RESUMEN
BACKGROUND AND AIMS: The ultrasonographic detection of subclinical atherosclerosis (scATS) at carotid and femoral vascular sites using the atherosclerosis burden score (ABS) improves the risk stratification for atherosclerotic cardiovascular disease beyond traditional cardiovascular (CV) risk factors. However, its predictive value should be further enhanced. We hypothesize that combining the ABS and the Framingham risk score (FHRS) to create a new score called the FHRABS will improve CV risk prediction and prevention. We aim to investigate if incorporating the ABS into the FHRS improved CV risk prediction in a primary prevention setting. METHODS AND RESULTS: 1024 patients were included in this prospective observational cohort study. Carotid and femoral plaques were ultra-sonographic detected. Major incident cardiovascular events (MACEs) were collected. The receiver operating characteristic curve (ROC-AUC) and Youden's index (Ysi) were used to compare the incremental contributions of each marker to predict MACEs. After a median follow-up of 6.0 ± 3.3 years, 60 primary MACEs (5.8%) occurred. The ROC-AUC for MACEs prediction was significantly higher for the FHRABS (0.74, p < 0.024) and for the ABS (0.71, p < 0.013) compared to the FHRS alone (0.71, p < 0.46). Ysi or the FHRABS (42%, p < 0.001) and ABS (37%, p < 0.001) than for the FHRS (31%). Cox proportional-hazard models showed that the CV predictive performance of FHRS was significantly enhanced by the ABS (10.8 vs. 5.5, p < 0.001) and FHRABS (HR 23.30 vs. 5.50, p < 0.001). CONCLUSIONS: FHRABS is a useful score for improving CV risk stratification and detecting patients at high risk of future MACEs. FHRABS offers a simple-to-use, and radiation-free score with which to detect scATS in order to promote personalized CV prevention.
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Aterosclerosis , Enfermedades Cardiovasculares , Humanos , Factores de Riesgo , Enfermedades Cardiovasculares/diagnóstico por imagen , Enfermedades Cardiovasculares/epidemiología , Estudios Prospectivos , Grosor Intima-Media Carotídeo , Medición de Riesgo , Factores de Riesgo de Enfermedad CardiacaRESUMEN
OBJECTIVE: Lipedema is a chronic and progressive disease associated with lymphatic impairment at later stages. The aim of our study was to describe the functional status and anatomy of lower limb superficial lymphatic system using indocyanine green (ICG) lymphography in patients with lipedema. METHODS: Following ICG injection at the dorsum of the foot, distance (cm) covered by the dye at 10 (T10') and 25 min (T25') was measured and normalized for limb length. If the dye did not reach the groin within 25 min, patients were classified as "drainage-needing" group (DNG). Values of fat and lean distribution assessed by dual-energy X-ray absorptiometry were extracted, and correlation analysis was performed. Furthermore, anatomical patterns of superficial lymphatics were assessed. RESULTS: Overall, 45 women were included, 25 (56%) of whom were classified as DNG. Symptoms duration was significantly associated with DNG status at multivariate analysis (odds ratio 1.07; 95% CI 1.01-1.14; p = 0.047). Moreover, Spearman's analysis showed a negative correlation between symptoms duration and T25' dye migration (r = -0.469; p = 0.037). Overall, no major anatomical lymphatic changes were found. CONCLUSIONS: Present study suggests that lymphatic functioning in patients with lipedema correlates with symptoms duration. Further research on larger cohorts should verify our findings and clarify their potential therapeutic implications. Overall, ICG lymphography may be promising technique to assess both lymphatic anatomy and functioning in patients with lipedema.
