Moderate Stenosis Group Research Articles

Ghrelin attenuates vascular calcification in diabetic patients with amputation

Vascular calcification is established to be a critical factor in diabetes mellitus, which causes cardiovascular and amputation complication of diabetic patients. OPG/RANKL/RANK axis serves as a regulatory role in vascular calcification. Ghrelin, an endogenous ligand of growth hormone secretagogue receptor (GHSR), has been reported to exhibit potent cardiovascular protective effects. However, the role of ghrelin in the regulation of diabetic vascular calcification is still elusive. Here, we reported the role of ghrelin and its relationship with OPG/RANKL/RANK system in patients with diabetic foot amputation. In vivo and in vitro investigations were performed. Sixty type 2 diabetic patients with foot amputation were enrolled in vivo investigation, and they were divided into three groups through Doppler ultrasound: mild stenosis group (n=20), moderate stenosis group (n=20), and severe stenosis/occlusion group (n=20). Morphological analysis results showed diffused calcium depositions in the anterior tibial artery of diabetic amputees. Compared with the mild and moderate stenosis group, the severe stenosis/occlusion group had more spotty calcium depositions in atherosclerotic plaques. Western blot analysis indicated the expressions of osteoprotegerin (OPG) and ghrelin were downregulated, while the expression of receptor activator of nuclear factor kappa B ligand (RANKL) was upregulated with the vascular stenosis aggravation. Pearson correlation analysis revealed a negative correlation between calcium content and ghrelin levels (r=−0.58, P<0.001), as well as the ghrelin levels and sRANKL levels (r=−0.57, P<0.001). Meanwhile, OPG levels were positively correlated with ghrelin levels (r=0.63, P<0.001). From in vitro investigation, we found that the high-glucose (HG), high-lipid (HL), and β-glycerophosphate (β-GP) considerably increased the total calcium content, ALP activity, and expression of osteogenic markers in vascular smooth muscle cells (VSMCs). Ghrelin blunted calcification in a dose-dependent manner. In addition, ghrelin upregulated OPG expression and downregulated RANKL expression in VSMC calcification when anti-OPG antibody and RANKL were performed. Collectively, we therefore conclude serum ghrelin level may be a predictor of diabetic vascular calcification. The possible mechanism may be related with OPG/RANKL signal.

Value of Low-Dose Dobutamine Stress Real-Time Myocardial Contrast Echocardiography in the Diagnosis of Coronary Heart Disease.

To investigate the value of low-dose dobutamine stress real-time myocardial contrast echocardiography (RT-MCE) in the diagnosis of coronary heart disease (CHD). A total of 65 hospitalized patients with suspected or confirmed CHD were detected by RT-MCE combined with low-dose dobutamine stress (0.84 mg/kg). Perfusion curves were quantitatively analyzed using QLAB software. Peak intensity (A), slope of curves (β), and perfusion (A × β) were also calculated. Based on the results of coronary angiography, patients were divided into no obvious stenosis group (<50%), mild stenosis group (50%-74%), moderate stenosis group (75%-89%), and severe stenosis group (≥90%). The A, β, and A × β values before and after low-dose dobutamine stress of each group were compared. In the basal state and after low-dose dobutamine stress, the A, β, and A × β values significantly decreased as the stenosis degree of the myocardial segments increased. The same variation tendency was also found in the A, β, and A × β reserve values, and there was significant difference in these reserve values between moderate and severe stenosis groups and no obvious stenosis and mild stenosis groups. Collateral circulation had marked effects on the values of myocardial perfusion parameters and their reserve values, especially in the segments with severe stenosis. Low-dose dobutamine stress RT-MCE can be a sensitive method for clinical diagnosis and risk assessment of CHD and may provide a basis for further treatment of CHD.

Feasibility study of rapid three dimensional MR angiography in visualization of carotid atherosclerotic plaque

Objective To explore the feasibility of delineation of the atherosclerotic plaque in carotid artery using compressed sensing three dimensional motion-sensitized driven equilibrium prepared rapid gradient echo (CS-3D MERGE) technique. Methods Twenty-three patients who underwent carotid endarterectomy (CEA) were enrolled prospectively. In all patients, bilateral carotid arteries were scanned by CS-3D MERGE and contrast-enhanced MR angiography (MRA) simultaneously. Image quality of CS-3D MERGE images was scored. Images from the CS-3D MERGE sequence and contrast-enhanced MRA were used to measure the carotid stenosis, which were divided into four groups: normal group, mild stenosis group, moderate stenosis group, and severe stenosis group. The results were compared between the two methods. And images from the CS-3D MERGE sequence were compared with corresponding histology in identifying major plaque components including lipid rich necrotic core (LRNC), intraplaque hemorrhage (IPH), and calcification (CA). Spearman rank correlation coefficient was used to compare the correlation between the CS-3D MERGE sequence and contrast-enhanced MRA in measuring the carotid stenosis. Agreement was tested comparing images from the CS-3D MERGE sequence with corresponding histology in identifying major plaque components including lipid-rich necrotic core, intraplaque hemorrhage, and calcification. Results Twenty-three CEA patients finished bilateral CS-3D MERGE scanning successfully. Image quality was 3.16±0.25. There was an excellent correlation between CS-3D MERGE and MRA in measuring stenosis (r= 0.95, P<0.01). The agreement between CS-3D MERGE and histological results for LRNC detection was 76.2% (16/21). It was less sensitive for IPH detection (71.4%, 15/21). CS-3D MERGE identified all CA accurately (100.0%, 21/21). Sensitivity and specificity were 86.6% (13/15) and 50.0% (3/6) for LRNC, 73.3% (11/15) and 66.6% (4/6) for IPH, 100.0% for CA respectively(16/16, 5/5). Conclusion CS-3D MERGE, a single sequence, can be used to quantify carotid stenosis and plaque components conveniently. Key words: Atherosclerosis; Magnetic resonance imaging; Vessel wall

