Carotid Ultrasound Scan Research Articles

Five-year exposure to PM2.5 and ozone and subclinical atherosclerosis in late midlife women: The Study of Women's Health Across the Nation.

Effects of more than one-year exposure to air pollution on atherosclerosis is seldom studied. This paper aims to examine the association between five-year exposure to particulate matter ≤2.5 μm (PM2.5), ozone (O3) and atherosclerosis observed about seven years later in late midlife women. This study was conducted among 1188 women of the Study of Women's Health Across the Nation (SWAN) from five sites, Detroit, MI; Oakland, CA; Pittsburgh, PA; Chicago, IL; and Newark, NJ, with available data on both air pollutant exposure and carotid ultrasound scans. Five-year mean annualized exposure levels of two air pollutants, PM2.5 and ozone (O3), were collected during 5 SWAN visits (1999-2005) from monitors 20 km within the participant's residential address. Linear regression models were used to estimate the association of prior five-year mean annualized exposure to PM2.5 and O3 with common carotid intima-media thickness (cIMT) and inter-adventitial diameter (IAD) examined approximately seven years later (2009-2013). Logistic and multinomial logistic regressions were applied to assess the associations of air pollutants with plaque presence and plaque index, respectively. At time of carotid ultrasound scan, women were on average 59.6 (±2.7) years old and a majority was postmenopausal (88.4%). The women were White (48.4%), Black (31.2%), Chinese (13.3%) and Hispanic (7.1%). A 1 μg/m3 higher 5-year mean annualized exposure to PM2.5 was associated with an 8.0 μm (95% CI: 1.0-15.1) greater maximum cIMT at a later mid-life, adjusting for cardiovascular disease risk factors; but was only related to IAD after adjusting for site. No association was found between either pollutant and plaque presence or plaque index. Long-term exposure to PM2.5 may contribute to elevated risk of atherosclerosis in the post-menopausal period.

Metabolically healthy and metabolically unhealthy obese children both have increased carotid intima-media thickness: a case control study

BackgroundThe cardiovascular disease risk was assessed in metabolically healthy obese (MHO) children, obese children with metabolic disorders (MUO), and to a control group of normal-weight children using carotid intima-media thickness (CIMT).MethodsParticipants were 204 obese children (114 M, 90 F), including 162 MUO (74 M, 88 F) and 42 MHO (24 M, 18 F), and 99 gender- and age-matched controls (45 M, 54 F). Glucose, triglycerides, total cholesterol, high-density and low-density lipoprotein cholesterol, and other serum values were determined in peripheral blood. Anthropometric parameters, blood pressure, and a carotid Doppler ultrasound scan were also acquired. The mean CIMT of obese subjects and controls was compared by analysis of variance. Abnormality of even one of the metabolic parameters assessed involved assignation to the MUO group. Mean CIMT was compared in MHO and MUO children.ResultsMean CIMT in control children was 402.97 ± 53.18 μm (left carotid artery) and 377.85 ± 52.47 μm (right carotid artery). In MHO and MUO patients CIMT was respectively 453.29 ± 62.04 and 460.17 ± 92.22 μm (left carotid artery) and 446.36 ± 49.21 and 456.30 ± 85.7 μm (right carotid artery). The mean CIMT was not significantly different in MUO and MHO children, whereas it showed a significant difference between both groups of obese children and controls (p < 0.01).ConclusionCIMT was significantly greater in obese patients, also in those without metabolic alterations, than in normal-weight children. Obesity is therefore an important risk factor for cardiovascular disease in itself, also in the absence of metabolic abnormalities.

Relationship between carotid artery atherosclerosis and bulb geometry.

