Common Carotid Artery Diameter Research Articles

Detection of Early Vascular Atherosclerosis in Type 2 Diabetes Mellitus Using Ultrasound Radiofrequency-Data Technique

ObjectivesTo quantitatively evaluate changes in vascular elasticity and intima-media thickness (IMT) of the common carotid artery (CCA) with Ultrasound radiofrequency (RF)-data technology in asymptomatic patients with type-2 diabetes mellitus (T2DM) and controls. Materials and methodsThirty-seven T2DM patients and 39 controls were enrolled. Arterial elasticity and CCA-IMT were quantitatively assessed by RF-data technology. The CCA diameters in the diastolic and systolic phases, carotid distensibility (CD), IMT, values of stiffness (β) and local pulse wave velocity (PWVβ) were measured and compared between the two groups. ResultsThe T2DM group had significantly larger CCA diastolic and systolic diameter, lower CD values, higher IMT measurements (all p < 0.001), and higher values of β and PWVβ (all P < 0.05) than the controls. Significant differences were not revealed in the mean values of IMT, β, PWVβ and CD across both sides of the CCA (all P > 0.05). ConclusionsHigher IMT measurement and lower arterial elasticity of the CCA are significantly pronounced in asymptomatic T2DM patients and may suggest atherosclerotic changes, and the ultrasound RF-data technique may be used as a potential approach for detection of early-stage atherosclerosis.

COGNITIVE FUNCTION AND CAROTID STRUCTURE OVER LONG-TERM OBSERVATION IN PATIENTS WITH RESISTANCE HYPERTENSION

Objective: to investigate the changes of cognitive function and carotid structure in patients with résistance hypertension (RH) over 24 months observation Design and method: In 51 pts with RH (average age 52,3 ± 0,9; 27 males) we measured ultrasonographically diameter (D) of common carotid arteries (CCA), carotid intima-media thickness (IMT) value at the carotid bifurcations and at the level of CCA, blood flow velocities (BFV) of CCA, internal carotid arteries (ICA) and cognitive function by Montreal cognitive assessment (MoCA) test twice: at baseline and after 24 months. Changes in D CCA, IMT and MoCA test were defined as a difference between subject's baseline D CCA, IMT, MoCA test and subsequent measurements obtained 24 months later. All pts received 4 antihypertensive drugs during observation period Results: systolic and diastolic blood pressure were significantly decreased at the end of observation period. Carotid diameter and IMT value at the level of CCA were significantly decreased during observation period (DCCA from 8,6 ± 0,03 to 8,3 ± 0,03 mm, p = 0,02, CCA IMT from 1,24 ± 0,02 to 1,11 ± 0,02 mm, p = 0,01). IMT value at carotid bifurcation didn’t change significantly. We observed improvement in cognitive function: MoCA test results at baseline was 22,2 ± 0,5 after 24 months - 24,9 ± 0,5. The end diastolic BFV in CCA, ICA were significantly increased (accordingly: CCA – 0,14 ± 0,03 vs 0,34 ± 0,03m/s, p = 0,001, ICA – 0,23 ± 0,02 vs 0,48 ± 0,03m/s, p = 0,001) and resistance index (RI) of ICA was significantly decreased from 0,65 ± 0,02 to 0,61 ± 0,02. Changes of peak systolic BFV were not significant. Changes of MoCA results were related to IMT value at the level of CCA at baseline and at the end of observation (accordingly: r = -0,81; p &lt; 0,01 and r = -0,79; p &lt; 0,02). The same relations were between MoCA results and IMT value at bifurcation CCA. Conclusions: our 24 months study showed the positive dynamics of cognitive function and carotid structure such as decreasing of carotid diameters, intima-media thickness at level CCA and carotid resistance in patients with resistance hypertension who were receiving antihypertensive treatment.

CA.ME.LI.A. An epidemiological study on the prevalence of CArdiovascular, MEtabolic, LIver and Autoimmune diseases in Northern Italy

Background and aimsCA.ME.LI.A (CArdiovascular risks, MEtabolic syndrome, LIver and Autoimmune disease) is a cross-sectional, epidemiological study performed between 2009–2011 in Abbiategrasso (Milan, Italy) to estimate the prevalence of cardiovascular risk factors, metabolic syndrome, liver and autoimmune diseases in the general adult population. This report focuses on the description and presentation of baseline characteristics of the population. Methods and resultsCitizens were randomly selected from the city electoral registers (n = 30903), yielding a sample of 2554 subjects (M = 1257, F = 1297; age, 47 ± 15 yrs; range 18–77 yrs). Men had higher prevalence of overweight or obesity (60.8% vs 41.6%; p < 0.0001) and greater thickness of visceral adipose tissue (40 ± 19 vs 27 ± 17 mm; p < 0.0001); no gender difference was found in subcutaneous adipose tissue thickness. Men also showed higher levels of serum triglycerides, γ-GT, fasting blood glucose, insulin and Homa-IR Index, while HDL, CRP, and prevalence of elevated (>5.0 mg/L) CRP were lower. Compared to normal weight men, risk-ratio (RR) of CRP elevation was 1.32 (ns) in overweight and 2.68 (p < 0.0001) in obese subjects. The corresponding figures in females were 2.68 (p < 0.0001) and 5.18 (p < 0.0001). Metabolic syndrome was more frequent in men (32.7% vs 14.5%; RR: 2.24, p < 0.0001). Interadventitia common carotid artery diameter was higher in men and increased with age and BMI. ConclusionsThe present study reports on the overall characteristics of a large population from Northern Italy. It aims to identify the associations among cardiovascular risk factors to prevent their development and progression, improve healthy lifestyle and identify subjects liable to pharmacological interventions.

