Extra-media Thickness Research Articles

Ultrasound Examination of Common Carotid Adventitial Thickness Can Differentiate Takayasu Arteritis and Large Vessel Giant Cell Arteritis.

Pathological studies have demonstrated that the adventitial layer is markedly thickened in Takayasu (TAK) as compared to large vessel giant cell arteritis (LV-GCA). An ultrasound (US) examination of the arterial vessels allows the determination of intima media thickness (IMT) and of adventitial layer thickness (extra media thickness (EMT)). No previous study has evaluated if there are differences in EMT thickness between TAK and LV-GCA. In this cross-sectional retrospective study of stored ultrasound (US) imaging, we have compared common carotid artery (CCA) EMT and IMT in a series of consecutive TAK and LV-GCA patients. US examination CCA IMT and EMT were significantly higher in TAK as compared to LV-GCA. With ROC curve analysis, we have found that an EMT > 0.76 mm has high sensitivity and specificity for TAK CCA examination. The percentage of CCA at EMT > 0.76 mm and the total arterial wall thickening were significantly higher in TAK group examinations. EMT thickness correlated with disease duration and IMT in the TAK group, as well as with the IMT and ESR values in the LV-GCA group. Upon multivariate logistic regression analysis, factors independently associated with TAK CCA were EMT > 0.76 mm and age. No significant variation in IMT and EMT could be demonstrated in subsequent US CCA examinations.

The relationship between Choroidal Vascular Index and non-invasive ultrasonographic atherosclerosis predictors

BackgroundThis study explores the intricate connections between choroidal vascular index (CVI) and non-invasive ultrasonographic atherosclerosis predictors, shedding light on the potential links between ocular vascular dynamics and systemic cardiovascular health. MethodsWe conducted a cross-sectional analysis of 81 participants, assessing CVI, intima-media thickness (IMT), extra-media thickness (EMT), and the PATIMA index. The presence of coronary artery disease (CAD) was also evaluated. Statistical methods included descriptive statistics, t-tests for group comparisons, Spearman correlation analysis, and receiver operating characteristic (ROC) curve analysis. ResultsOur findings revealed that patients with CAD had lower CVI values compared to those without CAD, underscoring a potential association between CVI and CAD. Significant negative correlations were observed between CVI and IMT, EMT, PATIMA, and CAD. ROC curve analysis identified optimal CVI cutoff values for hypertension and CAD detection, showcasing its potential as a diagnostic marker. DiscussionOur results align with existing literature on ocular vascular changes, supporting the notion that CVI may be a promising indicator of systemic vascular conditions. The study contributes to the broader understanding of the relationships between ocular and cardiovascular health, providing a foundation for future research and clinical applications. ConclusionThe study suggests that CVI holds clinical relevance as a non-invasive marker for identifying systemic conditions, offering insights into the fields of neurology, physical therapy, and rehabilitation. Addressing its limitations, this research encourages further investigation into the multifaceted connections between CVI and atherosclerosis predictors.

Peri-Carotid Adipose Tissue and Atherosclerosis at Carotid Bifurcation.