The carotid bifurcation is a common site of atherosclerotic plaque. Plaque development is thought to occur preferentially at geometrically predisposed areas such as arterial branch points. The aim of this study was to investigate the geometric and anatomical variables that contribute to the development of carotid plaque using three-dimensional (3D) ultrasound. Sixty-seven consecutive outpatients referred for elective coronary angiography underwent 3D carotid ultrasound scans for the purpose of carotid plaque quantification. Geometric quantification of the left and right carotid bulbs were performed retrospectively on this study population. Geometric values such as angle, area and length of the carotid bulb and the bifurcation were determined using QLAB software (Philips Healthcare). Plaque volume within the carotid bulb and artery branches was quantified using the stacked contour method. Pearson's correlation and linear regression analysis were used to determine the relationship between anatomical variables and plaque volume. The mean age for the total patient population was 65.9 ± 11.5years. Carotid bulb inflow area (BIA) (r = 0.28, p = 0.001), bulb volume (BV) (r = 0.21, p = 0.01) and bifurcation angle (BifA) (r = 0.18, p = 0.04) showed a positive linear relationship with plaque volume. In contrast, internal carotid artery angle (ICAA) (r = - 0.18, p = 0.04) and bulb flare (r = - 0.20, p = 0.02) displayed a negative linear relationship with plaque volume. When adjusting for age and sex, only the BIA remained significant (β = 0.18, p = 0.04). Geometric variables were identified as potential risk factors associated with plaque volume in the carotid bulb. Further analysis of the evolution of the BIA as well as the relationship to other geometric variables could create a stronger predictive model of atherosclerosis as well as assist in preoperative planning.

Segment-specific prevalence of carotid artery plaque and stenosis in middle-aged adults and elders in Taiwan: Acommunity-based study.

Plaque in carotid arteries (CAs) is a major factor of systemic atherosclerosis and cardiovascular disease (CVD). The left and right CAs have different anatomic and geometric features and may influence the predictability of CVD. However, the site- and segment-specific prevalence of carotid plaques (CP) and study on severity of carotid atherosclerosis with CVD risks was very limited. We enrolled 1539 healthy residents aged 40-to-74 years from two northern districts in Taiwan. All volunteers received high resolution B-mode carotid ultrasound scans and CVD risk factors evaluations. The prevalence rate of extracranial CP was 21.9% in females and 33.8% in males. Carotid bifurcation is the most affected segment. As compared with the right CAs, the age-sex-adjusted matched odds ratio of having plaques in the left CAs was 1.32 (95% confidence interval=1.02-1.73). The proportions of subjects had a total plaque number≥2, maximum stenosis≥30%, and plaque score≥3 were 8.9, 10.3, and 7.2%, respectively, in females and were 17.7, 17.2, and 15.1%, respectively, in males. Among subjects with moderate and severe carotid atherosclerosis, the mean±SD of estimated 10-year CVD risk was 19.1±14.6% and more than 65% of them need intensive blood pressure, lipids, or sugar controls. We found that bifurcation was the most prevalent segment, and left CAs was more likely to form plaque than right CAs. The major CVD risk factors were highly prevalent and the estimated CVD risks were high in subjects with more advanced carotid atherosclerosis. The study provides further direction for CVD prevention and treatment.

Atherosclerosis in systemic lupus erythematosus.

Cardiovascular disease (CVD), comprising coronary heart disease and stroke, is one of the most important causes of death in patients with systemic lupus erythematosus (SLE). The risks of developing both clinical CVD and sub-clinical atherosclerosis are increased in patients with SLE. This increase is not fully explained by traditional cardiovascular risk factors such as smoking, hypertension and elevated cholesterol, and it is believed that immune dysfunction also contributes to CVD risk in SLE. In particular, recent studies have shown that abnormalities in both serum lipid profile and the autoantibody and T lymphocyte response to lipids may play a role in development of atherosclerosis. The standard CVD risk calculation algorithms based on traditional risk factors underestimate the risk of developing CVD in patients with SLE. Thus, novel algorithms incorporating new biomarkers such as pro-inflammatory high-density lipoprotein and use of imaging techniques such as carotid ultrasound scanning may become increasingly valuable.

