Carotid Artery Plaque Research Articles

Association Between Risk Factors in Childhood and Sex Differences in Prevalence of Carotid Artery Plaques and Intima-Media Thickness in Mid-Adulthood in the Childhood Determinants of Adult Health Study.

Background The origins of sex differences in cardiovascular diseases are not well understood. We examined the contribution of childhood risk factors to sex differences in adult carotid artery plaques and intima-media thickness (carotid IMT). Methods and Results Children in the 1985 Australian Schools Health and Fitness Survey were followed up whentheywereaged 36 to 49 years (2014-19, n=1085-1281). Log binomial and linear regression examined sex differences in adult carotid plaques (n=1089) or carotid IMT (n=1283). Childhood sociodemographic, psychosocial, and biomedical risk factors that might contribute to sex differences in carotid IMT/plaques were examined using purposeful model building with additional adjustment for equivalent adult risk factors in sensitivity analyses. Women less often had carotid plaques (10%) than men (17%). The sex difference in the prevalence of plaques (relativerisk[RR] unadjusted 0.59 [95% CI, 0.43 to 0.80]) was reduced by adjustment for childhood school achievement and systolic blood pressure (RRadjusted 0.65 [95% CI, 0.47 to 0.90]). Additional adjustment for adult education and systolic blood pressure further reduced sex difference (RR adjusted 0.72 [95% CI, 0.49 to 1.06]). Women (mean±SD 0.61±0.07) had thinner carotid IMT than men (mean±SD 0.66±0.09). The sex difference in carotid IMT (β unadjusted -0.051 [95% CI, -0.061 to -0.042]) reduced with adjustment for childhood waist circumference and systolic blood pressure (β adjusted -0.047 [95% CI, -0.057 to -0.037]) and further reduced with adjustment for adult waist circumference and systolic blood pressure (β adjusted -0.034 [95% CI, -0.048 to -0.019]). Conclusions Some childhood factors contributed to adult sex differences in plaques and carotid IMT. Prevention strategies across the life course are important to reduce adult sex differences in cardiovascular diseases.

Evaluation of cholesterol crystals in carotid plaque by dual energy computed tomography

Cholesterol crystals (CCs) in carotid plaques might be an indicator of vulnerability, although they have not been fully investigated and non-invasive methods of assessment have not been established. This study examines the validity of assessing CCs using dual-energy computed tomography (DECT) that uses X-rays with different tube voltages for imaging, allowing material discrimination. We retrospectively evaluated patients who had undergone preoperative cervical computed tomography angiography and carotid endarterectomy between December 2019 and July 2020. We developed CC-based material decomposition images (MDIs) by scanning CCs crystallized in the laboratory using DECT. We compared the percentage of CCs in stained slides defined by cholesterol clefts with the percentage of CCs displayed by CC-based MDIs. Thirty-seven pathological sections were obtained from 12 patients. Thirty-two sections had CCs; of these, 30 had CCs on CC-based MDIs. CC-based MDIs and pathological specimens showed a strong correlation. Thus, DECT allows the evaluation of CCs in carotid artery plaques.

Abstract Number ‐ 267: The Role of Non‐stenosing Carotid Artery Plaques in ESUS, is it a Silent Offender?

Introduction The secondary prevention of Acute ischemic stroke (AIS)varies based on the root cause of the initial event; thus, determining the cause of an individual AIS is critical for implementing effective care. The well‐described TOAST classification is used to classify stroke etiology, and according to this paradigm, the presence of large vessel disease is considered a high risk for subsequent stroke only if >50% carotid artery stenosis is present. Cryptogenic strokes represent around 30% of all AIS and Embolic stroke of unknown source (ESUS) is a subcategory of the cryptogenic strokes and is characterized as a non‐lacunar ischemic stroke presumed to be of an embolic origin with no evidence of an obvious source of emboli. Here we discuss the most important and latest evidence on the relationship between ESUS and high‐risk plaque features not causing significant stenosis per NASCET criteria. Methods N/A Results The Relationship Between ESUS and Non‐stenosing Carotid Artery Plaques is mainly illustrated in the following points: Plaque vulnerability Researchers have described the following high‐risk features of plaques that may lead to stroke (Table). Plaque vulnerability is a plaque’s susceptibility to rupture and is a proposed determinant of high risk for superimposed thrombosis. According to a meta‐analysis conducted by Kamtchum‐Tatuene et al, high‐risk plaque features were three times more prevalent in patients with symptomatic versus asymptomatic carotid stenosis.3 Laterality of cartid plaques and stroke A meta‐analysis of 8 studies that assessed 323 patients with ESUS showed that mild carotid stenosis with high‐risk plaque features was more commonly located ipsilateral to the stroke side (32.5%) versus being contralaterally located (4.6%).4 Knight‐Greenfield et al evaluated plaque features by CTA in patients with AIS who did not have hemodynamic stenosis. It was also found that ESUS patients had a higher total plaque thickness ipsilateral to the stroke side when compared to the contralateral stroke‐free hemisphere.5 Clot composition and stroke etiology Fibrin/platelet component was dominant in cardioembolic thrombi and cryptogenic stroke, while red blood cells were seen more frequently in non‐cardioembolic thrombi. This supports the hypothesis that plaque histological features play a major role in causing large vessel occlusion despite the absence of significant stenosis.8 Conclusions Despite the evidence that high‐risk plaque features can predict a recurrent stroke, adoption of this principle and its integration into the medical guidelines have not yet been established. This reflects a lack of clinical trials that have utilized detailed plaque characterization for assessing risk of stroke.

