Stenotic Plaque Research Articles

Significance of myeloperoxidase, pentraxin-3 and soluble urokinase plasminogen activator receptor determination in patients with moderate carotid artery stenosis

We investigated serum concentrations of specific inflammatory parameters in patients with significant carotid artery stenosis (CAS) of 50–99%, with an additional focus on patients with moderate stenosis (50–69%), in terms of both symptomatic status and plaque morphology, to determine whether there are certain parameters that can be associated with plaque instability before the progression of CAS to a high degree. The study included 119 CAS patients, 29 of whom had moderate stenosis, and 46 controls. Ultrasonography of the carotid arteries was performed using color flow Doppler and B-mode duplex ultrasound, and serum inflammatory parameters were measured using commercially available enzyme immunoassays. When comparing patients with 50–99% stenosis, only serum amyloid A (SAA) was higher in symptomatic patients, while in the group of patients with 50–69% stenosis, myeloperoxidase (MPO) was higher and pentraxin-3 (PTX-3) was lower in symptomatic compared to asymptomatic patients, and soluble urokinase plasminogen activator receptor (suPAR) was higher in patients with carotid plaque of unstable compared to stable morphology. Our results suggest that the importance of different inflammatory parameters in patients with moderate CAS is not the same as in CAS patients in general, and therefore their separate investigation in patients with high and moderate stenosis may be beneficial. SAA has the potential to be further considered in research to predict CAS symptom risk. There is a possibility that MPO and PTX-3 play a role in the development of CAS symptoms originating from less stenotic plaques and that suPAR is involved in the destabilisation of such plaques.

Arterial floating mural thrombi are a characteristic imaging pattern in SARS-CoV-2-related ischemic stroke.

Acute ischemic stroke (AIS) is a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. We aimed to explore neurovascular imaging patterns in patients with SARS-CoV-2-related AIS. We retrospectively analyzed clinical and radiological data of patients hospitalized with AIS and a positive PCR test for SARS-CoV-2 prior to AIS onset. The control group comprised of AIS patients from a pre-COVID-19 pandemic period matched for gender and age. Thirty-five SARS-CoV-2-related stroke patients, and 35 controls were included. Fifty-seven percent of SARS-CoV-2 patients had either mild or asymptomatic disease. A distinctive imaging pattern of floating arterial mural thrombus was detected in 5 patients of the SARS-CoV-2 group. In 4 patients thrombus was attached to a stenotic atherosclerotic plaque in the proximal internal carotid artery. In the 5th patient a cardiac CTA showed multiple floating thrombi in the descending aorta. In the control group, floating thrombus was only detected in one patient. Treatment with dual antiplatelet therapy was associated with thrombus dissolution and good clinical outcome. Patients with floating thrombi had a longer time from SARS-CoV-2 diagnosis to stroke onset (mean 7.4 versus 3.4 days). Floating arterial mural thrombi attached to atherosclerotic plaques are unique characteristic source of AIS in SARS-CoV-2 patients. They may lead to ischemic stroke in patients with mild or asymptomatic infection up to 1-2 weeks from SARS-CoV-2 diagnosis. Patients with embolic AIS and SARS-CoV-2 diagnosis should perform high resolution cranio-cervical vascular imaging to evaluate floating thrombi as a potential embolic source.

Redefining the exact roles and importance of carotid intima-media thickness and carotid plaque thickness in predicting cardiovascular events.

