Intima-media Complex Research Articles

Association of Intima-Media Texture With Prevalence of Clinical Cardiovascular Disease.

Recent studies have suggested that textural characteristics of the intima-media complex (IMC) may be more useful than the intima-media thickness (IMT) in evaluating cardiovascular risk. The primary aim of our study was to investigate the association between texture features of the common carotid IMC and prevalent clinical cardiovascular disease (CVD). The secondary aim was to determine whether IMT and IMC texture features vary between the left and right carotid arteries. The study was performed on 2208 longitudinal-section ultrasound images of the left (L) and right (R) common carotid artery (CCA), acquired from 569 men and 535 women out of which 125 had clinical CVD. L and R sides of the IMC were intensity normalized and despeckled. The IMC was semiautomatically delineated for all images using a semiautomated segmentation system, and 61 different texture features were extracted. The corresponding IMT semiautomated measurements (mean±SD) of the L and R sides were 0.73±0.21 mm/0.69±0.19 mm for the normal population and 0.83±0.17 mm/0.79±0.18 mm for those with CVD. IMC texture features did not differ between the right- and left-hand sides. Several texture features were independent predictors of the presence of CVD. The multivariate logistic regression analysis combining age, IMT, and texture features produced a receiver operating characteristic curve with an area under the curve of 89%. A correct classification rate of 77% for separating the normal subject (NOR) versus CVD subjects was achieved using the support vector machine classifier with a combination of clinical features, IMT, and extracted texture features. Texture features provide additional information on the presence of clinical CVD, which is over and above that provided by conventional risk factors or IMT alone. The value of IMC texture features in the prediction of future cardiovascular events should be tested in prospective studies.

Metabolic Syndrome as a Factor Affecting on Intima-Media Thickness in Patients with Rheumatoid Arthritis

AIM: The aim of the study was to assess the association of the thickness of the intima-media complex with metabolic syndrome (MetS) and the degree of disease activity in patients with rheumatoid arthritis (RA). MATERIALS AND METHODS: The study included 101 patients with RA. All patients underwent a biochemical examination, the presence of MetS was determined, and the carotid thickness of the intima-media was determined. Statistical processing was performed using SPSS for Windows, version 18.0. RESULTS: Among 101 patients with RA, 41 (40.5%) had MetS. The frequency of detecting an increased value of the intima-media complex thickness was significantly higher in the group with MetS (n = 31 [75.6%]) than in the group without MetS (n = 21 [35.0%] p ≤ 0.0001). In the group of patients with MetS, the median carotid intima-media thickness (CIMT) was 1.2 mm, while this indicator in the group without MetS was 0.78 mm (U = 727, p = 0.001). In the regression model, MetS (B = 1.05; p = 0.027) and DAS28-ESR (B = 0.506; p = 0.021) were influenced by CIMT. CONCLUSIONS: The results of our study show the effect of MetS and RA activity on the increase of intima-media thickness.

Comparison of the multi‐phasic longitudinal displacement of the left and right common carotid artery in healthy humans

During the cardiac cycle, there is a multi-phasic bidirectional longitudinal movement (LMov) of the intima-media complex of large arteries, i.e. along the arteries. On the left side the common carotid artery (CCA) arises directly from the aortic arc, whereas on the right side the CCA originate from the innominate artery. The aim of this study was to compare LMov of the left and right CCA of healthy subjects to investigate whether the difference in anatomy is of importance for LMov. The CCA's of 93 healthy subjects were investigated using in-house developed ultrasound methods. Although the basic pattern were the same in the majority of subjects, several phases of LMov were significantly larger on the left side (the first retrograde phase, p=0.0006; the second antegrade, "returning" phase, p<0.00001; and the rapid retrograde phase of movement at the end of the cardiac cycle, p<0.000001). In contrast, no significant side-difference in the amplitude of the first antegrade movement was seen. The maximal (peak-to-peak) LMov was significantly larger on the left side (p=0.002). The side-differences found in LMov may be related to the difference in anatomy, including possible difference in distance to the heart and especially the presence of an extra bifurcation on the right side. Our data provide an important base for the further study of the relation between LMov and cardiovascular risk factors and atherosclerosis.