Abstract Number ‐ 243: The Non‐stenosing Carotid Artery Plaque in Embolic Stroke of Undetermined Source: A Retrospective Study

Introduction Atherosclerotic cervical internal carotid artery disease is one of the major causes of ischemic stroke and transient ischemic attacks. The risk of stroke from mild to moderate stenoses (i.e., < 50% stenosis) might be underestimated, and further investigation is mandated to describe the association between high‐risk plaque features and ESUS. Methods This was a retrospective observational study. Using the stroke registry of our hospital’s system between June 20th 2016 and June 20th 2021. We reviewed data for patients diagnosed with ESUS according to previously published definition criteria. Using computed tomography angiography (CTA), we analyzed laterality of high‐risk plaque features in relation to the stroke side, and then we identified the incidence of recurrent stroke events. Results Out of 1779 patients with cryptogenic ischemic stroke, only 152 met the inclusion criteria for ESUS. We Compared high‐risk plaque features ipsilateral to stroke side as to contralaterally. There were significantly more ulcerations defined as >1 mm depression (19.08% vs 5.26%, p< .0001), plaque thickness >3 mm (19.08% vs 7.24%, p = 0.001), and plaque length >1cm (13.16% vs 5.92%, p = 0.0218).Also, there was a significant difference in stenosis of ipsilateral to stroke when compared contralaterally, especially for stenoses of 10–30% and 31–49% (17.76% vs 10.53% and 5.26% vs 2.63%, respectively. p = 0.0327). There was also a significant difference in plaque component; both components (soft and calcified) and only soft plaque (42.76% vs 23.68% and 17.76% vs 9.21%, respectively. p< .0001) were more prevalent ipsilaterally. In total, 17patients were found to have a recurrent stroke event, 8 patients had an ipsilateral stroke to the index event, 7 had a bilateral and 2 had a contralateral event. Conclusions ESUS is more commonly found ipsilateral to high‐risk plaque features. Qualitative assessment of plaque features using CTA could be easily implemented in clinical practice. The small number of our sample is definitely a limitation. Further large and multicenter studies aiming to form precise prediction models and scoring systems are needed to help guide treatment with carotid artery stenting or carotid endarterectomy versus maximizing medical therapy.

Abstract Number ‐ 239: Subcortical Infarcts in Patients with Nonstenotic Cervical Atherosclerotic Disease

Introduction Prior studies have elucidated a relationship between nonstenotic plaque in patients with cryptogenic embolic (cortical) infarcts, however it is unclear if nonstenotic carotid plaque is relevant in subcortical infarct patterns. Methods A nested cohort of consecutive patients with anterior, unilateral, subcortical infarcts without an identifiable embolic source were identified from a prospective stroke registry (September 2019 ‐ June 2021). Patients with extracranial stenosis >50% were excluded. Patients with computed tomography angiography were included and comparisons made according to infarct pattern being lacunar (single lesion < 1.5cm on computed tomography [CT] or < 2.0cm on diffusion weighted imaging [DWI]) versus cryptogenic (≥ 1.5cm on CT or ≥ 2.0cm on DWI, or scattered subcortical lesions). Prevalence estimates for cervical internal carotid artery (ICA) plaque presence were estimated with 95% confidence intervals (CI), and differences in plaque thickness and features were compared between sides. Results Of the 1684 who were screened, 141 met inclusion criteria (n = 80 due to small vessel disease, n = 61 cryptogenic). The median age was 66y (interquartile range, IQR 58–73) and National Institutes of Health Stroke Scale score was 3 (IQR 1–5). There was a higher probability of finding excess plaque ipsilateral to the stroke (41.1%, 95%CI 33.3‐49.3%) than finding excess contralateral plaque (29.1%, 95%CI 22.2‐37.1%; p = 0.03), but this was driven by patients with cryptogenic infarcts (excess ipsilateral vs. contralateral plaque frequency of 49.2% vs. 14.8%, p< 0.001) and not lacunar disease (35.0% vs. 40.0%, p = 0.51). Conclusions The probability of finding ipsilateral, nonstenotic carotid plaque in patients with subcortical cryptogenic strokes exceeds the probability of contralateral plaque and is driven by larger subcortical infarcts, classically defined as being cryptogenic. Approximately 1 in 3 unilateral anterior subcortical infarcts may be due to nonstenotic ICA plaque.

