Mean Intima-media Thickness Research Articles

Sonographically measured perirenal fat thickness: An early predictor of atherosclerosis in HIV‐1‐infected patients receiving highly active antiretroviral therapy?

The aim of our study was to evaluate whether perirenal fat thickness (PRFT), a parameter of central obesity, is related to carotid intima-media thickness (IMT), an index of atherosclerosis in human immunodeficiency virus (HIV)-1-infected patients. We enrolled 70 consecutive HIV-1-infected patients receiving highly active antiretroviral therapy for more than 12 months, in a prospective cohort study. Sonographically measured PRFT and carotid IMT, as well as serum metabolic parameters, were evaluated. PRFT and IMT were measured using 3.75-MHz convex and 7.5-MHz linear probes, respectively. The mean PRFT and IMT in HIV-1-infected patients with visceral obesity was significantly greater than those in patients without it (p < 0.0001 and p < 0.01, respectively). Using the average IMT as the dependent variable in regression analysis, PRFT was an independent factor associated with carotid IMT (p < 0.05). A PRFT of 6.4 mm was the most discriminatory value for predicting an IMT >or= 0.9 mm (sensitivity 83.3%, specificity 83.9%). Subjects with visceral obesity had a progressively increasing carotid IMT on the 12-month measurement (p < 0.05). Our data demonstrated that PRFT measurement could be used as an early predictor of IMT increase in HIV-1-infected patients receiving highly active antiretroviral therapy.

Endogenous estrogen levels are associated with endothelial function in males independently of lipid levels

Estrogens and androgens may play an important role in vascular health in both sexes. The aim of this study was to examine the relation of endogenous sex hormone levels with early markers of atherosclerosis in a cohort of apparently healthy males. 124 males (age 46.25 ± 9.56) attending a preventive medicine program were examined for unrecognised features of the metabolic syndrome. Flow-mediated dilatation (FMD) and intima-media thickness (IMT) of the common carotid artery were evaluated. Obesity parameters were recorded; estradiol, testosterone, SHBG, free testosterone, insulin, as well as glucose and lipid levels were measured. FMD was positively correlated with estradiol (r = 0.201, P = 0.041) and negatively with total cholesterol (r = -0.205, P = 0.022), low density lipoproteins (r = -0.232, P = 0.009), and triglyceride levels (r = -0.179, P = 0.046). In multivariate analysis, the association of FMD with estrogen was independent of BMI and lipid levels. No significant association between FMD and testosterone levels was found. Subjects with an increased mean IMT (> 0.73 mm, i.e., > 3rd tertile) had lower levels of free (P = 0.021) and bioavailable (P = 0.016) testosterone. In multivariate logistic regression analysis, this association was no longer significant when age or cholesterol levels were considered. Endogenous estrogen levels are associated with FMD, independently of age and lipid levels, showing a protective effect in middle-age male subjects. Circulating androgens are associated, although not independently, with structural changes such as the IMT of carotid artery; this effect is possibly influenced by lipid levels and age.

Is A1C Variability an Independent Predictor for the Progression of Atherosclerosis in Type 2 Diabetic Patients?

BackgroundLittle is known about the relative contribution of long-term glycemic variability to the risk of macrovascular complications in type 2 diabetes. This study was conducted to evaluate the effect of A1C variability on the progression of carotid artery intima-media thickness (IMT) in type 2 diabetic patients.MethodsAmong type 2 diabetic patients who visited Hallym University Sacred Heart Hospital from March 2007 to September 2009, 120 patients who had carotid artery IMT measured annually and A1C checked every three months for at least one year were analyzed. Individual A1C variability was defined as the standard deviation (SD) of five A1C levels taken every three months for approximately one year. Change in IMT was defined as an increase in IMT on follow-up measurement. The association between the SD of A1C and changes in IMT was evaluated.ResultsWith greater A1C variability, there was a greater increase in the mean IMT (r = 0.350, P < 0.001) of the carotid artery. After adjusting for confounding factors that may influence IMT, A1C variability was significantly associated with the progression of IMT (r = 0.222, P = 0.034). However, the SD of A1C was not a significant independent risk factor for the progression of IMT in multiple regression analysis (β = 0.158, P = 0.093).ConclusionHigher A1C variability is associated with IMT progression in type 2 diabetic patients; however, it is not an independent predictor of IMT progression. Overall glycemic control is the most important factor in the progression of IMT.