Vulnerable carotid plaques are responsible for 20% of the ischemic strokes. The identification of these asymptomatic carotid plaques that will become symptomatic is essential but remains unclear. Our main goal was to investigate whether the amount of the peri-carotid adipose tissue, estimated by the extra-media thickness (EMT), is associated with the atherosclerotic characteristics at the carotid bifurcation in patients with PAD. An observational, prospective, single-center, longitudinal study was conducted. Overall, 177 patients were subjected to carotid Doppler ultrasound at the study admission. The following data were collected: EMT, intima-media thickness (IMT), the presence of carotid plaques, the area of the highest plaque, the presence of "acute culprit" carotid stenosis, and the grade of internal carotid stenosis. "Acute culprit" carotid stenosis was defined as a significant atherosclerotic plaque that leads to a neurologic event within 15 days. From each carotid bifurcation, a right and a left EMT were determined. We analyzed both the mean EMTs (calculated as the mean between the right and the left EMT) and the EMT ipsilateral to the carotid bifurcation. The presence of carotid plaques was associated with a higher mean EMT [Median = 1.14; IQR = 0.66 versus Median = 0.97; IQR = 0.40; p = 0.001]. A positive correlation was found between the mean EMT and IMT (right: ρ = 0.20; p = 0.010; left: ρ = 0.21; p = 0.007) and between the mean EMT and the area of the largest carotid plaque (right: ρ = 0.17; p = 0.036; left: ρ = 0.22; p = 0.004). Left carotid stenosis ≥ 70% was associated with higher ipsilateral EMT [Median = 1.56; IQR = 0.70 versus Median = 0.94; IQR = 0.42; p = 0.009]. Patients with "acute culprit" carotid stenosis had a higher ipsilateral EMT [left ipsilateral EMT: Median = 1.46; IQR = 0.63; "non-acute": Median = 0.94; IQR = 0.43; p = 0.009; right ipsilateral EMT: Median = 2.25; IQR = 0.62; "non-acute": Median = 1.00; IQR = 0.51; p = 0.015]. This difference was not found in the contra-lateral EMT. Six months after the neurologic event, EMT ipsilateral to an "acute culprit" carotid stenosis decreased (p = 0.036). The amount of peri-carotid adipose tissue, estimated with EMT, was associated with atherosclerosis at the carotid arteries. The mean EMT was associated with the features of chronic atherosclerosis lesions: the presence of carotid plaques, IMT, and the area of the highest plaque. Ipsilateral EMT was linked with "acute culprit" atherosclerotic plaque.

Adiposity, fat depots and the prediction of stroke.

Despite the progress in research, the utility of clinical assessment for the prediction of stroke is limited. The aim herein, was to evaluate the predictive values of major ultrasound indexes of carotid artery and fat depots for stroke in patients with high and very high cardiovascular (CV) risk. The study group included 364 patients (age: 61.3 ± 7.2 years old) with typical CV risk factors scheduled for elective coronary angiography (2012-2013). A comprehensive baseline assessment included the following ultrasound indexes: carotid artery intima-media thickness (IMT), extra-media thickness (EMT), epicardial (EFT) and pericardial fat thickness (PFT), abdominal subcutaneous (ASF) and visceral fat (AVF) and combined periarterial adipose tissue intima-media adventitia (PATIMA) index. Afterwards, all patients were followed for 80.9 ± 7.1 months. There were 23 strokes and 25 cases with new-onset atrial fibrillation during follow-up. Receiver operating characteristics (ROC) analysis showed, that selected clinical parameters (age, waist circumference [WC], waist-hip ratio [WHR]) and ultrasound indexes (EFT: area under curve [AUC] 0.672, p < 0.01 and PATIMA index: AUC 0.658, p < 0.01) were predictive for stroke. However, their predictive values showed no significant differences (p = NS). The baseline body mass index (BMI) was the only parameter, which showed a prediction for new-onset atrial fibrillation (BMI > 33 kg/m2: sensitivity 65%, specificity 76%). It was found that age, WC and echocardiographic EFT revealed significant predictive values for stroke. Both WC and EFT showed a very high NPV suggesting that they should be implemented into the clinical practice as a tool affirming a very low risk of stroke.

Age-related carotid extra-media thickening is associated with increased blood pressure and arterial stiffness.