Associations of continuous glucose monitoring-assessed glucose variability with intima-media thickness and ultrasonic tissue characteristics of the carotid arteries: a cross-sectional analysis in patients with type 2 diabetes

BackgroundThe association between glucose variability and the progression of atherosclerosis is not completely understood. We aimed to evaluate the associations of glucose variability with the progression of atherosclerosis in the early stages.MethodsWe conducted a cross-sectional analysis to investigate the associations of glucose variability, assessed by continuous glucose monitoring, with intima-media thickness (IMT) and gray-scale median (GSM) of the carotid arteries, which are different indicators for the progression of atherosclerosis. We used baseline data from a hospital-based multicenter prospective observational cohort study among Japanese patients with type 2 diabetes without a history of cardiovascular diseases aged between 30 and 80 years. Continuous glucose monitoring was performed by Freestyle Libre Pro, and glucose levels obtained every 15 min for a maximum of eight days were used to calculate the metrics of glucose variability. IMT and GSM were evaluated by ultrasonography, and the former indicates thickening of intima-media complex in the carotid artery wall, while the latter indicates tissue characteristics.ResultsAmong 600 study participants (age: 64.9 ± 9.2 (mean ± SD) years; 63.2%: men; HbA1c: 7.0 ± 0.8%), participants with a larger intra- and inter-day glucose variability had a lower GSM and most of these associations were statistically significant. No trend based on glucose variability was shown regarding IMT. Standard deviation of glucose (regression coefficient, β = − 5.822; 95% CI − 8.875 to − 2.768, P < 0.001), glucose coefficient of variation (β = − 0.418; − 0.685 to − 0.151, P = 0.002), mean amplitude of glycemic excursion (β = − 1.689; − 2.567 to − 0.811, P < 0.001), mean of daily differences (β = − 6.500; − 9.758 to − 3.241, P < 0.001), and interquartile range (β = − 4.289; − 6.964 to − 1.614, P = 0.002) had a statistically significant association with mean-GSM after adjustment for conventional cardiovascular risk factors, including HbA1c. No metrics of glucose variability had a statistically significant association with IMT.ConclusionsContinuous glucose monitoring-assessed glucose variability was associated with the tissue characteristics of the carotid artery wall in type 2 diabetes patients without cardiovascular diseases.

Accuracy verification in ultrasonic elasticity measurement within intima-media complex visible range using phantom experimental system

Studies to investigate the ultrasound elasticity measurement of the carotid artery, for early detection of arteriosclerosis, are ongoing. In the long-axis cross-sectional measurement in vivo, the position where the intima-media complex (IMC) is visible on the B-mode image was assumed to be the central axis of the short-axis view of the carotid artery. However, the IMC is also visible near the central axis of the short-axis view of the carotid artery. In the present study, accuracy in elasticity measurement within the IMC visible range was evaluated through a phantom experiment. The elasticities of the posterior wall measured at plural points within the IMC visible range differed by up to 6%. From the experimental results, we concluded that for the highest accuracy, it is important to measure along the central axis of the short-axis view of the carotid artery.

IL-6 AND IL-10 ACTIVITY IN HYPERTENSIVE MEN WITH MODERATE OR HIGH CARDIOVASCULAR RISK

Objective: To assess IL-6, IL-10 activity in hypertensive men with moderate or high cardiovascular risk (CVR). Design and method: 60 hypertensive men with moderate and high CVR were included. Two groups were formed: 1st - 30 hypertensive men with moderate CVR; 2nd - 30 men with high CVR. Control group - 15 men, 45–62 years old, without chronic diseases and hypertension. Anamnesis collection, CVR study, general examination, biochemical blood test, ECG, ECHO were held. IL-6, IL-10 were determined by the enzyme-linked immunosorbent assay method. The Mann-Whitney nonparametric test was used for groups comparison. The statistical significance of different values was determined by using the Pearson's Chi-square test. Correlation analysis was carried out on the basis of Spearman's nonparametric rank correlation. Results: IL-10 activity: moderate risk group - 5.18 [3.74; 7.03] pg/ml, high-risk group - 4.92 [2.96; 6.36] pg/ml, control group - 6.63 [5.90; 9.07] pg/ml. There was a statistically significant IL-10 decrease in the high-risk group in comparison with the control group (p = 0.0175). IL-6 activity: moderate risk group - 1.55 [0.75; 2.68] pg/ml, high-risk group - 1.16 [0.48; 2.41] pg/ml, control group - 1.02 [0.00; 9.83] pg/ml, there were no statistically significant differences in the groups. Correlation analysis revealed a multidirectional relationship between IL-10 and the hypertension duration in two groups: with a high risk a negative correlation was revealed (R = - 0.5, p &lt; 0.01), with a moderate risk a positive correlation was revealed (R = 0.46, p &lt; 0.05). IL-6 positively correlated with the thickness of the carotid artery intima-media complex (R = 0.41, p &lt; 0.05) in men with moderate CVR. Conclusions: IL-10 decrease was revealed in hypertensive men with high CVR as compared to the healthy people. It can be used as an additional criterion for high CVR. The negative IL-10 correlation with the hypertension duration reflects the unfavorable development of hypertension in hypertensive men with high CVR. The detection of high IL-6 values in hypertensive men indicates the risk of endothelial dysfunction.