The survey aimed to evaluate the precise roles and importance of carotid plaque thickness and carotid intima-media thickness measured in plaque-free areas (PF CC-IMTmean) in future cardiovascular risk prediction. 188 respondents between the age of 46 and 87 divided into two groups (I group - 94 respondents without plaques with CIMT measurement and II Group 94 respondents with carotid plaques; 118 men and 70 women; mean age ± SD, 61.80 ± 5.49) were prospectively examined by the carotid ultrasound Doppler (carotid measurements included plaque thickness PT - nonstenotic plaques (carotid stenosis <50%) and stenotic culprit plaques (carotid stenosis ≥50%), mean CIMT and maximum CIMT). Subjects were followed for 36 months from the inclusion in the study (regular control examinations). Data were recorded on new cases of mortality (CV mortality) and adverse CV events (myocardial infarction - -MI, surgical or endovascular revascularization - coronary or stroke). In this study, CIMT values vary between 0.62 and 1.43mm (mean CIMT = 1.21 ± 0.2mm) while 52 subjects had nonstenotic plaques (14 respondents plaque ulceration, 22 type 2 diabetes mellitus, 38 arterial hypertension) and 38 subjects had stenotic culprit plaques (17 respondents plaque ulceration, 20 type 2 diabetes mellitus, 31 arterial hypertension). After 36 months of follow-up, 76 vascular events were noted (MI, transient ischaemic attack - TIA, stroke and cardiovascular angioplasty or surgery) in this period. Respondents with carotid plaques had higher cardiovascular events occurrence (p < .01, high statistical difference). Carotid plaques as a parameter have higher predictive vascular event value importance than CIMT. Of note, stenotic plaques, the presence of ulceration on the free surface of the plaque, type 2 diabetes mellitus and hypertension were connected with the highest events occurrence.

Aortic aneurysms in patients with atherosclerotic coronary artery disease in the southwestern region of Romania - clinical and histopathological study.

An aneurysm is defined as a dilation of the arterial wall with a diameter exceeding 1.5 times the normal diameter of the vessel concerned. Aortic aneurysms (AAs) can develop at any level but are mostly found at the abdominal and infrarenal levels and extend to the iliac arteries. AAs are usually asymptomatic and are most often discovered incidentally during various imaging investigations for other conditions. Rupture of an AA is usually dramatic, being one of the causes of sudden cardiac death. Surgical treatment and, more recently, endovascular treatment are the only effective methods of AA repair. In this study, we screened for the diagnosis of AAs in patients with stable exertional angina who had indications for coronary angiography. The study was carried out in the period 2021-2023 in the Institute of Cardiovascular Diseases Timişoara, Romania. Of the 2458 patients with exertional angina who required coronary angiography, a number of 1844 (75%) patients had at least one stenotic atheromatous plaque, and of these 312 patients had AAs, of which 173 at the level of the abdominal aorta.

Amyloid beta is associated with carotid wall echolucency and atherosclerotic plaque composition

Circulating amyloid-beta 1–40 (Αb40) has pro-atherogenic properties and could serve as a biomarker in atherosclerotic cardiovascular disease (ASCVD). However, the association of Ab40 levels with morphological characteristics reflecting atherosclerotic plaque echolucency and composition is not available. Carotid atherosclerosis was assessed in consecutively recruited individuals without ASCVD (n = 342) by ultrasonography. The primary endpoint was grey scale median (GSM) of intima-media complex (IMC) and plaques, analysed using dedicated software. Vascular markers were assessed at two time-points (median follow-up 35.5 months). In n = 56 patients undergoing carotid endarterectomy, histological plaque features were analysed. Plasma Αb40 levels were measured at baseline. Ab40 was associated with lower IMC GSM and plaque GSM and higher plaque area at baseline after multivariable adjustment. Increased Ab40 levels were also longitudinally associated with decreasing or persistently low IMC and plaque GSM after multivariable adjustment (p < 0.05). In the histological analysis, Ab40 levels were associated with lower incidence of calcified plaques and plaques without high-risk features. Ab40 levels are associated with ultrasonographic and histological markers of carotid wall composition both in the non-stenotic arterial wall and in severely stenotic plaques. These findings support experimental evidence linking Ab40 with plaque vulnerability, possibly mediating its established association with major adverse cardiovascular events.

