Thickness Of Intima-media Complex Research Articles

Dependency between local carotid arterial stiffness and the presence of atherosclerotic plaque in the carotid basin in hypertensive patients with type 2 diabetes mellitus

Aim. To assess the impact of atherosclerotic plaque (ASP) on the local arterial stiffness of the common carotid arteries (CCA) in patients with stage II hypertension (HTN) in combination with type 2 diabetes mellitus (T2DM). Materials and methods. The study included 37 patients with stage II HTN and T2DM (mean age 60.4 ± 10.7; 66.7 % male). Patients were divided into two groups: 20 individuals with ASP and <50 % stenosis in the carotid basin, 17 without ASP. The study involved a clinical examination, body weight and percentage of adipose tissue (AT) measurements, analysis of lipid and carbohydrate metabolism laboratory parameters, echocardiography, CCA ultrasound examination with the determination of local stiffness and intima-media complex thickness (IMT). Statistical analysis was performed, significant differences were considered at p < 0.05. Results. The whole-body AT percentage <39.51 % increases the odds ratio (OR) of ASP by 6 times (p = 0.02), an exceeding compliance coefficient (CC) over 0.68 mm2/kPa – by 12.7 times (p = 0.02), right CCA-IMT of over 639 µm – by 1.012 times (p = 0.001), and the factors are mutually reinforcing in the multivariate models and independent of age, sex, body mass index, and glycated hemoglobin level. Ascending aorta dilatation of over 3.34 cm increases the OR of ASP by 11.6 times (p = 0.0107); the factor is enhanced after adjusting for elevated total cholesterol levels over >6.35 mmol/l (p = 0.036) and independent of age and sex. A greater left CCA diameter of more than 8.59 mm (p < 0.019) and right CCA diameter of more than 8.1 mm (p < 0.0001) increases the OR of ASP by 3.7 times (p = 0.001) and 6.6 times (p = 0.0013), respectively, the factor influence increases after adjusting for elevated total cholesterol levels over >6.35 mmol/l (p = 0.031) and it is also unaffected by age and sex. Conclusions. In individuals with stage II HTN and T2DM, the presence of CA atherosclerosis with stenosis up to 50 % is associated with a significantly increased CCA and ascending aorta diameter, a decreased percentage of AT, and an increased compliance coefficient of plaque-free wall segments.

Determinants of Carotid Wall Echolucency in a Cohort of European High Cardiovascular Risk Subjects: A Cross-Sectional Analysis of IMPROVE Baseline Data.

Echolucency, a measure of plaque instability associated with increased cardiovascular risk, can be assessed in both the carotid plaque and the plaque-free common carotid intima-media (IM) complex as a gray-scale median (plaque-GSM and IM-GSM, respectively). The impact of specific vascular risk factors on these two phenotypes remains uncertain, including the nature and extent of their influence. This study aims to seek the determinants of plaque-GSM and IM-GSM. Plaque-GSM and IM-GSM were measured in subjects from the IMPROVE study cohort (aged 54-79, 46% men) recruited in five European countries. Plaque-GSM was measured in subjects who had at least one IMTmax ≥ 1.5 mm (n = 2138), whereas IM-GSM was measured in all subjects included in the study (n = 3188). Multiple regression with internal cross-validation was used to find independent predictors of plaque-GSM and IM-GSM. Plaque-GSM determinants were plaque-size (IMTmax), and diastolic blood pressure. IM-GSM determinants were the thickness of plaque-free common carotid intima-media complex (PF CC-IMTmean), height, systolic blood pressure, waist/hip ratio, treatment with fibrates, mean corpuscular volume, treatment with alpha-2 inhibitors (sartans), educational level, and creatinine. Latitude, and pack-yearscode were determinants of both plaque-GSM and IM-GSM. The overall models explain 12.0% of plaque-GSM variability and 19.7% of IM-GSM variability. A significant correlation (r = 0.51) was found between plaque-GSM and IM-GSM. Our results indicate that IM-GSM is a weighty risk marker alternative to plaque-GSM, offering the advantage of being readily measurable in all subjects, including those in the early phases of atherosclerosis where plaque occurrence is relatively infrequent.

