Carotid Wall Research Articles

Unilateral Primary Carotiditis: A Case Report

We report the first case of isolated unilateral carotid arteritis, following an upper respiratory tract infection in a patient without other medical conditions. We collected clinical information during the patient’s hospitalization and follow-up. Through a Pubmed search, we identified articles discussing TIPIC syndrome, carotid pain, or inflammation. After reviewing the articles and the corresponding images, none of these reported clinical and radiological findings similar to ours. A 55-year-old man consulted for unilateral neck pain, without relevant clinical history apart from an upper respiratory tract infection, nor other signs or symptoms. An MRI before admission showed signs of focal adventitial inflammation of the left internal carotid artery. Ultrasound identified a mixed plaque with hypoechoic and isoechoic components at the beginning of the left internal carotid. In particular, there was no halo sign suggestive of giant cell arteritis. Extensive laboratory exams only found increased plasma IL-1 receptor antagonist. After three days of corticosteroid and acetylsalicylic acid treatment., cervicalgia completely regressed, and prednisone was stopped. The patient was discharged on day 7 on daily acetylsalicylic acid. At three months, he remained asymptomatic, carotid ultrasound was comparable to the first one, and treatment was stopped. We suggest that a purely vascular inflammation of the carotid could appropriately be defined “carotiditis”, considering the focal, isolated involvement of the carotid wall, and that such a unilateral presentation has never been reported before. Speculatively, we propose an association between carotidis and the upper respiratory tract infection in this patient.

Relationship between carotid atherosclerotic plaque characteristics in magnetic resonance imaging and perioperative hemodynamic instability

Objective: To analyze the relationship between carotid atherosclerotic plaque characteristics in magnetic resonance imaging (MRI) and perioperative hemodynamic instability in patients with severe carotid artery stenosis undergoing carotid artery stenting (CAS). Methods: A total of 89 patients with carotid artery stenosis who underwent CAS treatment at Beijing Tsinghua Changgung Hospital affiliated to Tsinghua University from January 1, 2017, to December 31, 2021, were prospectively included. Among them, 74 were male and 15 were female, with an age range of 43 to 87 years (mean age: 67.8±8.2 years). Preoperative examinations included carotid artery MRI vessel wall imaging to analyze the existence of large lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and fibrous cap rupture in carotid artery plaques. Plaques without the above-mentioned risk factors were defined as stable plaque group (34 cases), while those with such risk factors were defined as vulnerable plaque group (55 cases). The number of risk factors present in each plaque was also calculated. Intraoperative changes in blood pressure and heart rate were recorded, and the use of dopamine postoperatively was noted. Using the risk factors that the plaque has as independent variables and the clinical outcomes as dependent variables, the RR values were calculated, and the differences in clinical outcomes of patients with different risk factors were compared. Results: The incidence rates of hypotension and bradycardia were higher in patients with vulnerable plaques than those with stable plaques (60.0% (33/55) vs 14.7%(5/34) and 38.2%(21/55) vs 14.7%(5/34), respectively; both P<0.05). Based on MRI imaging features, the large LRNC was present in 45 cases, with RR values for hypotension and bradycardia of 3.15 (1.69-5.87) and 2.20 (1.07-4.53), respectively; IPH was present in 37 cases, with RR values for hypotension and bradycardia of 2.70 (1.61-4.55) and 2.25 (1.15-4.39), respectively; and fibrous cap rupture was present in 29 cases, with RR values for hypotension and bradycardia of 1.50 (0.94-2.40) and 1.29 (0.67-2.49), respectively. The higher the number of risk factors in vulnerable plaques, the higher the incidence of intraoperative blood pressure and heart rate decrease: when the number of risk factors ranged from 0 to 3, the incidence of blood pressure decrease was 14.7% (5/34), 9/18, 11/18, and 13/19, respectively (P<0.001), and the incidence of heart rate decrease was 14.7% (5/34), 6/18, 7/18, and 8/19, respectively (P=0.022). There was no significant difference in the number of cases of dopamine use between the two groups (P>0.05). Conclusion: Patients with a higher number of risk factors for vulnerable carotid plaques, as indicated by carotid artery MRI vessel wall imaging, are at a higher risk of experiencing blood pressure and heart rate decrease during CAS surgery.

Calcification circumference, area, and location are associated with carotid stent expansion rate: high-resolution magnetic resonance vessel wall imaging study.