Abstract P675: GlycA, but Not C-reactive Protein is Associated With Baseline Carotid Artery Plaque in the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil)

Introduction: Elevated GlycA and C-reactive protein (CRP) are associated with carotid artery plaque (CAP). However, it is not yet established if the presence of both inflammatory biomarkers provides incremental association with CAP. Objective: We cross-sectionally analyzed the association of high CRP and GlycA with CAP at baseline in the ELSA-Brasil cohort. Methods: Participants with information on CRP, GlycA, and CAP with no previous cardiovascular disease nor CRP greater than 10mg/L were included. GlycA was measured by nuclear magnetic resonance and values in the upper quintile were defined as high. CRP was measured by immunoassay and defined as high if greater than 3mg/L. Participants were classified into 4 groups: i. non-elevated CRP/GlycA (reference); ii. elevated CRP alone; iii. elevated GlycA alone; and iv. both elevated. The association with CAP was analyzed by logistic regression models and presented in odds ratio (OR) and 95% confidence interval (CI) both crude and adjusted for sex, age, ethnicity, education attainment, private health insurance, body mass index, smoking, alcohol consumption, physical activity, and medical diagnosis of diabetes, hypertension, and dyslipidemia. Results: The analysis included 4,126 participants (50.0 [45.0 - 57.0] median years-old, 54.2% women). The prevalence of CAP, elevated CRP, and elevated GlycA was 36.1%, 25.5%, and 20.1%, respectively. Males showed higher prevalence of CAP than females (42.8% vs. 30.3%, p<0.001), but had lower prevalence of elevated CRP (20.7% vs. 29.6%, p<0.001) and of elevated GlycA (17.1% vs. 22.7%, p<0.001). Comparing groups, participants with high CRP were mostly women and had the highest frequency of obesity, while participants with high GlycA presented with less socioeconomic support and higher prevalence of cardiovascular risk factor (CVRF) burden. Participants with CAP were older, mostly men, non-Whites, with low education attainment, current smokers, with high levels of CVRF and GlycA than participants without CAP (p<0.001 for all). Participants with high GlycA were more likely to have CAP than the reference group (OR: 1.39; 95% CI: 1.11 - 1.73; p=0.004), even after multivariable adjustment (OR: 1.37; 95% CI: 1.02 - 1.84; p=0.038). In contrast, no association was observed between high CRP and CAP (OR: 0.86; 95% CI: 0.71 - 1.04; p=0.110). Participants with both elevated CRP and GlycA were more likely to have CAP in crude (OR: 1.35; 95% CI: 1.10 - 1.65; p=0.003) but not in adjusted model (OR: 1.32; 95% CI: 0.99 - 1.77; p=0.059). Conclusions: The findings suggest that elevations in different serum markers of inflammation correlate with different disease states, where high GlycA is associated with CAP while high CRP is more associated with obesity.

Abstract P676: Association of Lipoprotein Subfractions With Atherosclerosis in the Baseline Sample of ELSA-Brasil Cohort Study - A Cross-Sectional Analysis