Validation of HPLC and TLC analytical methods to determine radiochemical purity of 99mTc-cAbVCAM1-5, a new experimental radiotracer

Cardiovascular diseases, including fatal myocardial infarctions from atheromatous plaques, are the primary global mortality cause. Detecting stenotic atheromatous plaques is possible through coronary angiography, but vulnerable plaques with eccentric remodeling are undetectable with current diagnostic methods. Addressing this challenge, our group developed a radiopharmaceutical drug targeting vascular cell adhesion molecule 1 (VCAM-1), radiolabeled with technetium-99m. Given the absence of a monograph in the European Pharmacopoeia, and in order to draft the investigational medicinal product documentation, analytical methods had to be validated by high performance liquid chromatography (HPLC) and thin layer chromatography (TLC) to determine the radiochemical purity (RCP) of 99mTc-cAbVCAM1–5. This study therefore presents the results of the validation of analytical methods obtained in this context. The method validation followed the European Association of Nuclear Medicine (EANM) recommendations adapted from ICH Q2(R1), ensuring conformity with specificity, accuracy, repeatability and intermediate precision, linearity, robustness, quantification limit (LoQ), and range criteria. Regarding the results of specificity, both HPLC and TLC methods demonstrated excellent separation of 99mTc-cAbVCAM1–5 from impurities 99mTcO4-. Accuracy results indicated recovery percentages within the range of 99.52–101.40% for the HPLC and 99.51–101.97% for TLC, ensuring reliable measurements for each concentration of 99mTcO4-. Precision of the methods was validated by assessing repeatability and intermediate precision. Linearity was determined over the usual concentrations range and the correlation coefficient was greater than 0.99 for both methods. The limit of quantification was measured by diluting the 99mTcO4- to obtain a signal-to-noise ratio of around 10:1. Under these conditions, we obtained an LOQ of 2.10 MBq/mL for HPLC and 2Mbq/mL for TLC. In conclusion, the analytical methods developed in this study comply with EANM recommendations. This therefore allows us to correctly assess the radiochemical purity of 99mTc-cAbVCAM1–5, a new radiotracer targeting inflammation in vulnerable plaques.

Clinical Applications of Dual‐Energy Computed Tomography for Acute Ischemic Stroke

Acute ischemic stroke is a leading cause for neurological disability worldwide, and treatment strategies are rapidly evolving. Patient selection for recanalization therapy and postintervention management relies heavily on diagnostic imaging. In this narrative review, we searched the existing literature for clinical applications of dual‐energy computed tomography for acute ischemic stroke. We summarized the current clinical evidence on the use of dual‐energy computed tomography for identifying early cerebral ischemia, detecting and predicting hemorrhagic transformations, and characterizing clots and stenotic plaques. We also highlight future opportunities for dual‐energy computed tomography to be used to address important diagnostic challenges during acute stroke triage and postintervention management. Dual‐energy computed tomography is a powerful tool that can be used to improve the diagnostic accuracy of ischemia, hemorrhage, and vascular lesions in the context of acute ischemic stroke.

Dataset for Automatic Region-based Coronary Artery Disease Diagnostics Using X-Ray Angiography Images

X-ray coronary angiography is the most common tool for the diagnosis and treatment of coronary artery disease. It involves the injection of contrast agents into coronary vessels using a catheter to highlight the coronary vessel structure. Typically, multiple 2D X-ray projections are recorded from different angles to improve visualization. Recent advances in the development of deep-learning-based tools promise significant improvement in diagnosing and treating coronary artery disease. However, the limited public availability of annotated X-ray coronary angiography image datasets presents a challenge for objective assessment and comparison of existing tools and the development of novel methods. To address this challenge, we introduce a novel ARCADE dataset with 2 objectives: coronary vessel classification and stenosis detection. Each objective contains 1500 expert-labeled X-ray coronary angiography images representing: i) coronary artery segments; and ii) the locations of stenotic plaques. These datasets will serve as a benchmark for developing new methods and assessing existing approaches for the automated diagnosis and risk assessment of coronary artery disease.

The role of post-dilatation in carotid MicroNet-covered stent implantation, evaluated using 3D cone-beam CT angiography.