The plaque imaging findings associated with the stent expansion rate (SER) of the carotid artery are not well known. The purpose of this study was to investigate the imaging findings associated with SER. It was a retrospective investigation. Based on the kind of carotid stents used, retrospective data from 89 patients who had carotid artery stenting (CAS) for atherosclerotic carotid stenosis were gathered and divided into two groups: open-cell stents and closed-cell stents. Patients underwent preoperative carotid high-resolution magnetic resonance vessel wall imaging (HR-VWI). Use HR-VWI to quantitatively evaluate carotid wall thickness and plaque components. Calculate SER using digital subtraction angiography (DSA). All patients' baseline and HR-VWI imaging features were retrospectively analyzed. Simple and multivariable linear regression analysis was used to determine the imaging findings associated with SER of open-cell and closed-cell stents. A total of 89 patients (mean age, 70±8 years; 69 men) were included in the final analysis. Among 89 patients, 35 patients were treated with open-cell stents. Fifty-four patients were treated with closed-cell stents. In the open-cell stents group, the Maximum single-slice calcification circumference score, maximum wall thickness (WTmax), and total calcification location score with P<0.10 in the simple linear regression analysis were included in the multivariable linear regression analysis. The results of the multivariable linear regression revealed that only the Maximum single-slice calcification circumference score (β=-9.35; 95% CI: -18.15 to -0.56; P=0.03) was associated with SER of open-cell stents. In the closed-cell stents group, the Maximum single-slice calcification circumference score, WTmax, maximum area percentage of calcification, calcification volume, and total calcification location score with P<0.10 in the simple linear regression analysis were included in the multivariable linear regression analysis. The results of the multivariable linear regression revealed that the Maximum area percentage of calcification (β=-0.67; 95% CI: -1.29 to -0.05; P=0.03), Maximum single-slice calcification circumference score (β=-8.43; 95% CI: -13.36 to -3.49; P=0.001) and total calcification location score (β=-0.37; 95% CI: -1.08 to 0.09; P=0.02) were associated with SER of closed-cell stents. Calcified plaques are associated with SER of the carotid artery. Calcification circumference correlates with SER of open-cell stents. Calcification circumference, calcification area, and calcification location are related to SER of closed-cell stents, which may provide a new consideration for clinicians when choosing carotid artery stents.

Ex-vivo atherosclerotic plaque characterization using spectral photon-counting CT: Comparing material quantification to histology

Background and aimsAtherosclerotic plaques are characterized as being vulnerable to rupture based on a series of histologically defined features, including a lipid-rich necrotic core, spotty calcification and ulceration. Existing imaging modalities have limitations in their ability to distinguish between different materials and structural features. We examined whether X-ray spectral photon-counting computer tomography (SPCCT) images were able to distinguish key plaque features in a surgically excised specimen from the carotid artery with comparison to histological images. MethodsAn excised carotid plaque was imaged in the diagnostic X-ray energy range of 30–120 keV using a small-bore SPCCT scanner equipped with a Medipix3RX photon-counting spectral X-ray detector with a cadmium telluride (CdTe) sensor. Material identification and quantification (MIQ) images of the carotid plaque were generated using proprietary MIQ software at 0.09 mm volumetric pixels (voxels). The plaque was sectioned, stained and photographed at high resolution for comparison. ResultsA lipid-rich core with spotty calcification was identified in the MIQ images and confirmed by histology. MIQ showed a core region containing lipid, with a mean concentration of 260 mg lipid/ml corresponding to a mean value of −22HU. MIQ showed calcified regions with mean concentration of 41 mg Ca/ml corresponded to a mean value of 123HU. An ulceration of the carotid wall at the bifurcation was identified to be lipid-lined, with a small calcification identified near the breach of the artery wall. ConclusionsSPCCT derived material identification and quantification images showed hallmarks of vulnerable plaque including a lipid-rich necrotic core, spotty calcifications and ulcerations.

Tofogliflozin long-term effects on atherosclerosis progression and major clinical parameters in patients with type 2 diabetes mellitus lacking a history of cardiovascular disease: a 2-year extension study of the UTOPIA trial

BackgroundThis study aimed to assess the long-term effects of tofogliflozin, a sodium-glucose cotransporter 2 (SGLT2) inhibitor, on atherosclerosis progression and major clinical parameters in patients with type 2 diabetes lacking an apparent history of cardiovascular disease.MethodsThis was a prospective observational 2-year extension study of the “Using TOfogliflozin for Possible better Intervention against Atherosclerosis for type 2 diabetes patients (UTOPIA)” trial, a 2-year randomized intervention study. The primary endpoints represented changes in the carotid intima-media thickness (IMT). Secondary endpoints included brachial-ankle pulse wave velocity (baPWV) and biomarkers for glucose metabolism, lipid metabolism, renal function, and cardiovascular risks.ResultsThe mean IMT of the common carotid artery (IMT-CCA) significantly decreased in both the tofogliflozin (− 0.067 mm, standard error 0.009, p < 0.001) and conventional treatment groups (− 0.080 mm, SE 0.009, p < 0.001) throughout the follow-up period; however, no significant intergroup differences in the changes (0.013 mm, 95% confidence interval (CI) − 0.012 to 0.037, p = 0.32) were observed in a mixed-effects model for repeated measures. baPWV significantly increased in the conventional treatment group (82.7 ± 210.3 cm/s, p = 0.008) but not in the tofogliflozin group (− 17.5 ± 221.3 cm/s, p = 0.54), resulting in a significant intergroup difference in changes (− 100.2 cm/s, 95% CI − 182.8 to − 17.5, p = 0.018). Compared to the conventional treatment group, tofogliflozin significantly improved the hemoglobin A1c and high-density lipoprotein cholesterol levels, body mass index, abdominal circumference, and systolic blood pressure. The frequencies of total and serious adverse events did not vary significantly between the groups.ConclusionsTofogliflozin was not associated with improved inhibition of carotid wall thickening but exerted long-term positive effects on various cardiovascular risk factors and baPWV while showing a good safety profile.