ХАРАКТЕРИСТИКА КАРДИОВАСКУЛЯРНОГО РИСКА У БОЛЬНЫХ С ПСОРИАТИЧЕСКИМ АРТРИТОМ

Abstract. Introduction. Patients with psoriatic arthritis are exposed to a higher risk of developing cardiovascular complications. Development and progression of these disorders are based on a complex of closely interrelated factors, such as traditional cardiovascular risk factors, cardiovascular toxicity of some antirheumatic drugs, primarily non- steroidal anti-inflammatory drugs and glucocorticoids, and chronic autoimmune inflammation, which, according to many researchers, is the leading pathogenetic mechanism of atherosclerotic vascular lesions. The aim of the study was to assess the prevalence of traditional risk factors, the state of the blood lipid spectrum, and atherosclerotic remodeling of peripheral arteries in patients with psoriatic arthritis. Materials and Methods. We examined 84 patients (41 women and 43 men) aged 20 to 65 years. Arthritis was diagnosed based on the CASPAR criteria. Patients were assessed regarding traditional risk factors, such as hypertension, obesity, smoking, aggravated family history of CVD, diabetes, physical inactivity, and dyslipidemia; ten-year total coronary risk was calculated using the SCORE scale. To diagnose subclinical atherosclerosis, the patients underwent Doppler ultrasound of the carotid arteries with an assessment of the intima-media complex thickness. Results and Discussion. Assessment of disease development risk factors showed that all patients with psoriatic arthritis had from one to five risk factors. More common risk factors were smoking in 50 (59.5 %) patients, AO in 44 (52.4 %), dyslipidemia in 48 (57.1 %), and arterial hypertension. Patients with a long history of the disease have a higher prevalence of risk factors. According to the results of calculating the ten-year total coronary risk (SCORE scale), most patients were in the group of low (46.4 %) and moderate (38 %) risk. An association was found between the level of total coronary risk and arthritis activity in groups of patients with low and moderate risk. The average intima-media complex thickness of the common carotid artery in the group of patients with psoriatic arthritis was statistically significantly higher than in those in the control group (p=0.0361).Conclusions. An increased risk of cardiovascular complications was found in patients with psoriatic arthritis, while most patients have several risk factors in various proportions. According to the risk assessment on the SCORE scale, it was found to be statistically significant in the group of patients with psoriatic arthritis, which correlates with disease activity. The presence of subclinical atherosclerosis was detected in form of a statistically significant increase in the intima-media complex thickness of the carotid arteries. All the above indicates the current problem of psoriasis comorbidity, which dictates a personalized comprehensive approach to therapy for the selection of safe and adequate therapy for all diseases diagnosed in an individual patient.

Origin and formation of early changes in the retina under the influence of atherosclerosis factors

Lesions of the microcirculatory bed of the retina are an urgent problem due to their prevalence, severity of irreversible changes and their association with an unfavorable cardiovascular prognosis. Their pathogenesis is associated with endothelial dysfunction. Determining the processes of the formation and progression of retinopathy (RP) will bring closer the solution of problematic issues in ophthalmology and cardiology, and reduce cardiovascular morbidity and mortality.Aim. To study the processes of formation and progression of retinopathy in the initial stages of mixed origin (hypertensive, diabetic, unspecified etiology).Material and methods. The origin and progression of I–II degree RP under the influence of predictors of this symptom has been revealed through statistical analysis using the data of the 2008–2013 prospective follow-up of 22 clinical indicators of a natural group of initially healthy 7.959 male workers of locomotive crews of the Trans-Baikal Railway aged 18–66 years. Multivariate stepwise analysis, a 2 × 2 confusion matrix, Cox and Kaplan-Meier proportional hazard models were used, and a relative risk was assessed.Results. Such predictors of grade I–II RP as arterial hypertension, I–III degree obesity, smoking, dyslipidemia, left ventricular hypertrophy, family history of early cardiovascular disease, hyperglycemia, aortic atherosclerosis, creatininemia, atherosclerotic plaque / intima-media complex thickening, microalbuminuria, type 2 diabetes mellitus and age showed statistical heterogeneity in mathematical models. The distinctive feature was the different mutually exclusive assessment of the predictors’ significance in the models used. Thus, the predictors of I–II degree RP showed their specific identification characteristics, defined in qualitative and quantitative dimensions, by which they could be found and studied in the cell as well as their damaging effect.Conclusions. The course of endothelial dysfunction varies significantly when influenced by RP predictors. Its manifestations are determined by the influence of a specific factor, a set of factors or by all predictors taken together and involved simultaneously. This shows the need to determine the qualitative and quantitative ultrastructural and biochemical specific markers of endothelial dysfunction of the microvasculature of the eye appearing under the influence of RP predictors during the formation and progression of this pathological symptom in order to restore the normal function of the endothelial cell and the affected organ as a whole, as long as there is still room for therapeutic efforts.

Maximum carotid intima-media thickness and NT-pro BNP in association with retinal vein occlusion

The purpose is to clarify the relationship between patients with retinal vein occlusion (RVO), maximal intima-media complex thickness (Max IMT), and N-terminal pro-brain natriuretic peptide (NT-proBNP), which is useful in assessing atherosclerosis. This was a retrospective observation, single center study. The patients were 86 RVO patients (male: female = 43:43, mean age 63.3 years), 25 with central retinal vein occlusion (CRVO) and 61 with branch retinal vein occlusion (BRVO), classified as ≧50 years old and <50 years old, Max IMT≧1.1 and less, NT-pro BNP≧55 and less. Results showed that Max IMT ≧1.1 was significantly more common in both the CRVO and BRVO groups at ≧50 years, and NT-pro BNP ≧55 was significantly more common in the CRVO group. Max IMT≧1.1 was seen in 80% of the BRVO group and in 85% of patients aged ≧50 years. Sixty-eight percent of patients in the CRVO group had Max IMT≧1.1, but none of those < 50 years had Max IMT≧1.1. Forty-eight percent of RVO patients had NT-pro BNP≧55, and significantly more patients had Max IMT≧1.1 than those who did not have NT-pro BNP more than 55 (p = 0.02). Multiple regression analysis with Max IMT as the dependent variable showed that age and NT-pro BNP were significantly associated with RVO (p = 0.015, 0.022). RVO patients were more likely to have a Max IMT≧1.1, which was associated with atherosclerosis. Max IMT and NT-pro BNP were also associated with RVO patients, so NT-pro BNP may be a marker of RVO.