Ageing results in higher blood pressure and arterial stiffening leading to increased cardiovascular disease (CVD) risk. The extra-media thickness (EMT) is a composite measure of the arterial adventitia, perivascular adipose tissue (PVAT) and the jugular vein, but the association among EMT and ageing, blood pressure and arterial stiffness is largely unknown. We hypothesized that EMT is associated with ageing, blood pressure and arterial stiffness. Fifty (18M/32F, age range 20-79years.) individuals underwent measures of EMT (media-adventitia border to jugular lumen interface) via ultrasonography, blood pressure (brachial; carotid), arterial stiffness (carotid beta-stiffness, distensibility and Young's modulus) and body composition (dual X-ray absorptiometry). Independent two-tailed t-tests compared characteristics between young and middle-aged/older adults (MA/O). Bivariate correlations assessed the relation between EMT, ageing, blood pressure and arterial stiffness endpoints. Partial correlations were used to adjust for age, sex, body mass index (BMI) and body fat percentage. Compared to young, MA/O adults had higher EMT, blood pressure, arterial stiffness, BMI and BF% (all, p≤0.05). Carotid EMT was positively correlated with age (r=0.46), brachial SBP (r=0.32), carotid SBP (r=0.42), PP (r=0.42), beta-stiffness (r=0.37) and Young's elastic modulus (r=0.43) (all, p≤0.05), and negatively correlated with carotid distensibility (r=-0.34, p≤0.05). All endpoints correlated with EMT remained after adjusting for BMI, BF% and sex (p≤0.05). These data suggest EMT is a clinically relevant target that may be associated with age-related CVD risk in humans, yet further investigation is required to elucidate the role of EMT in age-related increases in blood pressure and arterial stiffness.

Epicardial adipose tissue thickness as a possible predictor of carotid atherosclerosis in patients with abdominal obesity

Aim. To assess epicardial adipose tissue (EAT) thickness using echocardiography as one of the possible predictors of subclinical carotid atherosclerosis in patients with abdominal obesity in prospective follow-up.Material and methods. The study included 224 men (mean age, 49,1±2,4 years), without hypertension, carotid atherosclerosis, type 2 diabetes and symptoms of cardiovascular diseases, with abdominal obesity and SCORE risk &lt;5%. The levels of albuminuria, lipid and glucose profiles, C-reactive protein, uric acid, blood creatinine, EAT thickness, ultrasound parameters of abdominal obesity and perivascular adipose tissue (PVAT) were assessed. At the follow-up end (mean duration, 48,2±4,8 months), repeated triplex ultrasound of the brachiocephalic arteries was performed.Results. Patients with developed carotid atherosclerosis (n=70) had higher baseline values of blood pressure, fasting glycemia, C-reactive protein, as well as a higher incidence of prediabetes, hyperuricemia, and high-grade albuminuria. They were also distinguished by high values of EAT thickness (6,1±0,6 mm vs 5,0±1,0 mm, p &lt;0,001), abdominal visceral to subcutaneous fat ratio (3,1±0,5 vs 2,7±0,6, p &lt;0,05) and carotid extra-media thickness (0,64±0,08 mm vs 0,50±0,11 mm, p &lt;0,01). According to multivariate logistic regression, EAT thickness was characterized by the maximum standardized regression coefficient (0,443, p &lt;0,001), and the total percentage of correct mathematical model classifications was 88,2%. According to the ROC-analysis, the area under the curve was 0,86. With a cut-off value of EAT thickness of 5,9 mm, the sensitivity and specificity of the predictive model were 71,5% and 92,3%, respectively.Conclusion. EAT thickness assessed by echocardiography, as a marker of the severity of visceral EAT, can serve as a predictor of subclinical carotid atherosclerosis in persons with abdominal obesity and initially low cardiovascular risk according to the SCORE calculator. Patients with verified epicardial visceral obesity require more active preventive measures.

Association of SYNTAX Score with PATIMA Index, Carotid Intima- and Extra- Media Thicknesses

Objectives: Several risk scoring systems have been validated for cardiovascular risk prediction and prognosis. PATIMA index combining Carotid intima media thickness (CIMT), carotid extra media thickness (CEMT), cardiac epicardial fat thickness (EFT) and body mass index (BMI)), are related to coronary artery disease (CAD). Materials and Methods: One-hudered-twenty-four patients were categorized as low SYNTAX (

Carotid Extra-Media Thickness in Children: Relationships With Cardiometabolic Risk Factors and Endothelial Function