Abstract P067: Early Exposure to PM 2.5 and Ozone During the Menopausal Transition as Predictor of Subclinical Atherosclerosis in Late Midlife Women: the Study of Women’s Health Across the Nation (SWAN)

Introduction: Long-term air pollution may be a risk factor for CVD mortality, but few studies have investigated its effect on subclinical atherosclerosis. Moreover, data among women transitioning the menopause are lacking. Hypothesis: We hypothesized that mid-life women exposed to higher levels of air pollution across a 5-year period may have a greater burden of subclinical atherosclerosis (higher common carotid intima-media thickness (CIMT), inter-adventitial diameter (AD) and plaque) 5 to 7 years later compared to women exposed to lower levels. Methods: This longitudinal study was conducted among 1,188 women from the Study of Women’s Health Across the Nation (SWAN) with available data on both air pollution exposure and CIMT. We excluded participants who had an MI and stroke before the carotid ultrasound scan. Yearly cumulative exposure levels of two air pollutants, particulate matter ≤2.5 μm (PM 2.5 ) and ozone (O 3 ), were collected from monitors 20km within the participant’s residential address at SWAN visit 3 – 7 (1999-2005). Corresponding years cumulative levels of continuous CVD risk factors were used as covariates. CIMT, AD and plaque presence were assessed at visits 12/13 (2010-2012). Linear regression models were used to estimate the effect of early exposure to PM 2.5 and O 3 on mean and maximum CIMT. Logistic regression was applied to assess the effects of air pollutants on plaque presence. Full models were adjusted for CVD risk factors, including BMI, smoking, cholesterol, triglyceride, HDL-C, menopause status, hormone use, fasting blood glucose, insulin, diabetic medication and hypertension, and the extended models were further adjusted for SBP and inflammatory biomarkers (tPA, PAI-1 and CRP). Results: At time of carotid scan, women were on average 59.6±2.7 years old and a majority were postmenopausal (88.4%). The women were White (48.4%), Black (31.2%), Chinese (13.3%) and Hispanic (7.1%). Cumulative PM 2.5 significantly predicted maximum CIMT adjusting for CVD risk factors such that 1 μg/m 3 higher cumulative exposure to PM 2.5 over 5 years was associated with a 7.4 μm (95% CI: 0.4 – 14.4) greater maximum CIMT. The association was not significant after adjusting for SBP but was not attenuated by adjusting for inflammatory biomarkers. PM 2.5 was related to mean CIMT and AD when adjusting for site, SES and age, but not after adjusting for other CVD risk factors. Ozone levels were not associated with any of the outcomes. No association was found between air pollution exposure and plaque presence. Conclusion: Early cumulative PM 2.5 exposure was associated with maximum CIMT later in the post-menopausal period. This association was largely explained by SBP suggesting that early exposure to air pollutants may relate to higher values of CIMT potentially by increasing SBP.

Lipid Changes Around the Final Menstrual Period Predict Carotid Subclinical Disease in Postmenopausal Women.

Atherogenic changes in lipids occur among women around the time of the natural menopause, that is, within 1 year of the final menstrual period (FMP). We investigated whether lipid changes around the FMP are related to carotid intima-media thickness, interadventitial diameter, and plaque in postmenopausal women. A total of 863 natural postmenopausal women with no history of heart attack or stroke underwent carotid ultrasound scans at follow-up year 12 or 13 of the Study of Women's Health Across the Nation. Estimates of their annual change in lipids were segmented into the year before and after the FMP, before the year before FMP, and 1 year after FMP. Multivariate analyses were adjusted for sociodemographic characteristics, time from FMP to scan, baseline body mass index and systolic blood pressure, and use of medications for hypertension and diabetes mellitus at the scan. Smaller increases in high-density lipoprotein cholesterol and apolipoprotein A1 within 1 year of the FMP were related to greater interadventitial diameter, β (SE)=-0.036 (0.015), P=0.02, and β (SE)=-0.035 (0.013), P=0.006, respectively. Greater increases in low-density lipoprotein cholesterol within 1 year of FMP were related to greater likelihood of plaque scores ≥2, odds ratio, 1.071; 95% confidence interval, 1.018-1.127; P=0.009. Magnitude of associations was reduced but remained significant with further adjustment for premenopausal lipid levels. The difference in probability of elevated plaque scores was 50% between those in the highest and lowest low-density lipoprotein cholesterol change tertiles. Changes in lipids as women approach the FMP provide useful clinical information for understanding postmenopausal carotid indices.