Atherosclerosis in Patients With Cyanotic Congenital Heart Disease

Cyanotic patients with congenital heart disease (CHD) might be protected against atherosclerosis. Atherosclerotic risk factors and carotid intima - media thickness (IMT) were investigated in adults with cyanotic CHD and in unaffected age- and sex-matched controls. Fifty-four cyanotic patients (30 men, mean age 38, range 19-60 years) and 54 controls were included. Mean transcutaneous saturation of the cyanotic patients was 81+/-6%. Mean carotid IMT adjusted for age was significantly decreased in cyanotic patients compared to controls (0.55+/-0.1 mm vs 0.58+/-0.08 mm: DeltaIMT =0.04 mm [SE 0.015], P=0.01). In cyanotic patients lower total cholesterol levels were observed (4.4+/-1 mmol/L vs 4.9+/-1 mmol/L; P=0.02), as well as lower thrombocyte levels (173+/-81 x 10(9) /L vs 255+/-54 x 10(9) /L; P<0.01), higher bilirubin levels (18.6+/-11 micromol/L vs 12.7+/-6 micromol/L; P<0.01), and lower diastolic and systolic blood pressure (71+/-9 mmHg vs 76+/-9 mmHg, P<0.01; 113+/-14 mmHg vs 124+/-12 mmHg, P<0.01, respectively). In patients with cyanotic CHD carotid IMT, and hence atherosclerosis disease risk, was decreased. This might be due to a combination of reduced atherosclerotic risk factors such as lower blood pressure, lower total cholesterol levels, higher bilirubin levels and lower thrombocyte levels.

Endothelial cell markers reflecting endothelial cell dysfunction in patients with mixed connective tissue disease.

IntroductionThe aim of the present study was to investigate the association between cardiovascular risk factors and endothelial dysfunction in patients with mixed connective tissue disease (MCTD) and to determine which biomarkers are associated with atherosclerotic complications, such as cardiovascular disease.MethodsFifty MCTD patients and 38 healthy age-matched and sex-matched controls were enrolled in this study. In order to describe endothelial dysfunction, we assessed flow-mediated dilation (FMD), nitrate-mediated dilation (NMD) and carotid artery intima-media thickness (IMT). We investigated FMD of the brachial artery after reactive hyperemia and NMD after sublingual nitroglycerin administration, while the IMT of the common carotid artery was determined by ultrasound. Anti-U1 ribonucleoprotein (anti-U1RNP) antibodies, anti-cardiolipin (anti-CL) antibodies, anti-endothelial cell antibody (AECA) and endothelial cell markers, such as soluble thrombomodulin (TM) and von Willebrand factor antigen (vWFAg), were assessed.ResultsThe endothelium-dependent vasodilation (FMD) was significantly impaired in patients with MCTD, as compared with controls (%FMD: 4.7 ± 4.2% vs. 8.7 ± 5.0%; P < 0.001), while the percentage NMD did not differ (%NMD: 14.3 ± 6.6% vs. 17.1 ± 6.7%; P = 0.073). Mean carotid IMT values were higher in patients than in controls (IMT: MCTD, 0.64 ± 0.13 mm vs. controls, 0.53 ± 0.14 mm; P < 0.001). FMD negatively correlated with disease duration, the levels of apolipoprotein A1, the paraoxonase-1 activity, and systolic blood pressure in MCTD patients. The percentage FMD was significantly lower in MCTD patients with cardiovascular diseases (CVD), than in those without CVD (%FMD: 3.5 ± 2.9 vs. 5.8 ± 4.8, P < 0.0002), while percentage NMD did not differ between patients with and without CVDs. Serum levels of autoantibodies (anti-U1RNP, AECA and anti-CL) were significantly higher in MCTD patients and differed between MCTD patients with and without CVD. Endothelial cell markers such as soluble TM (12.2 ± 8.1 ng/ml vs. 3.2 ± 1.3 ng/ml; P < 0.001) and vWFAg (224.1 ± 115% vs. 89.4 ± 27.1%, P < 0.001) were the highest in MCTD patients with CVD.ConclusionsFMD is a reliable sensitive marker of endothelial cell dysfunction in MCTD. Beside the traditional risk factors, anti-U1RNP, AECA and anti-CL antibodies may be important not only in the pathogenesis of MCTD but in the induction of endothelial cell activation, and may play crucial roles in the development of early atherosclerosis in MCTD.