Implications of different definitions for aortic arch classification provided by contemporary guidelines on thoracic aortic repair.

Contemporary guidelines on thoracic aortic repair provide inconsistent reporting standards for the definition of aortic arch classification in Types I, II and III. The different reported criteria cannot be used interchangeably, due to a very low level of concordance, and this finding has relevant implications for the comparisons between studies using different classifications, and between different datasets of multicentre trials, which are not consistently analyzed with the same criteria. Also, the reported definitions, which were originally proposed for predicting difficult carotid stenting and therefore were conceived for healthy aortic arches, can be influenced by the pathological derangements of the aortic wall, including aneurysms and dissections. In this respect, the Madhwal's classification, which is based on the diameter of the left common carotid artery, appears to be the more suitable one for aortic arch classification in patients with thoracic aortic disease because it provides relevant clinical information along with an adequate reproducibility.

Quantitative Evaluation of a Telerobotic System for Vascular Ultrasound Measurement on a Short Arm Human Centrifuge

Artificial Gravity generated by Short Arm Human Centrifuges is a promising multi-system countermeasure for physiological deconditioning during long duration space flights. To allow a continuous assessment of cardiovascular hemodynamics during centrifugation, a telerobotic robotic system holding an ultrasound probe has been installed on a Short Arm Human Centrifuge. A feasibility study was conducted to define the use capabilities and limitations of such a novel method. The objective of this study is to estimate the reproducibility and precision of remotely controlled vascular ultrasound assessment under centrifugation by assessing peripheral vascular diameter and wall distension. Four repeated centrifugation runs of 5 min, with 2.4 g at feet level, were performed including a 15 min rest between each run for a group of eight healthy male volunteers. Vascular diameter and distention were assessed for the common carotid artery (CCA) and the femoral artery (FA) by ultrasound imaging using a 10 MHz linear array probe (Mylab1, Esaote). Ultrasound measurements were consecutively performed: a) by an expert user in hand-held mode in standing as well as supine position, b) using the telerobotic arm without centrifugation as baseline and c) using the telerobotic arm during centrifugation. Vascular responses were compared between baseline and under centrifugation. Inter-, intra-registration and group variability have been assessed for hand-held and remotely controlled examination. The results show that intra-registration variability, σh , was always smaller than inter-registration variability, σm, that is in turned smaller than the inter-subject variability σg (σh < σm < σg). Centrifugation caused no significant changes in CCA diameter but a lower carotid distension compared to manual and robotic ultrasound in supine position (p < 0.05). Femoral diameter was significantly decreased in hypergravity compared to robotic sonography without centrifugation. A good reproducibility and precision of the remotely controlled vascular ultrasound assessment under centrifugation could be demonstrated. In conclusion, arterial wall dynamics can be precisely assessed for the CCA and femoral artery during centrifugation using a telerobotic ultrasound measurement system. Potential improvements to further enhance reproducibility and safety of the system are discussed.