De novo expansion formation in the outer curvature of the internal carotid artery after flow diverter deployment for an infectious cavernous carotid aneurysm: illustrative case.

Infectious aneurysms very rarely occur in the cavernous carotid artery. Recently, treatment by flow diverter implantation with preservation of the parent artery has been the treatment of choice. A 64-year-old woman presented with stenosis at the C5 segment of the left internal carotid artery (ICA), followed by ocular symptoms within 2 weeks, with a de novo aneurysm in the left cavernous carotid artery and wall irregularity with stenosis from the C2 to C5 segments of the left ICA. Antimicrobial therapy was given for 6 weeks, and a Pipeline Flex Shield was implanted. Angiography 6 months after treatment showed complete obliteration of the infectious aneurysm and improvement of the stenosis. However, de novo expansions were formed in the outer curvature of C3 and C4 segments of the ICA where the Pipeline device had been deployed. Aneurysms that develop rapidly and show shape changes over time, accompanied by fever and inflammation, may be associated with an infection. Because of the fragility in the irregular wall of the parent vessel associated with infectious aneurysms, de novo expansion may form in the outer curvature of the parent vessel after flow diverter placement; thus, careful follow-up is necessary.

Vulnerable carotid plaque characteristics on magnetic resonance vessel wall imaging: potential predictors for hemodynamic instability during carotid artery stenting.

This cross-sectional study sought to explore the possible risk factors assessed with magnetic resonance (MR) vessel wall imaging for hemodynamic instability (HI) during carotid artery stenting (CAS). Patients with carotid stenosis who were referred for CAS from January 2017 to December 2019 were recruited and underwent carotid MR vessel wall imaging. The vulnerable plaque features, including lipid-rich necrotic core (LRNC), intraplaque hemorrhage (IPH), fibrous cap rupture, and plaque morphology, were evaluated. The HI was defined as a drop of systolic blood pressure (SBP) of ≥30 mmHg or the lowest SBP measurement of <90 mmHg after stent implantation. The carotid plaque characteristics were compared between the HI and non-HI groups. The association between carotid plaque characteristics and HI was analyzed. A total of 56 participants (mean age 68.7±8.3 years; 44 males) were recruited. Patients in the HI group (n=26, 46%) had a significantly greater wall area [median 43.2 (IQR, 34.9-50.5) vs. 35.9 (IQR, 32.3-39.4) mm2; P=0.008], total vessel area (79.7±17.2 vs. 69.9±17.3 mm2; P=0.03), prevalence of IPH (62% vs. 30%; P=0.02), prevalence of vulnerable plaque (77% vs. 43%; P=0.01), and volume of LRNC [median 344.7 (IQR, 155.1-665.7) vs. 103.1 (IQR, 53.9-162.9) mm3; P=0.001] in carotid plaque compared to those in non-HI group (n=30, 54%). Carotid LRNC volume (OR =1.005, 95% CI: 1.001-1.009; P=0.01) and presence of vulnerable plaque (OR =4.038, 95% CI: 0.955-17.070; P=0.06) were significantly and marginally associated with HI, respectively. Carotid plaque burden and vulnerable plaque features, particularly a larger LRNC, might be effective predictors for HI during the CAS procedure.