High-grade carotid artery stenosis: A forgotten area in cardiovascular risk management.

Patients with high-grade (≥70%) carotid artery stenosis (CAS) rank in the highest risk category for future cardiovascular (CV) events, but the quality of cardiovascular risk management in this patient group is unknown. Cross-sectional retrospective study. Data were collected for all patients diagnosed with high-grade CAS in Östergötland county, Sweden between 1 January 2009 and 31 July 2012 regarding the quality of cardiovascular risk management, co-morbidity and outcomes during the 2-year follow-up period after a diagnosis of CAS with a carotid ultrasound scan. Patients were included regardless of whether they underwent carotid endarterectomy (CEA). A total of 393 patients with CAS were included in the study; 133 (33.8%) underwent CEA and 260 (66.2%) were assigned to a conservative management (CM) group. In both groups of patients the prescription of platelet inhibitors, statins and antihypertensive drugs increased significantly (p < 0.001) after diagnosis. However treatment targets were not met in the majority of patients and the low-density lipoprotein level was on target in only 13.5% of patients. During follow-up, low-density lipoprotein levels were not measured in 19.8% of patients who underwent CEA and 44.2% of patients in the CM group (p < 0.001); HbA1c was not measured in 24.4% of patients with diabetes in the CEA group and in 18.8% of patients in the CM group (p = 0.560). There was no documentation of counselling on diet, exercise, smoking cessation or adherence to medication. The combined clinical event rate (all-cause mortality, cardiovascular mortality and non-fatal cardiovascular events) was high in both groups (CEA 36.8% and CM 36.9%; p = 1.00) with no difference in the occurrence of ipsilateral ischaemic stroke. The clinical event rate was high in patients with high-grade CAS and the management of cardiovascular risk was deficient in all aspects.

Low-glycaemic index diet to improve glycaemic control and cardiovascular disease in type 2 diabetes: design and methods for a randomised, controlled, clinical trial

IntroductionType 2 diabetes (T2DM) produces macrovascular and microvascular damage, significantly increasing the risk of cardiovascular disease (CVD), renal failure and blindness. As rates of T2DM rise, the need for effective...

Abstract P242: Carotid Plaque Characterization, Stenosis, and Intima-media Thickness According to Age and Gender in a Large Registry Cohort

Background: Carotid intima-media thickness (CIMT) is a well-established predictor of cardiovascular disease events. Not well described, however, is the prevalence of plaque and stenosis severity and how this varies according to extent of CIMT, age, and gender. Methods: We evaluated the extent of carotid plaque and stenosis severity according to CIMT, age and gender in a large CIMT screening registry. We studied 9347 women and 12676 men (n=22,023) who received carotid ultrasound scans. The presence and severity of both carotid plaque and stenosis was compared according to extent of CIMT ( &gt; 1 mm vs. &lt;1 mm), age, and gender using the Chi-square test of proportions. Results: Among those aged &lt;45 to &gt; 80 years the prevalence of CIMT &gt; 1 mm ranged from 0.13 to 29.3% in women and 0.6 to 40.1% in men, stenosis &gt;50% from 0.1% to 14.9% in women and 0.1% to 13.2% in men, and mixed/soft plaque from 7.1% to 66.5% in women and 9.2% to 65.8% in men (all p&lt;0.001 across age). While 6.6% of women and 8.5% of men with CIMT &lt;1mm had &gt;30% stenosis, this increased to 48.6% and 46.0%, respectively, in those with CIMT &gt; 1 mm. Even when CIMT levels were &lt;1 mm, &gt;30% of persons demonstrated mixed or soft plaque. Of those with CIMT &gt; 1mm, more than 70% had such mixed or soft plaque (Figure) and over 40% demonstrated stenoses of 30% or greater. Conclusions: We describe in a large CIMT registry study a substantial age-related increase in both men and women of CIMT, plaque presence and severity, as well as stenosis. Even in those with normal CIMT, mixed or soft plaque potentially prone to rupture was common, demonstrating the value in assessing for plaque when doing carotid ultrasound.