Improved Carotid Elasticity but Altered Central Hemodynamics and Carotid Structure in Young Athletes.

Young athletes most often exceed the physical activity recommendations of the World Health Organization. Therefore, they are of special interest for investigating cardiovascular adaptions to exercise. This study aimed to examine the arterial structure and function of young athletes 12–17 years old and compare these parameters to reference values of healthy cohorts. Carotid intima-media thickness (cIMT), carotid diameter, cIMT÷carotid diameter-ratio (cIDR), arterial compliance (AC), elastic modulus (Ep), β stiffness index (β), and carotid pulse wave velocity (PWVβ) were determined using ultrasound in 331 young athletes (77 girls; mean age, 14.6 ± 1.30 years). Central systolic blood pressure (cSBP) and aortic PWV (aPWV) were measured using the oscillometric device Mobil-O-Graph. Standard deviation scores (SDS) of all parameters were calculated according to German reference values. The 75th and 90th percentiles were defined as the threshold for elevated cIMT and arterial stiffness, respectively. Activity behavior was assessed with the MoMo physical activity questionnaire, and maximum power output with a standard cardiopulmonary exercise test. One-sample t-tests were performed to investigate the significant deviations in SDS values compared to the value “0”. All subjects participated in competitive sports for at least 6 h per week (565.6 ± 206.0 min/week). Of the 331 young athletes, 135 (40.2%) had cIMT >75th percentile, 71 (21.5%) had cSBP >90th percentile, and 94 (28.4%) had aPWV>90th percentile. We observed higher cIMT SDS (p < 0.001), cIDR SDS (p = 0.009), and AC SDS (p < 0.001) but lower β SDS (p < 0.001), Ep SDS (p < 0.001), and PWVβ SDS (p < 0.001) compared to the reference cohort. The cSBP SDS (p < 0.001) and aPWV SDS (p < 0.001) were elevated. In conclusion, cIMT and cIDR were higher in young athletes than in a reference cohort. Furthermore, young athletes presented better carotid elasticity and lower arterial stiffness of the carotid artery. However, central arterial stiffness was higher compared to the reference cohort. The thickening of the carotid intima-media complex in combination with a reduction in arterial stiffness indicates a physiological adaptation to exercise in youth.

Early signs of airflow restriction and cardiovascular damage in conditionally healthy smokers

Tobacco smoking is one of the most widespread and at the same time difficult to control risk factors for chronic noncommunicable diseases, which make the most significant contribution to the mortality. Smoking intensity, development of airflow restrictions, and damage to vascular endothelium are connected to the accelerated development of atherosclerosis. At the same time, there is no evidence of a possible relationship between the development of myocardial dysfunction and exposure to tobacco combustion products. It is of interest to study the incidence of airflow restrictions, arterial hypertension, and markers of early damage to target organs - the brachiocephalic arteries (BCA) and myocardium, in so-called relatively healthy smoking individuals. The aim of the study was to describe the incidence of airflow restrictions, hypertension, the state of the brachiocephalic arteries, and indicators of global and regional longitudinal strain of the left ventricle (GLSLV and RLSLV) in actively smoking conditionally healthy individuals. Methods. 100 active smokers were examined (smoking person index or ICH &gt; 10 (17 ± 2 packs/year)) at the mean age of 48,80± 0,68years. 55% of the patients were male. The diagnosis of COPD was made based on spirometry values before and after the test with bronchodilators (400 mcg of salbutamol) (FEV1/FVC &lt; 70% and FEV1 increase &lt;12% of the initial values). Blood pressure measurement, duplex scanning of brachiocephalic arteries, transthoracic echocardiography with GLSLV and RLSLV with 17-segment division by Strain method were performed in all patients. Results. COPD was diagnosed in 35% of the patients, hypertension - in 45%. Evaluation of BCA showed increased thickness of intimamedia complex in the patients with hypertension (р= 0.002) and a significantly higher degree of stenosis and number of plaques in patients with concomitant COPD and hypertension. Type 1 diastolic dysfunction of LV was detected both in patients with hypertension and in the patients with COPD, but it was most common in the patients with concomitant COPD and hypertension. The GLSLV values did not change in all patients, but the RLSLV values depended on the segment (basal, medial, apical) and were significantly lower in the patients with concomitant COPD and hypertension. Conclusion. Tobacco combustion products not only are risk factors of airflow restriction and systemic vascular dysfunction, but also cause preclinical myocardial damage, a marker of which is a violation of the longitudinal strain of the left ventricle.