Characteristics of cerebral hemodynamics in patients with chronic brain ischemia

Background. Literature sources report conflicting results regarding the severity of clinical symptoms of hydrocephalus (HC) and their association with cerebral arterial blood flow (CABF); most studies do not show a direct relationship, while some suggest a link between clinical severity and progressive decrease in CABF. The study of hemodynamic changes in the brain of patients with chronic brain ischemia (CBI), elucidation of their relationship with cognitive impairments helps to improve diagnostic approaches and optimize the prognosis of the disease. The purpose of this study is to investigate the state of cerebral hemodynamics and to establish its relationship with changes in cognitive functions in patients with CBI and HC. Materials and Methods. A comprehensive examination of 110 patients with CBI and HC was performed. The localization of the HC and results of Montreal Cognitive Test (MoCA scale) were taken into account. Computed tomography of the brain was performed with subsequent determination of morphometric parameters and indices. The state of cerebral blood flow and structural changes of blood vessels were studied using transcranial color-coded duplex ultrasonography (TCCS) of intracranial vessels and extracranial divisions. Microsoft Excel 2011 and Statistica were used for statistical processing of the results. Results. It was found that there was a significantly larger diameter of both common carotid arteries (CCA), thickness of complex intima\media (CIM), maximum systolic velocity (Vs), velocity at the end of the diastolic cycle (Vd), as well as peripheral resistance (IR) in left CCA (p &lt;0,05) in patients with CBI and HC compared with patients with CBI without HC. Significantly larger diameter of left internal carotid artery (ICA), Vs, Vd and IR was revealed; Vs and Vd in the right ICA; Vd in the extracranial devision of vertebral artery (VA) in patients with HC. A significant relationship was found between the following blood flow parameters and the values of the MoCA scale: Vs MCA/MoCA (r = 0,45, p &lt;0,05), Vs ACA/MoCA (r = 0,38, p &lt;0.05), ICA diameter/MoCA (r = -0,51, p &lt;0,05). It was found that the diameter of CCA and the thickness of CIM were significantly larger in patients with CBI with internal HC in comparison with patients with CBI with external HC (p &lt;0,01). Vs and Vd in patients with internal hydrocephalus were significantly lower, and IR was significantly higher compared with patients with external hydrocephalus (p &lt;0,01). The diameter of ICA and IR in patients with CBI with internal HC was significantly higher, and Vs was significantly lower compared with patients with CBI and external HC (p &lt;0,01). Significantly different values were found in Vs and IR meanings in middle cerebral artery (MCA) and Vs in anterior cerebral artery (ACA) in patients with CBI with internal HC compared with patients with CBI with external HC.Conclusions. Functional parameters of blood flow and structural changes of cerebral arteries in patients with CBI with concomitant hydrocephalus differed significantly from those in patients without hydrocephalus and depended on the type and severity of hydrocephalus. ICA occlusion, ICA stenosis &gt;50%, and intracranial venous stasis were significantly more common in patients with severe and moderate HC compared with those with mild HC. A weak relationship was found between the structure of carotid arteries and blood flow in intracranial arteries in patients with CBI and HC. There was a significant relationship between blood flow indices and the values of the MoCA scale, which indicated the effect of changes in the vessels of the anterior circular basin on the cognitive functions and the lack of such connection with blood flow indices in vertebrobasilar basin.

Common carotid artery true lumen flow impairment in patients with type A aortic dissection.

Our aim was to evaluate clinical and neurological effects of common carotid artery (CCA) true lumen flow impairment or occlusion in patients with type A aortic dissection. Characteristics and imaging data of patients with dissected CCA secondary to acute type A aortic dissection from 3 institutions were analysed. We defined true lumen blood flow as unimpaired when the maximum true lumen diameter exceeded 50% of the complete CCA diameter, as impaired when the true lumen was compressed to ˃50% of the complete lumen, or as occluded. Out of 440 patients, 207 presented unimpaired CCA flow, 172 impaired CCA flow and CCA occlusion was present in 61 patients. Preoperative shock (P = 0.045) or a neurological deficit (P < 0.001) were least common in patients with unimpaired CCA flow and most common in those with CCA occlusion. Non-cerebral, other-organ malperfusion was common in 37% of all patients, but the incidence was similar (P = 0.69). In patients with CCA occlusion, postoperative stroke (P < 0.001) and in-hospital mortality (0.011) were significantly higher, while the incidences were similar between patients with unimpaired and impaired CCA flow. Mixed-effects logistic regression models showed that CCA flow impairment (P = 0.23) or occlusion (P = 0.55) was not predictive for in-hospital mortality, but CCA occlusion was predictive for in-hospital stroke (odds ratio 2.166, P = 0.023). Shock and non-cerebral, other-organ malperfusion are common in patients with CCA dissection. While there is a high risk for stroke in patients with CCA occlusion, CCA flow impairment and occlusion were not predictive for in-hospital mortality. Surgery should not be denied to patients with CCA flow impairment or occlusion.

Parametry morfologiczne tętnic obwodowych w ocenie ryzyka sercowo-naczyniowego

Introduction. The aim of the study was to test the hypothesis that ultrasound measurements of common carotid artery (CCAd) and brachial artery (BAd) diameters represent markers of higher coronary artery disease risk (CAD, defined as ≥ 50% reduction in diameter of at least one large coronary artery segment). Materials and methods. Seventy-one patients (pts) evaluated for suspected stable CAD (23.9% women, age 61.5 ± 7.5) underwent ultrasound measurements of averaged diameters of both common carotid arteries and the brachial artery diameter of dominant arm. Clinical protocol included also: standard medical examination, assessment of biochemical parameters, resting electrocardiography, treadmill exercise test and transthoracic echocardiography. Diagnosis was established using quantitative coronary angiography measurements and calculation of Gensini Score (GS). Results. Angiographic CAD was present in 43 (60.5%) patients. Average CCAd was larger in CAD group (7.97 ± 0.96 mm vs. 7.37 ± 0.67 mm, p = 0.0052), similar to BAd (5.06 ± 0.65 vs. 4.68 ± 0.75, p = 0.03), respectively. The peripheral arterial diameters correlated with values of GS index, more pronounced for CCAd ( ρ = 0.35, p = 0.0023) than for BAd ( ρ = 0.24, p = 0.0368). CCAd significantly more positively correlated with the distal coronary artery segments values of the GS index ( ρ = 0.35, p = 0.0024), whereas the diameter of BA with the proximal segments values of GS index ( ρ = 0.239, p = 0.045). CCA and BD diameters indexed to body surface area (BSA) showed a strong trend toward larger average diameters in CAD patients: CCAd/BSA index: 4.06 ± 0.46 mm/m 2 vs. 3.85 ± 0.56 mm/m 2 , p = 0.087, BAd/BSA index: 2.57 ± 0.29 mm/m 2 vs. 2.42 ± 0.35 mm/m 2 , p = 0.057. Gensini score significantly correlated with CCAd/BSA index ( ρ = 0.24, p = 0.043) with a strong trend of positive correlation between GS index and BAd/BSA index ( ρ = 0.21, p = 0.076). Conclusions. The diameters of common carotid arteries and the brachial artery of dominant arm are greater in CAD pts. Peripheral arteries ultrasound may complement classic diagnostic pathway of stable coronary artery disease.