High prevalence of thrombophilic risk factors in patients with central retinal artery occlusion

IntroductionCentral retinal artery occlusion (CRAO) is a common cause of blindness and visual morbidity. In the majority of cases, it is related to thrombotic embolism. Nevertheless, the role of inherited or acquired thrombophilic risk factors in CRAO pathogenesis has not been comprehensively studied.MethodsIn 126 CRAO patients (66 [52.4%] men, median age 55 [range: 18–80] years) and 107 matched controls (56 [52.3%] men, median age 53 [range: 34–78] years) we evaluated classical atherosclerotic risk factors, including serum lipid profile and glucose level, analyzed intima-media complex thickness (IMT) of external carotid arteries, and performed transthoracic echocardiography. Furthermore, we established the prevalence of inherited and acquired thrombophilic risk factors, such as factor V Leiden (FVL) and prothrombin 20210 G/A genetic variants, plasma activity of factor (F) VIII, protein C and antithrombin activity, and free protein S levels. We also assessed the presence of antiphospholipid antibodies (APLA) and evaluated blood homocysteine in all enrolled subjects. Additionally, we estimated the occurrence of Val34Leu polymorphism of the A subunit of coagulation factor XIII (FXIII-A) in both groups as a potential thrombosis-protecting factor.ResultsAmong traditional atherosclerotic risk components, obesity/overweight and hypercholesterolemia were the most common in the CRAO group and occurred in 103 (81.7%) and 85 (67.5%) patients, respectively. CRAO patients also had elevated IMT and altered echocardiographic parameters, indicating diastolic cardiac dysfunction. In thrombophilia investigations, at least one laboratory risk factor occurred in 72.2% (n = 91) of CRAO patients, with APLA as the most frequent, detected in 38.1% (n = 48) of them (almost seven times more frequent than in controls, p < 0.001). Deficiencies in protein C activity and free protein S levels were also common in the CRAO group, reported in 17.5% (n = 22) and 19.8% (n = 25) of patients, respectively. Interestingly, among two analyzed prothrombotic genetic variants, only the FVL was related to CRAO, with the allelic frequency 2.4 times more prevalent than in controls (p = 0.044). Finally, the CRAO group was characterized by hyperhomocysteinemia, almost twice as common as in controls (p = 0.026). Antithrombin deficiency, elevated FVIII, and FXIII-A Val34Leu polymorphism were not associated with CRAO.ConclusionsOur findings suggest that thrombophilia plays a vital role in the pathogenesis of CRAO. Thus, proper laboratory screening should be considered in the primary and secondary prevention of those episodes, with implementing appropriate therapy as needed.

Assessment of Cardiovascular Risk Factors in Patients with Juvenile Idiopathic Arthritis

The aim of this study was to assess the exposure to cardiovascular disease (CVD) risk factors in patients with juvenile idiopathic arthritis (JIA). Intima-media complex thickness (IMT), selected metabolic parameters and health behaviors were assessed in the course of the study. The study included study group, which consisted of 45 patients with JIA and 37 healthy age- and sex-matched children in the control group. Analyses in both groups included anthropometric parameters, laboratory tests, IMT and a questionnaire on exposure to modifiable CVD risk factors. The study confirmed that CVD risk factors were present in both groups of patients. Significantly more children with JIA had abnormal BMI (p = 0.006) compared to the control group. Children in the study group were more likely to consume fruit regularly (p = 0.021) and less likely to consume fast food (p = 0.011) and sweetened beverages (p = 0.042) than children in the control group. Only 1 patient with JIA met criteria for ideal cardiovascular health. Dietary habits were not associated with IMT values, BMI, presence of joint pain or biochemical parameters in the study group. Patients with JIA are exposed to cardiovascular risk factors equally to their healthy peers. Ideal cardiovascular health should be pursued in the pediatric population with particular attention paid to patients with chronic diseases (i.e., JIA). The application of carotid artery IMT measurement in the assessment of CVD risk requires studies on a larger group of patients.

Assesmen of atherosclerotic lesions of the carotid artery and risk factors for rheumatoi arthritis patients

Aim . To study and evaluate risk factors and analyze carotid artery intima-media thickness parameters as an early predictor of atherosclerosis in patients with rheumatoid arthritis. Materials and methods . The study involved 86 patients (women - 67, men - 19) observed in the State Institution “City Medical Center №2”, Dushanbe, aged from 37 to 67 years (mean age - 56.5±2.9 years). The diagnosis of rheumatoid arthritis was established according to the American College of Rheumatologists/EULAR 2010 criteria. The examination program included general clinical and instrumental methods (examination of common and accessible parts of internal and external carotid arteries), estimation of lumen size, the thickness of intima-media complex (TCIM), straightness of its course, atherosclerotic plaques of carotid arteries (ABS), echocardiography (ECHO-KG). Results and discussion . Thus, in the absence of significant gender differences in the frequency of arterial hypertension and increased intima-media thickness (the earliest manifestation of atherosclerotic vascular lesions), hypercholesterolemia and long-term glucocorticoid intake were more frequently recorded in women. Undoubtedly, each of the considered risk factors makes a definite contribution to the development of vascular atherosclerosis and the instability of their organic changes. However, the significance of these risk factors in the thickening of the intima-media complex of vessels may differ. Conclusion . Data correlated with intima-media thickness show sex differences, the significance of risk factors, and an increase in intima-media thickness despite the duration of glucocorticoid therapy. The factors mentioned are more significant in men, while in women, intima-media thickness is closely related to the duration of rheumatoid arthritis, total cholesterol levels, and blood pressure.