Association of leisure-time physical activity and sedentary behavior with carotid atherosclerosis morphology: The ARIC carotid-MRI study

ObjectiveWe evaluated the prospective association of midlife leisure-time physical activity (LTPA) and sedentary behavior (SB), and their temporal patterns, with MRI-measured carotid atherosclerotic morphology. MethodsParticipants enrolled in the Carotid MRI substudy (2004–2006) of the Atherosclerosis Risk in Communities (ARIC) Study and with self-reported assessments of LTPA and SB at visits 1 (1987–1989) and 3 (1993–1995) were included in this study. LTPA was ascertained using the ARIC/Baecke physical activity questionnaire and categorized according to the American Heart Association's metric of poor, intermediate, or ideal physical activity. SB, measured as TV viewing frequency, was categorized as high, medium, and low. We used multivariable adjusted linear and logistic regression models to examine the associations between midlife (visit 3 only) and persistent (visit 1 to 3) LTPA and TV viewing with carotid artery plaque burden and components. ResultsAmong the 1,582 (mean age: 59 years, 43% male, 18% Black) participants, 45.7%, 21.7%, and 32.6% reported ideal, intermediate, or poor LTPA, respectively. High TV viewing was reported in 33.8% of participants, with 46.4% and 19.8% reporting medium or low TV viewing, respectively. Compared to poor LTPA, ideal LTPA in midlife was not associated with total wall volume (ß=0.01, 95% CI: -0.01, 0.03), maximum carotid wall thickness (ß=0.06, 95% CI: -0.08, 0.21), normalized wall index (ß=-0.01, 95% CI: -0.03, 0.01), or maximum stenosis (ß=-0.11, 95% CI: -1.98, 1.76). Low or middle, compared to high, TV viewing was also not associated with carotid artery measures of plaque burden. Compared to poor LTPA or high TV viewing, ideal LTPA (odds ratio (OR): 0.82, 95% CI: 0.55, 1.23) and low TV viewing (OR=0.90, 95% CI: 0.56, 1.44) was not associated with odds of lipid core presence, respectively. ConclusionOverall, this study does not provide strong evidence for an association between LTPA and SB with carotid plaque measures.

Association of Serum Cystatin C Level With Carotid Arterial Wall Elastic Resistance as a Potential Marker for Detection of Early Stage Atherosclerosis.

Early diagnosis of atherosclerosis is exigent in patients with known cardiovascular disease (CVD) risk factors. During the initial phases of atherosclerosis, appearance of plaques can be detected by the ultrasonic phased tracking method which measures the arterial wall elasticity. However, reliable and easily available biochemical markers are not evaluated in the diagnosis of early-stage atherosclerosis. So the current study was carried out to assess the serum cystatin C level as an atherosclerotic marker, by evaluating its association with carotid arterial elastic modulus using the phased tracking method. A cross-sectional study was conducted on 115 patients havingrisk factors for atherosclerosis but not meeting carotid intima-media thickness (IMT) criteria. The early-stage atherosclerosis was detected by using the ultrasonic phased tracking method and the patients were divided based onlow and high carotid elastic modulus. Serum levels of cystatin-C were measured in association with IMT, and elastic modulus was calculated using a novel method. This study also put forth the evaluation ofthe sensitivity and specificity of cystatin C for early diagnosis of atherosclerosis. Cystatin C was strongly related to carotid elasticity (r=0.650). Based on multi-linear regression analysis, cystatin C showed significant association with carotid elasticity (β=0.509; p<0.001). It also displayed significant positive association with high carotid elastic modulus (β=0.511; p=0.02). Cystatin C showed a sensitivity of 85% in the prediction ofhigh carotid elastic modulus. For patients who are at risk to evolve atherosclerosis but are not evident with arterial plaques, cystatin C exhibits a significant association with carotid wall elastic modulus, which eases the detection of atherosclerosis. Thus, cystatin C is a potential biochemical marker for early diagnosis of atherosclerosis.

Assessment of Takayasu's arteritis activity by ultrasound localization microscopy.

Ultrasound localization microscopy (ULM) based on ultrafast ultrasound imaging of circulating microbubbles (MB) can image microvascular blood flows invivo up to the micron scale. Takayasu arteritis (TA) has an increased vascularisation of the thickened arterial wall when active. We aimed to perform vasa vasorum ULM of the carotid wall and demonstrate that ULM can provide imaging markers to assess the TA activity. Patients with TA were consecutively included with assessment of activity by the National Institute of Health criteria: 5 had active TA (median age 35.8 [24.5-46.0] years) and 11 had quiescent TA (37.2 [31.7-47.3] years). ULM was performed using a 6.4MHz probe and a dedicated imaging sequence (plane waves with 8 angles, frame rate 500Hz), coupled with the intravenous injection of MB. Individual MB were localised at a subwavelength scale then tracked, allowing the reconstruction of the vasa vasorum flow anatomy and velocity. ULM allowed to show microvessels and to measure their flow velocity within the arterial wall. The number of MB detected per second in the wall was 121 [80-146] in active cases vs. 10 [6-15] in quiescent cases (p=0.0005), with a mean velocity of 40.5 [39.0-42.9] mm.s-1 in active cases. ULM allows visualisation of microvessels within the thickened carotid wall in TA, with significantly greater MB density in active cases. ULM provides a precise visualisation invivo of the vasa vasorum and gives access to the arterial wall vascularisation quantification. French Society of Cardiology. ART (Technological Research Accelerator) biomedical ultrasound program of INSERM, France.

