index during CAS.

Non-Invasive Pressure-Only Aortic Wave Intensity Evaluation Using Hybrid Fourier Decomposition-Machine Learning Approach.

The clinical significance of the wave intensity (WI) analysis for the diagnosis and prognosis of the cardiovascular and cerebrovascular diseases is well-established. However, this method has not been fully translated into clinical practice. From practical point of view, the main limitation of WI method is the need for concurrent measurements of both pressure and flow waveforms. To overcome this limitation, we developed a Fourier-based machine learning (F-ML) approach to evaluate WI using only the pressure waveform measurement. Tonometry recordings of the carotid pressure and ultrasound measurements for the aortic flow waveforms from the Framingham Heart Study (2640 individuals; 55% women) were used for developing the F-ML model and the blind testing. Method-derived estimates are significantly correlated for the first and second forward wave peak amplitudes (Wf1, r = 0.88, p 0.05; Wf2, r = 0.84, p 0.05) and the corresponding peak times (Wf1, r = 0.80, p < 0.05; Wf2, r = 0.97, p 0.05). For backward components of WI (Wb1), F-ML estimates correlated strongly for the amplitude (r = 0.71, p 0.05) and moderately for the peak time (r = 0.60, p 0.05). The results show that the pressure-only F-ML model significantly outperforms the analytical pressure-only approach based on the reservoir model. In all cases, the Bland-Altman analysis shows negligible bias in the estimations. The proposed pressure-only F-ML approach provides accurate estimates for WI parameters. The pressure only F-ML approach introduced in this work expand the clinical usage of WI into inexpensive and non-invasive settings such as wearable telemedicine.

Immediate hemodynamic effects of transcatheter aortic valve replacement on left ventricular stroke volume and carotid artery blood flow

IntroductionTranscatheter aortic valve replacement (TAVR) is performed in selected patients with severe aortic valve stenosis, leading to immediate relief of left ventricular outflow obstruction. The purpose of this study was to evaluate the immediate hemodynamic effects of TAVR on left ventricular stroke volume (SVLVOT) and common carotid artery stroke volume (SVCCA). Material and methodsTwenty-five TAVR patients were included in this prospective observational study. Patients were treated under either local, or general anesthesia. Echocardiographic, and carotid ultrasound measurements were performed in the operating room pre (T1), and post (T2) TAVR. Changes in SVLVOT, SVCCA, carotid peak systolic velocity (PSV), pulsatility index (PI) and other carotid Doppler parameters were evaluated. ResultsFollowing TAVR, the aortic valve area (AVA) increased from 0.8 [0.6–0.9] to 1.9 [1.6–2.3] cm2 (p < 0.001), and the peak transvalvular gradient (PGAV) decreased from 70 [65–81] to 15 [11-18] mm Hg (p < 0.001) from T1 to T2. SVLVOT increased from 58 ± 17 to 69 ± 24 ml, p < 0.01, whereas SVCCA remained unchanged (from 10 [7-11] to 10 [8-11] ml, p = 0.50). Δ SVLVOT was 19 [7–31] % and Δ SVCCA was 1 [-7-20] %, p < 0.05. PSV increased from 68 ± 17 to 81 ± 17 cm/s, p < 0.001, and PI increased from 1.7 [1.5–2.2] to 2.2 [1.7–2.6], p < 0.001. ConclusionSuccessful TAVR resulted in immediate improvement of left ventricular stroke volume, whereas carotid stroke volume remained unchanged.

Associations of alcohol intake with subclinical carotid atherosclerosis in 22,000 Chinese adults