Carotid Plaque Characterization, Stenosis, and Intima-Media Thickness According to Age and Gender in a Large Registry Cohort

Carotid intima-media thickness (CIMT) is a well-established predictor of cardiovascular disease events. Not well described, however, is the prevalence of plaque and stenosis severity and how this varies according to extent of CIMT, age, and gender. We evaluated the extent of carotid plaque and stenosis severity according to CIMT, age, and gender in a large CIMT screening registry. We studied 9,347 women and 12,676 men (n = 22,023) who received carotid ultrasound scans. The presence and severity of both carotid plaque and stenosis was compared according to extent of CIMT (≥1 mm vs <1 mm), age, and gender using the chi-square test of proportions. Among those aged <45 to ≥80 years, the prevalence of CIMT ≥1 mm ranged from 0.13% to 29.3% in women and 0.6% to 40.1% in men, stenosis ≥50% from 0.1% to 14.9% in women and 0.1% to 13.2% in men, and mixed and/or soft plaque from 7.1% to 66.5% in women, and 9.2% to 65.8% in men (all p <0.001 across age groups). Even when CIMT levels were <1 mm, >30% of patients demonstrated mixed or soft plaque potentially prone to rupture. Of those with CIMT ≥1 mm, more than 70% had such mixed or soft plaque and more than 40% demonstrated stenoses of 30% or greater. In conclusion, we describe in a large CIMT registry study a substantial age-related increase in both men and women of increased CIMT, plaque presence, and severity, and stenosis. Even in those with normal CIMT, mixed or soft plaque was common, further demonstrating the value in assessing for plaque when doing carotid ultrasound.

Carotid artery wall stiffness is increased in patients with small vessel disease: A case-control study

Cerebral ischemic small-vessel disease (SVD), causing lacunar infarcts and white matter hyperintensities on brain magnetic resonance imaging (MRI), is a progressive disease associated with an increased risk of stroke, dementia and death. Increased arterial stiffness has been associated with ischemic stroke and cerebral SVD independently of common vascular risk factors. The aim of the study was to analyze arterial stiffness in our patients with symptomatic SVD. In a cross-sectional study design we included 30 patients with clinical and MRI evidence of cerebral SVD and 30 age-, gender- and risk factor-matched control subjects with no neurological diseases. Patients were evaluated at the Ultrasound Laboratory at the Neurology Clinic, Clinical Center of Serbia in Belgrade, during a three-month period (from September 1st to December 1st 2012). Baseline demographic and vascular risk factors were recorded. All patients underwent standard carotid ultrasound scans with measuring of intima-media thickness (IMT) and analysis of atheromatous plaques. Internal carotid artery stiffness was evaluated with the use of e-tracking option as beta stiffness index (BSI) value. There were no differences between study groups in regard to degree of carotid stenosis and type of carotid plaques (p > 0.05). Patients in SVD group had significantly higher mean IMT (p = 0.0093) and mean BSI (p < 0.0001) than subjects in the control group. No significant correlation was detected between IMT and BSI in SVD group (r = 0.168; p = 0.376). Brain lesions severity correlated with BSI (r = 0.733; p < 0.0001). Arterial stiffness is increased in symptomatic patients with SVD, independently of vascular risk factors and IMT.

Carotid thin fluttering bands: A new element of arterial wall remodelling? An ultrasound study.