RELEVANCE OF COMMON CAROTID INTIMA-MEDIA THICKNESS AND CAROTID PLAQUE AS RISK FACTOR FOR ISCHEMIC AND HAEMORRHAGIC STROKE IN PATIENTS ATTENDING MEDICAL COLLEGE AND HOSPITAL, KOLKATA

Introduction: A stroke or cerebrovascular accident is dened as an abrupt onset of a neurologic decit that is attributable to a focal vascular cause due to cerebral ischemia or intracranial haemorrhage. Atherosclerosis and carotid artery stenosis are the major causes of stroke. Carotid Intimamedial thickness is a marker of subclinical atherosclerosis. So the measurement of CIMT is of major concern in high risk individuals. To measure the carotid wall thickness Aim: (CIMT) using B-mode ultrasound of both right and left carotid artery and to establish association between CIMT and stroke. A Hospit Methodology: al based prospective, cross-sectional study concluded 100 diagnosed cases of stroke of which 50 ischemic stroke and 50 hemorrhagic stroke. All these patients underwent clinical evaluation CT Scan and MRI Scan of Brain, CIMT and blood investigation including complete hemogram , lipid prole , fasting blood glucose. Results: Mean age for presentation of stroke was 68.68 with maximum number of patients belonging to 61-80 years of age group with lowest age taken was 39 and the highest was 92. 49 (98%) patients with hemorrhagic stroke and 30 (60%) patients with ischemic stroke had hypertension. The CIMT was measured using B-mode USG probe correlated with the type of Stroke. The minimum value of Right CIMT in Hemorrhagic Stroke was 0.6 with maximum value 1.1; the mean was 0.788 + 0.1305 (mean + SD). The minimum value of Right CIMT in Ischemic stroke was 0.6 with maximum value 1.2; the mean was 0.93 + 0.1258 (mean + SD). Independent T-Test was performed, and 95% condence interval was between: 0.0931 to 0.1909 and p-value was &lt;0.0001. There was positive correlation between the CIMT and t Conclusion: ype of stroke. Between Right CIMT and type of stroke, the p-value was &lt;0.0001 which is highly signicant. Between Left CIMT and type of stroke, the p-value was also &lt;0.0001 which is highly signicant

Morphometric assessment of the effects of monosodium glutamate on the carotid sinus wall: an experimental study

The increase in global burden of stroke is hard to overestimate. Every year it continues to be a leading cause of mortality worldwide. Extracranial pathology of the carotid arteries is a major underlying reason of stroke. Given the role of alimentary factors in the development of atherosclerosis of the carotid arteries, possible influence of food additives on the carotid sinus structure is of special interest. Monosodium glutamate is one of the most common food additives that is allowed for consumption in many countries due to it being considered relatively safe. Recent scientific research however points towards the possible adverse effects of monosodium glutamate on the living organism. The aim of this study was to analyze qualitative and quantitative parameters of carotid sinus structural organization of white male albino rats under normal conditions, in the setting of oral monosodium glutamate consumption and after its withdrawal. Carotid sinuses of 30 white male albino rats that had been daily consuming 10 mg/kg of monosodium glutamate for 4 or 8 weeks with subsequent withdrawal for 2 weeks were subjected to qualitative and quantitative analysis at different time-points of the experiment. The data obtained was compared with the results of morphologic and morphometric study of carotid sinuses of 9 rats of the control group. For morphometric analysis, the following parameters were considered: intima thickness, media thickness, adventitia thickness, diameters of the arterioles, venules and capillaries of the carotid sinus vasa vasorum. Summarizing the morphometric analysis results, it is worth noting that, for the duration of 8 weeks of the experiment, steady increase in the thickness of all layers of the vascular wall, but especially intima and adventitia, was observed in the study group. At the same time, the diameter of the arterioles located in the carotid sinus adventitia was decreasing, while venules and capillaries demonstrated invariable increase of their lumen diameter. After 2 weeks of monosodium glutamate withdrawal, the thickness of intima and adventitia continued to increase, while media thickness had somewhat decreased, probably due to fibrosis and dystrophy. The tendency towards narrowing of the arterioles’ lumen and widening of the venules and capillaries persisted for at least 2 weeks despite discontinuation of monosodium glutamate. Therefore, systematic consumption of monosodium glutamate may lead to impairment of carotid sinus structural organization, particularly endothelial proliferation, fibrotic and dystrophic changes of media, adventitia thickening as well as microcirculatory vessels damage, that continue to persist despite the food additive withdrawal.