Background and aimsWe investigated the causal relevance of alcohol intake with measures of carotid artery thickness and atherosclerosis in Chinese adults. MethodsThe study included 22,384 adults from the China Kadoorie Biobank, with self-reported alcohol use at baseline and resurvey, carotid artery ultrasound measurements, and genotyping data for ALDH2-rs671 and ADH1B-rs1229984. Associations of carotid intima media thickness (cIMT), any carotid plaque, and total plaque burden (derived from plaque number and size) with self-reported (conventional analyses) and genotype-predicted mean alcohol intake (Mendelian randomization) were assessed using linear and logistic regression models. ResultsOverall 34.2% men and 2.1% women drank alcohol regularly at baseline. Mean cIMT was 0.70 mm in men and 0.64 mm in women, with 39.1% and 26.5% having carotid plaque, respectively. Among men, cIMT was not associated with self-reported or genotype-predicted mean alcohol intake. The risk of plaque increased significantly with self-reported intake among current drinkers (odds ratio 1.42 [95% CI 1.14–1.76] per 280 g/week), with directionally consistent findings with genotype-predicted mean intake (1.21 [0.99–1.49]). Higher alcohol intake was significantly associated with higher carotid plaque burden in both conventional (0.19 [0.10–0.28] mm higher per 280 g/week) and genetic analyses (0.09 [0.02–0.17]). Genetic findings in women suggested the association of genotype-predicted alcohol with carotid plaque burden in men was likely to due to alcohol itself, rather than pleiotropic genotypic effects. ConclusionsHigher alcohol intake was associated with a higher carotid plaque burden, but not with cIMT, providing support for a potential causal association of alcohol intake with carotid atherosclerosis.

Abstract P359: Long-Term Exposure to Neighborhood Poverty Throughout Midlife and Subclinical Cardiovascular Disease Burden in Subsequent Years: The Study of Women's Health Across the Nation

Purpose: To examine whether longitudinal exposure to neighborhood poverty throughout midlife influences the degree of subclinical CVD (SCVD) burden experienced in early old age in a racially and ethnically-diverse cohort of women transitioning through menopause. Methods: We used longitudinal data on 1,212 women (aged 42-52 at baseline) from The Study of Women’s Health Across the Nation . Residential address histories were collected annually for eleven years across midlife (1996-2007). The following carotid ultrasound SCVD measures were collected during a subsequent follow-up visit (2009-2013): intima media thickness (CIMT), inter-adventitial diameter (IAD), and plaque presence. Values &gt;75th percentile of each were considered high (CIMT &gt; 0.79 mm; IAD &gt; 7.21 mm; plaque index &gt;=2) and were summed together to create our composite SCVD index (range: 0-3). We used longitudinal latent class analysis to identify distinct patterns of exposure to high neighborhood poverty among women across midlife, and used ordinal logistic regression models to determine if a woman’s neighborhood poverty class throughout midlife was associated with her future SCVD burden. Results: We identified five longitudinal neighborhood poverty classes across midlife: consistent low (72% of total), decreasing (6.4%), early-increasing (7.3%), late-increasing (5.5%), and consistent high (8.4%). In age and site-adjusted models, the odds of having greater SCVD burden were 70% higher among women living in consistently high poverty neighborhoods (OR=1.70, 95% CI: 1.14-2.54), 52% higher among women experiencing early increases in neighborhood poverty (OR=1.52, 95% CI: 0.97-2.38), and 69% higher among women experiencing late increases in neighborhood poverty (OR=1.69, 95% CI: 1.04-2.74), compared to women living in consistent low poverty throughout midlife. Controlling for social, behavioral, and menopause-associated factors reduced the magnitude and significance of the estimated effects towards the null. Adjusting for baseline age, race/ethnicity, site, education, marital status, employment, alcohol use, smoking, depressive symptoms, physical activity, menopausal status, hypertension, diabetes, and obesity, the estimated odds of greater SCVD burden were 6% higher among women living in consistently high poverty neighborhoods (95% CI: 0.69-1.63), 10% higher among women experiencing early increases in poverty (95% CI: 0.68-1.76), and 17% higher among women experiencing late increases in poverty (95% CI: 0.70-1.94), relative to women living in consistent low poverty neighborhoods across midlife. Conclusions: Women living in neighborhoods with higher levels of poverty throughout midlife had greater SCVD burden in early old age. Associations between neighborhood poverty trajectories and SCVD burden were largely accounted for by individual-level social, behavioral, and biomedical confounders.

Glycoprotein Serum Concentrations Assessed By 1H-NMR are Increased in Patients With High Blood Pressure.