Study on correlation between retinal vessel morphology or ocular hemodynamic parameter and internal carotid artery stenosis

Objective: To analyze the correlation between retinal vascular calibers, ocular blood flow parameters and internal carotid artery stenosis and to evaluate the effect of internal carotid artery stenosis on ocular blood vessels comprehensively. Methods: A retrospective case-control study. The clinical data of 141 patients who underwent head-and-neck computed tomography (CT) angiography examinations of the ICA were collected at Beijing Friendship Hospital, Capital Medical University from January 2014 to January 2016. According to diagnostic criteria, the patients were divided into four groups: the non-stenosis group, the mild stenosis group, the moderate stenosis group, and the severe stenosis andocclusion group. The retinal vascular caliber was measured in color fundus photograph by IVAN software. Color Doppler ultrasonography was used to measure the parameters of ocular blood flow, including the peak systolic velocity (PSV), end diastolic velocity (EDV), resistance index (RI) and pulsatility index (PI). The enumeration data were analyzed with chi-square test, the measurement data were analyzed with rank-sum test, and the correlation test was performed with spearman. Results: The gender ratio of the patients without stenosis, mild stenosis, moderate stenosis, severe stenosis and occlusion was 12/7, 31/19, 28/25, 12/7, χ2 test was not statistically significant (χ2= 0.79, P=0.85); There was no statistically significant difference between the different groups (χ2= 0.15, P=0.68), the age of four groups were (64.1±8.3), (54.3±14.3), (68.9±11.8) and (59.1±8.0) y, respectively. In the no internal carotid artery stenosis group, the arteries diameter is (164.5±15.6) μm ,the vein diameter is (245.6±20.0) μm and the arteriovenous ratio is 0.7±0.1. There is no difference among the mild stenosis group, moderate stenosis group and the severe stenosis (χ2artery caliber=6.92, Partery caliber=0.08; χ2vein diameter=4.16, Pvein diameter=0.25; χ2arteriolar-venular ratio=1.38,Parteriolar-venular ratio=0.71) . The PSV of central retinal artery in the above groups were (14.6±3.6), (34.4±13.2), (35.7±14.6), (42.3±19.0)cm/s respectively, the data were analyzed by rank-sum test and there was a significant difference (χ2=13.44, P< 0.01) ; The PSV of the posterior ciliary artery in the above groups (17.6±6.5), (15.0±4.6), (13.4±4.3) and (11.0±3.2)cm/s respectively, the data were analyzed by rank-sum test and there was a significant difference (χ2=22.71, P<0.01) , EDV were (5.90±2.2), (5.1±2.1), (4.3±1.5) and (4.3±4.8)cm/s respectively and there was a significant difference (χ2=20.36, P<0.01) .There was a correlation between retinal artery diameter, PSV and EDV of the central retinal artery, PSV and EDV of the posterior ciliary artery and the diameter of the internal carotid artery but without linear correlation. (rartery caliber=-0.23, Partery caliber=0.01; rPSV of central retinal artery= -0.29, PPSV of central retinal artery<0.01; rPSV of posteri or ciliary artery=-0.34, PPSV of posterior ciliary artery<0.01, rEDV of posterior ciliary artery=-0.35, PEDV of posterior ciliary artery<0.01). Conclusions: There was a correlation between retinal artery diameter, PSV and EDV of the central retinal artery, PSV and EDV of the posterior ciliary artery and the diameter of the internal carotid artery. PSV of the central retinal artery, PSV and EDV of the posterior ciliary artery changed significantly when the internal carotid artery stenosis existed. (Chin J Ophthalmol, 2016, 52: 905-910).

Mild coronary artery stenosis has no impact on cardiac and vascular parameters in miniature swine exposed to positive acceleration stress.