Genetic Variants Associated with Non-Alcoholic Fatty Liver Disease Do Not Associate with Measures of Sub-Clinical Atherosclerosis: Results from the IMPROVE Study

Non-alcoholic fatty liver disease (NAFLD) and atherosclerosis-related cardiovascular diseases (CVD) share common metabolic pathways. We explored the association between three NAFLD-associated single nucleotide polymorphisms (SNPs) rs738409, rs10401969, and rs1260326 with sub-clinical atherosclerosis estimated by the carotid intima-media thickness (c-IMT) and the inter-adventitia common carotid artery diameter (ICCAD) in patients free from clinically overt NAFLD and CVD. The study population is the IMPROVE, a multicenter European study (n = 3711). C-IMT measures and ICCAD were recorded using a standardized protocol. Linear regression with an additive genetic model was used to test for association of the three SNPs with c-IMT and ICCAD. In secondary analyses, the association of the three SNPs with c-IMT and ICCAD was tested after stratification by alanine aminotransferase levels (ALT). No associations were found between rs738409, rs1260326, rs10401969, and c-IMT or ICCAD. Rs738409-G and rs10401969-C were associated with ALT levels (p < 0.001). In patients with ALT levels above 28 U/L (highest quartile), we observed an association between rs10401969-C and c-IMT measures of c-IMTmax and c-IMTmean-max (p = 0.018 and 0.021, respectively). In conclusion, NAFLD-associated SNPs do not associate with sub-clinical atherosclerosis measures. However, our results suggest a possible mediating function of impaired liver function on atherosclerosis development.

Poor concordance between definitions of type III arch and implications for risk prediction and assessment for carotid artery stenting

ObjectiveThe type III arch configuration has been inconsistently reported as a stroke risk factor during carotid artery stenting. However, at least three different methods for the definition of type III arch can be identified in the literature, related to the level of the origin of the innominate artery (IA). According to Casserly's definition, a type III arch presents with an origin of the IA below the horizontal plane of the inner curvature. According to Madhwal's definition, a type III arch has a distance greater than twice the diameter of the left common carotid artery between the highest point of the arch and the origin of the IA. According to MacDonald's definition, a type III arch presents with a distance of ≥2 cm between the highest point of the arch and the origin of the IA. Our aim was to assess the level of concordance between these different methods. MethodsAnonymized thoracic computed tomography scans of 100 healthy patients were reviewed. Two of us independently stratified the selected cases as a type I to III arch, according to the three considered definitions. The interobserver level of concordance for each type III arch classification and level of concordance among the three definitions were assessed. ResultsThe 100 selected patients (64% male) were 76 ± 7 years old. For each definition, the interobserver repeatability was almost perfect for all three (Madhwal, κ = 0.81; 95% confidence interval [CI], 0.71-0.99; MacDonald, κ = 0.82; 95% CI, 0.72-0.92; Casserly, κ = 0.84; 95% CI, 0.74-0.93). The level of concordance among the different definitions was very low (Madhwal vs MacDonald, 85% [P = .002]; 33% for type III arch; Madhwal vs Casserly, 60% [P < .0001]; 12% for type III arch; MacDonald vs Casserly, 75% [P < .0001]; 12% for type III arch). ConclusionsThe three definitions of the type III arch have a very low level of concordance, which might account for the varying clinical relevance of this configuration. Our findings have relevant implications for risk prediction for carotid artery stenting based on the presence of a type III arch, for comparisons of the results from different studies, and for comparisons of different datasets from multicenter trials.

Global REACH 2018: The carotid artery diameter response to the cold pressor test is governed by arterial blood pressure during normoxic but not hypoxic conditions in healthy lowlanders and Andean highlanders.