Lack of evidence of the correlation between plasma Asymmetrical Dimethylarginine correlation and IMT in type 2 diabetic patients with chronic vascular complication.

Patients with type 2 diabetes represent 50% of all sudden cardiac deaths. Disseminated arteriosclerotic lesions are the cause of vascular incidents that cause permanent disability resulting from lower limb amputations. Our study was designed to investigate the relationship between asymmetrical dimethylarginine (ADMA), symmetric dimethylarginine (SDMA) plasma concentration and intima-media thickness (IMT) in subjects with diabetes mellitus without vascular complications (group A) and a group of diabetic patients diagnosed with diabetes micro- and macroangiopathy (group B). The experimental groups included 42 diabetic patients. Group A - 22 patients (9 W and 13 M), free from vascular complications (mean age 55.83±7.37 years), group B - 20 patients (6 W, 14 M) with accompanying micro- and macropathic changes (mean age 63.80±8.79 years). Group C (n=22), the control group, consisted of healthy volunteers (12 W and 10 M), between the ages of 40 to 60 (mean age 51.16±6.39), selected in reference to the age and sex of the research group. The carotid artery intima-media complex thickness (IMT) was evaluated with the use of a duplex ultrasound. There was no correlation between ADMA and the maximal or mean intima-media thickness (IMT) of the common carotid artery (CCA) and internal carotid artery (ICA). We demonstrated a correlation between symmetric dimethylarginine (SDMA) concentration and CCA IMT. The results suggest that ICA IMT may serve as a marker of vascular complication among patients with diabetes.

Vascular markers of cognitive dysfunction in patients with uncontrolled arterial hypertension

The presence of arterial hypertension (AH) leads to the development of cognitive dysfunction, in the genesis of which a significant role is assigned to vascular factors. Aim. To study the state of cognitive function and associated vascular factors in patients with uncontrolled AH. Materials and methods. The research involved 88 patients with uncontrolled AH (UAH) — group 1 (median age 60, men — 39%) and 46 patients with controlled AH (CAH) — group 2 (median age 59, men — 41%). Cognitive function was assessed using the Montreal Cognitive Assessment (MoCA). There were studied vascular factors: thickness of the intima-media complex (IMC), pulse wave velocity (PWV), microcirculation flow index (MFI) and asymmetric dimethylarginine (ADMA) concentrations. For the statistical analysis the following criteria were used: Student t-test, Mann—Whitney test. Multifactorial linear regression analysis was performed in groups. Results. In Group 1, there was a lower cognitive function index by MoCA — 24 [22; 26] points against 26 [25; 27] points in Group 2 (p = 0.002). IMC thickness was higher in Group 1 than in Group 2 (1.1 [0.90; 1.20] mm vs 1.0 [0.80; 1.10] mm, p = 0.042), concentration of ADMA was higher in Group 1 (0.73 ± 0.21 µmol/l vs 0.65 ± 0.1 µmol/l, p = 0.02), MFI was higher in Group 2 (30.6 [27.1; 34.4] perf. units vs. 22.8 [18.6; 26.1] perf. units, р &lt; 0.001). No differences between the groups were found in PWV. In regression analysis, the following factors had a statistically significant effect on MoCA scores: in Group 1 — age, IMC thickness, ADMA and MFI; in Group 2 — age and glomerular filtrate rate. Conclusion. Patients with uncontrolled AH have more pronounced cognitive dysfunction than those with controlled AH, which is associated with increased IMC thickness, impaired microcirculation and increased ADMA concentration.

Study of Arterial Stiffness - Based on Scientific Evidence, What are the Current Tools for the Study of Arterial Stiffness?