Exposure of pilots' heart to acceleration-associated stress (+Gz stress) is an adverse effect of high-performance aviation. The occurrence of coronary heart diseases is one of the most frequent medical causes leading to cessation of flying. To assess the effects of +Gz stress on coronary artery stenosis (CAS) in a minimally invasive miniature swine model with a fast recovery. The proximal left anterior descending branch was ligated in 20 swine using silk suture. CAS degree (mild, moderate, severe) was analyzed by quantitative computerized angiography. Five swine underwent a sham operation. +Gz stress exposure was performed and venous blood was collected before/after exposure. Plasma C-reactive protein (CRP), endothelin (ET)-1, angiotensin (Ang) II and urotensin 2 (U2) levels were measured. CAS models were successful in 18 animals. Two swine exhibited ventricular fibrillation during the procedure and died. Plasma CRP, ET-1, Ang II and U2 changed significantly after maximal tolerated +Gz stress exposure (all P < 0.05). After maximal tolerated +Gz stress exposure, plasma CRP, ET-1, Ang II and U2 levels increased in the moderate and severe stenosis groups, compared with the sham group (all P < 0.05), but there was no significant difference between the mild stenosis group and the sham group (all P > 0.05). The fully endoscopic operation method successfully generated animal models of different degrees of CAS. Plasma CRP, ET-1, Ang II and U2 levels increased after +Gz stress exposure with increasing CAS severity. Animals with mild stenosis showed no ill effect under +Gz stress, suggesting that pilots with mild stenosis might be allowed to continue flying, but it must be confirmed in humans.

The effect of internal carotid stenosis on white matter lesion and cognition function of Binswanger disease

Objective To investigate the influence of the different degree of internal carotid stenosis on the white matter lesion and cognition of Binswanger disease. Methods A total of 108 elderly patients with Binswanger disease from Department of Geriatric Neurology of Qilu Hospital were recruited during December 2013 and June 2014. At the end of follow-up, 6 cases showed acute cerebrovascular disease, 39(<10%)had no internal carotid stenosis, 31(10%-49%)had mild internal carotid stenosis, 32(50%-70%)had moderate internal carotid stenosis through B ultrasound examination and MRI and MRA examination on internal carotid artery and brain. The B ultrasound examination of internal carotid artery included intima-media thickness (IMT), plaque index and the peak systolic velocity (PSV). Cognitive function of Binswagner disease was assessed by Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MOCA). The white matter lesion was assessed by reformed visual Scheltens scale. The relationship among IMT, plaque index, PSV, white matter lesion, and cognitive function was investigated. The variation of cognition was observed after 1 year. Results There were statistically significant differences in IMT, PSV, plaque index, reformed Scheltens scale scores between groups of non, mild, moderate internal carotid stenosis (all P 0.05). There were positive correlation between PSV and reformed Scheltens scale scores (r=0.630, P=0.020). There were negative correlation between PSV and MMSE scores (r=-0.970, P=0.040). The scores of MMSE and MOCA both were declined after 1 year in three groups (0.61±0.60, 0.68±0.81), (0.70±0.60, 0.93±0.69), (1.06±0.68, 1.13±0.76). The declination of MMSE and MOCA of BD patients was higher in moderate internal carotid stenosis group than in non internal carotid stenosis group (P 0.05). Conclusions Internal carotid stenosis is one of risk factors for the cognitive impairment of BD, the abnormal IMT and PSV are both correlated with white matter lesion and cognitive impairment in BD. Early standardized therapy can postpone the rate of cognitive impairment in BD. Key words: Carotid stenosis; Cerebrovascular disorders; Cognition disorders; Binswanger disease

Establishment of a novel rat model of different degrees of portal vein stenosis following 70% partial hepatectomy.

Liver transplantation may fail due to complications of insufficient portal vein (PV) flow such as portal vein stenosis (PVS). Therefore, establishing a model to explore the effect of PV flow on liver regeneration is crucial and essential. Rats were randomly divided into 6 groups: sham operation rats group; 70% partial hepatectomy (PH) group (group A); PVS groups with mild, moderate, or severe stenosis (group B–D) and portal vein ligation (PVL) group. PVS was produced by ligating PV with parallelly placed needles of different gauges. Ultrasound was performed to validate the stenosis ratio (SR) and velocity ratio (VR) at the prestenotic and stenotic site. Rats were sacrificed on day 1,3,7, and 14 after surgery, and liver regeneration rate (LRR) was calculated. We successfully established rat models of different degrees of PVS following 70%PH in 72 rats. The SRs of each PVS group were 44.8 ± 5.23%, 59.3 ± 4.07% and 69.5 ± 2.17%, which showed no statistical differences compared with those measured by stenosis ratio measured by ultrasound. The survival rate in groups A-D were 100%, 83.3%, 66.7% and 50% respectively. Differences were demonstrated between groups A and C, as well as groups A and D (both P<0.05). Moreover, LRR negatively correlated with SRu and VR, and the correlation coefficients were −0.534 and −0.522, respectively. The rat model we established has the potential to be applied in most conditions of liver regeneration with reduced PV inflow, and it provides a foundation for further exploring the relationship between PV hemodynamic changes and liver regeneration.