Characteristics of atherosclerotic plaque and the thickness of the carotid artery intima-media complex in patients with rheumatoid arthritis

Background/Aim. Rheumatoid arthritis (RA) represents an independent risk factor for the development of cardiovascular (CV) disease (CVD). Early detection of atherosclerotic changes is of tremendous importance in the prevention of CV events. An increase in the carotid artery intima-media thickness (cIMT) is considered a sensitive marker of early subclinical atherosclerosis. The aim of our investigation was to assess the cIMT, the number and type of carotid plaques (CPs), and the severity of carotid artery stenosis in RA patients. Furthermore, we investigated the correlation between all the above-mentioned parameters and disease duration and activity. Methods. The research included 92 participants, of which 58 were patients with RA, and the remaining 34 participants were healthy individuals (control group). In patients with RA, clinical examination and laboratory findings were used for assessing disease activity. All participants underwent a color Doppler ultrasound examination of the carotid arteries with a linear probe in order to assess cIMT, the number and type of CPs, as well as the se-verity of stenotic lesions. Results. The mean cIMT in RA patients was statistically significantly higher compared to the control group (0.8 ? 0 .2 mm vs. 0.7 ? 0.2 m m; p &lt; 0.01). CPs were found in 34 out of 58 RA patients (58.6%) and 4 out of 34 (11.8%) participants in the control group (p &lt; 0.001). The number of CPs per patient was significantly higher in the RA group compared to the control group (1.4 ? 0.9 vs. 0.2 ? 0.4; p &lt; 0.001). The cIMT, the presence and number of CPs, and the severity of carotid artery stenosis were not statistically significantly related to disease activity. There was a statistically significant direct correlation between the duration of RA and the percent-age of carotid arterial stenosis (r = 0.320, p = 0.034). Conclusion. The cIMT and the presence and number of CPs per patient were significantly higher in RA patients. More-over, there was a positive correlation between RA disease duration and the severity of carotid artery stenosis. This study showed that RA represents an independent risk factor for an increase in cIMT and the development of sub-clinical atherosclerosis.

МОБИЛЬНОЕ ПРИЛОЖЕНИЕ В ПРОГНОЗИРОВАНИИ СИСТОЛИЧЕСКОЙ ФУНКЦИИ ЛЕВОГО ЖЕЛУДОЧКА ПРИ ЛЕЧЕНИИ РАКА МОЛОЧНОЙ ЖЕЛЕЗЫ АНТРАЦИКЛИНАМИ

Purpose. To evaluate the effect of complex treatment of breast cancer (BC) on the parameters of systolic myocardial function, and the efficiency of the prescription of cardiotropic therapy (CT) – a fixed combination of valsartan and carvedilol – in the prevention of the identified changes. To develop a mobile application, namely, an electronic statistical calculator for calculating the left ventricular ejection fraction by Simpson during BC treatment with anthracyclines, using the baseline anthropometric and instrumental data of the patient. Methods. We evaluated the cardiovascular health of 100 women who received complex treatment of BC. The patients were divided into three groups, depending on the presence of arterial hypertension and the prescription of CT. In the study, all women received a complex evaluation of the cardiovascular health at the beginning and at the end of BC treatment Results. In the non-CT group af ter the end of complex BC treatment the following was found: a decrease in the shortening fraction (FS) from 41.0 (38.0; 45.0)% to 38.0 (35.0; 43.0)%, (p &lt; 0.05), in ejection fraction (EF) by Teinholz from 72.0 (69.0; 76.0)% to 68.0 (64.0; 73.0)%, (p &lt; 0.05); in ejection fraction by Simpson from 66.0 (62.0; 71.0)% to 60.0 (57.0; 66.0)%, (p &lt; 0.05); an increase in the vagosympathetic interaction LF/HF index (ratio of lowfrequency (LF) to high-frequency (HF) components) from 0.8 (0.7; 1.0) to 1.05 (0.8; 1.2), (p &lt; 0.05); reduction of brachial artery diameter change from 12.5 (11.0; 16.0)% to 9.0 (6.0; 12.0)%, (p &lt; 0.05). A model of the prognosis of EF by Simpson during BC treatment was proposed, which included a total dose of doxorubicin calculated per body surface area, early diastolic rate of transtricuspid blood flow, diameter of the trunk of the pulmonary artery, the rate of circular shortening of myocardial fibers, thickness of the intima-media complex of the left carotid arteries, HF, % of brachial artery diameter change. The prognosis model formed the basis for the development of the mobile application for predicting left ventricular systolic function during BC treatment with anthracyclines. We proposed a model for prediction of LVEF by Simpson against during breast cancer treatment, which included the total doxorubicin dose calculated per body surface area, early diastolic rate of transtricuspidal blood flow, pulmonary artery trunk diameter, myocardial fiber circular shortening rate, left carotid artery intima-media complex thickness, HF, percentage of brachial artery diameter change. The prognostic model formed the basis for the development of the mobile application for predicting left ventricular systolic function during BC treatment with anthracyclines.