This study aims to assess the role and safety of post-dilatation in protected carotid artery stenting (PCAS) using the new MicroNet-covered 2nd-generation stent assessed by cone beam CT scans. From March 2020 to March 2022, patients were enrolled in the study according to CT angiography results based on the following criteria: Evidence of 70% to 99% carotid stenosis in asymptomatic patients and 50% to 99% in symptomatic patients, per the NASCET index. Using a FilterWire EZ™ (Boston Scientific, Natick, MA, USA) embolic protection system (EPS), MicroNet-covered stent PCAS was performed by two interventional radiologists with at least 8 years of experience in endovascular intervention. Each patient underwent post-dilatation following stent placement. Finally, a third radiologist (not participating in the interventional procedures) evaluated the cone beam CT scans and calculated residual stenosis. Major and minor complications were recorded in the 30 days following the procedure. A total of 192 patients (121 male, mean age 73±10 years) were included in the study, and all patients received post-dilatation following stent implantation. Technical successes were achieved in all procedures. Adverse events noted in this study were limited to periprocedural transient ischemic attacks that occurred in three out of 192 patients (1.6%) and showed a swift complete recovery. The post-dilatation balloon diameters used in the study were: 5.0 mm (30.3%), 5.5 mm (39.3%) and 6 mm (30.3%). Optimized postdilatation resulted in a significant increase in the final luminal area. Similar improvements were observed in all subtypes of plaque. Post-dilatation in protected CAS is safe and induces a significant improvement in the cross-sectional area regardless of the stenotic plaque.

Acute Myocardial Infarction Due to Coronary Artery Embolism During Chemotherapy with mFOLFOX-6 Plus Bevacizumab for Metastatic Colon Cancer: A Case Report.

Bevacizumab, a monoclonal antibody against vascular endothelial growth factor, may be associated with arterial embolisms. We herein report a case of acute myocardial infarction caused by coronary embolism during combination chemotherapy with mFOLFOX-6 and bevacizumab in a patient with metastatic colon cancer. Thromboembolism occurred only in the distal right posterolateral branch without stenotic lesions or plaque rupture in the proximal branch of the right coronary artery. Sole thromboaspiration was successfully performed; the final angiogram demonstrated no stenosis in the right coronary artery. Bevacizumab may be associated with acute coronary syndrome in patients with coronary risk factors, despite no significant coronary narrowing.

Culprit Plaques of Large Parent Arteries, Rather than Cerebral Small Vessel Disease, Contribute to Early Neurological Deterioration in Stroke Patients with Intracranial Branch Atheromatous Disease

Introduction: Intracranial branch atheromatous disease (BAD) has been applied to occlusions that occur at the origin of large caliber penetrating arteries due to the microatheromas or large parent artery plaques. This study aimed to explore the association between culprit plaques of large parent arteries, neuroimaging markers of cerebral small vessel disease (CSVD), and the risk of early neurological deterioration (END) in stroke patients with BAD. Methods: A total of 97 stroke patients with BAD in the vascular territories of the lenticulostriate arteries or paramedian pontine arteries, diagnosed using high-resolution magnetic resonance imaging, were prospectively recruited in this observational study. A culprit plaque in the middle cerebral artery was defined as the only arterial plaque on the ipsilateral side of an infarction visible on diffusion-weighted imaging. A culprit plaque in the basilar artery (BA) was identified when it was observed within the same axial slices of an infarction or on the adjacent upper or lower slice, whereas a plaque within the BA located in the ventral region was considered non-culprit. If more than one plaque was present in the same vascular territory, the most stenotic plaque was chosen for the analysis. Four CSVD neuroimaging markers, including white matter hyperintensity, lacunes, microbleeds, and enlarged perivascular spaces, were evaluated in accordance with the total CSVD score. The associations between neuroimaging features of lesions within large parent arteries, neuroimaging markers of CSVD, and the risk of END in stroke patients with BAD were investigated using logistic regression analysis. Results: END occurred in 41 stroke patients (42.27%) with BAD. The degree of large parent artery stenosis (p < 0.001), culprit plaques of large parent arteries (p < 0.001), and plaque burden (p < 0.001) were significantly different between the END and non-END groups in stroke patients with BAD. In logistic regression analysis, culprit plaques of large parent arteries (odds ratio, 32.258; 95% confidence interval, 4.140–251.346) were independently associated with the risk of END in stroke patients with BAD. Conclusions: Culprit plaques of large parent arteries could predict the risk of END in stroke patients with BAD. These results suggest that lesions in the large parent arteries, rather than damage to the cerebral small vessels, contribute to END in stroke patients with BAD.