Introduction: The association between lipoprotein subparticles and atherosclerosis is not consistent in literature. For example, it is still unclear whether low-density lipoprotein particles (LDLP), high-density lipoprotein particles (HDLP), and triglyceride-rich lipoprotein particles (TRLP) were associated with carotid artery plaque (CAP) in adult population. Objective: We analyzed the cross-sectional association of LDLP, HDLP, and TRLP subparticles with CAP at ELSA-Brasil baseline. Methods: Data from 3801 participants (median age of 50.0[44.0-57.0] years, 54.3% of women) with no previous cardiovascular (CV) disease and without using lipid-lowering medications were analyzed. CAP presence was assessed by ultrasound images, while LDLP (total, large, medium and small), HDLP (total, large, medium and small) and TRLP (total, very large, large, medium, small and very small) were analyzed by nuclear magnetic resonance spectroscopy. Logistic regression models included all lipoprotein subparticles simultaneously and were adjusted by sociodemographic (age, sex, ethnicity, education, private health insurance) and CV risk factors (body mass index, smoking, alcohol consumption, family history of CV disease, diabetes, hypertension), with odds ratios (OR) and respective 95% confidence interval according to 1 standard deviation increase in the predictor. Results: The prevalence of CAP was 33.9% (n=1287). Participants with CAP had higher age (median 55.0 vs. 47.0, p<0.001), higher prevalence of males (55.7% vs. 40.6%, p<0.001), of non-Whites (57.4% vs. 53.7%, p=0.028), and of lower education attainment (22.3% vs. 12.3%, p<0.001), as well as greater burden of CV risk factors than participants without CAP (current smoking [22.1% vs. 14.1%], family history of CV disease [29.7% vs. 23.6%], diabetes [20.1% vs. 11.9%] and hypertension [38.7% vs. 21.8%], p<0.001), LDL-Cholesterol [median 127.3 vs. 115.2, p<0.001] and Triglycerides [median 112.4 vs. 100.5, p<0.001]). Lipoprotein subparticles were majority correlated (p<0.05). Among the lipoprotein classes (total TRLP, LDLP and HDLP), only total LDLP (OR: 1.89 [1.47; 2.44], p<0.001) was associated with CAP. All the LDLP subparticles were associated with CAP: large (OR: 1.64 [1.27; 2.11], p<0.001), medium (OR: 1.38 [1.08; 1.76], p=0.010) and small (OR: 1.58 [1.20; 2.07], p=0.001). The TRLP subparticles of small (OR: 1.42 [1.11; 1.82], p=0.006) and very small size (OR: 1.37 [1.05; 1.79], p=0.022) were also associated with CAP. Conclusion: The LDLP (large, medium and small) and TRLP (small and very small) were associated with CAP beyond sociodemographic and CV risk factors. This finding is in line with CV risk burden of large LDLP besides small LDLP and highlights a potential role of TRLP in atherosclerosis. However, further investigation between LDLP and TRLP with CAP progression is still needed.

Pairing of single-cell RNA analysis and T cell antigen receptor profiling indicates breakdown of T cell tolerance checkpoints in atherosclerosis

Atherosclerotic plaques form in the inner layer of arteries triggering heart attacks and strokes. Although T cells have been detected in atherosclerosis, tolerance dysfunction as a disease driver remains unexplored. Here we examine tolerance checkpoints in atherosclerotic plaques, artery tertiary lymphoid organs and lymph nodes in mice burdened by advanced atherosclerosis, via single-cell RNA sequencing paired with T cell antigen receptor sequencing. Complex patterns of deteriorating peripheral T cell tolerance were observed being most pronounced in plaques followed by artery tertiary lymphoid organs, lymph nodes and blood. Affected checkpoints included clonal expansion of CD4+, CD8+ and regulatory T cells; aberrant tolerance-regulating transcripts of clonally expanded T cells; T cell exhaustion; Treg–TH17 T cell conversion; and dysfunctional antigen presentation. Moreover, single-cell RNA-sequencing profiles of human plaques revealed that the CD8+ T cell tolerance dysfunction observed in mouse plaques was shared in human coronary and carotid artery plaques. Thus, our data support the concept of atherosclerosis as a bona fide T cell autoimmune disease targeting the arterial wall.

Routine assessment of carotid plaques on Doppler USG and associated presenting symptoms at a Tertiary Care Centre, Lahore

Objective: To determine the frequency of carotid plaques on Doppler USG and associated presenting symptoms at Tertiary Care Centre, Lahore. Methods: A cross-sectional study of 366 individuals was conducted from January 2020 to November 2020 at the Radiology Department of Shiekh Zayed Hospital, Lahore, Pakistan. A consultant radiologist scanned both sides of the extra-cranial carotid artery tree. The DUS of carotid arteries was done with a GE Voluson Expert 730 Doppler ultrasound machine, using a linear probe with a transducer frequency of 6-12.5MHz. Results: A total of 366 patients underwent bilateral carotid Doppler ultrasound examinations. Our findings showed carotid plaques in 156 (42.62%) patients; the majority were males 105(67.53). The mean age recorded was 61.17 ±9.54 years and the mean body mass index was 25.43±3.40 Kg/m2. The highest number of plaques were noted in the left carotid artery 64 (41.03%), the main location was the common carotid artery 88 (56.41%) and, the majority were homogenous plagues 88 (56.41%).The majority of patients presented with headaches 177 (48.36%). Associated comorbidities were diabetes mellitus, hypertension, and dyslipidemia. Conclusion: The accuracy of diagnosing Carotid artery plaques has greatly increased over time payable to radiological innovation.