Lipid profile peculiarities and matrix Gla protein concentration in Ukrainian pediatric patients with heterozygous familial hypercholesterolemia

Atherosclerotic changes in the vascular walls begin early in childhood, especially in association with familial hypercholesterolemia (FH). The process may be subclinical, which nevertheless requires therapeutic and preventive measures. Purpose - to evaluate baseline lipid profiles, the thickness of carotid intima-media complexes, blood pressure indices and the association with concentration changes of dephosphorylated-uncarboxylated matrix Gla protein (dp-uc MGP) as a marker of subclinical arterial lesions in different age groups of pediatric patients with FH. Materials and methods. Children with heterozygous FH (n=15), stratified by age and sex, were included in the study. The control group consisted of healthy peers (n=21). Blood samples were analyzed to determine levels of total (TC), low-density (LDL-C), very-low-density (VLDL-C), high-density (HDL-C), remnant (rC) and non-high-density (non-HDL-C) cholesterol, triglycerides (TG), apolipoproteins A1 (apoA1) and B (apoB), lipoprotein (a), and dp-uc MGP. The intima-media complex thickness of the common carotid artery and blood pressure were measured in all study subjects. The obtained data were processed using the accepted methods of medical statistics and SAS® OnDemand for Academics. Results. Lipid profile changes in pediatric patients with FH were characterized by high levels of LDL-C, non-HDL-C and lipoprotein (a) in the 5-9 years age group; in the 10-14 years age group - high levels of LDL-C, TG, rC, non-HDL-C and lipoprotein (a); in the 15-18 years age group - high levels of LDL-C, TG, non-HDL-C and lipoprotein (a). At the same time, the most marked dyslipidemia changes were evident in children aged 10-14 years in the FH group. apoA1 levels were significantly decreased in all FH children. Elevated levels of lipoprotein (a) (&gt;30 mg/dL) in FH children were found in all age groups, suggesting that elevated lipoprotein (a) levels can be used as a factor for cardiovascular risk stratification. Dp-uc MGP levels were significantly elevated in all age groups of FH children compared to healthy peers. Conclusions. A lipid profile examination is necessary to diagnose FH in children, along with family health history and cascade screening. As atherosclerotic changes at 5-18 years of age remain subclinical, and the instrumental tests available in routine medical practice are not sensitive enough to detect them, therefore, preventive or therapeutic measures cannot be initiated promptly. The evaluation of circulating matrix Gla protein in pediatric patients with FH can be used as a marker of vascular wall calcification, which may allow early preventive measures against microcalcification to be developed. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.

Endothelial dysfunction in patients with obesity

Endothelial dysfunction has been considered in the pathogenesis of obesity widespread in the population. The purpose of this review was to provide updated information about pathogenetic features and markers of endothelial dysfunction in obese patients. We mentioned systemic disorders in obesity, such as oxidative stress, an increase in pro-inflammatory cytokines – tumor necrosis factor alpha, interleukin-6, and arginase activity. We also discussed the role of insulin resistance in the development of endothelial dysfunction, as well as the product of adipose tissue metabolism – monocyte chemoattractant protein-1. The participation of perivascular adipose tissue, hyperoxia of adipose tissue in the regulation of inflammation was considered. We illustrated the influence of atherogenic concentrations of oxidized low-density lipoproteins, the asymmetric dimethyl-L-arginine level on endothelial function. Changes in laboratory parameters were analyzed: endothelin-1, levels of microalbuminuria, homocysteine and uric acid. We also described cytological (circulating vascular cells, endothelial microparticles) and instrumental (endothelium-dependent vasodilation, peripheral arterial tonometry, intima-media complex thickness of the common carotid artery, ultrasound kidneys examination with duplex scanning of the renal arteries) methods for assessing endothelial function. Factors that influence the risk of cardiovascular complications were arterial hypertension and arterial stiffness, high levels of low-density lipoprotein and triglycerides, reduced physical activity. The determination of endothelial function in patients with obesity can be important for predicting the pathology of the cardiovascular system. Information on the assessment of markers of endothelial dysfunction in such patients may expand the possibilities of early diagnosis and prevention of cardiovascular complications.

An altered balance of plasma arginine metabolites is associated with increased thickness of the coronary intima-media complex in the adjacent to the culprit segment of an infarct-related artery

Abstract Background The biomarkers of atherosclerosis remain insufficiently understood. Purpose We sought to investigate whether an altered balance of arginine metabolites in patients following myocardial infarction (MI) is associated with remodeling of the adjacent to the culprit segments of an infarct-related artery (IRA) and with clinical outcomes. Methods Arginine and its metabolites including ornithine, citrulline, proline and asymmetric dimethylarginine were measured using liquid chromatography and tandem mass spectrometry in 85 consecutive ST-segment elevation MI patients upon admission and at 6-month follow-up and were compared with morphology of the adjacent to the culprit proximal and distal 10-mm segments of IRA assessed with optical coherence tomography. A composite ischemic event was defined as death, recurrent MI, stroke, or unplanned percutaneous coronary intervention. Results The ratios of citrulline/ornithine and citrulline/arginine decreased 5.22 and 2.20 times (both P&amp;lt;0.001) respectively, while the ornithine/arginine index (I_O/A) increased 2.96 times (P&amp;lt;0.001) following ischemia compared with stable follow-up, indicating the enhanced arginase activity over nitric oxide synthase (NOS) in acute phase of STEMI. Follow-up I_O/A correlated with the mean intima-media (R=0.34, P=0.003, Figure 1A) and intima (R=0.30, P=0.008) diameter of an adjacent to the culprit IRA segment. By multivariate analysis, apart from male gender (P&amp;lt;0.001) and diabetes mellitus (P=0.02), a higher follow-up I_O/A was associated with the larger mean intima-media diameter of an adjacent to the culprit IRA segments (coefficient 0.218, 95% confidence interval 0.040–0.397, P=0.017, per 0.01). Within the median follow-up of 25 (19–35) months, ischemic composite endpoint was found in 13 (15.3%) patients. The follow-up I_O/A reached the area under the ROC curve of 0.78 (95% confidence interval 0.66–0.91, P=0.005) for prediction of composite ischemic endpoint with a cut-off value of ≥0.57, and a sensitivity of 72.3% and specificity of 80.0% (Figure !B). Conclusions Our findings provide arguments that during the acute phase of MI, arginine metabolism is shifted from NOS towards arginase, as compared to 6-month stable conditions. Simultaneously, the enhanced residual arginase activity over NOS in chronic phase was correlated with a higher thickness of intima or intima-media in the adjacent to the culprit segment within the IRA, and was also associated with unfavorable clinical outcomes. Funding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): Grant of the National Science Center of Poland (Number 2016/21/B/NZ5/01378 to J.Z.)