What is the central question of this study? What is the impact of oxygen on the circulatory responses to an isocapnic cold pressor test (CPT) in lowlanders and Andean highlanders? What is the main finding and its importance? Overall, the circulatory responses to an isocapnic CPT were largely unaltered with acute normobaric hypoxia and chronic hypobaric hypoxia exposure in lowlanders. However, the relationship between mean arterial pressure and common carotid artery diameter was dampened in hypoxic conditions. Furthermore, there were no differences in the circulatory responses to the CPT between lowlanders and Andean highlanders with lifelong exposure to high altitude. The impact of oxygen on the circulatory responses to a cold pressor test (CPT) in lowlanders and Andean highlanders remains unknown. Our hypotheses were as follows: (i) in lowlanders, acute normobaric and hypobaric hypoxia would attenuate the common carotid artery (CCA) diameter response to the CPT compared with normobaric normoxia; (ii) Andean highlanders would exhibit a greater CCA diameter response compared with lowlanders; and (iii) a positive relationship between CCA diameter and blood pressure in response to the CPT would be present in both lowlanders and highlanders. Healthy lowlanders (n=13) and Andean highlanders (n=8) were recruited and conducted an isocapnic CPT, which consisted of a 3min foot immersion into water at 0-1°C. Blood pressure (finger photoplethysmography) and CCA diameter and blood flow (Duplex ultrasound) were recorded continuously. The CPT was conducted in lowlanders at sea level in isocapnic normoxic and hypoxic conditions and after 10 days of acclimatization to 4300m (Cerro de Pasco, Peru) in hypoxic and hyperoxic conditions. Andean highlanders were tested at rest at high altitude. The main findings were as follows: (i) in lowlanders, normobaric but not hypobaric hypoxia elevated CCA reactivity to the CPT; (ii) no differences in response to the CPT were observed between lowlanders and highlanders; and (iii) although hypobaric hypoxaemia reduced the relationship between CCA diameter and blood pressure compared with normobaric normoxia (P=0.132), hypobaric hyperoxia improved this relationship (P=0.012), and no relationship was observed in Andean highlanders (P=0.261). These data demonstrate that the circulatory responses to a CPT were modified by oxygen in lowlanders, but were unaltered with lifelong hypoxic exposure.

Age-dependent characterization of carotid and cerebral artery geometries in a transgenic mouse model of sickle cell anemia using ultrasound and microcomputed tomography

To define morphological changes in carotid and cerebral arteries in sickle cell transgenic mice (SS) as they age, a combination of ultrasound and microcomputed tomography of plastinated arteries was used to quantify arterial dimensions and changes in mice 4, 12, and 24 weeks of age. 12-week SS mice had significantly larger common carotid artery diameters than AS mice, which continued through to the extracranial and intracranial portions of the internal carotid artery (ICA). There were also side specific differences in diameters between the left and right vessels. Significant ICA tapering along its length occurred by 12- and 24-weeks in SS mice, decreasing by as much as 70%. Significant narrowing along the length was also measured in SS anterior cerebral arteries at 12- and 24-weeks, but not AS. Collectively, these findings indicate that sickle cell anemia induces arterial remodeling in 12- and 24-weeks old mice. Catalog of measurements are also provided for the common carotid, internal carotid, anterior cerebral, and middle cerebral arteries for AS and SS genotypes, as a reference for other investigators using mathematical and computational models of age-dependent arterial complications caused by sickle cell anemia.

The Relation Between Common Carotid Artery Diameter and Central Venous Pressure for Assessment of Intravascular Fluid Status after Major Surgeries; an Observational Study.

ObjectivesThe current study aimed to find the relation between the changes in the common carotid artery (CCA) diameter and the central venous pressure (CVP) in response to a fluid challenge in spontaneously breathing adult patients.MethodsThis study included 65 adult patients aged 20 - 60 years who were admitted to the surgical ICU. The CCA diameter and CVP were measured before and after fluid challenge, and the percentage of increase in the CCA diameter and CVP were calculated. The correlation was assessed between changes in the CVP and CCA diameter.ResultsThe CCA diameter before fluid administration had a significant strong positive correlation to the CVP (r = 0.8, P value < 0.001); the increase in the CCA diameter after fluid administration had a significant moderate positive correlation with the increase in the CVP (r = 0.4, P value < 0.001). The percentage of increase in CCA diameters was positively correlated to the percentage of increase in CVP (r = 0.589, P value = 0.001) following fluid administration. However, the Receiver Operating Characteristic (ROC) analysis was an invalid test (area under curve 0.513, P value = 0.885).ConclusionsAfter major surgeries, the change in the CCA diameter was positively correlated with the change in the CVP values in response to fluid administration in the spontaneously breathing adult patients, but the cut-off limit cannot be reached.