Carotid Intima-media thickness in childhood and adolescent obesity relations to abdominal obesity, high triglyceride level and insulin resistance.

To investigate risk factors which impact on common carotid artery intima media thickness (IMT). A total of 86 obese children and adolescents and 22 healthy children and adolescents with normal weight were enrolled. Moreover, 23 of 86 obese children and adolescents were diagnosed with metabolic syndrome (MetS). The clinical, biochemical data and the IMT of the common carotid artery were measured in all subjects. Obese and obese with MetS subjects demonstrated a significantly (p < 0.01) thicker intima media (0.69mm, 0.66mm) as compared to the control group (0.38mm), but there was no significant difference of IMT between obese and MetS group. IMT was correlated to body weight, body mass index, waist circumference, waist to hip ratio, systolic blood pressure, diastolic blood pressure, fasting insulin, homoeostasis model assessment-insulin resistance, triglyceride, high-density lipoprotein- cholesterol, low-density lipoprotein-cholesterol, alanine aminotransferase, aspartate aminotransferase and fatty liver. Waist circumference, waist to hip ratio, triglyceride and homoeostasis model assessment-insulin resistance were independent determinants of mean IMT level. Obesity especially abdominal obesity, high TG and insulin resistance may be the main risk predictors of increased IMT.

Association between Albuminuria, Carotid Atherosclerosis, Arterial Stiffness, and Peripheral Arterial Disease in Korean Type 2 Diabetic Patients

Background: To evaluate the association between albuminuria, carotid atherosclerosis, arterial stiffness, and peripheral arterial disease (PAD) in Korean type 2 diabetic patients. Methods: In total, 673 type 2 diabetic patients registered with the public health center participated. Following an overnight fast, venous blood and urine samples were collected and analyzed. The carotid intima-media thickness (IMT), amount of carotid plaque, brachial ankle pulse wave velocity (baPWV), and the ankle-brachial index of each patient were also assessed. Results: Albuminuria was significantly associated with PAD (odds ratio (OR) 2.33; 95% confidence interval (CI) 1.28–4.25 for normoalbuminuria vs. microalbuminuria and OR 3.28; 95% CI 1.40–7.66 for normoalbuminuria vs. macroalbuminuria), but not with carotid plaque. The mean baPWV differed significantly according to the level of albumin relative to the creatinine ratio (1,764.79, 1,778.98, and 2,001.33, respectively; p < 0.001), while no significant difference was observed in the mean IMT value (0.73, 0.74, and 0.72, respectively; p = 0.399). Conclusions: Albuminuria was significantly associated with baPWV and PAD, but not with carotid plaque or CCA-IMT, in Korean type 2 diabetic patients.

Serum Folate and Low-Density Lipoprotein Particle Size

Nutritional parameters, such as B-vitamins, have not been studied for an association with low-density lipoprotein (LDL) particle size. The present study explored whether serum vitamin levels, including folate and vitamin B-12, could be associated with LDL particle size. Using a randomly selected population of 255 hospital workers, we collected detailed lipid profiles, including triglyceride (TG), high-density lipoprotein (HDL) cholesterol, and LDL particle sizes. The peak particle size of LDL was measured by density gradient ultracentrifugation and a pore gradient lipoprotein system. Serum folate and vitamin B-12 levels were measured about 1 year later and analyzed. Carotid intima-media thickness (IMT) and hepatic steatosis were diagnosed ultrasonographically, and metabolic syndrome was diagnosed using ATP III criteria. LDL peak particle size was significantly correlated with carotid mean IMT (r=-0.16, p=0.010). Serum folate levels were significantly and positively correlated with HDL cholesterol and negatively with TG, although the latter showed borderline significance. With increasing serum folate levels, the LDL peak particle size showed a gradual independent increase, even when adjusted for age, sex, hepatic steatosis, metabolic syndrome, and the TG/HDL cholesterol ratio. Folate may act to enhance LDL particle size. Future clinical and research work should include a study of the safe application and manipulation of folate levels in order to control LDL particle size.