Patients with hypertension present a permanent state of low-grade inflammation, as the disease activates several pro-inflammatory cells and inflammatory pathways. Glycoproteins A, B, and F, determined by proton nuclear magnetic resonance, provide a highly sensitive method for determining a group of liver-derived pro-inflammatory proteins, and their role has not yet been explored in patients with hypertension. In this study, we evaluated the impact of plasma concentrations of these glycoproteins in patients with hypertension. This cross-sectional study involved 340 patients attending our vascular and metabolism medicine unit. Of them, 129 were normotensive and 211 were hypertensive. Standard biochemistry and carotid ultrasound measures were performed. Serum concentrations of glycoproteins A, B, and F were determined by proton nuclear magnetic resonance. Hypertensive patients presented a higher prevalence of obesity, metabolic syndrome, and diabetes and higher glycoprotein A, B, and F concentrations. Glycoproteins A, B, and F were positively correlated with systolic and diastolic blood pressure. Multivariate logistic models showed that glycoproteins A, B, and F were associated with higher odds of being hypertensive. Machine learning methods corroborated the relationship between glycoproteins and high blood pressure. The higher prevalence of carotid plaques in patients with high blood pressure was partially mediated by glycoproteins A and F. Patients with hypertension present systemic, subclinical inflammation as assessed by liver-derived glycoprotein A, B, and F serum levels. These results support the effect of hypertension on the mechanisms of systemic inflammation. Hypertension-associated systemic inflammation plays a role in hypertension-associated vascular injury and probably in hypertension-induced damage to other organs.

Clinical Characteristics of Target Organ Damage in Primary Aldosteronism with or without Metabolic Syndrome.

The aim of this study is to investigate the prevalence of metabolic disorders in patients with primary aldosteronism (PA) and target organ damage (TOD) in different subtypes of patients with PA with or without metabolic syndrome (MS). Patients with PA were screened out from those with secondary hypertension and then subtyped via adrenal venous sampling (AVS). Baseline clinical characteristics (blood pressure, blood glucose, abdominal circumference, and lipid profile) were collected for the diagnosis of MS. Organ damage was evaluated according to cardiac and carotid ultrasound and urine microalbumin measurements. In all 261 patients with PA, 113 patients had concomitant MS and experienced more severe cardiac hypertrophy and increased intima-media thickness (IMT). The incidence of MS and diabetes mellitus (DM) had no statistic difference between the two groups, moreover, the rates of TOD were not different except microalbuminuria. However, metabolic disorders caused more remarkable TOD in PA patients with unilateral hypersecretion. It showed that cardiac hypertrophy was associated with obesity while microalbuminuria was related to plasma aldosterone concentration (PAC) in PA patients. In this retrospective study, our findings suggest that the effect of metabolic disorders on organ damage is more remarkable in patients with unilateral PA.

Cardiovascular Risk Prediction Equations Underestimate Risk in People Living with HIV: Comparison and Cut-point Redefinition for 19 Cardiovascular Risk Equations.

Rates of cardiovascular disease are higher in people living with HIV. Early detection of high-risk subjects (applying cardiovascular risk equations) would allow preventive actions. D:A:D, ASCVD, and FRS:CVD equations are the most recommended. However, controversies surround these equations and cut-points, which have the greatest capacity to discriminate high-risk subjects. The study aims (i) to assess the association/agreement between cardiovascular risk levels obtained with D:A:D and fifteen other cardiovascular risk equations, (ii) to detect cardiovascular risk equation's capability to detect high-risk subjects, and (iii) to specify the optimal cardiovascular risk equation´s cut points for the prediction of carotid plaque presence, as a surrogate of high cardiovascular risk. 86 adults with HIV were submitted to the clinical, laboratory, and cardiovascular risk evaluation (including carotid ultrasound measurements). Cardiovascular risk was evaluated through multiple risk equations (e.g., D.A.D, ASCVD, and FRS equations). Association and agreement between equations (Correlation, Bland-Altman, Williams´test) and equation's capacity to detect plaque presence (ROC curves, sensitivity, specificity) were evaluated. Cardiovascular risk equations showed a significant and positive correlation with plaque presence. Higher high-cardiovascular risk detection capability was obtained for ASCVD and D:A:D. Full D:A:D5y>0.88 %, ASCVD>2.80 %, and FRS:CVD>2.77 % correspond to 80 % sensitivity. All cardiovascular risk equations underestimate the true risk in HIV subjects. The cut-- points for high cardiovascular risk were found to vary greatly from recommended in clinical guidelines.

Workability, quality of life and cardiovascular risk markers in aging nightshift workers: a pilot study.