Carotid artery ultrasound is a non-invasive and reproducible technique used for early atherosclerotic assessment. Intimal flap has been described in the presence of dissection or mobile plaque rupture, however presence of carotid thin fluttering bands (TFBs) have not been described yet. To investigate frequency, characteristics and impact of TFBs in carotid lumen of patients who underwent carotid ultrasound scan (CUS). 3341 patients were admitted from January 2009 to January 2014. Patients with history of cerebral ischemia (CI) were excluded. In the cases in which TFBs were observed, a 3-months clinical and CUS follow-up (FU) was performed. TFBs were found in 71 patients (2.1%). The mean age was 63.41 ± 11.20 years (range 42-89). All patients showed a mean increase in intima-media thickness. We identified two subgroups: in 22 patients the TFB was related to a carotid plaque while in 49 no carotid plaque was found. TFB mostly originated in the carotid bulb (88.7%) and was similarly located in carotid arteries (49.3% left-side and 50.7% right-side). CUS and clinical FU were available for all patients (mean duration 25.34 months, median 19). CI occurred in none of the patients. TFB disappeared in 13 patients (18.3%) with no sign or symptoms of CI. In 3 of 49 patients without carotid plaque (6.1%), progressive thickening beneath TFB was observed. TFB is a rare finding. Longer FU is needed to evaluate its prognosis. To date, the pathophysiology is unknown, however it could be related to vascular remodeling.

Preoperative Cardiovascular Assessment and Late Cardiovascular Events after Elective Abdominal Aortic Aneurysm Repair

Cardiovascular evaluation is performed before elective repair of abdominal aortic aneurysm (AAA) because of the high prevalence of cardiovascular disease. We investigated the association between preoperative cardiovascular evaluation and the incidence of late cardiovascular events after AAA repair. We retrospectively analyzed 438 patients who underwent elective repair of AAA. Echocardiography, serial coronary assessment using functional myocardial scanning or coronary angiography, and carotid ultrasound scanning were performed preoperatively. Coronary revascularization after serial coronary assessment was performed preoperatively or simultaneously in 21 patients, and 54 patients had a remote history of coronary revascularization. The 5-year survival rate, incidence rate of cardiovascular events (myocardial infarction or stroke), and incidence rate of major adverse cardiovascular events (MACE; cardiovascular death or cardiovascular events) were 86.0%, 5.7%, and 11.5%, respectively. Carotid stenosis was associated with these long-term outcomes, and hypokinesis, determined by echocardiography, increased the incidence of cardiovascular events and MACE. Serial coronary assessment findings and history of previous or preoperative coronary revascularization were not associated with these long-term outcomes. Preoperative cardiovascular evaluation and treatment are beneficial for reducing not only perioperative risk but also late cardiovascular events.

SYNTAX Score II predicts carotid disease in a multivessel coronary disease population

BackgroundThe SYNTAX Score (SxScore) is an angiographic tool that evaluates CAD complexity, which we previously reported lacking correlation with the presence of carotid disease. Recently, SxScore II has been developed including both angiographic and clinical variables, which could increase the prognostic accuracy for detection of carotid disease. Methods and resultsFrom January 2013 to June 2014, 244 patients with multivessel CAD (mean age 65.37years, 84% males) underwent carotid ultrasound scan. At least one carotid lesion (CL) was found in 77% of patients with significant carotid disease (SCD) in 23.4% of cases. Logistic regression analysis revealed no relation between SxScore and CL/SCD (p=0.781 and p=0.368) while SxScore II well correlated with CL (SxScore II-PCI: odds ratio [OR] 1.036; 95% confidence interval [CI]:1.006–1.067; p=0.019; SxScore II-CABG: OR 1.045; 95% CI: 1.015–1.076, p=0.003) and SCD (SxScore II-PCI: OR 1.042; 95% CI: 1.012–1.073, p=0.006; SxScore-CABG: OR 1.054; 95% CI: 1.029–1.080, p<0.0001). The areas under the receiver-operating characteristic curves were: for SxScore 0.512 (95% CI: 0.448–0.577; p=0.77), for SxScore II-PCI and SxScore II-CABG 0.600 (95% CI: 0.536–0.662; p=0.01) and 0.645 (95% CI: 0.581–0.705; p=0.0008), respectively, and 0.527 (95% CI 0.462–0.591; p=0.56), 0.619 (95% CI: 0.555–0.681; p=0.01) and 0.681 (95% CI: 0.619–0.739; p=0.0001), respectively, for the identification of SCD. ConclusionsThe SxScore II, with inclusion of clinical variables over angiographic complexity, seems more suited to predict the presence of carotid disease than the SxScore.