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Colorantes Fluorescentes , Verde de Indocianina , Lipedema/diagnóstico por imagen , Vasos Linfáticos/diagnóstico por imagen , Linfografía/métodos , Imagen Óptica , Absorciometría de Fotón , Adiposidad , Adulto , Diagnóstico Precoz , Femenino , Humanos , Lipedema/fisiopatología , Extremidad Inferior , Vasos Linfáticos/fisiopatología , Masculino , Valor Predictivo de las Pruebas , Estudios RetrospectivosRESUMEN
Purpose: We carried out this study to evaluate the predictive value of atherosclerosis burden score (ABS) to predict coronary artery disease (CAD) among asymptomatic patients without known cardiovascular disease (CVD), as compared to other imaging or functional techniques, namely coronary artery calcium (CAC) score, carotid intima-media thickness (C-IMT), and ankle brachial index (ABI). Patients and methods: This prospective study included 198 asymptomatic consecutive patients referred for evaluation of their cardiovascular (CV) risk and for therapeutic advice. Traditional CV risk factors, ABS, CAC score, C-IMT, ABI and an ECG-synchronized coronary CT-angiography (CCTA) were performed for each patient. We compared the predictive values of these atherosclerosis markers to detect CAD defined as coronary stenosis ≥30% objectivated by CCTA. Results: Among the whole sample, the area under the receiver-operating characteristic curve (ROC-AUC) was significantly higher for CAC score (0.81, p=0.015) than for ABS, the reference (0.70) but these values were lower for C-IMT (0.60, p=0.16) and particularly for ABI (0.56, p=0.0015). However, among patients at intermediate risk of coronary heart disease (CHD), according to Framingham risk score (FRS), the differences between the ROC-AUC values for ABS (0.70) and CAC score (0.76, p=0.36) were less pronounced. Again, as compared to ABS, the ROC-AUC values were lower for C-IMT (0.60, p=0.21) and ABI (0.57, p=0.06). Conclusions: ABS, an ultrasonographic score based on the assessment of carotid and femoral plaque burden, predicts more accurately CAD than other non-radiation tools analyzed here, and has a similar performance to CAC in patients at intermediate CHD risk. Thus, ABS could be an appropriate non-invasive and safe method to improve the detection of high-risk patients who will benefit from a more intensive therapy for the primary prevention of CVD.
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Aterosclerosis , Enfermedad de la Arteria Coronaria , Grosor Intima-Media Carotídeo , Humanos , Valor Predictivo de las Pruebas , Estudios Prospectivos , Medición de Riesgo , Factores de RiesgoRESUMEN
Characterized by an aplasia, hypoplasia or dysplasia of the lymphatic network, the primary lymphedema takes part of rare diseases. If 10 % of cases are congenital, the majority of them are detected before 35 years, most of the time due to an intercurrent event suh as a sprain or an infection. Although rarer, some primaries lymphedemas are family forms such the syndromes of Milroy and Meige. The primary lymphedema can also be a part of more complex malformative diseases such as Klinefelter, Turner or Noonan syndromes. If the lymphatic drainage associated with the elastic contention remains the basis care of lymphedema, we have to identify these patients as well as their family, sometimes requiring multidisciplinary cares.
Caractérisé par une aplasie, une hypoplasie ou une dysplasie du réseau lymphatique, le lymphÅdème primaire fait partie des maladies rares. Si 10 % des cas sont congénitaux, la majorité d'entre eux sont dépistés plus tardivement mais avant 35 ans, le plus souvent suite à un événement intercurrent tel qu'une entorse ou une infection. Bien que plus rares, certains lymphÅdèmes primaires revêtent un caractère familial comme les syndromes de Milroy et de Meige. Le lymphÅdème primaire peut aussi s'inscrire dans des tableaux cliniques plus complexes tels les syndromes de Klinefelter, de Turner ou de Noonan. Si le drainage lymphatique associé à la contention élastique demeure la base de la prise en charge de ces patients, il nous appartient de les identifier ainsi que leur famille, car ils nécessitent parfois une prise en charge multidisciplinaire.
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Linfedema , Humanos , Vasos Linfáticos/fisiopatología , Linfedema/diagnóstico , Linfedema/etiología , Linfedema/terapia , SíndromeRESUMEN
Venous malformations are slow flow dysplastic lesions, constituted by a vascular nest without arterial or capillary connections, more or less independent of the normal venous anatomy and circulation. In certain cases a treatment is required for symptom relief or for natural complications management. The percutaneous sclerotherapy under ultrasound guidance is increasingly used as an effective and mini-invasive option, allowing obtaining very good results with minor side effects. Several substances have been used with different efficacy and side effects rate. We review the literature and present some cases.
Les malformations veineuses sont des lésions à flux lent, constituées d'un nid vasculaire sans connexion artérielle ni capillaire, plus ou moins indépendantes du réseau veineux normal. Dans certains cas, un traitement est indiqué pour en diminuer les symptômes ou pour gérer les éventuelles complications naturelles. Le traitement par sclérothérapie percutanée sous guidage échographique se révèle une option efficace et peu invasive, permettant de diminuer le volume et d'obtenir de très bons résultats avec moins d'effets secondaires. Plusieurs substances ont été utilisées, avec différents résultats en termes d'efficacité et d'effets secondaires. Nous présentons une revue de la littérature et quelques exemples.