Dynamic Cerebral Autoregulation in Asymptomatic Patients With Unilateral Middle Cerebral Artery Stenosis.

The aim of the study was to assess the capacity of dynamic cerebral autoregulation (dCA) in asymptomatic patients with unilateral middle cerebral artery (MCA) stenosis.Fifty-seven patients with asymptomatic mild, moderate, and severe unilateral MCA stenosis and 8 patients with symptomatic severe unilateral MCA stenosis diagnosed by transcranial Doppler were enrolled. Twenty-four healthy volunteers served as controls. The noninvasive continuous cerebral blood flow velocity and arterial blood pressure were recorded simultaneously from each subject in the supine position. Transfer function analysis was applied to determine the autoregulatory parameters (phase difference [PD] and gain).The PD values in the severe stenosis groups were significantly lower than those of the control group (60.71 ± 18.63°), the asymptomatic severe stenosis group was impaired ipsilaterally (28.94 ± 27.43°, P < 0.001), and the symptomatic severe stenosis group was impaired bilaterally (13.74 ± 19.21°, P < 0.001; 19.68 ± 14.50°, P = 0.006, respectively). The PD values in the mild and moderate stenosis groups were not significantly different than the controls (44.49 ± 27.93°; 48.65 ± 25.49°, respectively). The gain values in the mild and moderate groups were higher than in the controls (1.00 ± 0.58 cm/s/mm Hg vs 0.86 ± 0.34 cm/s/mm Hg, and 1.20 ± 0.59 cm/s/mm Hg vs 0.86 ± 0.34 cm/s/mm Hg, respectively). The gain values in the severe stenosis groups were significantly lower than that in the control group: the asymptomatic severe stenosis group was lower bilaterally (0.56 ± 0.32 cm/s/mm Hg, P = 0.003; 0.60 ± 0.32 cm/s/mm Hg, P < 0.05, respectively), whereas the symptomatic severe group was lower unilaterally (on the contralateral side) (0.53 ± 0.43 cm/s/mm Hg, P < 0.05).In asymptomatic patients with unilateral MCA stenosis, only the dCA of the severe stenosis was ipsilaterally impaired. Acute stroke may aggravate the impaired dCA and even spread contralaterally.

Hemodynamic Impact of Systolic Blood Pressure and Hematocrit Calculated by Computational Fluid Dynamics in Patients with Intracranial Atherosclerosis.

Success in clinical trials of intracranial atherosclerosis (ICAS) is related to accurate identification of high-risk patients. Noninvasive computational fluid dynamics (CFD) of stenotic lesions may enhance therapeutic decision-making. We determined whether physiologic parameters change downstream cerebral hemodynamics in patients with ICAS. Consecutive ICAS patients who underwent both CT angiography (CTA) and digital subtraction angiography were enrolled. CFD models were made using CTA source images. Inlet boundary conditions were defined using three ranges of systolic blood pressure (BP) (109.2, 158, and 225 mmHg) and hematocrit (27.3, 40.2, and 48.8). Ratios of pressure, shear strain rates (SSR), and flow velocity across the lesion were calculated using CFD simulations. A linear mixed model was used for the statistical analysis of repeated simulations. Among the 56 patients, 32 had moderate stenosis (50-69%) and 24 had severe stenosis (70-99%). A linear mixed model revealed that the ratio of pressure was predicted by systolic BP and stenosis group interaction (P = .036). These pressure decreases were associated with systolic BP (P < .001) and stenosis group (P < .001), but not with hematocrit (P = .337). Post-hoc analysis revealed that pressure decreases were more profound in the severe stenosis than the moderate stenosis group when comparing high and low systolic BP (P = .0108). Ratios of SSR and velocity were only associated in the stenosis group. Our study showed that systolic BP along with the degree of stenosis was associated with pressure decreases across stenotic lesions. Physiologic conditions may superimpose further changes in post-stenotic or downstream blood flow.

Abstract 15758: Relationship Between Physiological Coronary Artery Stenosis Severity Assessed by Fractional Flow Reserve and Optical Coherence Tomography Findings in Stable Angina Pectoris