Association of urinary 15-F 2t-isoprostane level with oxygen desaturation and carotid intima–media thickness in nonobese sleep apnea patients

Obstructive sleep apnea (OSA) is characterized by recurrent apnea during sleep that may unbalance oxidative stress, increasing atherosclerosis. Among oxidative stress markers, 15-F 2t-isoprostane is considered one of the most sensitive and specific metabolites of lipid peroxidation. To explore the relationship between urinary 15-F 2t-isoprostane with sleep apnea severity and carotid modifications in nonobese OSA patients, 31 nonobese sleep apnea patients were studied, along with 10 lean subjects without OSA. Patients were assessed by polysomnography, blood pressure measurement, and ultrasonography to determine the carotid intima–media thickness (IMT). Urinary 15-F 2t-isoprostanes were measured by liquid chromatography–tandem mass spectrometry. Urinary 15-F 2t-isoprostane concentrations were increased in severe OSA patients compared to control subjects (20.2 ± 7.3 vs 12.3 ± 2.8 ng/mmol creatinine; P = 0.020). Mean carotid IMT was correlated with 15-F 2t-isoprostane ( r = 0.532; P < 0.001) and with the apnea–hypopnea index ( r = 0.345; P = 0.029). 15-F 2t-Isoprostane level was related to the night time spent at SaO 2 < 90% ( r = 0.478; P = 0.002), the apnea–hypopnea index ( r = 0.465; P = 0.003), and the mean nocturnal SaO 2 ( r = − 0.424; P = 0.007). These results showed a relationship between lipid peroxidation, carotid intima–media thickness, and intermittent hypoxia in nonobese OSA patients, thus reinforcing the hypothesis that oxidative stress could be involved in the early atherosclerotic process.

Walking speed and subclinical atherosclerosis in healthy older adults: the Whitehall II study

ObjectiveExtended walking speed is a predictor of incident cardiovascular disease (CVD) in older individuals, but the ability of an objective short-distance walking speed test to stratify the severity of preclinical...

Clinical assessment of atherosclerotic parameters and cardiac function in chronic hemodialysis patients

Atherosclerosis is evaluated by carotid mean intima-media thickness (mean IMT), pulse wave velocity (PWV), and the aortic calcification index (ACI). We have attempted to examine if these atherosclerotic parameters are associated with each other and which parameters are closely related to cardiac function in chronic HD patients. The mean IMT, PWV and ACI were examined in 69 maintenance HD patients using carotid ultrasonography, a blood volume plethysmographic apparatus and abdominal CT, respectively. Echocardiographic studies were also performed for measuring left ventricular (LV) geometry. Serum total cholesterol, high density lipoprotein cholesterol, low density lipoprotein cholesterol, triglyceride, albumin, C-reactive protein (CRP), calcium and phosphate were measured. The mean IMT correlated positively with ACI (r = 0.461, P < 0.0001) and tended to be correlated with PWV, but did not reach statistical significance. The PWV value correlated positively with ACI (r = 0.494, P <or= 0.0001). The mean IMT correlated positively with the LV mass index (r = 0.273, P = 0.0228), and fractional shortening (FS) correlated negatively with PWV value (r = -0.293, P = 0.0141) and ACI score (r = -0.289, P = 0.0158). Multivariate analyses indicated that the LV mass index was independently associated with mean IMT (P = 0.0231) as well as systolic blood pressure (P < 0.0001), pulse pressure (P < 0.0001) and hemoglobin (P = 0.016), and FS is independently associated with ACI (P = 0.0162) as well as PWV (P = 0.0144) and CRP (P = 0.0375). Atherosclerosis and reduced LV function are associated with increased vascular calcification and arterial stiffness in chronic HD patients.