Background: Emerging evidence suggests that structural adventitial modifications and perivascular adipose tissue (PAT) may have a role in early atherogenesis. In a cohort of children and adolescents, we explored (1) the association of carotid extra-media thickness (cEMT), an ultrasound measure whose main determinants are arterial adventitia and PAT, with obesity and its cardiometabolic complications; and (2) the interplay between cEMT and endothelial function.Methods: The study participants included 286 youths (age, 6–16 years; 154 boys, and 132 girls). Anthropometric and laboratory parameters, liver ultrasound, vascular structure measures [cEMT and carotid intima-media thickness (cIMT)], endothelial function [brachial artery flow-mediated dilation (FMD)] were obtained in all subjects. Non-alcoholic fatty liver disease (NAFLD) was diagnosed in the presence of hepatic fat on ultrasonography, in the absence of other causes of liver disease. Diagnosis of metabolic syndrome (MetS) was established on the basis of three or more of the following cardiovascular disease (CVD) risk variables: abdominal obesity, high triglycerides, low high-density lipoprotein cholesterol, elevated blood pressure (BP), and impaired fasting glucose.Results: cEMT demonstrated significant associations with body-mass index (BMI) and waist circumference (WC), BP, insulin resistance, NAFLD, and inflammation. No association was found between cEMT and lipid values, and between cEMT and MetS. A stepwise multivariate linear regression analysis indicated that WC (β coefficient, 0.35; P < 0.0001) was the only determinant of cEMT, independently of other major cardiometabolic risk factors. Further adjustment for cIMT did not significantly alter this association. FMD was correlated to age, Tanner stage, total and abdominal obesity, BP, NAFLD, and cEMT. The association between FMD and cEMT was independent of age, sex, Tanner stage, WC, and BMI (β coefficient, −0.14; P = 0.027). After controlling for CVD risk factors and basal brachial artery diameter, cEMT remained associated with FMD (β coefficient, −0.11; P = 0.049).Conclusions: In youths, cEMT is associated with abdominal fat, a well-established body fat depot with important implications for cardiovascular diseases. Furthermore, cEMT is related to FMD, suggesting that arterial adventitia and PAT may be involved in the early changes in endothelial function.

The Inverse Association of Muscular Strength with Carotid Intima-media and Extra-media Thickness in Women.

The purpose of this study was to determine the relationship between strength and atherosclerotic cardiovascular disease (CVD) risk in young women. Carotid intima-media thickness (IMT) and extra-media thickness (EMT) were used as measures of subclinical atherosclerosis and CVD risk. Muscular strength, IMT, and EMT were measured in 70 young women (mean age=21±4 years). Strength was determined using a handgrip dynamometer and expressed relative to body mass. IMT and EMT were measured using ultrasonography of the left common carotid artery. Objectively measured moderate-vigorous physical activity (MVPA) was assessed with accelerometry. Higher relative handgrip strength was associated with lower IMT (r=-0.23; p<0.05) and lower EMT (r=-0.27; p<0.05). Associations between relative handgrip strength and IMT (r=-0.24) as well as EMT (r=-0.25) remained significant after adjusting for potential confounders including traditional CVD risk factors and MVPA (p<0.05). These results show that there is an inverse association between handgrip strength with carotid IMT and EMT in young women. Muscular strength may reduce CVD risk in young women via favorable effects on subclinical carotid atherosclerosis independent of physical activity.

Age‐Related Increase in Extra‐Media Thickness is Associated with Arterial Stiffening and Carotid Blood Pressure