Soluble low-density lipoprotein receptor-related protein 1 as a surrogate marker of carotid plaque inflammation assessed by 18F-FDG PET in patients with a recent ischemic stroke

Background18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) identifies carotid plaque inflammation and predicts stroke recurrence.AimOur aim was to evaluate the performance of soluble low-density lipoprotein receptor-related protein 1 (sLRP1) as an indicator of carotid plaque inflammation.MethodsA prospective study was conducted among adult patients with recent (< 7 days) anterior circulation ischemic stroke and at least one atherosclerotic plaque in the ipsilateral internal carotid artery. Patients underwent an early (< 15 days from inclusion) 18F-FDG PET, and the maximum standardized uptake value (SUVmax) within the plaque was measured. sLRP1 levels were measured in plasma samples by ELISA. The association of sLRP1 with SUVmax was assessed using bivariate and multivariable linear regression analyses. Hazard ratios (HR) were estimated with Cox regression to evaluate the association between circulating sLRP1 and stroke recurrence.ResultsThe study was conducted with 64 participants, of which 57.8% had ≥ 50% carotid stenosis. The multivariable linear and logistic regression analyses showed that sLRP1 was independently associated with (i) SUVmax within the plaque (β = 0.159, 95% CI 0.062–0.257, p = 0.002) and (ii) a probability of presenting SUVmax ≥ 2.85 g/mL (OR = 1.31, 95% CI 1.00–1.01, p = 0.046), respectively. Participants with stroke recurrence showed higher sLRP1 levels at baseline [6447 ng/mL (4897–11163) vs. 3713 ng/mL (2793–4730); p = 0.018].ConclusionssLRP1 was independently associated with carotid plaque inflammation as measured by 18F-FDG PET in patients with recent ischemic stroke and carotid atherosclerosis.

A metal-organic framework-based immunomodulatory nanoplatform for anti-atherosclerosis treatment.

Immunomodulatory therapy has become a promising method for the clinical treatment of many diseases. Recently, pilot studies revealed that immunomodulatory therapy exhibited good effects on the treatment of cardiovascular diseases, but many problems remain to be solved, such as useful platforms for drug co-delivery and combination therapies. In this study, we designed and constructed the multifunctional nanoparticle Rapa@UiO-66-NH-FAM-IL-1Ra (RUFI) for the treatment of atherosclerotic cardiovascular disease. This nanoplatform combined the advantages of metal-organic frameworks (MOFs) for drug co-delivery, rapamycin and IL-1Ra for immunomodulation, IL-1Ra for cellular targeting, and 5-FAM for fluorescence imaging. RUFI exhibited good drug release of rapamycin and IL-1Ra and specific cytotoxicity for inflammatory macrophages in vitro. In an atherosclerotic model of diet-fed ApoE-/- mice, RUFI significantly targeted and reduced atherosclerosis plaques in coronary arteries, carotid arteries, and aortas. Mechanistic studies indicated that RUFI modulated macrophage phenotype, cytokine expression, and autophagy. This study demonstrated that combination therapy with rapamycin and IL-1Ra via MOF carriers enhanced the immunoregulatory effects against atherosclerosis. This drug co-delivery system suggests that MOF carriers loaded with immunomodulators are promising treatments for atherosclerosis or other inflammatory diseases.