BackgroundIn aging healthcare professionals, multiple stressors such as night work may affect life and work satisfaction and risk for chronic diseases (e.g. cardiovascular disease [CVD]). In this pilot study we compared workability, quality of life (QoL), and CVD risk markers between night shift and day workers.MethodsWe included 70 hospital employees (mean age 52 ± 4 years, 91.4% female): 32 rotating night shift workers (> 3 nights/month) and 38 permanent day workers. In addition to sociodemographic, lifestyle, and sleep characteristics, we assessed i) workability index (WAI), ii) QoL (World Health Organization Quality of Life [WHOQOL-Bref]) and iii) CVD risk markers, i.e. carotid ultrasound measurements, and biomarkers (NTproBNP, CRP, IL‑6, LDL, ferritin, copper, zinc, and selenium). WAI, QoL, and CVD risk markers were compared between night and day workers. In a subgroup of participants (N = 38) with complete data, we used quantile regression analysis to estimate age and multivariate adjusted differences in biomarker levels.ResultsWe found no differences in the domains of QoL (physical health, psychological, social relationships, and environment) and WAI scores between night and day workers. Night shift workers were less likely to report excellent workability than day workers, although differences were not statistically significant. Night shift workers reported more sleep problems (73.1% vs. 55.6%) and tended to have lower zinc levels and higher inflammatory markers (CRP, IL‑6, ferritin), but differences were not significant after adjusting for potential confounders.ConclusionsWorkability, QoL and CVD markers did not significantly differ between rotating night shift and day workers in this small pilot study. Sleep problems and inflammatory marker levels carry implications for occupational health.Supplementary InformationThe online version of this article (10.1007/s00508-021-01928-6) contains supplementary material, which is available to authorized users.

Abstract P146: Sex Differences In The Association Between Systolic Blood Pressure And Carotid Distensibility In Adults

Background and Aim: We explored sex differences in the association between systolic and diastolic blood pressure (SBP), in early adulthood with carotid plaques, carotid IMT and carotid distensibility (CD) in mid-adulthood. Methods: Participants in the Childhood Determinants of Adult Health study at ages 26-36 years were followed-up at ages 39-49 years. Systolic BP and diastolic BP and carotid ultrasound measures (plaques, IMT and CD) were performed in clinics. We used log binomial and linear regression models with risk factor*gender interactions for predicting these carotid measures. Sex-stratified models adjusted for sociodemographic, health-related behavior and biomedical factors were fitted when likelihood ratio tests suggested the effect of risk factors on outcomes differed by sex. Results: Among 1,286 participants (53% women), men, compared to women, had higher prevalence of carotid plaques (17% vs. 10%), thicker carotid IMT (Mean 0.66 ± 0.09 vs. 0.61 ± 0.07) and lower CD (Mean 1.87 ± 0.60 vs. 2.37 ± 0.77). In women, greater SBP in early adulthood was sharply associated with significantly smaller CD (β -0.016 95%CI -0.023, -0.010 vs. β -0.006 95%CI -0.012, -0.001) than men in mid-adulthood adjusted for sociodemographic factors (Figure 1a). In analyses restricted to women, the effect of SBP on CD has decreased after adjusting for age, education, occupation, DBP and use of contraceptives (β -0.009 95%CI -0.019, 0.000) (Figure 1b). Conclusion: CV health was worse in men than women. However, elevated SBP in women put them at greater risk of poorer CV health compared to men, which was partly explained by sociodemographic, biomedical and female-specific factors.

Deep Learning-Based Carotid Plaque Segmentation from B-Mode Ultrasound Images

Carotid ultrasound measurement of total plaque area (TPA) provides a method for quantifying carotid plaque burden and monitoring changes in carotid atherosclerosis in response to medical treatment. Plaque boundary segmentation is required to generate the TPA measurement; however, training of observers and manual delineation are time consuming. Thus, our objective was to develop an automated plaque segmentation method to generate TPA from longitudinal carotid ultrasound images. In this study, a deep learning-based method, modified U-Net, was used to train the segmentation model and generate TPA measurement. A total of 510 plaques from 144 patients were used in our study, where the Monte Carlo cross-validation was used by randomly splitting the data set into 2/3 and 1/3 for training and testing. Two observers were trained to manually delineate the 510 plaques separately, which were used as the ground-truth references. Two U-Net models (M1 and M2) were trained using the two different ground-truth data sets from the two observers to evaluate the accuracy, variability and sensitivity on the ground-truth data sets used for training our method. The results of the algorithm segmentations of the two models yielded strong agreement with the two manual segmentations with the Pearson correlation coefficient r = 0.989 (p < 0.0001) and r = 0.987 (p < 0.0001). Comparison of the U-Net and manual segmentations resulted in mean TPA differences of 0.05 ± 7.13 mm2 (95% confidence interval: 14.02–13.02 mm2) and 0.8 ± 8.7 mm2 (17.85–16.25 mm2) for the two models, which are small compared with the TPA range in our data set from 4.7 to 312.8 mm2. Furthermore, the mean time to segment a plaque was only 8.3 ± 3.1 ms. The presented deep learning-based method described has sufficient accuracy with a short computation time and exhibits high agreement between the algorithm and manual TPA measurements, suggesting that the method could be used to measure TPA and to monitor the progression and regression of carotid atherosclerosis.