Older age is a primary risk factor associated with future cardiovascular disease (CVD) related events. Age‐related changes in perivascular adipose tissue (PVAT) and vascular remodeling both contribute to arterial stiffening and increased blood pressure which are established CVD risk factors. The non‐invasively measured extra‐media thickness (EMT) is a novel and composite measure, which includes PVAT, arterial adventitia, and the jugular vein that may provide translational insight for these factors contributing to age‐related arterial stiffening and higher blood pressure. However, it is unknown if aging increases EMT and is associated with arterial stiffness and blood pressure. We hypothesized that age‐related increases in EMT will be associated with higher arterial stiffness and blood pressure. Forty participants (young: 8M/12F, 23.2 ± 1.1 yrs and middle‐aged/older: 7M/13F, 60.7 ± 9.4 yrs) underwent measures of blood pressure (brachial; carotid), arterial stiffness (carotid b‐stiffness), EMT via ultrasonography and body composition with dual x‐ray absorptiometry. All measurements were taken in the supine position. Group mean differences between young and middle‐aged/older participants were analyzed with unpaired t‐tests and Pearson correlations were used to assess relations between EMT and arterial stiffness and blood pressure endpoints. Compared to younger participants, middle‐aged/older participants had higher EMT (0.80 ± 0.03 vs. 0.69 ± 0.02 mm), carotid beta stiffness (3.24 ± 0.08 vs. 2.60 ± 0.04), carotid SBP (116.5 ± 4.9 vs. 99.1 ± 2.3 mmHg), and carotid PP (44.6 ± 4.2 vs. 34.8 ± 1.5 mmHg) (all, p&lt;0.05). Brachial SBP was not different between groups (p&gt;0.05). Carotid beta stiffness (r= 0.410), carotid SBP (r= 0.501), and carotid PP (r= 0.5037) were all positively correlated with EMT for the entire cohort (all, p&lt;0.05). Our findings indicate that there is an age‐related increase in EMT that is associated with both carotid arterial stiffness and pressure. These data suggest that increases in arterial stiffness and blood pressure with advancing age may be attributable, in part, to increases in EMT, which may be due to changes in PVAT and arterial adventitial remodeling. Therefore, EMT, a potential surrogate for PVAT and arterial remodeling, may provide novel insight into age‐related arterial stiffening, higher blood pressure and increased CVD risk with aging.

Carotid artery stenosis and ultrasound vascular indexes predict the coronary revascularization in patients with high cardiovascular risk scheduled for coronary angiography.

Carotid artery atherosclerosis is a complex and multifactorial chronic disease. We aimed to assess the predictive value of cardiovascular (CV) risk factors, carotid artery stenosis (CAS), and ultrasound vascular indices for coronary revascularization in patients referred for coronary angiography. Patients scheduled for elective coronary angiography were enrolled. The following ultrasound indices were obtained: CAS, carotid intima‑media thickness (IMT), extra‑media thickness (EMT), intra‑abdominal thickness (IAT), and the combined PATIMA index. The study included 322 patients (118 women, 204 men) with CV risk factors (mean [SD] number, 5.4 [1.5]) and coronary artery disease (n = 228; 71%) with equal rates of 1-, 2-, and 3-vessel disease (35%, 33%, and 32%, respectively). Indications for percutaneous or surgical coronary revascularization were reported for 158 patients (49%). Patients with and without revascularization had a similar total number of CV risk factors (mean [SD], 5.4 [1.3] vs 5.3 [1.1]; P = 0.9) and IAT (mean [SD], 74 [24] mm vs 77 [28] mm; P = 0.4). The receiver operating characteristic (ROC) curve analysis showed that baseline CAS, carotid IMT, EMT adjusted for body mass index, and PATIMA index have a similar significant predictive value for coronary revascularization (mean [SD] area under the ROC curve, 610 [31] u, 590 [31] u, 610 [32] u, and 630 [30] u, respectively). The severity of CAS and carotid vascular indices (IMT, EMT, and PATIMA index) may predict coronary revascularization in patients with high or very high CV risk. Clinical assessment and the presence of CV risk factors do not add predictive value in these patients.

Emerging measurements of atherosclerosis: extra-media thickness, epicardial adipose tissue, and periarterial adipose tissue intima media adventitia index in morbidly obese patients undergoing bariatric surgery.

IntroductionIncreased values of emerging fat indices are correlated with increased cardiovascular risk.AimTo examine the novel non-invasive predictors of coronary disease, namely the carotid extra-media thickness (EMT), PATIMA, and epicardial adipose tissue (EAT), in a group of patients with morbid obesity.Material and methodsWe examined a group of 40 morbidly obese (OB) patients and a control group (CG). All patients were subjected to anthropometric measurements, as well as laboratory and ultrasound examinations.ResultsEATmean and EMTmean differed significantly between groups (OB vs. CG): 5.09 vs. 3.50 and 808.50 vs. 737.00, p < 0.0001, respectively.ConclusionsStrong correlations were found between novel non-invasive predictors of coronary disease, namely the carotid extra-media thickness, PATIMA, and epicardial adipose tissue. The above-mentioned fat indices were not found to correlate significantly with BMI or other body weight-related parameters used to assess the adipose tissue content. Further studies are required.