Procoagulants and Subclinical Atherosclerosis in Young Adults: The CARDIA Study.

Abstract 2973Poster Board II-948 Background:Elevated levels of procoagulants (FVII, FVIII, vWF) have been associated with cardiovascular disease, but whether they play a role in atherogenesis is unclear. Study of these factors in young adulthood, prior to clinically manifested disease, and years later when subclinical atherosclerosis has developed, might clarify these associations. The Coronary Artery Risk Development in Young Adults (CARDIA) Study provides an opportunity to examine this issue. Methods:Assays of FVII, FVIII, and vWF were performed in 1255 participants ages 23-37 (Year 7,Y7) and repeated at ages 38-50 (Year 20,Y20). Coronary artery calcification (CAC) prevalence and mean intimal-medial thickness (IMT) in the common carotid (CC) and internal carotid (IC) were measured at Y20. Prospective (Y7 clotting factors, Y20 CAC & IMT) and cross-sectional (Y20 clotting factors, Y20 CAC & IMT) analyses were performed. We also grouped participants according to whether they had one or more procoagulants in the highest tertile at Y7, Y20, or both, and evaluated their associations with subclinical disease. Results:Y7 levels of procoagulants (%), mean(SD) were: FVII 76(18), FVIII 102(38), and vWF 108(47). At Y20, all had increased by 40% to 55%, and CAC>0 was present in 20% of participants. After adjustment for age, the prospective analyses showed a trend of progressively greater CC thickness from the lowest to the highest tertile of FVII activity in the total group (P=0.007) and in whites (P=0.002) and men (P=0.015). Associations of FVII with IC thickness (0.82 mm to 0.84 mm) and the prevalence of CAC (18.6% to 23%) were weaker (P-trend, 0.1-0.3). Higher FVIII levels were associated with greater IC thickness in the total group, in whites, and in women (highest vs lowest tertile, P<0.05 for each comparison). No associations were seen with vWF. Cross-sectional analyses confirmed the association between FVII and carotid thickening, most strongly with the CC (P=0.002). Most associations were attenuated by multivariable adjustment (BMI, smoking, education, blood pressure, cholesterol, & CRP). Participants with FVII values in the highest tertile at Y7, Y20, or both had a higher prevalence of CAC and greater carotid thickening than those with values in the lowest tertile (P<0.05). Such associations were not observed with FVIII or vWF. Conclusion:FVII is a marker but not an independent risk factor for future atherosclerosis in young adults; FVIII is associated with IC thickening, and no associations were observed for vWF. Disclosures:No relevant conflicts of interest to declare.

Extended-Release Niacin or Ezetimibe and Carotid Intima–Media Thickness

Treatment added to statin monotherapy to further modify the lipid profile may include combination therapy to either raise the high-density lipoprotein (HDL) cholesterol level or further lower the low-density lipoprotein (LDL) cholesterol level. We enrolled patients who had coronary heart disease or a coronary heart disease risk equivalent, who were receiving long-term statin therapy, and in whom an LDL cholesterol level under 100 mg per deciliter (2.6 mmol per liter) and an HDL cholesterol level under 50 mg per deciliter for men or 55 mg per deciliter for women (1.3 or 1.4 mmol per liter, respectively) had been achieved. The patients were randomly assigned to receive extended-release niacin (target dose, 2000 mg per day) or ezetimibe (10 mg per day). The primary end point was the between-group difference in the change from baseline in the mean common carotid intima-media thickness after 14 months. The trial was terminated early, on the basis of efficacy, according to a prespecified analysis conducted after 208 patients had completed the trial. The mean HDL cholesterol level in the niacin group increased by 18.4% over the 14-month study period, to 50 mg per deciliter (P < 0.001), and the mean LDL cholesterol level in the ezetimibe group decreased by 19.2%, to 66 mg per deciliter (1.7 mmol per liter) (P < 0.001). Niacin therapy significantly reduced LDL cholesterol and triglyceride levels; ezetimibe reduced the HDL cholesterol and triglyceride levels. As compared with ezetimibe, niacin had greater efficacy regarding the change in mean carotid intima-media thickness over 14 months (P = 0.003), leading to significant reduction of both mean (P = 0.001) and maximal carotid intima-media thickness (P < or = 0.001 for all comparisons). Paradoxically, greater reductions in the LDL cholesterol level in association with ezetimibe were significantly associated with an increase in the carotid intima-media thickness (R = -0.31, P < 0.001). The incidence of major cardiovascular events was lower in the niacin group than in the ezetimibe group (1% vs. 5%, P = 0.04 by the chi-square test). This comparative-effectiveness trial shows that the use of extended-release niacin causes a significant regression of carotid intima-media thickness when combined with a statin and that niacin is superior to ezetimibe. (ClinicalTrials.gov number, NCT00397657.)