Determinants of Arterial Stiffness in Patients with Morbid Obesity. The Role of Echocardiography and Carotid Ultrasound Imaging

Background and objective: Morbid obesity is accompanied by an increased cardiovascular (CV) risk, which justifies a multidisciplinary, integrative approach. Arterial stiffness has a well-defined additional role in refining individual CV risk. Given that echocardiography and carotid ultrasound are usual methods for CV risk characterization, we aimed to identify the imaging parameters with a predictive value for early-onset arterial stiffness. Material and methods: We conducted a study in which 50 patients (divided into two equal groups with morbid obesity and without obesity), age and gender matched, untreated for cardiovascular risk factors, were addressed to bariatric surgery or non-inflammatory benign pathology surgery. Before the surgical procedures, we evaluated demographics, anthropometric data and biochemical parameters including adipokines (chemerin, adiponectin). Arterial stiffness was evaluated using the Medexpert ArteriographTM TL2 device. Transthoracic echocardiography and carotid ultrasound were also performed. We also analyzed adipocyte size and vascular wall thickness in intraoperative biopsies. Results: Left ventricle (LV) mass index (p = 0.2851), LV ejection fraction (LVEF) (p = 0.0073), epicardial adipose tissue thickness (p = 0.0001) as echocardiographic parameters and carotid intima-media thickness (p = 0.0033), relative wall thickness (p = 0.0295), wall to lumen thickness ratio (p = 0.0930) and carotid cross-sectional area (p = 0.0042) as ultrasound parameters were significant measures in our groups and were assessed in relation to adipocyte size, blood vessel wall thickness and adipokines serum levels. Statistical analysis revealed directly proportional relationships between LV mass index (p = 0.008), carotid systolic thickness of the media (p = 0.009), diastolic thickness of the media (p = 0.007), cross-sectional area (p = 0.001) and blood vessel wall thickness. Carotid relative wall thickness positively correlates with adipocyte size (p = 0.023). In patients with morbid obesity, chemerin and adiponectin/chemerin ratio positively correlates with carotid intima-media thickness (p = 0.050), systolic thickness of the media (p = 0.015) and diastolic thickness of the media (p = 0.001). The multiple linear regression models revealed the role of epicardial adipose tissue thickness and carotid cross-sectional area in predicting adipocyte size which in turn is an independent factor for arterial stiffness parameters such as pulse wave velocity, subendocardial viability ratio and aortic augmentation index. Conclusions: Our results suggest that epicardial adipose tissue thickness, carotid intima-media thickness, relative wall thickness and carotid cross-sectional area might be useful imaging parameters for early prediction of arterial stiffness in patients with morbid obesity.

Long-term cardiovascular consequences of adolescent anorexia nervosa

BackgroundAnorexia nervosa (AN) is associated with maladaptive cardiovascular changes. This study investigated whether individuals who recovered from AN during adolescence experience long-term cardiovascular risk in early adulthood.MethodsFormer AN patients discharged from the Royal Children’s and Monash Children’s Hospital Eating Disorder Services in Melbourne, Australia underwent cardiovascular testing. Measurements were performed using an oscillometric device for blood pressure and pulse wave velocity, ultrasound for carotid wall structure/function, resting electrocardiogram for heart-rate variability, and the EndoPat 2000 (Itamar) system for endothelial function. Patient measures were compared to healthy controls and/or normal thresholds.ResultsNinety-one percent of the former AN patients (N = 22) and controls (N = 66) were female, aged approximately 25 years, with a healthy body mass index. The mean time interval from AN recovery to participation was 7.4 years. Pulse wave velocity was lower in the former AN patients than controls. Carotid intima–media thickness was not different; however, carotid distensibility and compliance were lower, and the elastic modulus higher in the former AN patients. Greater vagal tone was observed and endothelial dysfunction was evident in 46% of the former patients.ConclusionsYoung adults who recovered from adolescent AN exhibit persistent cardiovascular adaptations. Routine cardiovascular monitoring could manage potential disease risk.ImpactCardiovascular complications are common in patients with anorexia nervosa (AN) and population studies have revealed that developmental adaptations in response to undernutrition have long-term consequences for cardiovascular health.In this study of young adults treated for AN during adolescence, there was evidence of increased carotid artery stiffness, reduced aortic stiffness, vagal hyperactivity, and endothelial dysfunction in early adulthood when compared to healthy controls.It is important to consider the cardiovascular health of patients with AN beyond achieving medical stability.Interventions that monitor cardiovascular health could minimise the burden of future cardiovascular disease.