One of the biggest challenges in modern medicine is the early identification of patients with higher cardiovascular risks. The early identification of vascular damage in hypertensive patients is a challenge for cardiologists around the world in their attempt to reduce the risk of cardiovascular complications in patients. We know how important it is today to measure the thickness of the carotid intima-media complex through ultrasound examination in order to identify a greater or lesser cardiovascular risk. Arterial stiffness has proven [...]

Carotid artery longitudinal wall motion alterations associated with metabolic syndrome and insulin resistance.

Our objective was to study relationships between the new biomarker of vascular health, carotid artery longitudinal wall motion (CALM) and metabolic syndrome (MetS). Carotid ultrasound and assessment of MetS and its components were performed with 281 subjects aged 30-45years. In the longitudinal motion analysis, the amplitude of motion and the antegrade-oriented and retrograde-oriented components of motion between the intima-media complex and adventitial layer of the common carotid artery wall were assessed. Metabolic syndrome, according to the harmonized criteria, was detected in 53 subjects (19%). MetS was significantly associated with increased antegrade and decreased retrograde longitudinal motion in the carotid artery wall. Augmented antegrade amplitude of longitudinal motion was associated with obesity (β=0.149, p<.05) and low HDL cholesterol (β=0.177, p<.01). Attenuated retrograde amplitude of longitudinal motion was associated with hypertension (β=-0.156, p<.05), obesity (β=-0.138, p<.05) and hyperinsulinaemia (β=-0.158, p<.01). Moreover, insulin resistance (homeostasis model assessment index above 2.44) was associated with adverse changes in CALM. Metabolic syndrome and insulin resistance were associated with alterations in CALM. In particular, hypertension, obesity and hyperinsulinaemia were associated with reduced total peak-to-peak amplitude as well as increased antegrade and reduced retrograde amplitudes, all of which might be markers of unfavourable vascular health.

Fat mass and vascular health in overweight/obese children

Background and aimChildhood obesity is one of the most serious public health challenges of the 21st century. Body mass index (BMI), the most widely used marker of body fatness, has serious limitations, particularly in children, since it does not accurately discriminate between lean and fat mass. Aim of our study was to investigate if the estimate of fat mass, as derived by a new prediction model, was associated with carotid intima media thickness (IMT) and the cross-sectional area of the intima media complex (CSA-IMC) in overweight or obese children. Methods and resultsAs many as 375 overweight/obese Italian children, 54.7% males, aged 5–15 years, admitted to a tertiary care hospital, were consecutively enrolled in a study on cardiovascular markers of atherosclerosis. All children underwent an ultrasound carotid examination.Mean weight was 62.2 ± 20.8 Kg and fat-mass was 26.2 ± 10.7 Kg. Multiple regression analyses showed a significant association of fat mass with carotid IMT (β 0.156, p 0.01) and CSA-IMC (β 0.216, p < 0.001); these associations remained significant after controlling for the main cardiovascular risk factors (age, sex, blood pressure, HOMA-index, triglycerides, LDL-cholesterol, HDL-cholesterol, birth weight and high-sensitivity C-reactive protein). ConclusionFat mass calculated with the new formula is independently associated with subclinical atherosclerosis in overweight/obese children.

STRUCTURAL AND FUCNTIONAL PARAMETERS OF THE CARDIOVASCULAR SYSTEM DURING ATRIAL FIBRILLATION IN PATIENTS AFTER STROKE

The aim: To evaluate the structural and functional parameters of the cardiovascular system during atrial fibrillation (AF) in patients after a stroke. Materials and methods: In the main group, we selected 28 patients with non-valvular AF who had previously suffered an ischemic stroke (IS). The comparison group (30 people) included patients with AF without a stroke, comparable in age and gender. Results: As a result of the study, we discovered an increase in the risk of stroke with an increase in the thickness of the intima-media complex>0.9mm. The thickness of the interventricular septum was 1.19 (1.1; 1.25) in the group of patients with IS, and in the group of patients without IS - 1.09 (1.0; 1.19) cm (p = 0.019), the thickness of the LV posterior wall is greater in the main group 1.14 (1.05; 1.24) and 1.09 (1.01; 1.18) cm in the comparison group (p = 0.038). The myocardial mass index is 123.3 in the main group and 107.4 g/m2 in the comparison group (p = 0.41), which indicates left ventricle (LV) hypertrophy in the main group. Conclusions: thus, during AF in stroke patients, changes in the following structural and functional parameters of the cardiovascular system were discovered: an increase in the thickness of the interventricular septum, thickness of the posterior wall of the LV, and in the thickness of the intima-media complex.