Treated HIV Infection and Progression of Carotid Atherosclerosis in Rural Uganda: A Prospective Observational Cohort Study.

BackgroundAlthough ≈70% of the world's population of people living with HIV reside in sub‐Saharan Africa, there are minimal prospective data on the contributions of HIV infection to atherosclerosis in the region.Methods and ResultsWe conducted a prospective observational cohort study of people living with HIV on antiretroviral therapy >40 years of age in rural Uganda, along with population‐based comparators not infected with HIV. We collected data on cardiovascular disease risk factors and carotid ultrasound measurements annually. We fitted linear mixed effects models, adjusted for cardiovascular disease risk factors, to estimate the association between HIV serostatus and progression of carotid intima media thickness (cIMT). We enrolled 155 people living with HIV and 154 individuals not infected with HIV and collected cIMT images at 1045 visits during a median of 4 annual visits per participant (interquartile range 3–4, range 1–5). Age (median 50.9 years) and sex (49% female) were similar by HIV serostatus. At enrollment, there was no difference in mean cIMT by HIV serostatus (0.665 versus 0.680 mm, P=0.15). In multivariable models, increasing age, blood pressure, and non–high‐density lipoprotein cholesterol were associated with greater cIMT (P<0.05), however change in cIMT per year was also no different by HIV serostatus (0.004 mm/year for HIV negative [95% CI, 0.001–0.007 mm], 0.006 mm/year for people living with HIV [95% CI, 0.003–0.008 mm], HIV×time interaction P=0.25).ConclusionsIn rural Uganda, treated HIV infection was not associated with faster cIMT progression. These results do not support classification of treated HIV infection as a risk factor for subclinical atherosclerosis progression in rural sub‐Saharan Africa.RegistrationURL: https://www.ClinicalTrials.gov; Unique identifier: NCT02445079.

Adipokines and Subclinical Cardiovascular Disease in Post-Menopausal Women: Study of Women's Health Across the Nation.

BackgroundThe menopausal transition is characterized by increased cardiovascular risk, weight gain, and increased adiposity for many women. The adipose‐derived secretory proteins adiponectin and leptin are associated with insulin resistance, metabolic syndrome, and cardiovascular disease but their role in subclinical atherosclerotic disease is unclear. This cross‐sectional study evaluated the associations of adiponectin and leptin with carotid artery intima‐media thickness, adventitial diameter, presence of carotid plaques, and brachial‐ankle pulse wave velocity (baPWV) in women aged 54 to 65 years.Methods and ResultsParticipants were 1399 women from SWAN (Study of Women's Health Across the Nation), a community‐based study of women transitioning through menopause. Carotid ultrasound and baPWV measures were obtained at SWAN follow‐up visits 12 or 13, when 97% of participants were post‐menopausal. Adipokines were assayed from serum specimens obtained concurrently at these visits. Linear and logistic regression models were used to evaluate adiponectin or leptin, both log‐transformed attributable to skewness, in relationship to carotid artery intima‐media thickness, adventitial diameter, baPWV, and presence of carotid plaque. Covariates included age, race, study site, smoking, alcohol use, obesity, cardiovascular disease risk factors, and menopausal status. Lower levels of adiponectin were related to greater carotid artery intima‐media thickness, wider adventitial diameter, and faster baPWV; associations were attenuated after adjusting for cardiovascular disease risk factors. Higher levels of leptin were associated with greater carotid artery intima‐media thickness and wider adventitial diameter in minimally and fully adjusted models, and contrary to expectation, with slower baPWV, particularly among women with diabetes mellitus or obesity.ConclusionsAdiponectin and leptin are 2 important inflammatory pathways that may contribute to adverse subclinical cardiovascular disease risk profiles in women at midlife.