Carotid wall echogenicity at baseline associates with accelerated vascular aging in a middle-aged population

Ultrasonic echolucent carotid intima-media (IM) complex and accelerated progression of carotid intima mediathickness (cIMT) have both separately been shown to predict future cardiovascular events. The aim of this studywas to evaluate if the echogenicity of the IM-complex is associated with the 3-year progression of cIMT. B-modeultrasound images captured at baseline and 3-year follow-up in the ‘Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention’ (VIPVIZA) trial were included (n: 3154). The bilateral mean cIMT and IM-echogenicity by greyscale median (GSM) were measured in the common carotid artery. Associations between IM-GSM at baseline and the 3-year cIMT progression were investigated using linear regression models for the whole population and stratified by sex, age and VIPVIZA study group (intervention versus control). In addition, adjusted analyses for confounding factors were performed. Unadjusted analysis showed that decreased IM-GSM at baseline was associated with increased progression of cIMT (p < 0.001). Stratified by age, the association was significant among 40 (p < 0.001) and 60 years old (p < 0.001). The association was statistically significant in both sexes and on comparison of VIPVIZA study subgroups. Adjustments for confounding factors did not alter the estimated relationship between IM-GSM and cIMT progression. Echolucent carotid intima media at baseline associates with increased 3-year cIMT progression among an asymptomatic, middle-aged population. Echogenicity of the intima media may identify individuals at risk for accelerated vascular aging.

Use of optical coherence tomography in selected patients with recurrent cryptogenic stroke: A case series and technical discussion.

Despite advances in secondary stroke prevention during the last several years, cryptogenic stroke remains associated with a high risk of recurrence. Studies have shown that the recurrence risk is higher in patients with large artery disease in which complex carotid plaques and carotid WEBs are identified. This is a case series of six patients with cryptogenic recurrent stroke in which conventional imaging and extensive workup did not identify an etiology. Intravascular optic coherence tomography (OCT) was performed using a ballon-guided flow-arrest technique to identify possible covert carotid lesions. We present six cases in which, with the help of OCT, we identified three carotid WEBs with associated thrombosis and two ulcerated carotid artery plaques. Four patients were subsequently treated with endovascular stent placement without complications. OCT permitted the distinction between complicated carotid artery plaque and carotid WEB. Intravascular OCT is a feasible and safe approach to identifying patients with covert carotid wall abnormalities, like carotid WEBs and ulcerated plaques, that are amenable to carotid stenting to reduce recurrent stroke risk.

A Study of Oxidative Stress, Inflammation, and Endothelial Dysfunction in Diabetic and Nondiabetic Chronic Kidney Disease Pre-Dialysis Patients.

Oxidative stress, inflammation, and endothelial dysfunction represent a key triad for the development and progression of atherosclerosis. Due to chronic low-grade inflammation in chronic kidney disease (CKD), concentrations of various inflammatory, endothelial, and oxidative stress markers are elevated, increasing the risk of atherosclerosis. The present study was undertaken to compare oxidative stress, inflammation, and endothelial dysfunction in diabetic and nondiabetic CKD pre-dialysis patients. This was an observational study on 120 CKD pre-dialysis patients: 60 with diabetes and 60 without diabetes. Markers of oxidative stress were measured in blood - malondialdehyde (MDA), ferric reducing ability of plasma (FRAP), paroxonase-1 (PON-1), ischemia-modified albumin (IMA); inflammation - interleukin-6 (IL-6), high-sensitivity C-reactive protein (hsCRP); and endothelial dysfunction - nitric oxide (NO), carotid wall intima-media thickness (CIMT). Comparisons between the two groups for continuous variables were made with the Student's unpaired t-test or Mann-Whitney test and for categorical values with χ2-test, as appropriate. MDA, IMA, IL-6, hsCRP, NO, and CIMT were significantly higher, while FRAP and PON-1 were significantly lower in the diabetic group when compared to nondiabetic group (P < 0.001). The number of atherosclerotic plaques was also significantly higher in the diabetic group compared to nondiabetic group. Our study showed increased oxidative stress, inflammation, endothelial dysfunction, and atherosclerosis in diabetic CKD pre-dialysis patients when compared to nondiabetic CKD pre-dialysis patients and in late stages when compared to early stages of CKD in both groups, indicating increased cardiovascular risk in late stages and diabetic CKD pre-dialysis patients.

S-09-5: HOMOARGININE AND CARDIOVASCULAR PROTECTION: POTENTIAL THERAPEUTIC TARGET?