Characteristics of intracranial plaque in patients with non-cardioembolic stroke and intracranial large vessel occlusion

ObjectiveTo determine the characteristics of intracranial plaque proximal to large vessel occlusion (LVO) in stroke patients without major-risk cardioembolic source using 3.0 T high-resolution MRI (HR-MRI).MethodsWe retrospectively enrolled eligible patients...

Impact of Coronary Artery Disease on The Outcomes of Catheter Ablation in Patients with Atrial Fibrillation.

The objective of this study is to investigate the possible impact of coronary artery disease (CAD) on clinical outcomes of catheter ablation in patients with atrial fibrillation (AF). Patients with AF who underwent coronary computed tomography and catheter ablation were enrolled. The presence of stenotic severity and plaque, characteristics of coronary arteries, clinical data, and adverse outcomes of catheter ablation were analysed. A total of 243 patients were enrolled, 100 (41%) patients with CAD. The CHA2DS2-VASc (congestive heart failure, hypertension, age ≥ 75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65-74 years, and sex category) score of AF patients with CAD was significantly (P<0.001) higher than of those without CAD. Presence of stenotic artery and plaques increased significantly with increase of CHA2DS2-VASc score (P<0.05). There was no significant (P=0.342) difference in AF recurrence between patients with and without CAD (30% versus 24%). Age, AF type, duration of AF, heart failure, CHA2DS2-VASc score, left ventricular ejection fraction, and left atrial diameter were significantly (P<0.05) correlated with AF recurrence in univariant analysis. Multivariable analysis revealed that duration of AF (hazard ratio [HR] 1.769), heart failure (HR 1.821), and left atrial diameter (HR 1.487, P=0.022) remained significant independent predictors of AF recurrence. Patients with AF and concomitant CAD were significantly (P=0.030) associated with a worse outcome. CAD concomitant with AF may be associated with a worse clinical outcome even though CAD does not significantly affect the risk of AF recurrence after ablation therapy.

Adaptive Wall Shear Stress Imaging in Phantoms, Simulations and In Vivo.

WSS measurement is challenging since it requires sensitive flow measurements at a distance close to the wall. The aim of this study is to develop an ultrasound imaging technique which combines vector flow imaging with an unsupervised data clustering approach that automatically detects the region close to the wall with optimally linear flow profile, to provide direct and robust WSS estimation. The proposed technique was evaluated in phantoms, mimicking normal and atherosclerotic vessels, and spatially registered Fluid Structure Interaction (FSI) simulations. A relative error of 6.7% and 19.8% was obtained for peak systolic (WSSPS) and end diastolic (WSSED) WSS in the straight phantom, while in the stenotic phantom, a good similarity was found between measured and simulated WSS distribution, with a correlation coefficient, R, of 0.89 and 0.85 for WSSPS and WSSED, respectively. Moreover, the feasibility of the technique to detect pre-clinical atherosclerosis was tested in an atherosclerotic swine model. Six swines were fed atherogenic diet, while their left carotid artery was ligated in order to disturb flow patterns. Ligated arterial segments that were exposed to low WSSPS and WSS characterized by high frequency oscillations at baseline, developed either moderately or highly stenotic plaques (p < 0.05). Finally, feasibility of the technique was demonstrated in normal and atherosclerotic human subjects. Atherosclerotic carotid arteries with low stenosis had lower WSSPS as compared to control subjects (p < 0.01), while in one subject with high stenosis, elevated WSS was found on an arterial segment, which coincided with plaque rupture site, as determined through histological examination.

HRU-Net: A Transfer Learning Method for Carotid Artery Plaque Segmentation in Ultrasound Images.