Abstract TP160: The Non-stenosing Carotid Artery Plaque In Embolic Stroke Of Undetermined Source: A Retrospective Study

Introduction: Atherosclerotic cervical ICA disease is one of the major causes of ischemic stroke. The risk of stroke from mild to moderate stenoses (i.e., &lt;50% stenosis) might be underestimated. Further investigation is mandated to describe the association between high-risk plaque features and ESUS. Methods: This was a retrospective observational study. Using the stroke registry of our hospital's system between June 20th 2016 and June 20th 2021, we reviewed data for patients diagnosed with ESUS according to previously published definition criteria. Using CTA, we analyzed laterality of high-risk plaque features in relation to the stroke side, and then we identified the incidence of recurrent stroke events. Results: Out of 1779 patients with cryptogenic ischemic stroke, only 152 met the inclusion criteria for ESUS. We Compared high-risk plaque features ipsilateral to stroke side as to contralaterally. There were significantly more ulcerations defined as &gt;1 mm depression (19.08% vs 5.26%, p&lt;.0001), plaque thickness &gt;3 mm (19.08% vs 7.24%, p=0.001), and plaque length &gt;1cm (13.16% vs 5.92%, p=0.0218). Also, there was a significant difference in stenosis of ipsilateral to stroke when compared contralaterally, especially for stenoses of 10-30% and 31-49% (17.76% vs 10.53% and 5.26% vs 2.63%, respectively. p=0.0327). There was also a significant difference in plaque component; both components (soft and calcified) and only soft plaque (42.76% vs 23.68% and 17.76% vs 9.21%, respectively. p&lt;.0001) were more prevalent ipsilaterally. In total, 17 patients were found to have a recurrent stroke event, 8 patients had an ipsilateral stroke to the index event, 7 had a bilateral and 2 had a contralateral event. Conclusion: ESUS is more commonly found ipsilateral to high-risk plaque features. The small number of our sample is definitely a limitation. Further large and multicenter studies aiming to form precise prediction models and scoring systems are needed to help guide treatment.

Single-cell T cell receptor sequencing of paired human atherosclerotic plaques and blood reveals autoimmune-like features of expanded effector T cells

Atherosclerosis is a lipid-driven chronic inflammatory disease; however, whether it can be classified as an autoimmune disease remains unclear. In this study, we applied single-cell T cell receptor seqencing (scTCR-seq) on human carotid artery plaques and matched peripheral blood mononuclear cell samples to assess the extent of TCR clonality and antigen-specific activation within the various T cell subsets. We observed the highest degree of plaque-specific clonal expansion in effector CD4+ T cells, and these clonally expanded T cells expressed genes such as CD69, FOS and FOSB, indicative of recent TCR engagement, suggesting antigen-specific stimulation. CellChat analysis suggested multiple potential interactions of these effector CD4+ T cells with foam cells. Finally, we integrated a published scTCR-seq dataset of the autoimmune disease psoriatic arthritis, and we report various commonalities between the two diseases. In conclusion, our data suggest that atherosclerosis has an autoimmune compondent driven by autoreactive CD4+ T cells.

The Gut Microbiome, Microbial Metabolites, and Cardiovascular Disease in People Living with HIV.

To synthesize recent evidence relating the gut microbiome and microbial metabolites to cardiovascular disease (CVD) in people living with HIV (PLWH). A few cross-sectional studies have reported on the gut microbiome and cardiovascular outcomes in the context of HIV, with no consistent patterns emerging. The largest such study found that gut Fusobacterium was associated with carotid artery plaque. More studies have evaluated microbial metabolite trimethylamine N-oxide with CVD risk in PLWH, but results were inconsistent, with recent prospective analyses showing null effects. Studies of other microbial metabolites are scarce. Microbial translocation biomarkers (e.g., lipopolysaccharide binding protein) have been related to incident CVD in PLWH. Microbial translocation may increase CVD risk in PLWH, but there is insufficient and/or inconsistent evidence regarding specific microbial species and microbial metabolites associated with cardiovascular outcomes in PLWH. Further research is needed in large prospective studies integrating the gut microbiome, microbial translocation, and microbial metabolites with cardiovascular outcomes in PLWH.

Intraobserver and Interobserver Consistency Evaluation of Carotid Plaque Volume Measured by Different 3-Dimensional Ultrasound Methods.