Increasing evidence suggests that homoarginine may offer cardiovascular protection via several mechanisms. We previously investigated prospective associations between homoarginine and i) incident hypertension; ii) carotid wall thickening; and iii) cardiovascular mortality over a five to ten year period in a South African cohort based in the North West Province of the international Prospective Urban and Rural Epidemiology (PURE) study. No significant associations were found between baseline homoarginine levels and incident hypertension (n = 166). However, in a group who remained normotensive over the course of ten years (n = 166), homoarginine levels correlated positively with brachial systolic blood pressure (β = 0.33; p = 0.001); brachial pulse pressure (β = 0.40; p = 0.001); and central pulse pressure (β = 0.30; p = 0.003). This may suggest that the protective effects of homoarginine is not infinite and may become overshowed by other factors once hypertension develops. When investigating prospective associations between homoarginine at baseline and cross-sectional wall area (CSWA) five years later, we indicated that the protective association between CSWA and homoarginine was limited to the female participants of this cohort (n = 396; β = - 0.11; p = 0.024). We also examined whether homoarginine could predict 10-year risk of all cause and cardiovascular mortality. Higher homoarginine levels were found in survivors when compared to nonsurvivors (n = 143; 1.25 μM vs. 0.89 μM P &lt; 0.001) and in multivariable Cox regression analyses, higher homoarginine predicted a reduction in ten year cardiovascular (standardized hazard ratio, 0.61; 95% CI 0.50 to 0.75) and all cause (standardized hazard ratio, 0.59; 95% CI 0.41 to 0.84) mortality risk. Clearly, it would be beneficial to investigate the regulation of homoarginine levels as therapeutic target in the management of cardiovascular disease. Previous experimental findings indicated that homoarginine infusions have beneficial effects on left ventricular contractility and diastolic function, as well as blood pressure lowering effects to normotensive levels in hypertensive rats. The safety of oral homoarginine levels was established in healthy adults and provided the foundation for two clinical trials to provide data on the optimal dosing of homoarginine in humans (NCT02675660), and to evaluate the applicability of an oral formulation of homoarginine to normalize homoarginine blood levels in patients with acute ischemic stroke (NCT03692234).

The influence of respiration, neck flexion, and arterial segment on carotid artery longitudinal wall motion.

While carotid artery longitudinal wall motion (CALM) has been highly detailed in cross-sectional studies, there is little evidence to explain population inter-individual variability. This study was conducted to investigate how common external factors impact CALM. Twenty-one young healthy adults (11 females, aged 22±2 years) underwent three within-subject protocols. To evaluate probe positioning, vascular ultrasound was performed at a proximal and distal location along the common carotid artery. To evaluate neck angle, scans were acquired with the neck positioned at 70°, 90°, maximum extension (112±9°), and maximum flexion (51±7°). For the respiratory cycle condition, scans were taken during 7 sec of inhalation, 7 sec of exhalation, and 7 sec of breath hold. CALM was evaluated for anterograde, retrograde, and maximum displacements, as well as radial-axial displacement. CALM was greater at proximal vs. distal locations (retrograde = 1.14±0.62 vs. 0.63±0.24 mm, maximal = 1.32±0.59 vs. 0.73±0.24 mm; all p<0.05). Minimum neck angles had greater motion than maximum angles (maximum displacement = 1.03±0.43 vs. 0.77±0.23 mm, p<0.05). Without correcting breathing bias, retrograde displacement was greater during inspiration vs. expiration (1.06±0.34 vs. 0.58±0.24 mm) and breath hold (1.06±0.34 vs. 0.58±0.24 mm), diastolic CALM was greater during expiration vs. breath hold (1.10±0.44 vs. 0.76±0.33 mm), and maximum CALM was smaller during breath hold vs. expiration (0.89±0.31 vs. 1.21±0.39 mm) and inspiration (0.89±0.31 vs. 1.41±0.70 mm). We recommend scanning 1-2 cm proximal to the carotid bifurcation, maintaining a neutral neck angle (70-90°) for optimal CALM data collection in humans.

The Effect of Primary Aldosteronism on Carotid Artery Texture in Ultrasound Images.

Primary aldosteronism (PA) is the most frequent cause of secondary hypertension. Early diagnoses of PA are essential to avoid the long-term negative effects of elevated aldosterone concentration on the cardiovascular and renal system. In this work, we study the texture of the carotid artery vessel wall from longitudinal ultrasound images in order to automatically distinguish between PA and essential hypertension (EH). The texture is characterized using 140 Haralick and 10 wavelet features evaluated in a region of interest in the vessel wall, followed by the XGBoost classifier. Carotid ultrasound studies were carried out on 33 patients aged 42-72 years with PA, 52 patients with EH, and 33 normotensive controls. For the most clinically relevant task of distinguishing PA and EH classes, we achieved a classification accuracy of 73% as assessed by a leave-one-out procedure. This result is promising even compared to the 57% prediction accuracy using clinical characteristics alone or 63% accuracy using a combination of clinical characteristics and intima-media thickness (IMT) parameters. If the accuracy is improved and the method incorporated into standard clinical procedures, this could eventually lead to an improvement in the early diagnosis of PA and consequently improve the clinical outcome for these patients in future.