Carotid artery stenotic plaque segmentation in ultrasound images is a crucial means for the analysis of plaque components and vulnerability. However, segmentation of severe stenotic plaques remains a challenging task because of the heterogeneities of inter-plaques and intra-plaques, and obscure boundaries of plaques. In this paper, we propose an automated HRU-Net transfer learning method for segmenting carotid plaques, using the limited images. The HRU-Net is based on the U-Net encoder−decoder paradigm, and cross-domain knowledge is transferred for plaque segmentation by fine-tuning the pretrained ResNet-50. Moreover, a cropped-blood-vessel image augmentation is customized for the plaque position constraint during training only. Moreover, hybrid atrous convolutions (HACs) are designed to derive diverse long-range dependences for refined plaque segmentation that are used on high-level semantic layers to exploit the implicit discrimination features. The experiments are performed on 115 images; Firstly, the 10-fold cross-validation, using 40 images with severe stenosis plaques, shows that the proposed method outperforms some of the state-of-the-art CNN-based methods on Dice, IoU, Acc, and modified Hausdorff distance (MHD) metrics; the improvements on metrics of Dice and MHD are statistically significant (p < 0.05). Furthermore, our HRU-Net transfer learning method shows fine generalization performance on 75 new images with varying degrees of plaque stenosis, and it may be used as an alternative for automatic noisy plaque segmentation in carotid ultrasound images clinically.

Reduced Incidence of Severe Coronary Atherosclerosis in Obese Subjects With Type 2 Diabetes – An Obesity Paradox?

An obesity paradox wherein a lower incidence of cardiovascular (CV) morbidity and mortality is seen in overweight/ obese patients compared with patients with a ‘normal’ body mass index (BMI) has been reported in patients with type 2 diabetes mellitus (T2DM). We evaluated the relationship between BMI and coronary atherosclerosis in a cohort of subjects with T2DM who were asymptomatic for CV disease using computed tomography coronary angiography. Subjects were followed up for a composite endpoint of all-cause death, non-fatal myocardial infarction or late coronary artery revascularisation. Of the 258 patients enrolled, 226 were eligible for follow-up over a median of 22.8 months. In patients with a normal BMI (&lt;25 kg/m2), 53% had ≥1 significantly stenotic plaque compared with 26% of patients with a BMI &gt;30 kg/m2 at baseline. Subjects with a BMI ≥35 kg/m2 were 82% less likely to present with significant coronary artery plaque at baseline compared with those with a BMI &lt;25 kg/m2 (p=0.01). The risk of a composite CV endpoint event in the overweight/obese group (&gt;25 kg/m2) was approximately 70% lower than in subjects with normal weight. In conclusion, higher BMI may be associated with a lower prevalence of coronary atherosclerosis in patients with T2DM.

Characterization of non-stenotic plaques in intracranial arteries with multi-contrast, multi-planar vessel wall image analysis

ObjectivesNon-stenotic plaques have been observed in intracranial arteries but are less understood compared to those in coronary and carotid arteries. We sought to compare plaque distribution and morphology between stenotic and non-stenotic intracranial plaques with MR vessel wall imaging (VWI) and quantitative image analysis. Materials and methodsTwenty-four patients with intracranial arterial stenosis or luminal irregularity on clinical imaging were scanned with a multi-contrast VWI protocol. Plaques were detected as focal wall thickening on co-registered multiplanar reformats of multi-contrast VWI, with assessment of the location and morphology. TOF-MRA was independently reviewed for any appreciable stenosis using the WAISD criteria. ResultsAcross 504 arterial segments, a total of 80 plaques were detected, including 23 (29%) with stenosis on TOF-MRA, 56 (70%) without, and 1 (1%) not covered by TOF-MRA. Plaques involving the ICA were more likely to be non-stenotic than those involving other segments (80% versus 55%, p = 0.030) whereas the basilar artery (40%) and PCA (33%) had the lowest proportions of non-stenotic plaques. Maximum wall thickness, indicative of plaque burden, correlated poorly with degree of stenosis (p = 0.10) and overlapped substantially between stenotic and non-stenotic plaques (1.9 [1.5, 2.4] versus 2.0 [1.5, 2.2] mm, p = 0.074). ConclusionsIntracranial plaques without appreciable stenosis on TOF-MRA represent a large proportion of lesions throughout arterial segments but disproportionately affect the ICA. Morphological characterization of plaques with and without stenosis shows that luminal stenosis is a poor indicator of the underlying burden of intracranial atherosclerosis.