Backgrounds: The aim of the present study is to investigate the relationship between physiological coronary artery stenosis severity and lesion instability by Optical Coherence Tomography (OCT) in patients with stable angina pectoris (SAP). Methods and Results: We investigated 198 culprit lesions of 180 SAP patients who underwent OCT imaging and fractional flow reserve (FFR) measurement before PCI procedure. Physiological coronary stenosis severity was assessed by FFR analysis, and lesions were divided into two groups on the basis of FFR values; severe stenosis group (group S): FFR &lt;0.75 (n=78, 39%), moderate stenosis group (group M): FFR ≥0.75 (n=120, 61%) according to the previous study. Thin-capped fibroatheroma (TCFA) was defined as lipid-rich plaque (lipid arc ≥90°) with fibrous cap thickness &lt;70μm. The median FFR values in total lesions, group S, and group M were 0.77 (interquartile range [IQR]: 0.69—0.83), 0.65 (0.57—0.72), and 0.81 (0.78—0.87), respectively. There were no significant differences in patient characteristics expect for the frequency of previous myocardial infarction (S: 15%, M: 38%, P &lt;0.01) and previous PCI (S: 29%, M: 60%, P &lt;0.01). In angiographic analysis, there were significant differences in the frequency of culprit lesion location in LAD (S: 72%, M: 49%, P &lt;0.01), minimum lumen diameter (S: 1.07±0.36 mm, M: 1.35±0.32 mm, P &lt;0.01), % diameter stenosis (S: 58.9 % [53.1—70.8], M: 52.8 % [47.7—57.5], P &lt;0.01), and lesion length (S: 13.7 mm [10.6—17.5], M: 11.5 mm [9.2—14.5], P = 0.02) between the two groups. In OCT analysis, there were significant differences in the lipid arc (S: 200° [160—232], M: 168° [143—211], P &lt;0.01), CT (S: 110 μm [63—157], M: 140 μm [93—197], P &lt;0.01), and frequency of TCFA (S: 27%, M: 9%, P &lt;0.01) between the two groups. Subgroup analysis of LAD lesions showed similar results between the two groups. Conclusions: Lesions of physiologically severe coronary stenosis in SAP were associated with lesion instability assessed by OCT. These findings may challenge the concept that lesions responsible for acute coronary syndromes are mild in most cases provided that plaque rupture of TCFA evenly results in coronary events in the wide range of stenosis severity in patients with SAP.

Abstract 9925: Mixed Aortic Valve Disease: Natural History and Predictors of Adverse Events

Objectives: To determine freedom from symptoms and adverse events (AE) defined as aortic valve replacement (AVR) or death in patients (pt) with mixed aortic valve disease (MAVD). Methods: Reviewed pt with moderate/severe MAVD (moderate/severe aortic stenosis and regurgitation) at the Mayo Clinic from 1994-2013. Only asymptomatic pt with normal ejection fraction (&gt;50%) and trileaflet aortic valves were included. Cox proportional-hazard models were used to determine predictors of AE. Event-free survival curves were generated with the Kaplan-Meier method. Results: We identified 213 pt (age=69±11 years, male=67%). AE occurred in 155 pt, and 71% of these AE occurred in moderate MAVD (peak velocity of 3 to 3.9 m/s). Mean follow-up was 10.1±3 years and time to AE was 2.9±2.1 years. Concomitant coronary artery bypass grafting (CABG) and/or aortic replacement during AVR was performed in 54/151 (36%). Early mortality was 0.7%. Freedom from AE was 30% and 15% at 5 and 10 years. Freedom from symptoms was 34% and 16% at 5 and 10 years. Predictors of AE were peak aortic velocity (hazard ratio [HR] 2.56 Confidence interval [CI] 2.24-2.93, p&lt;0.0001) for every 1m/s increase in peak velocity, and having severe stenosis or regurgitation at presentation (HR 2.92; CI 2.73-3.14, p=0.001). Conclusion: MAVD had high rate of AE and development of symptoms, even in a subset of pt with only moderate MAVD. Peak aortic velocity and severe MAVD at presentation predict AE. Figure Legend: pVel: peak velocity group 1: moderate aortic stenosis and regurgitation Group ≥2: severe aortic stenosis or regurgitation

Abstract 9944: Bicuspid and Unicuspid Aortic Valve: Fate of Moderate/Severe Mixed Aortic Valve Disease

Objectives: There is paucity of data about mixed aortic valve disease (MAVD) in patients with bicuspid/unicuspid aortic valve (BAV). This study sought to describe the natural history of moderate/severe MAVD in this population. Methods: We queried our database for patients with BAV and moderate/severe MAVD from 1994-2013. We excluded patients with NYHA III/IV symptoms, left ventricular ejection fraction &lt;50%, aortic dimension &gt;50 mm, and significant disease of other valves. Primary endpoint was freedom from adverse events (AE) defined as aortic valve replacement (AVR) or death. Secondary endpoint was freedom from developing NYHA III/IV symptoms, and to identify predictors of AE. Cox proportional hazard model was used. Results: There were 138 patients (age 51±12 years, males 81%) who were followed for 8.5±4 years. Ninety-two patients (67%) underwent AVR at a mean follow-up duration of 3.7±2.5 years. Mechanical prostheses were implanted in 79% and 52% had concomitant CABG and/or aortic replacement during AVR. No early surgical mortality. Event-free survival was 51%, and 20% at 5 and 10 years. Predictors of AE were age at presentation (hazard ratio [HR] 5.22 Confidence interval [CI] 3.10 to 6.64) for every decade increase in age and having severe stenosis or regurgitation at the time of presentation (HR 1.32; CI 1.05 to 3.16). Conclusion: Time (age and duration of follow-up) was the strongest predictor of AE in BAV population unlike in patients with trileaflet aortic valve stenosis where peak aortic velocity was prognostic. Figure Legend: pVel: peak velocity group 1: moderate aortic stenosis and regurgitation Group ≥2: severe aortic stenosis or regurgitation