The relationship between famine exposure during early life and carotid plaque in adulthood.

Famine exposure is a potential risk factor for adverse cardiometabolic health. However, the relationship between famine exposure during early life and carotid plaque in adulthood remains unclear. Therefore, the aim was to investigate the relationship between famine exposure during early life and the risks for carotid plaque in adulthood. This was a cross-sectional study. Data were collected between 2017 and 2018 in Guangdong, China. Subjects who were born between 1 October 1952 and 30 September 1964, and had the carotid ultrasound measurement were enrolled. All included participants were divided into five groups: no exposure, fetal exposure, early-childhood exposure, mid-childhood exposure, and late-childhood exposure. Carotid plaque was assessed by carotid ultrasound examination. Multivariate logistic regression was used to estimate the odds ratio (OR) and confidence interval (CI) between famine exposure and carotid plaque. There were 2652 subjects enrolled, 973 (36.7%) of them were males, and the mean age was 59.1 ± 3.6 years. The prevalence of carotid plaque in unexposed, fetal-exposed, early-childhood, mid-childhood, and late-childhood exposed groups were 40.2%, 40.8%, 55.3%, 56.8%, and 62.1%, respectively. When compared with the unexposed group, the fully adjusted ORs for carotid plaque from fetal-exposed, early-childhood, mid-childhood to late-childhood exposed were 1.023 (95% CI: 0.771, 1.357, P = 0.872), 1.755 (95% CI: 1.356, 2.275, P < 0.001), 1.780 (95% CI: 1.391, 2.280, P < 0.001), and 2.119 (95% CI: 1.643, 2.739, P < 0.001), respectively. Subgroup analyses showed that the famine effect on carotid plaque did not interact with body mass index, gender, smoking status, hypertension, and diabetes history (all P for interaction > 0.500). Famine exposure during early life was significantly associated with an increased risk of carotid plaque in adulthood.

Association Between Asymptomatic Vulnerable Carotid Plaques and Cognitive Impairment in Rural Adults.

Background: The prevalence of cognitive impairment is growing and higher in rural areas. The association between carotid plaque and cognitive impairment remains uncertain, and few studies focused on the cognitive function of the rural population. We designed this study to investigate the association between carotid plaque and cognitive impairment in a rural community.Methods: We enrolled 3,336 participants who underwent carotid ultrasound and cognitive function measurements, free of cerebrovascular diseases, and without neurological deficits, from the China National Stroke Screen Survey program. Cognitive function was evaluated by the Montreal Cognitive Assessment (Beijing version). We used multivariable logistic regression to assess the association between asymptomatic carotid plaques and the presence of cognitive impairment.Results: Nine hundred seventy-six participants had cognitive impairment in this study. After adjustment for potential confounding factors, asymptomatic carotid plaques (odds ratio was 1.35; 95% confidence interval, 1.15–1.58), especially vulnerable carotid plaques (odds ratio was 1.54; 95% confidence interval, 1.28–1.85), were associated with cognitive impairment.Conclusion: In this community-based and observational study, asymptomatic vulnerable carotid plaque is an independent and significant risk factor for cognitive impairment in rural residents.

Ultrasound Measurement of Carotid Intima–Media Thickness and Plaques in Predicting Coronary Artery Disease

Ultrasound measurement of carotid intima-media thickness (CIMT) and plaque thickness (PT) may be an additional tool for risk stratification of patients with suspected acute coronary syndrome (ACS) in the emergency department (ED). The aim of this study was to evaluate the correlation of CIMT and PT with coronary artery disease (CAD) in risk stratification tests.This prospective observational study was conducted in an academic tertiary care ED. Carotid ultrasound measurements were obtained for emergency patients with suspected ACS. Carotid measurements included PT, mean CIMT and maximum CIMT. The correlations between carotid ultrasound and the results of coronary catheter angiography (CA), coronary computed tomography angiography (CCTA) and stress tests were identified. The convenience sample included 58 patients comprising 39 men and 19 women with a mean age of 60 ± 12 y. Twenty-two percent (13/58) of patients were positive for CAD, as indicated by results of the cardiac risk stratification tests. Presence of plaque correlated with CCTA findings, with a high specificity (92.8%) for a positive test. Max CIMT predicted abnormal CCTA (area under the curve [AUC] = 0.93, 95% confidence interval: 0.80-1). The correlations with stress test (0.78, 0.46-1) and CA (0.55, 0.28-0.82) were weaker. Presence of carotid plaque correlated significantly with findings of CAD on all risk stratification tests, but especially with CCTA. Carotid ultrasound could have a role in risk stratification in the ED, though more research is needed.