Abstract O.67: Carotid Intima-media Thickness In Patients With A History Of Kawasaki Disease

Aims: Kawasaki disease (KD) is an acute pediatric vasculitis with the development of coronary artery aneurysms (CAA) being recognized as a serious clinical complication of KD. It has been suggested that KD predisposes to premature cardiovascular disease (CVD) later in life, however, conflicting results have been reported. We therefore assessed the risk of CVD in patients with a history of KD. Methods and results: Carotid B-mode ultrasound scans and measurements of carotid intima-media thickness (cIMT), a validated marker of CVD risk, were performed in 161 KD patients (119 with CAA, 42 without CAA based on worst-ever z-score; age range: 7-20 years). CIMT measurements were also performed in 82 unaffected family controls in the same age range. Differences in cIMT between patients and controls were evaluated by linear regression analyses while correcting for confounders by stepwise backward elimination. Mean cIMT (±SD) was increased in patients with KD (0.378 ± 0.030 mm versus 0.360 ± 0.027 mm; P adjusted &lt; 0.0001). If the difference in cIMT between patients and controls was plotted against age, in patients without CAA, increased cIMT was only apparent at young age, whereas in patients with CAA increased cIMT was observed over the entire age range. Conclusion: Our findings in KD patients show significant arterial wall changes in patients with a history of KD, in particular in those with CAA. In contrast to the cIMT findings at young age - irrespective of the absence or presence of CAA, the data demonstrate that - with age - the cIMT in KD patients without CAA became indistinguishable from controls but remained increased in the patients with CAA. The age-dependency of cIMT values could in part explain the variable and conflicting results of previous reports in KD. Furthermore, these explicit differences in cIMT between CAA-negative and CAA-positive patients may suggest that the pathophysiology of the arterial wall changes in KD differ from atherosclerosis. Finally, our results indicate that follow-up in patients with KD seems justified in patients with CAA, but may not be necessary in children without CAA.

Age but not ABCD(2) score predicts any level of carotid stenosis in either symptomatic or asymptomatic side in transient ischaemic attack.

The ABCD(2) score is routinely used in assessment of transient ischaemic attack (TIA) to assess the risk of developing stroke. There remains uncertainty regarding whether the ABCD(2) score could be used to help predict extent of carotid artery stenosis (CAS). We aimed to (i) collate and analyse all available published literature on this topic and (ii) compare the data from our local population to the existing evidence base. We conducted a retrospective-observational study over a 6-month period using our East of England hospital-based TIA clinic data with a catchment population of ~750,000. We also searched the literature on studies reporting the association between ABCD(2) score and CAS. We included 341 patients in our observational study. The mean age in our cohort was 72.86 years (SD 10.91) with 52% male participants. ABCD(2) score was not significantly associated with CAS (p = 0.78). Only age > 60 years was significantly associated with ipsilateral (> 50%) and contralateral CAS (> 50% and > 70%) (p < 0.01) after controlling for other confounders. The systematic review identified four studies for inclusion and no significant association between ABCD(2) score and CAS was reported, confirming our findings. Our systematic review and observational study confirm that the ABCD(2) score does not predict CAS. However, our observational study has examined a larger number of possible predictors and demonstrates that age appears to be the single best predictor of CAS in patients presenting with a TIA. Selection of urgent carotid ultrasound scan thus should be based on individual patient's age and potential benefit of carotid intervention rather than ABCD(2) score.