Distribution of Th1, Th2 and Th17 in peripheral blood of patients with carotid atherosclerotic ischemic stroke

Objective To investigate the distribution of T helper cell 1 (Th1), Th2 and Th17 in peripheral blood of patients with carotid atherosclerotic ischemic stroke. Methods There were a total of 180 patients with carotid atherosclerotic ischemic stroke and 60 normal controls enrolled in this study. According to the degree of carotid artery stenosis, 180 patients were divided into 3 subgroups: mild stenosis group (N = 60), moderate stenosis group (N = 60) and severe stenosis group (N = 60). Flow cytometry (FCM) was used to test the proportion of Th1, Th2 and Th17 cells in peripheral blood. Results Compared with control group, the proportion of Th1 [(5.76 ± 1.81)% vs (3.54 ± 0.29)%, P = 0.000] and Th17 [(0.36 ± 0.13)% vs (0.18 ± 0.03)% , P = 0.000] cells in ischemic stroke group was significantly increased. There were statistical differences in the proportion of Th1 cells [(4.56 ± 0.55)%, (4.88 ± 0.42)% and (7.83 ± 1.69)%; P = 0.000] and Th17 cells [(0.23 ± 0.04)%, (0.34 ± 0.02)% and (0.50 ± 0.09)%; P = 0.000] in peripheral blood of patients with different degrees of carotid stenosis. The proportion of Th1 cells ( P = 0.001, 0.001) and Th17 cells ( P = 0.000, 0.001) in severe stenosis group were higher than those in mild and moderate stenosis groups, and the proportion of Th17 cells was higher in moderate stenosis group than that in mild stenosis group ( P = 0.000). Conclusions Th1 and Th17 cells participate in the pathological process of carotid atherosclerosis. As the degree of carotid atherosclerosis in patients with ischemic stroke is increased, the proportion of peripheral blood Th17 cells is increased, suggesting that cellular immune mechanism is involved in the occurrence and development of atherosclerosis and provide theoretical basis for the immune treatment of carotid atherosclerotic ischemic stroke. DOI: 10.3969/j.issn.1672-6731.2016.09.008

Association between the severity of coronary artery stenosis and the combination of the difference in blood pressure between arms and brachial-ankle pulse wave velocity

Background: A difference in systolic blood pressure (SBP) ≥10 mmHg between the arms is associated with an increased risk of coronary artery disease (CAD) and mortality in high-risk patients. Methods and results: Four hundred and fourteen patients were divided into three groups according to the percent most severe luminal narrowing of a coronary artery as diagnosed by coronary computed tomography angiography: no or mild coronary stenosis (0–49%), moderate stenosis (50–69%) and severe stenosis (≥70%) groups. The relative difference in SBP between arms in the severe group was significantly lower than those in the no or mild and moderate groups. The brachial-ankle pulse wave velocity (baPWV) significantly increased as the severity of coronary stenosis increased. We confirmed that severe coronary stenosis was independently associated with both the relative difference in SBP between arms and baPWV, in addition to age, gender, hypertension, dyslipidemia, diabetes mellitus and ankle-brachial index by a logistic regression analysis. The group with a relative difference in SBP between arms of <1 mmHg and baPWV ≥ 1613 cm/s showed a higher percentage of patients with severe coronary stenosis than groups that met neither or only one of these criteria. Conclusion: The combination of the relative difference in SBP between arms and baPWV may be a more effective approach for the non-invasive assessment of the severity of CAD.

The value of area strain imaging diastolic index for predicting left anterior descending severe stenosis

To evaluate the value of locating and defining severe stenosis of left anterior descending (LAD) with area strain imaging diastolic indexes (ASI-DI) derived from three dimensional speckle tracking imaging (3D-STI). A total of 92 suspected coronary heart disease patients with left ventricular ejection fraction (LVEF) ≥ 50% and without regional wall motion abnormality, who underwent echocardiography before coronary angiography in our department from July 2012 to April 2014, were included in this retrospective study. Patients were divided into three groups by the level of LAD stenosis: severe stenosis group (≥ 75%, n = 36), mild to moderate stenosis group (1%-74%, n = 22) and control group (without coronary artery stenosis, n = 34). Global peak systolic area strain (GPSAS), global ASI-DI (GASI-DI), and ASI-DI of the regional myocardial segments with blood supplied by LAD were measured. Receiver operating curves (ROC) were obtained between ASI-DI and stenosis level of LAD to locate and to find out the optimal segment and cutoff values. There was no significant difference of GPSAS among serious stenosis group, mild and moderate stenosis group and control group ((-25.2 ± 6.2) % vs. (-20.3 ± 6.6) % vs. (-21.3 ± 8.6) %, P = 0.159). GASI-DI was significantly lower in severe stenosis group than in mild to moderate stenosis group and control group ((-34.3 ± 14.7) vs. (-48.1 ± 13.3) % vs. (-59.4 ± 12.2) %, both P < 0.01). GASI-DI was similar between mild to moderate stenosis group and control group (P = 0.217). The optimal cutoff values of ASI-DI were 40.3% and area under the curve (AUC) were 0.829 in the base anterior segment for detecting proximal severe stenosis of LAD (sensitivity 0.967, specificity 0.651), 38.3% and 0.843 in the middle anteroseptum for detecting mid-distal sever stenosis of LAD (sensitivity 0.967, specificity 0.651). Patients with severe LAD stenosis can be screened by ASI-DI among patients with LVEF ≥ 50% and without regional wall motion abnormality. The ASI-DI of base anterior segment and middle anteroseptum can be used to locate the proximal and mid-distal sever stenosis of LAD.