Atherosclerotic artery damage in miners with metabolic syndrome

Introduction. Metabolic disorders can lead to dysfunction of various systems of the human body, including cardiovascular. There is a lesion of the artery endothelium in the form of stenosing atherosclerotic plaques, which can become a substrate for the occurrence of life-threatening and fatal events. The study of the health of miners in this direction is particularly relevant due to the difficult working conditions and the danger of the profession. The study aims to evaluate the relationship of metabolic syndrome and its components with atherosclerotic artery damage in miners. Materials and methods. We examined 199 underground workers of mines in the South of the Kemerovo Region - Kuzbass in the order of passing preventive medical examinations. The researchers divided them into two groups based on the presence of a diagnosed metabolic syndrome. The first of them consisted of persons with metabolic disorders - 75 (37.7%) people, the second - without it - 124 (62.3%); the average age of the examined two cohorts did not differ from each other and amounted to 46.94±5.66 and 46.17±5.14 years, respectively, p=0.321. We conducted the condition of the arterial walls, the function of external respiration, as well as biochemical blood parameters on modern equipment in all the subjects Results. In miners with metabolic syndrome, vascular lesions in the form of atherosclerotic plaques were most common - 54.9% versus 35.8% in people without metabolic syndrome, p=0.011. When analyzing the occurrence of atheromas in different vascular basins, we found that miners with metabolic syndrome had carotid artery lesions more often than those without metabolic disorders: 36.5% and 20.2%, p=0.012. Experts also found a similar pattern with duplex scanning of the main arteries of the lower extremities: 46.7% vs. 25.8%, p=0.0025. There was the greatest association of atherosclerosis in people with hypertension, so stenotic plaques were more often among people with high blood pressure: 64.1% vs. 27.7%. Hyperbetacholesterolemia increased the relative risk of atherosclerosis by 2.2 times. Compared with abdominal obesity, the waist-hip index was a more significant indicator of body anthropometry, increased values of which were in 85.5% of cases against 70.3% in the comparison group. Impaired respiratory function increased the relative risk of atherosclerosis by 2.5 times. Conclusion. The presence of metabolic syndrome in miners we are strongly associating with the development of vascular stenosis. In the prevention of atherosclerosis in miners with metabolic syndrome, it is necessary to take into account elevated values of low-density lipoprotein cholesterol, the level of glycated hemoglobin, impaired respiratory function and the waist-hip index. Ethics. We have conducted the study in compliance with the standards of the Bioethical Committee of the Research Institute of Complex Problems of Hygiene and Occupational Diseases, established in accordance with the Helsinki Declaration of the World Association "Ethical Principles of Scientific Medical Research with Human Participation" as amended in 2013 and the "Rules of Clinical Practice in the Russian Federation", approved by Order of the Ministry of Health of the Russian Federation No. 266 dated 06/19/2003. All the subjects signed an informed consent to participate in the study.

P417 ASSESSMENT OF RESIDUAL CARDIOVASCULAR RISK AFTER STENTING: THE ROLE OF IMAGING

Abstract Background Reduction of residual risk after myocardial infarction (MI) represents the main goal in secondary prevention. Imaging may provide additional evidence beyond the monitoring of risk factors. Clinical Case In June 2019 a 29–year old man, Pakistani ethnicity, former smoker with family history of cardiovascular disease experienced a myocardial infarction without ST–segment elevation. Coronary angiography revealed a severe disease of circumflex branch (LCx) and of second obtuse marginal branch (OM2) treated with drug eluting stent (DES) implantation. A strong medical therapy was planned including dual antiplatelet therapy, high–potency statin and ACE inhibitor. The year after, a new coronary angio was performed because of effort angina: intrastent restenosis of LCx–OM2 was highlighted and treated with balloon, associated with a critical disease of right coronary artery (RCA), treated with DES. In the following months, the patient experienced three hospitalization for unstable angina related to critical intra–stent restenosis of LCx and intermediate stenosis of left anterior descendent (LAD). In order to better understand the subtle mechanism of patient’s symptoms, an invasive assessment of microvascular disease was performed, showing microvascular dysfunction (IMR 30; CFR 2.2; RRR 2.7). Additionally, coronary angio images raised the suspicion of positive remodeling on mid tract of RCA and LCx, expression of a progressive and high risk atherosclerosis (Figure 1). A close follow up was planned: a coronary computed tomography angiography (CCTA) 4 months after the last angio was performed aiming the assessment of atherosclerosis progression. CT images showed patency of the previously placed stents. A severe amount of positive plaque remodeling of RCA and LCx was documented: it was characterized by hypodense eccentric plaque (&amp;lt;30 HU) with some little calcific spot near to the lipid core. These features underlined the presence of high–risk coronary plaque (Figure 2, Figure 3). Taking into account clinical history, instrumental and laboratory data, the patient was a candidate for therapy with PCSK9 inhibitors, which previously demonstrated an effect on reduction of plaque’s lipid core. Conclusions CT coronary represents an excellent method for the assessment of residual risk in ischemic patients thanks to its ability to detect not only stenotic plaques, but also high–risk features of atherosclerosis, thus allowing therapeutic optimization.