Endothelial Shear Stress In The Common Carotid Artery During Boxing Training

PURPOSE: Endothelial function is highly regulated by the interaction between blood flow and the endothelium. Endothelial shear stress (ESS) is defined as the dragging force generated by this interaction and it has been reported that low ESS affects nitric oxide bioavailability which in turn might increase blood pressure. Exercise programs are one of the best suited approaches to prevent high blood pressure, however, there are no studies describing changes on ESS in the common carotid artery during specific modalities of exercise, such as boxing training. Therefore, the purpose of this study was to quantify ESS in the common carotid artery during maximal and submaximal boxing training in normotensive and pre-hypertensive subjects. METHODS: A cohort of 5 healthy normotensive and 5 pre-hypertensive subjects matched by age, gender, height, and weight were recruited for this study. All 10 subjects performed two boxing tests. The first was a graded maximal boxing test to estimate their maximal oxygen uptake (VO₂max). The second one, performed 48 hours after the first evaluation, was a 2-workload steady-state boxing test at 60%VO2max and at 95%VO2max for 3 minutes each. A high-definition Doppler ultrasound recorded common carotid artery diameters and blood flow velocities throughout each steady-state condition. ESS was estimated using Womersley’s approximation. RESULTS: There was a significant increase in antegrade ESS with higher workloads in both groups (p < 0.05 for all). No difference were found in anterograde ESS at baseline (Normotensive: 33.9±13.9 dynes/cm2, Pre-HTA: 34.7±5.5 dynes/cm2; p = 0.936), at 60%VO₂max (Normotensive: 51.3±19.1 dynes/cm2, Pre-HTA: 49.6±7.6 dynes/cm2; p = 0.894, and at 95%VO₂max (Normotensive: 72.9±30.9 dynes/cm2 , Pre-HTA: 85.2±12.5 dynes/cm2; p = 0.560) between both groups. Meanwhile, no retrograde blood flow was present at baseline for either groups, but it was identified at 60%VO₂max (Normotensive: 8.1±0.7 dynes/cm2, Pre-HTA: 7.8±7.8 dynes/cm2; p = 0.971) and 95%VO₂max (Normotensive: 22.5±18.9 dynes/cm2 , Pre-HTA: 20.8±5.6 dynes/cm2; p = 0.891). CONCLUSIONS: ESS increases in an exercise-intensity manner during boxing training in normotensive and prehypertensive population. Boxing training might be beneficial in high blood pressure prevention due to increments on ESS.

Circulating Monocyte Count as a Surrogate Marker for Ventricular-Arterial Remodeling and Incident Heart Failure with Preserved Ejection Fraction.

Among 2085 asymptomatic subjects (age: 51.0 ± 10.7 years, 41.3% female) with data available on common carotid artery diameter (CCAD) and circulating total white blood cell (WBC) counts, higher circulating leukocytes positively correlated with higher high sensitivity C-reactive protein (hs-CRP). Higher WBC/segmented cells and monocyte counts were independently associated with greater relative wall thicknesses and larger CCADs, which in general were more pronounced in men and obese subjects (body mass index ≥ 25 kg/m2) (all P interaction: < 0.05). Using multivariate adjusting models, only the monocyte count independently predicted the left ventricular mass index (LVMi) (ß-Coef: 0.06, p = 0.01). Higher circulating WBC, segmented, and monocyte counts and a greater CCAD were all independently associated with a higher risk of heart failure (HF)/all-cause death during a median of 12.1 years of follow-up in fully adjusted models, with individuals manifesting both higher CCADs and monocyte counts incurring the highest risk of HF/death (adjusted hazard ratio: 2.81, 95% CI: 1.57. −5.03, p < 0.001; P interaction, 0.035; lower CCAD/lower monocyte as reference). We conclude that a higher monocyte count is associated with cardiac remodeling and carotid artery dilation. Both an elevated monocyte count and a larger CCAD may indicate a specific phenotype that confers the highest risk of HF, which likely signifies the role of circulating monocytes in the pathophysiology of heart failure with preserved ejection fraction (HFpEF).

Effects of Xueshuantong Injection on thrombosis formation and blood flow in rats

The aim of this paper was to explore the effect of Xueshuantong Injection(freeze-dried powder,XST) on κ-carrageenan-induced thrombosis and blood flow from the aspects of interactions among blood flow,vascular endothelium and platelets. Fifty male Sprague-Dawley rats(190-200 g) were randomized into five groups: control group, model group, heparin sodium(1 000 U·kg~(-1)) group, low-dose and high-dose(50, 150 mg·kg~(-1)) XST groups. Rats were intraperitoneally injected with corresponding drugs and normal saline(normal control and model groups) for 10 days. One hour after drugs were administered intraperitoneally on the 7 th day, each rat was injected with κ-carrageenan(Type Ⅰ, 1 mg·kg~(-1)) which was dissolved in physiological saline by intravenous administration in the tail to establish tail thrombus model. The lengths of black tails of the rats were measured at 2, 6, 24 and 48 h after modeling. Vevo®2100 small animal ultrasound imaging system was used to detect the internal diameter of rat common carotid artery, blood flow velocity and heart rate, and then the blood flow and shear rate were calculated. Meanwhile, the microcirculatory blood flow perfusion in the thigh surface and tail of rats were detected by laser speckle blood flow imaging system. Platelet aggregometry was used to detect the max platelet aggregation rate in rats. Pathological changes in tail were observed through hematoxylin-eosin staining, and Western blot was used to detect the protein content of platelet piezo1. According to the results, XST could inhibit the rat tail arterial thrombosis and significantly reduce the length of black tail(P&lt;0.05). The blood flow of common carotid artery in XST low dose group was significantly higher than that in the model group(P&lt;0.05). XST high dose group could significantly increase the microcirculatory blood flow perfusion of the tail in rats as compared with the model group(P&lt;0.05). XST high dose group could significantly inhibit platelet aggregation rate(P&lt;0.05) and XST low dose group could significantly inhibit platelet piezo1 protein expression(P&lt;0.01). In summary, XST could play an effect in fighting against thrombosis induced by κ-carrageenan in rats, which may be related to significantly inhibiting platelet aggregation, improving body's blood flow state, maintaining normal hemodynamic environment and affecting mechanical ion channel protein piezo1.