Chronic Kidney Disease and Carotid Atherosclerosis in Patients With Acute Stroke.

Chronic kidney disease (CKD) is increasingly recognized as an independent risk factor for cardiovascular disease and stroke. Our aim was to examine the association between estimated glomerular filtration rate (eGFR) and carotid plaques, stenosis and occlusions, and to assess whether CKD and its severity affect carotid atherosclerosis in a cohort of unselected patients with acute stroke. A total of 249 consecutive patients with acute stroke (ischemic or hemorrhagic) were included in this study and baseline eGFR, carotid intima-media thickness (cIMT), and carotid stenosis were evaluated. The eGFR was calculated using the modified Modification of Diet in Renal Disease equation, which was adjusted for data from Chinese CKD patients. An eGFR rate of <60 mL/min/1.73 m was defined as CKD. The cIMT and carotid plaques were detected by carotid ultrasound. CKD, defined as eGFR<60 mL/min/1.73 m, was found in 66 individuals (26.50%). Among the 5 subtypes, the level of low-density lipoprotein cholesterol was significantly higher in the moderate and severe stenosis groups compared with the normal, elevated cIMT and mild stenosis groups (P<0.01). The value of eGFR gradually decreased with increasing degree of carotid stenosis, and the differences between the groups were statistically significant (P<0.01). On linear regression analysis, eGFR was negatively correlated with the degree of carotid stenosis (r=0.03; P<0.05). On ordinal logistic regression analysis, eGFR was an independent risk factor associated with carotid atherosclerosis (1.05; 95% confidence interval, 0.47-1.63). There was a significant burden of atherosclerosis among individuals with CKD. CKD is an independent predictor of carotid plaques, stenoses, and occlusions in patients with acute stroke.

Endoplasmic Reticulum Is Involved in Myocardial Injury in a Miniature Swine Model of Coronary Artery Stenosis Exposed to Acceleration-Associated Stress.

This study aimed to investigate the effects of myocardial injury in a minimally-invasive miniature swine model with different levels of coronary artery stenosis (CAS) and exposed to maximal tolerated +Gz. Proximal left anterior descending branch was ligated in 20 swine. Five swine underwent a sham operation. A trapezoid acceleration curve was used for +Gz stress. Pathological changes of myocardial tissue were detected by H&E staining. Apoptotic cardiomyocytes were detected by TUNEL. GRP78 and CHOP were investigated by immunohistochemistry and western blot. CAS models were successful in 18 animals.Compared with the sham-operated group (+8.00±0.71 Gz), the maximal tolerated +Gz values of the moderate stenosis (+6.00±0.89 Gz, P<0.05) and severe stenosis groups (+5.20±0.84 Gz, P<0.05) were decreased.Compared with sham animals (12.16±1.25%), after exposure to maximum +Gz, apoptotic cells of the moderate (43.53±8.42%, P<0.05) and severe stenosis group (60.50±9.35%, P<0.05) were increased, MDA content was increased (1.89 and 4.91 folds, respectively, P<0.05), and SOD activity was reduced (-13.66% and -21.71%, respectively). After exposure to maximum +Gz, GRP78 protein expression was low in the sham-operated (0.29±0.05) and mild stenosis groups (0.35±0.04), while expression was high in the moderate (0.72±0.04, P<0.05) and severe stenosis groups (0.65±0.07, P<0.05). CHOP protein expression was not observed in the sham-operated group, while expression was high in the moderate and severe stenosis groups. These results indicated that Under maximum exposure to +Gz stress, different levels of CAS led to different levels of myocardial injury. Endoplasmic reticulum response is involved in the apoptosis of cardiomyocytes after +Gz stress.