CORRELATION BETWEEN CAROTID INTIMA-MEDIA THICKNESS WITH URINE ALBUMIN CREATININE RATIO IN PATIENTS WITH TYPE 2 DABETES MELLITUS

Introduction: Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of morbidity and mortality for individuals with diabetes. Common conditions coexisting with type 2 diabetes (e.g., hypertension and dyslipidemia) are clear risk factors for ASCVD, and diabetes itself confers independent risk. Large benets are seen when multiple cardiovascular risk factors are addressed simultaneously. Increased urinary albumin excretion (albuminuria) and reduced Glomerular Filtration Rate (GFR) are risk factors for progressive kidney failure and cardiovascular disease. It has been reported that microalbuminuria had a close association with cardiovascular diseases (CVD) as well. It was also reported that microalbuminuria or macroalbuminuria increased the mortality rate by 60 – 80% (1) . Albuminuria can be most easily performed by urinary albumin-to Creatinine ratio (ACR) in a random spot urine collection (2). Atherosclerosis is the main cause of cardiovascular diseases; measurement of IMT (Intima Media Thickness) enables the detection of atherosclerosis lesions of the arterial wall. CIMT (Carotid Intima Media Thickness) can be measured by high frequency B mode ultrasonography, which provides a high degree of accuracy in estimating the arterial wall thickness. B-mode gray scale sonography allows for imaging of atherosclerotic plaques and intima-media thickness of carotid arteries. Of these, continuous- wave Doppler and single-gate pulsed-wave Doppler sonography incorporated in duplex systems are reported to be highly accurate relative to angiography for the detection and classication of the degree of obstruction producing a narrowing of lumen more than 50%. In addition, the use of high-resolution B-mode real-time sonography makes it possible to identify small, non stenotic (&lt;50%) plaques and to describe the echo morphology of carotid arteries (3). The carotid IMT is signicantly higher in diabetic patients than that in non-diabetic patients (4), and the increased IMT can predict future events of silent brain infarction and coronary heart disease in the patients with T2DM (5). Carotid IMT is considered to reect an early stage of macroangiopathy in patients with diabetes. An increasing CIMT above normal level (&gt; 0.8 mm) is associated with increasingly severe coronary artery disease, an increased risk of myocardial infarction and also stroke. Urine ACR is an important marker for the progression of renal dysfunction and is currently recognized as predictive factors for CVD. However, association of IMT with both urinary ACR (Albumin Creatinine Ratio) in type 2 diabetic patients has been investigated in a few reports. Keeping them in mind, a hospital based cross sectional study was performed on the patients presenting with type 2 diabetes mellitus. The study was aimed to establish the role of urine ACR as a leading investigation in patients presenting with type 2 diabetes mellitus for cardiovascular risk assessment. It was intended to evaluate the Carotid IMT in these patients and also detection of atherosclerotic plaque which are clearly related to pathogenesis and aid in planning of management. Our objective is to nd out the correlation between urine ACR and carotid intima media thickness (CIMT) in type 2 diabetes patients and whether urine ACR can be used as a screening tool for risk stratication for future cardiovascular disease in Indian population.