Abstract 5204: Vascular Remodelling in Patients With Psoriatic Arthritis: The Impact of Blood Pressure

Increased cardiovascular mortality have been observed in several immune mediated rheumatic diseases, including psoriatic arthritis (PsA). We evaluated subclinical atherosclerosis in PsA patients according with hypertensive status by studying non invasively structural and functional properties of arteries. We studied 41 consecutive patients with PsA (of whom, 48% hypertensives) attending hospital outpatient clinics. 40 normotensives healthy subjects (NC) and 18 hypertensives (HT-C) served as controls. We evaluated by B-mode ultrasound the carotid intima media thickness (IMT) expressed as mean-IMT (cumulative mean of mean IMT measured in each carotid segment, common, bulb, and internal carotid artery, bilaterally) and as M-MAX (cumulative mean of maximum IMT). Endothelial function was evaluated by post-occlusion flow mediated dilation (FMD) of the brachial artery using ultrasonography. NO-independent vasodilation was evaluated by the response to sublingual glyceril trinitrate (GTN). PsA had a higher mean-IMT compared to NC. Hypertensive PsA displayed higher M-MAX versus both HT-C (p=0.007) and normotensive PsA (p=0.026). FMD was lower in PsA than in NC, whereas there was no difference between hypertensive PsA, normotensive PsA, and HT-C. GTN response was similar in all groups. In conclusion, our data show that subclinical atherosclerosis is enhanced in PsA compared to NC. In PsA, the hypertensive status proved to exert an additional effect on M-MAX, a parameter of advanced pro-atherogenic remodeling. FMD was reduced in PsA irrespective of hypertensives status. Thus, PsA per se implies a pro-atherogenic remodeling which is enhanced by the hypertensive status.

Abstract 5029: Carotid Plaque Regression Following 6-Month Statin Therapy Assessed by 3T MRI: Comparison With Ultrasound Intima-Media Thickness

Statin’s role in short-term plaque regression is unknown. 3T MRI has superior plaque volume (PV) measurement capacity compared to ultrasound intima-media thickness (IMT). We tested the hypothesis that carotid plaque progression is attenuated by 6 month statin therapy and this can be detected by MRI PV but not IMT. Methods : 15 subjects (68±3 years, 4F) with carotid atherosclerosis had carotid MRI (4 channel coil, resolution 0.3– 0.6×0.3– 0.6×2mm) and IMT assessed at baseline and 6 months post-statin treatment. T1, T2, proton density and time of flight images were obtained±12 mm from flow divider. PV and components were measured with Plaqueview software. Same day mean posterior IMT were measured by standard method. Observers were blinded to subject/scan order. Results : LDL changed from 90±7 to 78±7 mg/dL (p=NS). MRI PV decreased (1166±83 to 1084±102 mm 3 , p=0.007). Mean IMT was unchanged (1.14±0.07 vs. 1.14±0.07 mm, p=NS). Change in necrotic and hemorrhage volume correlated with MRI PV change (R=0.8, 0.7, all p&lt;0.001), but not IMT change. In 8 subjects, plaque spatial distribution (6 quadrants) was analyzed (see figure ). Greatest thickness was seen opposite the flow divider (241–300°, p&lt;0.01), a region not accessed by US IMT. Conclusions : In carotid disease, there was a measurable reduction in plaque burden following short-term statin treatment using 3T MRI that was not seen with US IMT. The heterogenous spatial distribution of plaque supports use of volumetric measurement for serial studies. 3T MRI may be useful to assess treatment efficacy, reduce number of subjects needed and be a better imaging tool to assess effects of novel therapies for carotid atherosclerosis in clinical trials.