The Relations of TNF-?, CRP and Lipid Profile with Carotid Intima-Media Thickness (CIMT) in OBESE Adolescents

Background: Obesity is a health problem, causes serious complications. The mechanism of fat accumulation in the initial process of atherosclerosis is still unclear. The process occurs due to chronic inflammation where the indicator of atherosclerosis that related to inflammatory processes, such as levels of C-reactive protein (CRP) and tumor necrosis factor alpha (TNF-α)in the blood are higher in children with obesity. Purpose: To examine the relationship of TNF-α, hsCRP and lipid profile with CIMT in obese adolescents. Method: A cross sectional study was conducted on obese adolescents in Dr. Soetomo Hospital Child Health Unit from January until September 2018. Measurements of TNF-α, hsCRP and lipid profile were examine using ELISA method. CIMT was obtained through carotid ultrasound. TNF-α correlation, hsCRP and lipid profile with CIMT were analyzed using Pearson and Spearman Rho with significant value of P<0.05. Logistic regression analysis was carried out to determine the effect of cardiovascular disease risk factors on CIMT. Result: 59 adolescents with central obesity were obtained, consisting of 32 (54.2%) boys and 27 (45.8%) girls. Total of 38 (64.4%) adolescents with dyslipidemia. There was no correlation between TNF-α, hsCRP, lipid profile and CIMT. The diameter of common carotid artery had a positive correlation with hsCRP (r=0.284;P=0.029). In girls, hsCRP had a positive correlation with the diameter of the left common carotid artery (r = 0.533; P=0.004). This correlation was not found in boys. Conclusions: There was no correlation between TNF-α, hsCRP, lipid profile and CIMT.

Endothelial shear stress in the common carotid artery during boxing training in prehypertension

PURPOSEEndothelial function is highly regulated by the friction between blood flow and the endothelium. Endothelial shear stress (ESS) is defined as the dragging force generated by this interaction and it has been reported that low ESS affects nitric oxide bioavailability which in turn might increase blood pressure. Exercise programs are one of the best suited approaches to treat high blood pressure, however, there are no studies describing changes on ESS in the common carotid artery during upper‐body exercise, such as boxing training. Therefore, the purpose of this study was to quantify ESS in the common carotid artery during 60% and 95% of the maximal boxing exercise capacity in normotensive and pre‐hypertensive subjects.METHODSA total of 5 healthy normotensive and 5 pre‐hypertensive subjects matched by age, gender, height, and weight were recruited for this study. All 10 subjects performed two boxing exercise tests. The first was a graded maximal boxing test to estimate their maximal oxygen uptake (VO2max). The second one, performed 48 hours after the first evaluation, was a 2‐workload steady‐state boxing test at 60%VO2max and at 95%VO2max for 3 minutes each. A high‐definition Doppler ultrasound recorded common carotid artery diameters and blood flow velocities throughout each steady‐state condition. ESS was estimated using Womersley’s approximation.RESULTSThere was a significant increase in antegrade ESS with higher workloads in both groups (p &lt; 0.05 for all). No difference were found in anterograde ESS at baseline (Normotensive: 33.9±13.9 dynes/cm2, Pre‐HTA: 34.7±5.5 dynes/cm2; p = 0.936), at 60%VO2max (Normotensive: 51.3±19.1 dynes/cm2, Pre‐HTA: 49.6±7.6 dynes/cm2; p = 0.894, and at 95%VO2max (Normotensive: 72.9±30.9 dynes/cm2, Pre‐HTA: 85.2±12.5 dynes/cm2; p = 0.560) between both groups. Meanwhile, no retrograde blood flow was present at baseline for either groups, but it was identified at 60%VO2max (Normotensive: 8.1±0.7 dynes/cm2, Pre‐HTA: 7.8±7.8 dynes/cm2; p = 0.971) and 95%VO2max (Normotensive: 22.5±18.9 dynes/cm2, Pre‐HTA: 20.8±5.6 dynes/cm2; p = 0.891).CONCLUSIONESS increases in an exercise‐intensity manner during boxing training in normotensive and prehypertensive population. Boxing training might be beneficial in high blood pressure prevention due to increments on ESS.