Does Varicella Zoster Virus in Children Affect Temporal Artery Structure or Blood Flow?

Introduction: Varicella-Zoster Virus (VZV) is a member of the Herpesviridae family of viruses and causes two different clinical conditions. The main objective of our study is not to diagnose GCA but instead, we wanted to assess whether there is a structural or flow change following VZV during childhood using US in temporal artery, which is the most commonly affected artery by GCA in advanced age and to review whether the patients show any clinical symptoms related with GCA. Materials and Methods: The study was designed as a prospective single-blind study and included 30 patients diagnosed with varicella under 16 by the same pediatrician and shows infection characteristics. Results: None of the patients included in the study showed halo signs. Moreover, none of the patients showed compression signs, occlusion, or stenosis results. The mean value for intima-media complex thickness was measured as 0.25mm (0.18 - 0.27mm) in a common superficial temporal artery. Conclusion: Chickenpox patients did not show any ultra sonographic changes in their temporal artery and no clinical symptoms related to GCA, yet we think that the relationship between VZV infection and GCA development warrants further studies with larger series and longer follow-up periods.

Virus persistence in atherosclerotic plaques in patients after carotid endarterectomy

Objective ‒ to mark the quantity of herpes and flu infection detection of the none-stabil and stabil atherosclerotic (AS) plaques in patients with ischemic stroke (IS)/TIA and with the progressing AS and in the anamnesis after carotid endarterectomy.Materials and methods. 103 patients with IS/TIA after carotid endarterectomy were examined: 67 males 42‒82 years old (average age ‒ 66,1±1,4 years), 36 females 44‒81 years old (average age ‒ 63,0±1,3 years). Average age ‒ 65,1± 0,9 year. We examined the width of intima-media complex, presence of AS plaques, their constitution.Results. Among all viruses investigated with transfection and polymerase chain reaction in AS plaques and blood after carotid endarterectomy (HSV1,2, ЕВV, CMV, HHV6), the most prefer are with CMV and associated CMV + HSV1, CMV + HSV2, where patients, hwo have HHV6 and associated HSV1 + HHV6, HHV6 + HSV1 + HSV2.Conclusions. Presentation of CMV and associated CMV + HSV1, CMV + HSV2 increases the risk of development of the hypoechoic none-stabil AS plaques of internal carotid artery (ICA). Presentation of HHV6 and associated HSV1 + HHV6, HSV1 + HSV2 + HHV6 in AS plaques of ICA increases the relative risk of development of severe stenosis in the patients with symptomatic stenosis. The investigation confirms the necessary of periodical administration at exclusion of the stenosis of ICA.

Influence of the statin therapy on cardiovascular remodeling in arterial hypertension, combined with subclinical hypothyroidism