Obesity, visceral adiposity and carotid atherosclerosis

Carotid artery atherosclerosis is a complex and multifactorial chronic disease. Our aim was to assess the associations between obesity, fat depots and carotid artery stenosis (CAS) in patients with high cardiovascular (CV) risk. MethodsThe study group included 391 patients (F/M: 136/255 pts.; age: 61.8 ± 8 years) scheduled for elective coronary angiography. A comprehensive clinical assessment included a carotid artery and abdominal ultrasound involving the following fat depots: (1) carotid extra-media thickness (EMT) indexed to the body mass index (perivascular adipose tissue [PVAT]), and (2) abdominal visceral and subcutaneous fat. ResultsPatients with a ≥50% stenosis of internal carotid artery (ICA) were older (65.9 ± 7 vs 60.3 ± 7 years, p < 0.0001) and had increased PVAT (836 ± 120 vs 779 ± 127 μm, p < 0.01) compared to individuals with <50% internal carotid artery stenosis. None of the CAS parameters were associated with any measures of obesity. Multivariable regression model showed that age (p < 0.0001), PVAT (p < 0.0001) and smoking (p = 0.04) were independently associated with the severity of ICA stenosis. ConclusionsOur study showed that carotid extra-media thickness, an index measure of PVAT, is associated with CAS severity. It is a strong and independent predictor of significant ICA stenosis. None of the obesity measurements revealed associations with carotid atherosclerosis.

Obesity, Visceral Fat, and Hypertension-Related Complications.

Background: Hypertension and obesity are very common and complex cardiovascular (CV) risk factors. Our aim was to provide a comprehensive assessment of associations between visceral fat depots and vascular or cardiac complications of hypertension. Methods: All the consecutive patients (age: 45-80 years old) scheduled for elective coronary angiography in the Department of Cardiology were screened, and 400 patients were included into the study group. All the patients had a comprehensive clinical assessment focused on hypertension and obesity, risk factors, fat depots, and several hypertension-related vascular or cardiac complications. Results: The study group (n = 400; F/M: 140/260; age: 61 ± 7 years) included patients with hypertension (n = 354; 88.5%) and normal blood pressure (n = 46; 11.5%) and individuals with obesity (n = 192; 48%), diabetes (n = 139; 35%), metabolic syndrome (n = 240; 60%), and coronary artery disease (n = 286; 71%). Patients with higher degrees of hypertension (grade 3 vs. 2 vs. 1) showed increased body mass index (BMI) and waist circumference and ultrasound indexes of perivascular, epicardial, and abdominal visceral fat with no differences in age, waist-hip ratio, and subcutaneous fat. Both visceral fat depots: perivascular fat (carotid extra-media thickness) and abdominal visceral fat (intra-abdominal thickness) assessed as single measures and ratios were significantly increased in hypertensive patients with high versus low global CV risk in a hypertension-focused risk model (differences more pronounced in patients ≤60 years old). Visceral fat parameters were not independent, but rather additive to general obesity (BMI), except for visceral abdominal fat depot. Conclusions: Visceral abdominal and perivascular fat depots assessed as ultrasound indexes are associated with complications of hypertension and CV risk indicators, especially in patients with a mild-to-moderate hypertension and in younger patients.

Carotid extra-media thickness increases with age, but is not related to arterial stiffness in adults