This study aims to evaluate the accuracy of the semiautomatic planimetric measurement (SAPM) method and the necessity of manually adjusted boundary measurement in 3-dimensional ultrasound measurement of plaque volume. A total of 50 patients with 82 plaques in the common carotid arteries between December 2020 and March 2021 were included in this study. Two observers measured the 3-dimensional volume of plaque for each patient in 3 different methods (contour tracing method [CTM], SAPM method without manually adjusted boundary [SAPM1], and SAPM method with manually adjusted boundary [SAPM2]). The difference in measurement time between the 3 methods was evaluated by Kruskal-Wallis H test. Intraclass correlation coefficient and 95% confidence interval were used to evaluate the intraobserver and interobserver reliability of the 3 measurement modes. The Bland-Altman analysis was used to assess the agreement, which was expressed as the mean difference with the 95% limits of agreement (LOA). The difference in measurement time between the 3 methods was statistically significant ( P < 0.001). Both observers' intraobserver and interobserver reliability showed well in the 3 methods (all of the intraclass correlation coefficients were >0.75). The mean differences of the plaque volume measurement were 38.17, 26.42, and 11.75 mm 3 , respectively. The agreement between CTM and SAPM2 was the best, and LOA was -57.00 to 80.51. The agreement between SAPM1 and SAPM2 and the agreement between SAPM1 and CTM were similar, and the LOAs were -126.10 to 202.40 and -158.00 to 210.80, respectively. The SAPM method may be recommended to measure plaque volume in clinical practice.

Association of glomerular hyperfiltration with carotid artery plaque in the general population

Background and aimsGlomerular hyperfiltration (GHF) is a hemodynamic change of the kidney as an adaptive response to nephron loss. Although GHF is associated with metabolic risk factors and cardiovascular disease (CVD), the mechanisms that explain these relationships remain largely unknown. This is partially caused by a non-unified definition of GHF based on pathophysiologic vascular changes. Thus, the objective of this study was to evaluate the association between various definitions of GHF and carotid plaque in a health checkup cohort. MethodsA total of 4493 individuals without history of CVD who had carotid ultrasonography (USG) results available between January 2016 and June 2018 were enrolled. GHF was defined as >90th percentile of eGFR residuals after adjusting for confounding factors. Carotid plaque score was calculated based on carotid USG results. ResultsOf 4493 individuals (mean age, 52.3 ± 10.1 years; 3224 [71.8%] males), 449 subjects were included in the GHF group (mean eGFR, 107.0 ± 7.1 ml/min/1.73 m2) and 4044 subjects were included in the non-GHF group (mean eGFR, 92.5 ± 12.3 ml/min/1.73 m2). When the GHF group was compared to the non-GHF group, GHF was associated with the presence of significant carotid plaque (carotid plaque score ≥2) (adjusted OR: 1.46; 95% CI: 1.16 to 1.83; p = 0.001). GHF defined in this study showed higher sensitivity to the presence of carotid plaque than other definitions of GHF. ConclusionsGHF status was associated with risk of carotid plaque in individuals without history of CVD. Presence of subclinical carotid plaque was associated with risk of future CVD. Therefore, GHF based on creatinine could be a useful surrogate marker for surveillance of CVD in asymptomatic individuals.

Carotid atherosclerosis in people of European, South Asian and African Caribbean ethnicity in the Southall and Brent revisited study (SABRE).

Atherosclerotic cardiovascular disease (ASCVD) risk differs by ethnicity. In comparison with Europeans (EA) South Asian (SA) people in UK experience higher risk of coronary heart disease (CHD) and stroke, while African Caribbean people have a lower risk of CHD but a higher risk of stroke. To compare carotid atherosclerosis in EA, SA, and AC participants in the Southall and Brent Revisited (SABRE) study and establish if any differences were explained by ASCVD risk factors. Cardiovascular risk factors were measured, and carotid ultrasound was performed in 985 individuals (438 EA, 325 SA, 228 AC). Carotid artery plaques and intima-media thickness (cIMT) were measured. Associations of carotid atherosclerosis with ethnicity were investigated using generalised linear models (GLMs), with and without adjustment for non-modifiable (age, sex) and modifiable risk factors (education, diabetes, hypertension, total cholesterol, HDL-C, alcohol consumption, current smoking). Prevalence of any plaque was similar in EA and SA, but lower in AC (16, 16, and 6%, respectively; p < 0.001). In those with plaque, total plaque area, numbers of plaques, plaque class, or greyscale median did not differ by ethnicity; adjustment for risk factors had minimal effects. cIMT was higher in AC than the other ethnic groups after adjustment for age and sex, adjustment for risk factors attenuated this difference. Prevalence of carotid artery atherosclerotic plaques varies by ethnicity, independent of risk factors. Lower plaque prevalence in in AC is consistent with their lower risk of CHD but not their higher risk of stroke. Higher cIMT in AC may be explained by risk factors. The similarity of plaque burden in SA and EA despite established differences in ASCVD risk casts some doubt on the utility of carotid ultrasound as a means of assessing risk across these ethnic groups.