There is a proven relation between hypothyroidism and appearance of the pronounced structural and functional changes of the heart and blood vessels as well as atherosclerosis and its related diseases progress. At the same time, there is a lack of information regarding the influence of statins on indices of the structure and function of the heart and blood vessels in patients with arterial hypertension (AH) combined with subclinical hypothyroidism (SH).Aim. To study the effect of the long-term statin therapy on the cardiac structure and function, as well as on vascular remodeling in patients with arterial hypertension combined with subclinical hypothyroidism.Material and methods. The study involved 31 patients with arterial hypertension grade 1–3, stage II, of high and very high additional cardiovascular risk, with a concomitant SH. All patients received a combination of two or three first-line antihypertensive drugs at average therapeutic daily doses and atorvastatin at a dose of 20–30 mg per day.Prior to treatment and after one year of follow-up, all patients underwent an echocardiographic examination and a carotid artery scan on My Lab Seven (Italy) device as well as a 24h-blood pressure monitoring on a bifunctional device “Cardiotechnics-04” (Inkart, St. Petersburg, RF) with the simultaneous registration of BP and ECG.Results. Under the influence of therapy, the target level of systolic blood pressure was reached in 74 % (23/31) of patients during the daytime observation period, in 65 % (20/31) of patients during the nighttime observation period; target diastolic blood pressure for the daytime observation period – in 87 % (27/31) of patients, for the nighttime observation period – in 71 % (22/31) patients. However, there was no significant change in the size of cavities of the left atrium and both ventricles, ejection fraction (before treatment 68.84 ± 5.43 %, after 67.13 ± 5.45 %), thickness of the interventricular septum and posterior wall, relative wall thickness (before treatment 0.41 ± 0.07, after 0.41 ± 0.07, P = 0.871), LV mass index (before treatment 122.29 ± 37.36 g/m2, after 118.00 ± 31.00 g/m2, P = 0.849), indices of diastolic function of the left ventricle (LV). The specific gravity of patients with eccentric LV hypertrophy after a year of treatment increased from 32 % to 39 % (P = 0.5668), with concentric hypertrophy decreased from 42 % to 39 % (P = 0.8107), with normal LV geometry – from 19 % to 16 % (P = 0.7570). The number of patients with AH with a concomitant SH with signs of a concentric LV remodeling remained unchanged – before treatment 6 %, after 6 %. The influence of the statin therapy on vascular remodeling in patients with AH with a concomitant SH was characterized by a tendency towards a decrease in the thickness of the intima-media complex of the right (0.769 ± 0.276 mm vs. 0.701 ± 0.222 mm, P = 0.512) and left (0.759 ± 0.185 mm vs. 0.745 ± 0.179 mm, P = 0.988) common carotid arteries.Conclusion. In patients with AH with a concomitant SH, the antihypertensive therapy during the year with the first-line drugs with addition of statins was associated with achievement of the target SBP level in the active period in 74 %, in the passive period – in 65 % of patients (according to the 24h-BPM data), but was not accompanied by a significant decrease in the cavity size, wall thicknesses, LV mass, improvement of LV diastolic filling, reduction in thickness of the intima-media complex.

White matter hyperintensity in middle-age adults (40–59 years) and risk factors for cerebrovascular disease

Introduction. White matter hyperintensity (WMH) is a neuroimaging age-related phenomenon associated with an increased cardiovascular risk in people with arterial hypertension (AH). The prevalence of WMH and its relationship with risk factors for cerebrovascular disease (CVD) in middle-age population requires clarification. Aim: to assess the prevalence of the WMH phenomenon in people of working age (40–59 years) and to establish cerebrovascular risk factors associated with its development. Material and methods. Study cohort (n = 376; 156 (41.5%) men and 220 (58.5%) women; mean age 49.7 ± 5.0 years) was formed by screening an open population (40–59 years of age). Using a questionnaire and clinical, laboratory and instrumental findings, including brain MRI (1T), the prevalence of cardiovascular and cerebrovascular risk factors was analyzed. The odds ratio (OR) of the event occurring and a 95% confidence interval were calculated. Results. High prevalence of risk factors was revealed in the age group of 40–59 years, including AH in 46.7%, increased body mass index (BMI) in 60.6%, dyslipidemia (up to 39%), metabolic syndrome in 21.5%, thickening of the intima-media complex in 57.2%, atherosclerotic plaques in 49.7% of all cases. WMH was identified in 32% (120/376) of the subjects examined. An association between presence, severity of WMH and age, presence and severity of AH, as well as total burden of vascular risk factors was established. The most significant factors associated with the development of WMH in people aged 40–59 were found to be AH (OR 3.35), atherosclerosis of the brachiocephalic arteries (OR 1.79), and hyperglycemia (OR 1.36). Conclusion. Thus, there is a high prevalence of risk factors for cardiovascular and cerebrovascular diseases in the working-age population of the megalopolis (Moscow) at the age of 40–59 years, which is associated with accelerated WMH formation. Significant factors that are associated with WMH are AH, atherosclerosis of the brachiocephalic arteries, hyperglycemia, as well as dyslipidemia and metabolic syndrome. Early detection and management of the listed modifiable risk factors are necessary to prevent the development and progression of cerebral injury.