BackgroundAssessment of carotid artery perivascular adipose tissue through carotid artery extra-media thickness (EMT) ultrasonography has emerged as a novel assessment technique that might contribute unique information to comprehensive evaluations of arterial health. Currently, there is a lack of research examining relationships between EMT and existing measures of arterial health in adults. We investigated the relationships between EMT and established measures of arterial health, including aortic pulse wave velocity (aPWV), carotid distensibility, and intima-media thickness (IMT) in adults. MethodsUsing a cross-sectional, observational design, we assessed resting aPWV, carotid distensibility, IMT and EMT in 81 participants who were categorized as younger healthy adults (YHA; n = 51; 25 ± 6 years), older healthy adults (OHA; n = 15; 70 ± 5 years) or older adults with coronary artery disease (CAD; n = 15; 68 ± 9 years). ResultsEMT, IMT, and aPWV were higher while carotid distensibility was lower in OHA and CAD versus YHA (P < 0.05). EMT was correlated with age (r = 0.48; P < 0.01), aPWV (r = 0.43; P < 0.01), IMT (r = 0.41; P = 0.01), and distensibility (r = −0.37; P < 0.01). Despite significant correlations, EMT was not an independent predictor of any of the traditional measures of arterial health included in this study. ConclusionsThe novel finding of this study is that while EMT is elevated in older versus younger adults, in agreement with established indicators of arterial health, it is not a predictive factor in these existing measures. EMT may, however, still have clinical utility as a target for comprehensive monitoring of interventions specifically designed to impact arterial structure and function.

Novel combined index of cardiometabolic risk related to periarterial fat improves the clinical prediction for coronary artery disease complexity

Background and aimsCardiovascular (CV) risk assessment based on conventional risk factors has a limited performance in the prediction of obstructive coronary artery disease (CAD). Therefore, our aim was to provide a complete assessment on the associations between single or combined cardiovascular ultrasound indexes and the complexity of CAD in high and very-high risk patients. MethodsTwo hundred fifteen patients scheduled for elective coronary angiography were enrolled in the study (F/M: 80/135 pts; age: 61.8 ± 7.9 years). Detailed clinical characteristics, including several obesity parameters, and the following ultrasound indexes were obtained: carotid intima-media thickness (IMT) and extra-media thickness (EMT), epicardial fat thickness (EFT) and intra-abdominal fat thickness (IAT). CAD severity and complexity were assessed based on the well-evidenced SYNTAX score (SS) algorithm. ResultsThe study patients (79% with a very high CV risk) had central obesity (77%), and arterial hypertension (81%), one-third (37%) had diabetes and most of the individuals (74%) were current or previous smokers. In the study group, male sex, higher number of CV risk factors, diabetes and increased carotid vascular indexes (IMT or EMT ≥ 900 μm) were associated with significantly higher SS (p < 0.05). Paradoxically, obese patients revealed a significantly lower SS compared to non-obese individuals (3.65 ± 6.66 vs. 5.93 ± 8.8; p < 0.01), which was not explained by the number of CV risk factors or age. All the ultrasound indexes (except for visceral fat – IAT) revealed significant associations with the SS and the highest correlation coefficient was found for PATIMA combined index (r = 0.45; p < 0.01). Hence, none of the obesity-related clinical indexes showed any associations with CAD complexity. Multivariate regression analysis showed that male sex, chronic kidney disease and the PATIMA index were independently associated with the Syntax Score. The ROC analysis showed that the highest sensitivity (71% and 82%) and specificity (77% and 72%) in prediction of either SS > 1 or SS > 7 were found for the combined PATIMA index (negative predictive value = 92% for SS > 7). ConclusionsWe present the first study showing that a combination of ultrasound indexes related to periarterial fat and vascular wall (PATIMA index) is associated with more complex CAD in high and very-high risk patients. PATIMA index revealed improved predictive value compared to other single ultrasound indexes and clinical risk assessment.