Clinical case of the coronavirus infection in anamnesis with complication

Abstract: coronavirus infection, the causative agent of which is SARS-CoV-2, can cause a wide range of clinical manifestations. This infection is especially dangerous for patients with a predisposition to cardiovascular diseases, such as hypertension. Changes in vascular tone under conditions of increased blood pressure, as well as dysfunction of vascular walls under the influence of a viral infection, lead to irritation of the suprasegmental part of the autonomic nervous system, namely the posterior part of the hypothalamus, which provokes the development of sympathoadrenal attacks with panic attacks. This study aimed to demonstrate that comorbid disease of the cardiovascular system occurred after coronavirus infection worsens the course of the initial manifestations of cerebrovascular insufficiency. Patient T., who suffered from COVID-19 in October 2020, was examined in the neurological department of the State Institution «Head medical center of the Ministry of Internal Affairs of Ukraine» in December-January 2020-2021. During the examination of the patient’s neurological status, positive pathological reflexes were found: proboscis and Marinescu-Radovichi reflex, foot pathological Strumpell extensor reflex on both sides, and lability of the autonomic nervous system in the form of acrohyperthermia, tremors of the eyelids and fingers of outstretched hands, slight unsteadiness in the Romberg pose. The patient underwent a general blood count, biochemical blood test, Doppler ultrasound of the main arteries of the head, ultrasound of the heart, and electrocardiography (ECG). Special attention should be paid to the results of the Doppler ultrasound of the main arteries of the head: the intima-media complex thickness of the left common carotid artery in the middle third is up to 0.91 mm, in the bifurcation it has a local thickening up to 1.27 mm, the right common carotid artery in the middle third is up to 0.85 mm (normal up to 1.0 mm), in the bifurcation up to 1.04 mm (normal up to 1.1 mm), with partially lost differentiation into layers, echogenicity is not changed. In consequence of the patient’s treatment with statin drugs, scavenger-receptors of monocytes are blocked, the number of which on the surface of cells is stimulated by viruses in the presence of infection, and right to them LDL are attached. Blocking of the capture of LDL by phagocytes limits the formation of foam cells, which are the basis of atherosclerotic plaques, and leads to a decrease in the intima-media complex thickness. According to the results of the ultrasound of the main arteries of the head, after six months of treatment, the thickness of the intima-media complex of the left common carotid artery decreased from 0.91 mm to 0.76 mm, the right one - from 0.85 to 0.65 mm. Conclusions. Comorbid diseases occurring under the influence of coronavirus infection, namely arterial hypertension, worsen the course of such slowly progressive disorders of cerebral blood circulation, as the initial manifestations of cerebral blood circulation insufficiency with the development of sympathoadrenal paroxysms with panic attacks. Treatment with statins, anticoagulants, antihypertensive, nootropic, and sedative drugs helps to stabilize arterial hypertension and reduce the number of sympathoadrenal attacks with panic attacks in patients.

Central Retinal Artery Occlusion Is Related to Vascular Endothelial Injury and Left Ventricular Diastolic Dysfunction.

Central retinal artery occlusion (CRAO) is an emergency state characterized by sudden, painless vision impairment. Patients with CRAO have an increased risk of cardiovascular events, including stroke, likely related to vascular endothelial damage. Therefore, we investigated flow-mediated dilatation (FMD) of the brachial artery as a marker of endothelial dysfunction, intima-media complex thickness (IMT) of the common carotid artery, pointing to the arterial wall atherosclerotic alteration, and transthoracic echocardiographic parameters in 126 consecutive CRAO patients (66 men [52.4%], median age 55 years) and 107 control participants (56 men [52.3%], matched by age, sex, and body mass index). Most CRAO patients (n = 104, 82.5%) had at least one internal medicine comorbidity, mainly hypercholesterolemia and hypertension, which coexisted in one-fourth of them. Furthermore, they had a 38.2% lower relative increase of FMD (FMD%) and a 23.1% thicker IMT compared to the controls (p < 0.001, both, also after adjustment for potential confounders). On echocardiography, the CRAO group was characterized by increased dimensions of the left atrium and thicker left ventricular walls, together with impaired left ventricular diastolic function. CRAO is related to vascular endothelial damage, atherosclerosis, and left ventricular diastolic cardiac dysfunction. Thus, non-invasive ultrasound assessments, such as FMD%, IMT, and echocardiography, may be helpful in screening patients with increased CRAO risk, particularly those with other comorbidities.