Effects of pioglitazone on subclinical atherosclerosis and insulin resistance in nondiabetic renal allograft recipients

The aim of this study was to evaluate the effect of pioglitazone treatment on the progression of subclinical atherosclerosis and insulin resistance in renal allograft recipients with no preoperative history of diabetes. Eighty-three patients without diabetes were randomly assigned to either the pioglitazone group or the control group. Carotid intima-media thickness (IMT), serum adiponectin level and lipid profile were assessed before transplantation and at 12 months after transplantation. Insulin secretory function and insulin resistance were evaluated by the oral glucose tolerance test. The pioglitazone group showed a significant reduction in the mean and maximum carotid IMT compared with the control group after 12 months (mean carotid IMT, 0.05 +/- 0.04 vs -0.03 +/- 0.07 mm, P < 0.001; maximum carotid IMT, 0.08 +/- 0.05 vs -0.05 +/- 0.09 mm, P < 0.001). Pioglitazone increased the adiponectin level, and the change in adiponectin was negatively correlated with carotid IMT changes. Pioglitazone treatment increased the insulin sensitivity index compared with the control group (-0.8 +/- 3.1x10(-)(2) vs +1.1 +/- 3.7x10(-)(2), P = 0.036). These results suggest that pioglitazone treatment reduces the progression of carotid IMT and improves insulin resistance in renal allograft recipients without a history of diabetes. Trial Registration. Clinicaltrials.gov Identifier: NCT00598013.

Impact of Transradial Coronary Procedures on Radial Artery

We evaluated the impact of transradial coronary procedures on the radial artery (RA). A total of 355 patients who underwent the transradial coronary procedures including transradial coronary angiography (CAG) and percutaneous coronary intervention (PCI) were enrolled. The right RA (RRA) was examined by ultrasound. The mean RRA diameter was 2.37 +/- 0.57, 1.95 +/- 0.50, and 2.23 +/- 0.41 mm, respectively, before the procedure, 1 day, and 1 month after the procedures (P < .01 at 1 day, P < .05 at 1 month). The mean intima-media thickness of RRA was 0.25 +/- 0.12, 0.69 +/- 0.31, and 0.38 +/- 0.17 mm, respectively, before the procedure, 1 day and 1 month after the procedure (P < .01 at 1 day, P < .05 at 1 month). The incidence of RRA stenosis was 0%, 15.7%, and 7.6%, respectively; the incidence of RRA occlusion was 0%, 2.8%, and 1.7%, respectively, before the procedure,1 day and 1 month after the procedure. Transradial coronary procedures can lead to early RA injury, but this repairs later.

Segmentation of the carotid intima-media region in B-mode ultrasound images

This paper proposes a new approach for the segmentation of both near-end and far-end intima-media regions of the common carotid artery in ultrasound images. The method requires minimal user interaction and is able to segment the near-end wall in arteries with large, hypoechogenic and irregular plaques, issues usually not considered previously due to the increased segmentation difficulty. The adventitia is detected by searching for the best fit of a cubic spline to edges having features compatible with the adventitia boundary. The algorithm uses a global smoothness constraint and integrates discriminating features of the adventitia to reduce the attraction by other edges. Afterwards, using the information of the adventitia location, the lumen boundary is detected by combining dynamic programming, smooth intensity thresholding surfaces and geometric snakes. Smooth contours that correctly adapt to the intima are produced, even in the presence of deep concavities. Moreover, unlike balloon-based snakes, the propagation force does not depend on gradients and does not require a predefined direction. An extensive statistical evaluation is computed, using a set of 47 images from 24 different symptomatic patients, including several classes, sizes and shapes of plaques. Bland–Altman plots of the mean intima-media thickness, for manual segmentations of two medical experts, show a high intra-observer and inter-observer agreement, with mean differences close to zero (mean between −0.10 mm and 0.18 mm) and with the large majority of differences within the limits of agreement (standard deviation between 0.10 mm and 0.12 mm). Similar plots reveal a good agreement between the automatic and the manual segmentations (mean between −0.07 mm and 0.11 mm and standard deviation between 0.11 mm and 0.12 mm).