Carotid stiffness, extra-media thickness and visceral adiposity in young adults

Background and aimsCarotid extra-media thickness (EMT) encompasses arterial adventitia and perivascular adipose tissue (PAT). Adventitial remodeling and PAT may contribute independently to functional (stiffness) and structural (remodeling) changes in artery wall properties. Visceral adiposity may contribute to PAT, thereby affecting artery stiffness. We investigated the relationships between carotid artery stiffness, EMT, and visceral adiposity in young, healthy individuals. Methods135 healthy males (20 ± 2 yr, body mass index [BMI] 24.8 ± 3.3 kg/m2) underwent anthropometric and vascular measures on two separate days. Visceral adiposity was assessed using waist circumference and sagittal abdominal diameter (SAD). Brachial and carotid systolic, diastolic, and pulsatile (PP) blood pressures were assessed using an oscillometric cuff and applanation tonometry, respectively. Carotid intima-media thickness (IMT) and EMT were assessed using Doppler ultrasound. Carotid artery stiffness was calculated as β-stiffness and calibrated to carotid pressures. ResultsSeparate stepwise multiple regression models demonstrated that carotid PP (β = 0.205) and EMT (β = 0.267) accounted for 12.6% of variance in β-stiffness, while carotid PP (β = 0.195) and SAD (β = 0.226) accounted for 10.5% of variance in EMT (p < 0.05). Mediation analyses revealed carotid PP partially mediated the relationship between a) EMT and β-stiffness, and b) SAD and EMT (p < 0.05). ConclusionsCarotid PP and EMT, but not IMT, are related to carotid β-stiffness. Carotid PP and visceral adiposity (SAD) are related to EMT. Carotid PP partially mediates the association between a) EMT and carotid β-stiffness, and b) SAD and EMT. Our findings suggest visceral adiposity may detrimentally affect subclinical markers of cardiovascular disease risk (carotid PP, EMT) and contribute to artery stiffness.

Carotid extra-media thickness is associated with intima-media thickness and renal dysfunction in Korean patients with type 2 diabetes

Carotid extra-media thickness is associated with intima-media thickness and renal dysfunction in Korean patients with type 2 diabetes

Extra-medial thickness of carotid artery in patients with Behçet's disease: evaluation of atherosclerotic vessel wall changes with a novel carotid artery ultrasound index.

Chronic inflammation and endothelial dysfunction are the characteristic features of Behçet's disease (BD). We researched carotid extra-medial thickness (cEMT), a novel ultrasound parameter for atherosclerotic vessel wall changes, and carotid intima media thickness (cIMT), a widely accepted marker of subclinical atherosclerosis, in patients with BD, and we evaluated the relationship between these two parameters. In total, 31 patients with BD were matched to 26 control subjects based on age, gender, and major cardiovascular risk factors. Laboratory parameters, including lipid profile, were measured for both patients and controls. B-mode ultrasonography was used to assess the cEMT and cIMT. There was no significant difference in the cEMT values between the patients with BD and the control group (P = 0.90). cIMT in the BD group was significantly higher compared with the control group (P = 0.021). There was a significant positive correlation between cIMT and cEMT (r = 0.585, P = 0.001). Both cEMT and cIMT were positively correlated with age and the presence of arthritis. There was linear correlation with sedimentation, C-reactive protein, and cEMT. To the best of our knowledge, this is the first study to evaluate both cEMT and cIMT in BD. This study presents morphological evidence of subclinical atherosclerosis in terms of cIMT. Although there was no significant increment in cEMT, it has the potential to assess endothelial dysfunction in BD. Further studies are required to confirm this finding.

Subclinical atherosclerosis in patients with recurrent aphthous stomatitis.

Recurrent aphtous stomatitis (RAS) is an inflammatory oral mucosal disease. It has been known that inflammatory cascade plays important role in the atherosclerotic process. The aim of the study was to investigate the relationship between subclinical atherosclerotic findings and a systemic inflammatory disease, RAS. In total, 32 patients with RAS were matched with 30 control subjects on the basis of age, sex, and major cardiovascular risk factors. Laboratory parameters including lipid profiles were determined for patients and controls. B-mode ultrasonography was used to assess carotid extra-medial thickness (cEMT) and carotid intima-media thickness (cIMT). Both cEMT and cIMT in the RAS group were significantly higher than in the control group (P=0.002 and 0.013, respectively). There was a significant positive correlation between cIMT and cEMT (r=0.381, P=0.034). cIMT was positively correlated with age, triglyceride levels, and systolic blood pressure, while cEMT was positively correlated with age in patients with RAS. To our knowledge, this is the first reported study to evaluate cEMT and cIMT in patients with RAS. This study presents morphological evidence of subclinical atherosclerosis in patients with RAS. Further studies investigating the relationship between atherosclerosis and RAS are needed.