Carotid Ultrasound to Predict Fluid Responsiveness: A Systematic Review.

To perform a systematic review of the accuracy of carotid ultrasound measures in determining volume responsiveness in adults. We conducted a systematic review of Ovid MEDLINE and Scopus from conception until January 1, 2019. Two independent reviewers used an iterative process to identify relevant articles and abstract information from them. The quality and risk of bias were assessed with the Quality Assessment of Diagnostic Accuracy Studies version 2 tool. We identified 17 relevant articles with 956 patients. The 2 most frequently cited carotid measures of fluid responsiveness were corrected flow time and peak velocity or change in peak velocity with respiration (ΔCDPV). Accordingly, the diagnostic characteristics of corrected flow time in these studies varied widely, with sensitivities from 60% to 73%, specificities from 82% to 92%, and areas under the receiver operating characteristic curves from 0.75 to 0.88. Optimal cutoff values for ΔCDPV ranged from 9.1% to 14%, with areas under the receiver operating characteristic curves from 0.81 to 0.91, sensitivities from 73% to 86%, and specificities from 78% to 86%. Other measures, such as carotid blood flow and carotid diameter, had limited data to support their use. Heterogeneity of the studies prohibited a meta-analysis. Most studies had a moderate risk of bias and high applicability. Preliminary research suggests that carotid ultrasound measures may be useful adjunct measures of fluid status; however, they should not be interpreted as absolute and should be placed in a clinical context. The most well-defined and supported measure currently is ΔCDPV, with cutoffs from 9% to 14%. Corrected flow time shows promise, because of heterogeneity of how this value is measured, an optimal cutoff has not been established.

Abstract 34: Association of Carotid Intima-Media Thickness and Other Carotid Ultrasound Features With Incident Dementia in The Atherosclerosis Risk in Communities Neurocognitive Study (ARIC-NCS)

Background: Increased carotid intima-media thickness (cIMT), a measure of carotid artery thickness, and carotid plaque are predictors of cardiovascular disease and atherosclerosis. Likewise, increased interadventitial diameter (IAD), which references arterial remodeling, and lower carotid distensibility coefficient (DC), which indicates carotid stiffness, are also predictors. These indices likely relate to cerebrovascular disease, and thus may constitute a form of vascular contributions to dementia and Alzheimer’s disease and related dementias. Therefore, we assessed the relationship of carotid measures and distensibility with incident dementia in the Atherosclerosis Risk in Communities (ARIC) study. Methods: 12,459 ARIC participants who had carotid ultrasound measurements in 1990-92 were followed through 2017 for incident dementia. Dementia cases were identified using in-person and phone cognitive status and informant assessments, hospitalization discharge codes, and death certificate codes. Cox proportional hazards models were used to estimate the hazards ratios for incident dementia per 1-SD and per quintile increment in arterial index (cIMT, IAD, and DC) and for presence of carotid plaque. Results: Participants were aged 57±6 at baseline, 57% were female, and 23% were black. Over a median follow-up of 24 years, 2,224 dementia events were ascertained. After multivariable adjustments, the highest quintile of both cIMT and IAD in midlife were associated with increased risk of incident dementia (Table; HRs [95% CIs]: 1.33 [1.15, 1.54]; 1.24 [1.06, 1.46]), while presence of carotid plaque was not (HR [95% CI]: 1.06 [0.97, 1.15]). Additionally, higher distensibility was associated with lower risk of dementia (HR [95% CI] highest vs. lowest quintile: 0.73 [0.61, 0.88]). Conclusion: Increased cIMT, IAD, and lower carotid distensibility are associated with an increased risk of incident dementia. These findings suggest that both atherosclerosis and carotid stiffness may be implicated in dementia risk.