Вікові особливості структурних та гемодинамічних показників магістральних судин шиї при неалкогольній жировій хворобі печінки та підвищеній масі тіла

Усього було обстежено 290 пацієнтів (85 чоловіків та 205 жінок). Порівнювались показники пацієнтів із неалкогольною жировою хворобою печінки (НАЖХП) (стеатоз), поєднаною з підвищеною масою тіла, та показники пацієнтів контрольних груп з нормальною масою тіла без патології печінки. Обстежені були розподілені на чотири вікові групи (за критерієм ВООЗ): 1-ша вікова група — від 25 до 34 років, 2-га — від 35 до 44 років, 3-тя — від 45 до 59 років, 4-та — від 60 до 75 років. Проаналізовані структурні та гемодинамічні показники магістральних судин шиї, отримані при комплексному дуплексному обстеженні (ультразвукова сонографія в В-режимі, режимі колірного допплерівського картування й допплер-обстеження).Встановлені зміни структурних та гемодинамічних показників магістральних судин шиї (стовщення комплексу інтима-медія, зменшення лінійних швидкостей кровотоку). НАЖХП (стеатоз), поєднана з підвищеною масою тіла, справляє прямий вплив на структурний та гемодинамічний стан магістральних судин шиї. Виявлений кореляційний зв’язок між НАЖХП (стеатоз), поєднаною з підвищеною масою тіла, та швидкісним показником кровотоку — піковою систолічною швидкістю кровотоку (p &lt; 0,05). Порушення структури та гемодинаміки магістральних судин шиї, виявлені при комплексному дуплексному обстеженні, є результатом прямого впливу НАЖХП (стеатоз) та підвищеної маси тіла та призводять до зростання кардіоваскулярного ризику переважно в групах середнього та похилого віку.

Endothelial function status in hypogonadal men

Background: Type 2 diabetes mellitus (T2DM) and hypogonadism are mutually aggravating diseases associated with the development and progression of cardiovascular pathology. The status of endothelial function in men with T2DM and hypogonadism hasn’t been studied.Aims: To assess the effect of hypogonadism on endothelial function in men with T2DM.Materials and methods: Patients underwent clinical studies, assessment of carbohydrate and lipid metabolism, the content of sex hormones (total testosterone (T), sex hormones binding globulin, free T, luteinizing hormone) and markers of endothelial function (nitric oxide (NO), endothelial nitric oxide synthase type 3 (eNOS3), endothelin, adhesion molecules ICAM-1, VCAM-1, p- and e-selectins, cadherin), ultrasound examinations of endothelium-dependent vasodilation (EDVD) of the brachial artery (BA) and carotid arteries with an assessment of the thickness of intima-media complex (TIM) were performed.Results: The study included 276 men with T2DM (age 54.0[49;60] years), who were divided into 2 groups: 1–124 patients with hypogonadism; 2–152 eugonadal patients. Reduction of the endothelial vasomotor function was detected in 32.4% of patients in the 2st group and in 55.3% of the 1nd group (χ2=6.1; p=0.01), which was associated with a decrease in EDVD by 29.8 % (p&lt;0.001) and an increase in the time of development of maximal BA vasodilation by 30 seconds in patients with hypogonadism (p&lt;0.001). The TIM of the carotid arteries was 10% more in group 1 compared with group 2 (p=0.03). The ­level of NO in the 1st group was reduced by 1.6 times (p=0.001), eNOS3–by 1.5 times (p=0.038) compared with the 2nd group. The concentrations of adhesion molecules were higher in group 1 compared to group 2: VCAM-1 by 32.5% (p&lt;0.001), ICAM-1 by 43.5% (p&lt;0.001), p-selectin–by 19.3% (p=0.004), cadherin–6 times (p&lt;0.001).Conclusion: Hypogonadism in men with T2DM is associated with the development of endothelial dysfunction, which manifests in a weakening of the EDVD and a slowdown in its development, as well as disturbances of the secretory activity of endothelium–a decrease in NO synthesis and activation of the adhesion molecules expression, which can be regarded as an universal pathogenetic mechanism of the development of cardiovascular diseases in combination of T deficiency and T2DM.

Факторы, предрасполагающие к прогрессированию атеросклероза каротидных артерий у пациентов с артериальной гипертензией

The aim of the research. To study clinical and genetic factors predisposing to progression of carotid artery atherosclerosis among the Shor people based on a 5-year dynamic follow-up of hypertensive patients. Material and methods. A prospective clinical and epidemiological study of the indigenous population of the Mountain Shoria was carried out including patients with arterial hypertension (367 subjects). The dynamics of the intima-media complex thickness and atherosclerotic plaque thickness was assessed 5 years later by repeat ultrasound examination of carotid arteries. Polymorphisms of ACE (I/D, rs 4340), AGT (c.803T&gt;C, rs699), AGTR1 (A1166C, rs5186), ADRB1 (c.145A&gt;G, Ser49Gly, rs1801252), ADRA2B (I/D, rs28365031), MTHFR (C677T, rs1801133) and eNOS (VNTR 4b/4a) genes were tested using polymerase chain reaction. Results. The 5-year observation of the indigenous population of the Mountain Shoria has shown that such factors as the age (p=0.011) and the course of arterial hypertension (3rd-degree AH, duration of the disease for over 10 years, failure to achieve the target level of arterial pressure during treatment) play a significant role in the frequent unfavourable dynamics of the intima-media complex thickness. Th e study has also established association between the development of the atherosclerotic process in carotid arteries and smoking (OR=1.52), abdominal obesity (OR=2.87) and impaired glucose tolerance (OR=2.94). The increased level of low-density lipoprotein cholesterol also determines the negative dynamics as manifested by the growth of the atherosclerotic plaque in brachiocephalic arteries (OR=1.93). A high risk of atherosclerosis in the Shor cohort is associated with carriership of the prognostically unfavourable D alleles of the ACE gene (OR=8.29), C of the AGTR1 gene (OR=7.04) and T of the MTHFR gene (OR=3.25). Conclusion. The 5-year prospective observation of the small indigenous population of the Shors has revealed certain clinical and genetic factors for patients with arterial hypertension that are associated with the carotid artery atherosclerosis. The polymorphism of certain candidate genes is an important strategic biomarker that can be used in the future for early diagnostics of diseases associated with atherosclerosis.