2083060 A New Technique For Compartmental-IMT Estimation in Presence of Bulb in Carotid Ultrasound Scans: a Stroke Risk Assessment System

IMT is a biomarker for stroke risk. Conventional IMT techniques do not take bulb into account during their measurement systems. Further bulb edge is a reference marker for comparing different IMT measurement systems. The bulb edge in carotid ultrasound scans can be difficult to locate due to: (a) low signal to noise ratio in the bulb region as compared to common carotid artery region; (b) uncertainty of bulb location in craniocaudal direction; and (c) variability in carotid bulb shape and size. The primary OBJECTIVES: is to automatically detect the bulb and then measure the IMT in bulb region and three 10 mm segments proximal to the bulb. The secondary OBJECTIVES: is to show that the SNR and ultrasound image quality in the bulb region is affected by the shape and dynamics of the blood flow at the flow divider/bulb region. This paper presents a patented novel automated system for segmentation IMT measurement using an integrated approach which combines geometry and classification paradigms. The system first finds the bulb edge and then measures the segmental IMT proximal to the bulb edge. The system also estimates IMT in bulb region (bIMT). SNR is also compared in CCA region and bulb regions. Our results show that the IMT contributions in different carotid segments are: bIMT 34%, s1-IMT 29.46%, s2-IMT 11.48%, and s3-IMT 12.75%, respectively. In mixed database of 649 images, performance against manual tracings shows: mean lumen-intima error: 0.01235±0.01224 mm mean media-adventitia error: 0.020933±0.01539 mm and mean IMT error: 0.01063±0.0031 mm. Our system's Figure-of-Merit (FOM) is: 98.23%, coefficient of correlation between automated and Reader's IMT is: 0.998 (p-value <0.0001). Our bulb detection accuracy was 100%. This is the first system of its kind which finds the IMT in the bulb region automatically.

Evaluation of clinical and inflammatory markers of subclinical carotid atherosclerosis in postmenopausal women

This study aims to evaluate clinical and inflammatory markers of subclinical carotid atherosclerosis (ATS) in asymptomatic postmenopausal women. This cross-sectional study included 268 Brazilian women (aged ≥45 y and amenorrhea ≥12 mo). Subclinical ATS was defined as increased carotid intima-media thickness (>1.0 mm) and/or the presence of plaques evaluated by carotid duplex ultrasound. Inflammatory markers included C-reactive protein (CRP), as well as heat shock protein (HSP) 60 and HSP70 and their antibodies. Pearson's correlation and stepwise logistic regression were used for statistical analysis. Among the women studied, 45.9% (123 of 268) had a diagnosis of ATS, and 54.1% (145 of 268) had normal carotid ultrasound scans (controls). Women with ATS were older (56.6 vs 52.5 y), and their time since menopause was longer (6.0 vs 4.0 y). In addition, higher prevalences of metabolic syndrome (39.0% vs 25.5%), hypertension (52.0% vs 30.3%), and diabetes (11.4% vs 4.8%), and elevated circulating levels of CRP and HSP60, were observed in women with ATS compared with controls (P < 0.05). Intima-media thickness was positively correlated with anti-HSP70 antibodies (r = 0.110, P = 0.049) and CRP (r = 0.167, P = 0.009). ATS risk increased with age at menopause (odds ratio [OR], 1.18; 95% CI, 1.10-1.26), time since menopause (OR, 1.12; 95% CI, 1.02-1.14), and glucose of 100 mg/dL or higher (OR, 2.17; 95% CI, 1.12-4.20). Serum HSP70 levels (OR, 0.71; 95% CI, 0.47-0.98) were associated with a lower ATS risk (P < 0.05). In postmenopausal women, age, menopause status, and hyperglycemia are associated with a higher prevalence of ATS, whereas elevated serum HSP70 is associated with a lower prevalence of ATS.

Carotid Doppler ultrasound scanning and onward referral following ischaemic cerebral event: are we meeting national guidelines?

Carotid Doppler ultrasound scanning and onward referral following ischaemic cerebral event: are we meeting national guidelines?