Microcirculation as a goal of correction in macroangiopathy (atherogenesis)

Background. The microcirculatory system (MCS) is a network of blood vessels that includes arterioles, capillaries, venules, and terminal lymphatic vessels. Microcirculation is characterized by the constant variability. Factors of atherogenesis development due to MCS dysfunction include shear stress, hyperglycemia, dyslipidemia, systemic and local inflammation, hypoxia and endothelial dysfunction mediated by oxidative stress. Laser Doppler flowmetry (LDF) is used to study microcirculation in the clinical settings. The advantages of LDF include simplicity, accessibility and non-invasiveness.&#x0D; Objective. To describe the features of microcirculation disorders and their elimination.&#x0D; Materials and methods. Analysis of literature data on this topic; own study. The study involved 98 patients (59 females; 39 males) with a mean age of 52.0 years. The first group consisted of patients with coronary heart disease (CHD) and chronic heart failure of I-IIA grades, the second – of relatively healthy individuals. All patients underwent LDF, ultrasound examination of the carotid arteries, and determination of anthropometric parameters.&#x0D; Results and discussion. MCS dysfunction is not only a risk factor for atherogenesis, but also a trigger for its acute complications (myocardial infarction, stroke, sudden death). Nitric oxide (NO) deficiency plays an important role in this. A potential target of therapeutic influence in the treatment of coronary heart disease is not only macrovascular system, but also vasa vasorum. The condition of the latter determines the course of atherosclerosis. According to the results of our own study, patients with CHD demonstrated a muscle mass decrease, an increase in waist and hip circumference, and in body mass index. In addition, the groups differed in thickness of the intima-media complex of both common carotid arteries (right common carotid artery: CHD group – 0.79±0.18 mm; group of relatively healthy individuals – 0.69±0.13 mm, p&lt;0,05; left common carotid artery: CHD group – 0.81±0.19 mm, group of relatively healthy individuals – 0.70±0.14 mm, p&lt;0,05). When assessing the indicators of wavelet analysis of LDF, a significant decrease in the rate of microcirculation and capillary blood flow reserve is revealed in the CHD group, as well as an increase in peripheral vascular resistance. According to previous own studies, sorbitol (Reosorbilact, “Yuria-Pharm”) and pentoxifylline (Latren, “Yuria-Pharm”) can be used to correct microcirculation disorders. The use of these drugs leads to vasodilation of precapillary sphincters and improvement of regional microperfusion.&#x0D; Conclusions. 1. Disorders of MCS are the pathogenetic factors of the atherogenesis. 2. Laser Doppler flowmetry is used to study microcirculation in the clinical settings. 3. In patients with CHD there is an increase in neuro- and myotonus of the MCS, which is associated with the impaired release of nitric oxide. 4. Changes in microcirculation contribute to the development of atherosclerosis, which should be taken into account when choosing treatment for such patients. 5. Sorbitol (Reosorbilact) and pentoxifylline (Latren) can be used to correct microcirculation disorders.

Chronic non-viral liver pathology in military personnel exposed to military-professional factors

Abstract. The prevalence and structure of chronic non-viral liver disease of military personnel whose service is associated with the influence of various military-professional factors are estimated. It is established that the frequency of chronic diffuse liver diseases of viral etiology in a group of servicemen radio-technical troops was 77,3%, from persons engaged in diving and altitude descents 65,9%, pilots of the aerospace defence forces of Russia 62,8%, in persons without exposure to military occupational factors is 69,5%. The largest number of persons suffering from chronic non-viral liver disease in the group of military radio-technical troops, probably related to low levels of physical activity and higher values of body mass index and waist circumference, but also the influence of microwave radiation, can enhance the damaging effects of lipid peroxidation. The lowest prevalence of non-viral chronic diffuse liver diseases among pilots and aquanauts is probably related to the maximum health requirements imposed on military personnel of these categories. It was found that the level of alcohol consumption and the nature of nutrition in the study groups did not significantly differ. The highest values of body mass index and waist circumference in combination with the lowest level of physical activity were observed in the group of military personnel of the radio engineering troops, which is probably due to the nature of daily military service, which is mainly sedentary. Among the metabolic changes of blood serum, increased total cholesterol levels in groups of divers, pilots and military Radio-technical troops compared with a control. In addition, the level of glucose in Aquanauts, as well as triglycerides in soldiers of the radio engineering troops was higher than in the control group. Ultrasound examination in all groups related to the impact of military occupational factors, recorded an increase in the thickness of the left lobe of the liver, and oblique vertical size and thickness of the right lobe in the group of soldiers of the radio-technical troops compared with a control. In addition, the values of the thickness of the intima-media complex as a marker of preclinical atherosclerosis associated with non-alcoholic and alcoholic-metabolic fatty liver diseases in this category of individuals significantly exceed them in the other groups. The maximum level of liver damage in the group of military personnel of radio engineering troops is confirmed by the highest values of the controlled parameter of attenuation of ultrasound, reflecting the degree of liver steatosis.