Abstract T P110: Impact Of Systolic Blood Pressure On Cerebral Hemoynamics Measure By Computational Fluid Dynamics In Patients With Intracranial Atherosclerosis

Background: Success in clinical trials of intracranial atherosclerosis (ICAS) hinges upon the definition of high-risk patients. Noninvasive computational fluid dynamics (CFD) of stenotic lesions may enhance therapeutic decision-making, yet the wide hemodynamic variation may limit the snapshot data of CFD. We determined whether different physiologic parameters may change downstream cerebral hemodynamics in patients with ICAS. Methods: Based on degree of stenosis, patients were divided into a moderate (50-69%) and severe group (70-99%). CFD models were made using CTA source images of patients with symptomatic middle cerebral artery stenosis. Inlet boundary conditions were defined using three ranges (2.5, 50, and 97.5 percentiles) of systolic BP (109.2, 158, and 225 mmHg) and hematocrit (27.3, 40.2, and 48.8). According to systolic BP and hematocrit, 9 distinct scenarios were simulated. Ratio of pressure was calculated using the simulated pressure at pre- and post-stenotic segments. Ratio of shear strain rate (SSR) and velocity were assessed between throat and proximal normal segment. A linear mixed model was used for the statistical analysis of repeated simulations. Results: Among the 56 patients, 32 (57.1%) patients had moderate stenosis and 24 (42.9%) had severe stenosis. Patients with severe stenosis showed unfavorable hemodynamics in terms of ratio of pressure, velocity, and SSR comparing with moderate stenosis group. A linear mixed model revealed that ratio of pressure was predicted by systolic BP X stenosis group interaction (p = 0.036). These pressure drops were associated with systolic BP (p&lt;0.001), and stenosis group (p&lt;0.001), not with hematocrit (p = 0.337). Ratios of SSR and velocity were only associated with stenosis group. Conclusions: Downstream blood flow may be significantly altered by systolic BP along with severity of stenosis. As individual patient’s specific anatomy influences hemodynamics, physiologic conditions may superimpose further changes in post-stenotic blood flow in patients with ICAS.

Value of three-dimensional speckle tracking imaging for quantitative assessment of global left ventricular systolic function in patients with coronary heart disease

Objective To explore the accuracy of three-dimensional speckle tracking imaging (3D-STI) in quantitative coronary evaluation of (CHD) patients′ left ventricular global systolic function. Methods Sixty-eight CHD patients were divided into three groups according to the coronary artery angiography (CAG) results: 32 cases in severe stenosis group, 23 cases in moderate stenosis group, and 13 cases in mild stenosis group. Thirty gender-age-matched healthy subjects(control group) were enrolled in this study. All patients underwent 2D-echocardiography and real-time three-dimensional echocardiography(3DE). The global longitudinal strain(GLS), global radial strain(GRS), global circumferential strain(GCS), global area strain(GAS), global area strain rate(GASrate) and 3D global LV strain(3D-Strain) were analyzed using 3D-STI. Correlation between strain measurements and left ventricular ejection fraction(LVEF) by simpson method, 3D-LVEF by 3DE were assessed using linear regression analysis. Results All 3D-STI parameters in the severe stenosis group were significant decreased compared with the other groups. GLS, GRS, GCS, GAS, 3D-Strain of moderate stenosis group shown more significant decrease than both mild stenosis group and control group(P<0.05). Strong correlations were demonstrated in all 3D-STI parameters between 3D-LVEF and LVEF. The strongest correlation was observed between GAS with 3D-LVEF in severe stenosis group(r=-0.910, P<0.05). Intraobserver and interobserver reliability of GAS was better than other parameters. Conclusions Global strain of 3D-STI can quantitatively evaluate the global LV function in CHD patients, and GAS is more sensitive and reproducible than other parameters. Key words: Echocardiography, three-dimensional; Coronary stenosis; Ventriular function, left; Three-dimensional speckle tracking imaging

Echocardiographic evaluation of aortic atheromas in patients with aortic stenosis.

The association of aortic atheromas in patients with isolated aortic stenosis has recently been acknowledged, probably because the pathogenic mechanisms are similar. Therefore, this study evaluated the extent and severity of thoracic aortic atheromas in patients with different grades of aortic stenosis using transesophageal echocardiography. We retrospectively evaluated transesophageal echocardiographic examinations of 686 consecutive patients with a diagnosis of aortic stenosis. The prevalence and morphologic characteristics of atheromas in 3 segments of the thoracic aorta were assessed. Plaque thickness was measured at each segment, and the thickest plaque was used to establish severity. Atheromas were graded as mild, moderate, or severe according to plaque thickness (<2, 2-4, or >4 mm, respectively). Aortic stenosis was graded as mild, moderate, or severe on the basis of the gradient and anatomic aortic valve area (>1.5, 1.0-1.5, or <1.0 cm(2)). A total of 382 patients were men, and 304 were women (mean age ± SD, 74 ± 15 years); 86% of the patients had aortic atheromas. The severe stenosis group had a significantly higher rate of atheromas (95% versus 40%; P < .001) than the mild stenosis group, with more complex atheromas (52% versus 22%; P< .001). There was no significant difference in the atheroma grades between the severe and moderate stenosis groups, but moderate cases had more moderate and severe atheromas than mild cases (45% and 15% versus 19% and 3%; P < .01). This study showed a correlation in the extent of aortic atheromas across several degrees of aortic stenosis. Patients with moderate and severe stenosis had more extensive atherosclerotic atheromas than those with mild stenosis.