Phenotyping of embolic cryptogenic stroke based on ultrasound diagnosis and determination of serum concentration NT-proBNP

Determining the potential mechanisms underlying cryptogenic ischemic stroke is essential to guide diagnostic discovery and personalize secondary prevention.Purpose is to study the phenotypes of embolic stroke of undetermined source (ESUS) based on ultrasound diagnosis and determination of the serum concentration of pro-natriuretic N-terminal peptide B-type (N-Terminal Pro-brain Natriuretic Peptide, NT-proBNP).Materials and methods. 141 patients with ESUS were examined. In addition to the standard examination aimed at fi nding the cause of stroke, the functional characteristics of the left atrium were assessed using the emptying fraction (left atrial emptying fraction, LAEF) and the functional index (left atrial function index, LAFI), and the concentration of NT-proBNP in blood serum was also measured.Results. The most common potential sources of embolism were atherosclerotic plaques in the stroke-associated carotid artery with stenosis in 30–49% (31.9% of patients) and atrial cardiopathy with a decrease in LAEF &lt; 51.8% (24.8% of patients). An analysis of combinations of potential sources showed that 46.1% of patients had a negative phenotype, 21.3% of patients had a cardiac phenotype, 19.1% of patients had an atherosclerotic phenotype, and 13.5% of the examined patients had a mixed phenotype. Patients with a cardio-atherosclerotic phenotype diff ered from patients with a negative phenotype by higher disability on the Rankin scale at discharge from the hospital.Conclusion. The main potential embolic sources in patients with ESUS are non-stenosing carotid atherosclerosis and atrial cardiopathy with decreased LAEF. Cardiac and atherosclerotic phenotypes are determined in a quarter of patients, a mixed phenotype is found in every seventh patient, while in almost half of the patients no sources of embolism are found.

Use of optical coherence tomography in selected patients with recurrent cryptogenic stroke: A case series and technical discussion.

Despite advances in secondary stroke prevention during the last several years, cryptogenic stroke remains associated with a high risk of recurrence. Studies have shown that the recurrence risk is higher in patients with large artery disease in which complex carotid plaques and carotid WEBs are identified. This is a case series of six patients with cryptogenic recurrent stroke in which conventional imaging and extensive workup did not identify an etiology. Intravascular optic coherence tomography (OCT) was performed using a ballon-guided flow-arrest technique to identify possible covert carotid lesions. We present six cases in which, with the help of OCT, we identified three carotid WEBs with associated thrombosis and two ulcerated carotid artery plaques. Four patients were subsequently treated with endovascular stent placement without complications. OCT permitted the distinction between complicated carotid artery plaque and carotid WEB. Intravascular OCT is a feasible and safe approach to identifying patients with covert carotid wall abnormalities, like carotid WEBs and ulcerated plaques, that are amenable to carotid stenting to reduce recurrent stroke risk.

PS-C05-9: COMBINED EFFECT OF INTER-ARM SYSTOLIC BLOOD PRESSURE DIFFERENCE AND CAROTID ARTERY PLAQUE ON CARDIOVASCULAR EVENTS

Objectives: Previous studies have confirmed the relations between inter-arm systolic blood pressure difference (IASBPD) and carotid artery plaque with the risk of cardiovascular diseases (CVD) respectively. But it is unclear whether the combined effect of IASBPD and carotid artery plaque further increases the risk of CVD and all-cause mortality. Methods: We enrolled 4970 participants (≧ 40 years old) in the prospective Kailuan Study. All participants underwent dual-arm blood pressure and carotid artery ultrasounds. IASBPD was the absolute value of the difference between dual-arm blood pressure. All the participants were divided into four groups according to their IASBPD levels and the presence or absence of carotid artery plaque, Cox proportional hazards models were used to calculate the hazard ratios (HRs) and 95% confidence interval (CI) for incident CVD and all-cause mortality. Results: During a median follow-up of 7 years, 179 CVD events and 266 deaths occurred. Multivariable Cox Regression showed that participants with IASBPD ≧ 10mmHg and plaque had a significantly higher incidence of CVD, cerebral infarction (CI) and myocardial infarction (10%, 7.27%, 1.36%, respectively). After adjusting for covariates, the IASBPD ≧ 10mmHg and carotid plaque group significantly increased risks for CVD (HR 2.38; 95% CI, 1.40∼4.05), CI (HR, 2.47; 95% CI, 1.31∼4.67), and all-cause mortality (HR, 2.08; 95% CI, 1.20∼3.59). Conclusions: Our study indicated that the combination of IASBPD and carotid artery plaque was associated with incident CVD and all-cause mortality.