Anatomic criteria in the selection of treatment modality for atherosclerotic carotid artery disease

ObjectiveThree procedures are currently available to treat atherosclerotic carotid artery stenosis: carotid endarterectomy (CEA), transfemoral carotid artery stenting (TF-CAS), and transcarotid artery revascularization (TCAR). Although there is considerable debate evaluating each of these in a head-to-head comparison to determine superiority, little has been mentioned concerning the specific anatomic criteria that make one more appropriate. We conducted a study to define anatomic criteria in relation to inclusion and exclusion criteria and relative contraindications. MethodsA retrospective review was conducted of 448 carotid arteries from 224 consecutive patients who underwent a neck and head computed tomography arteriography (CTA) scan before carotid intervention for significant carotid artery stenosis. Occlusion of the internal carotid artery (ICA) occurred in 15, yielding 433 arteries for analysis. Anatomic data were collected from CTA images and demographic and comorbidities from chart review. Eligibility for CEA, TF-CAS, and TCAR was defined on the basis of anatomy, not by comorbidity. ResultsCTA analysis revealed that 92 of 433 arteries (21%) were ineligible for CEA because of carotid lesions extending cephalad to the second cervical vertebra. Overall, 26 arteries (6.0%) were not eligible for any type of carotid artery stent because of small ICA diameter (n = 11), heavy circumferential calcium (n = 14), or combination (n = 1). An additional 126 arteries were ineligible for TF-CAS on the basis of a hostile aortic arch (n = 115) or severe distal ICA tortuosity (n = 11), yielding 281 arteries (64.9%) that were eligible. In addition to the 26 arteries ineligible for any carotid stent, TCAR was contraindicated in 39 because of a clavicle to bifurcation distance <5 cm (n = 17), common carotid artery diameter <6 mm (n = 3), or significant plaque at the TCAR sheath access site (n = 20), yielding 368 arteries (85.0%) that were eligible for TCAR. ConclusionsA significant proportion of patients who present with carotid artery stenosis have anatomy that makes one or more carotid interventions contraindicated or less desirable. Anatomic factors should play a key role in selecting the most appropriate procedure to treat carotid artery stenosis. Determination of superiority for one procedure over another should be tempered until anatomic criteria have been assessed to select the best procedural options for each patient.

Effect of different perfusion flow on carotid artery blood flow during cardiopulmonary bypass.

To investigate the effect of cardiopulmonary bypass (CPB) with different perfusion flow on carotid artery blood by using the carotid artery ultrasound. Forty-five adult patients during Dec. 2014 to Jan. 2015 scheduled for heart valve replacement or ventricular septal defect repair were randomly divided into 3 groups (n=15) according to different perfusion flow during CPB: A Group 1 [(62±2) mL/(kg·min)], a Group 2 [(72±2) mL/(kg·min)], and a Group 3 [(82±2) mL/(kg·min)]. The diameter of the common carotid artery (CCAD), the peak velocity of the common carotid artery (CCAV),the flow of the common carotid artery (CCAF), the diameter of the internal carotid artery (ICAD), the peak velocity of the internal carotid artery (ICAV) and the flow of the internal carotid artery (ICAF) were measured at the responding time points before the anesthesia induction (T1), after the anesthesia induction (T2), 10 min into CPB (T3), 20 min into CPB (T4), 40 min into CPB (T5), 60 min into CPB(T6), 20 min after CPB ending (T7) by doppler ultrasonography, respectively. The hemoglobin (Hb) and lactic acid were compared at the time before CPB(P1),the time when temperature was decreased to the lowest during CPB (P2), the time when temperature was reheated to 35 ℃ (P3), 20 min after CPB was ended (P4), 2 hours after CPB was ended (P5) by α-steady method. The parameters of CPB and hemodynamic parameters at each time point and postoperative condition were recorded. There was no significant difference in Hb and lactic acid between the three groups (all P>0.05). For intra-group comparison, the Hb concentration at P2-P5 was lower than that at P1 (all P<0.05), and the Hb concentration was the lowest at P2 and P3. The level of lactic acid at P3-P5 was higher than those at P1 (all P<0.05).There were no significant differences in measurement of carotid artery between the left and right sides of the patients at T1 (all P>0.05). There was no significant difference in CCAV and CCAF among the 3 groups (both P>0.05). For intra-group comparison, the CCAV at T2-T6 was significantly lower than that at T1 (P<0.05), and higher at T7 than that at T2-T6 (all P<0.05), but it was still significantly lower than that at T1 (P<0.05). The difference of CCAF between T2-T5 and T1 was significant (all P<0.05). ICAV of G1 was lower than G3 at T3 (P<0.05). ICAV of G1 was lower than G2, and G2 was lower that G3 at T4 (both P<0.05). ICAV of G1 was lower than G2 at T6 (P<0.05). For intra-group comparison, the ICAV at T2 was significantly lower than that at T1 (P<0.05), and that at T3-T6 was significantly lower than that at T1 and T2 (all P<0.05). At T3-T6, ICAF of G1 was lower than that of G3 (all P<0.05). For intra-group comparison, ICAF at T2-T6 was significantly lower than that at T1 (all P<0.05). At T4, perfusion flow was positively correlated with CCAF, ICAV and ICAV (all P<0.05). None of the patients had obvious motor, sensory, or consciousness disturbance, and no neurological complications.There was no significant difference in postoperative hospital stay, postoperative ICU time, and postoperative extubation time among the 3 groups (all P>0.05). Different perfusion flows of CPB have different effects on carotids hemodynamics.There is correlation between carotids hemodynamics and perfusion flow. Carotid ultrasound examination can be used to evaluate cardiac output.