Intima‐Media Thickness and Flow‐Mediated Vasodilation in Asymptomatic Subjects with Newly Detected Severe Hypercholesterolemia

The aim was to establish the predictors of early functional and structural vascular alterations (using intima-media thickness (IMT)) and flow-mediated vasodilation (%FMD) as well as to investigate the interrelationship between IMT and %FMD in asymptomatic, never-treated, severe hypercholesterolemia (HH). One hundred and twenty patients with asymptomatic, severe, untreated HH and 100 controls were included. ELISA was used for asymmetric dimethylarginine (ADMA) and cellular adhesion molecules, and fluid chromatography for total homocysteine (tHcy). Hewlett Packard SONOS 5500 with a 7.5 MHz transducer and MedicaSoft IMT software were used for evaluation of %FMD and IMT of common carotid artery (CCA). Patients and controls differ with respect to all tested biomarkers (P < 0.05), except for P-selectin and E-selectin (P < 0.05). %FMD was lower in patients (P < 0.001). The IMT of the CCA was higher in patients (P < 0.001). Inverse correlations were found between %FMD and IMT mean and age, ADMA, Apo-B, Apo-B/Apo-A(1), and tHcy. ADMA was established as the most important factor related to %FMD. Age and Apo-B were established as the most important factors related to IMT mean. An inverse correlation was established between %FMD and IMT mean (r(xy)= 0.546; P < 0.001)). If cases with IMT mean > or =1 were excluded, the correlation weakened. In patients with IMT mean > or =1 mm, the correlation did not change. In conclusion, asymptomatic, untreated patients with severe hypercholesterolemia are at high risk of having increased IMT of the CCA, especially if there is endothelial dysfunction, verified by %FMD of the brachial artery.

Identification of Inflamed Atherosclerotic Plaque using 123I-Labeled Interleukin-2 Scintigraphy in High-Risk Peritoneal Dialysis Patients: A Pilot Study

Patients with end-stage renal disease (ESRD) suffer from markedly increased cardiovascular morbidity and mortality. Common carotid artery (CCA) intima-media thickness (IMT) assessment and CCA plaque identification using ultrasound are well-recognized tools for identification and monitoring of atherosclerosis. A new method for monitoring the inflammatory status of plaque, namely radiolabeled interleukin-2 (IL-2) scintigraphy, was proposed recently. The aim of this pilot study was to perform (123)I-labeled-IL-2 carotid plaque scintigraphy in ESRD patients treated with peritoneal dialysis and to correlate obtained results with ultrasound assessment of CCA and selected inflammatory markers. CCA-IMT was measured and CCA plaques were identified by ultrasound in 10 patients (5 women, 5 men; mean age 62.4 +/- 10.4 years; median peritoneal dialysis duration 32.5 months, range 12 - 55 months) with advanced cardiovascular comorbidity. Following CCA ultrasound, (123)I-labeled IL-2 carotid plaque scintigraphy was performed. Several biomarkers of inflammation and atherosclerosis were also measured in all patients. Mean target/non-target ratio for focal (123)I-IL-2 uptake within the plaque was 3.15 +/- 0.54, and mean IMT from the site of the scintigraphy analysis was 0.975 +/- 0.337 mm. Highly significant correlation was found between CCA-IMT and a target/non-target ratio for focal (123)I-IL-2 uptake in a corresponding artery (R = 0.92, p = 0.01). However, no significant correlations were found between target/non-target ratio for focal (123)I-IL-2 uptake and levels of measured biomarkers. Our preliminary results suggest potential for identification of an inflamed (vulnerable) plaque using IL-2 scintigraphy in ESRD patients with cardiovascular comorbidities.