Сравнение эффективности лосартана и комбинации валсартана / сакубитрила у лиц с хронической сердечной недостаточностью с низкой фракцией выброса левого желудочка в сочетании с сахарным диабетом 2 типа

The purpose — to compare the efficacy and safety of the use of two regimens for the use of renin-angiotensin system blockers — valsartan / sacubitril (V/C) and losartan in patients with diabetes mellitus (DM) type 2 in combination with chronic heart failure (HF) and low ejection fraction (EF) of the left ventricle (LV). Material and methods. We observed 46 patients with type 2 diabetes. All these patients had previously suffered from myocardial infarction and had clinical manifestations of chronic HF class II-III with LV EF &lt; 40%. All patients were recommended lifestyle changes, they received adequate hypoglycemic and organ-protective therapy. Two groups were distinguished: group A (16 patients, taking V/C at an initial dose of 100 mg/day, followed by titration to 400 mg/day) and group B (30 patients, taking losartan at an initial dose of 50 mg/day, with titration up to 150 mg/day). In the course of treatment and after 11 months, clinical and laboratory studies were performed, in dynamics, echocardiography with tissue Doppler, ultrasound of the brachiocephalic arteries, and a test with reactive hyperemia were performed. Results. During treatment in group A, compared with group B, a more significant positive dynamics of clinical manifestations and the following studied parameters were noted: HOMA-IR and ΔHOMA-B indices, glycated hemoglobin levels, chronic HF class, LV EF, left atrial volume index, ratio of early diastolic velocity of transmitral blood flow to early diastolic velocity of the mitral valve ring, carotid intima-media complex thickness, and indexbrachial arteries resistivity; all changes are significant. Conclusions. Combined neurohumoral blockade using V/S compared with losartan in patients with DM type 2 and chronic HF with low LV EF helped to have more positive changes in clinical-laboratory and instrumental indicators.

Diagnostic accuracy of vascular ultrasound in patients with suspected giant cell arteritis (EUREKA): a prospective, multicentre, non-interventional, cohort study.

Temporal artery biopsy is considered the diagnostic gold standard for giant cell arteritis, despite approximately 39% of patients who are negative for the condition by biopsy subsequently being given a clinical diagnosis of giant cell arteritis. We aimed to assess the diagnostic accuracy of ultrasound examination in patients with suspected giant cell arteritis. In this prospective, multicentre, non-interventional, cohort study (evaluation of ultrasound's role in patients suspected of having extracranial and cranial giant cell arteritis; EUREKA), we consecutively recruited patients aged 50 years or older, with clinically suspected giant cell arteritis from three Danish hospitals (South West Jutland Hospital in Esbjerg, Silkeborg Regional Hospital, and Rigshospitalet, Glostrup). Participants had a bilateral ultrasound of the temporal, facial, common carotid, and axillary arteries. Ultrasounds were done by ultrasonographers who were systematically trained in vascular ultrasound using appropriate equipment and settings. Participants then had a temporal artery biopsy within 7 days of initiation of corticosteroid treatment. A blinded ultrasound expert assessed all ultrasound images. Ultrasound vasculitis was defined in cranial arteries as a homogeneous, hypoechoic, intimamedia complex thickness and a positive compression sign and as a homogeneous intimamedia complex of 1 mm in thickness or wider in the axillary arteries and of 1·5 mm thickness or wider in the common carotid artery. Participants were followed up at 6 months. During this 6 month period, clinicians were able to collect data from all clinical examinations to enable a full clinical diagnosis at 6 months. Clinical diagnosis was based on the expert opinion of the treating rheumatologist. The diagnostic criterion standard was diagnosis confirmed after 6 months of follow-up. We used logistic regression analyses to calculate the odds ratio and 95% CI of ultrasound as a predictor for giant cell arteritis. Between April 1, 2014, and July 31, 2017, 118 patients were screened for inclusion, of whom 106 had both ultrasound examinations and an eligible temporal artery biopsy and were included in the intention-to-diagnose population. The mean age was 72·7 years (SD 7·9), 63 (59%) participants were women, and 43 (41%) were men. Temporal artery biopsy was positive in 46 (43%) of 106 patients, and 62 (58%) of 106 patients had a clinically confirmed diagnosis of giant cell arteritis at 6 months (temporal artery biopsy sensitivity 74% [95% CI 62-84], specificity 100% [95% CI 92-100]). Cranial artery ultrasound was positive in all patients who had a positive temporal artery biopsy, and seven (58%) of 12 patients who were positive by ultrasound and negative by temporal artery biopsy were confirmed to have large-vessel giant cell arteritis via other imaging methods. The sensitivity of ultrasound diagnosis of giant cell arteritis was 94% (84-98) and specificity was 84% (70-93). Logistic regression analysis confirmed that ultrasound was the strongest baseline predictor for a clinically confirmed diagnosis of giant cell arteritis at 6 months (crude odds ratio 76·6 [95% CI 21·0-280·0]; adjusted for sex and age 141·0 [27·0-743·0]). Vascular ultrasound might effectively replace temporal artery biopsy as a first-line diagnostic method in patients suspected of having giant cell arteritis when done by systematically trained ultrasonographers using appropriate equipment and settings. The Institute for Regional Research at Hospital of Southwest Jutland, Esbjerg, Denmark.