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Escleroterapia , Malformaciones Vasculares , Adulto , Humanos , Estudios Retrospectivos , Soluciones Esclerosantes/uso terapéutico , Resultado del Tratamiento , Malformaciones Vasculares/terapiaRESUMEN
INTRODUCTION: The high risk of cardiovascular events in smokers requires adequate control of other cardiovascular risk factors (CVRFs) to curtail atherosclerosis progression. However, it is unclear which CVRFs have the most influence on atherosclerosis progression in smokers. METHODS: In 260 smokers aged 40-70 included in a smoking cessation trial, we analyzed the association between traditional CVRFs, high-sensitivity C-reactive protein (hs-CRP), smoking cessation and 3-year progression of carotid intima-media thickness (CIMT, assessed by repeated ultrasound measurements) in a longitudinal multivariate model. RESULTS: Participants (mean age 52 years, 47% women) had a mean smoking duration of 32 years with a median daily consumption of 20 cigarettes. Baseline CIMT was 1185 µm (95% confidence interval [CI]: 1082-1287) and increased by 93 µm (95% CI: 25-161) and 108 µm (95% CI: 33-183) after 1 and 3 years, respectively. Age, male sex, daily cigarette consumption, systolic blood pressure (SBP), but neither low-density lipoprotein cholesterol nor hs-CRP, were independently associated with baseline CIMT (all P ≤ .05). Baseline SBP, but neither low-density lipoprotein cholesterol nor hs-CRP, was associated with 3-year atherosclerosis progression (P = .01 at 3 years). The higher the SBP at baseline, the steeper was the CIMT increase over 3-year follow-up. We found an increase of 26 µm per each 10-mmHg raise in SBP at 1 year and an increase of 39 µm per each 10 mmHg raise in SBP at 3 years. Due to insufficient statistical power, we could not exclude an effect of smoking abstinence on CIMT progression. CONCLUSION: Control of blood pressure may be an important factor to limit atherosclerosis progression in smokers, besides support for smoking cessation. IMPLICATIONS: Among 260 smokers aged 40-70 years with a mean smoking duration of 32 years, baseline SBP was associated with atherosclerosis progression over 3 years, as measured by CIMT (P = .01 at 3 years), independently of smoking variables and other CVRFs. The higher the SBP at baseline, the steeper was the CIMT increase over 3-year follow-up. Our findings emphasize the importance of focusing not only on smoking cessation among smokers, but to simultaneously control other CVRFs, particularly blood pressure, in order to prevent future cardiovascular disease.
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Enfermedades de las Arterias Carótidas/complicaciones , Enfermedades de las Arterias Carótidas/epidemiología , Fumadores/estadística & datos numéricos , Fumar/epidemiología , Adulto , Anciano , Presión Sanguínea , Proteína C-Reactiva , Femenino , Humanos , Inflamación , Masculino , Persona de Mediana Edad , Factores de RiesgoRESUMEN
We report the case of a 37-year-old woman who developed critical upper limb ischemia caused by a cervical rib. Because the malformation was initially undiagnosed, a vascular bypass was performed, and failure occurred. Following a 6-month therapy with sildenafil, revascularization of the arm was successful and amputation was avoided. A 6-year follow-up shows a rich collateral network at the compression site and normal values of digital plethysmography. Because hand surgeons often see patients with digital ulcerations and other manifestations of peripheral vascular pathology, therapy of ischemia with sildenafil could be an effective treatment option in patients not responding to classic drugs.
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Brazo/irrigación sanguínea , Isquemia/tratamiento farmacológico , Enfermedades Vasculares Periféricas/tratamiento farmacológico , Citrato de Sildenafil/uso terapéutico , Úlcera Cutánea/tratamiento farmacológico , Síndrome del Desfiladero Torácico/complicaciones , Vasodilatadores/uso terapéutico , Adulto , Femenino , Humanos , Isquemia/etiología , Necrosis , Enfermedades Vasculares Periféricas/etiología , Úlcera Cutánea/etiologíaRESUMEN
If clinical examination has an essential importance in lymphology disorders and requires experimented practitioners, lymphoscintigraphy and more recently green indocyanine lympho-fluoroscopy constitute precious complementary investigations in prevention, diagnosis, and treatment of lymphatic vascular pathologies. The lymphoscintigraphy interest lies in qualitative and quantitative analysis of macromolecules migration within lymphatic vessels and the deep lymphatic network. The lympho-fluoroscopy distinguishes itself from lymphoscintigraphy allowing real time superficial lymphatic vessels detailed mapping, gathering important information on their contractility, and the presence of compensatory derivations to be favored during manual lymphatic drainage to angiologist and physiotherapist.
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Fluoroscopía/métodos , Enfermedades Linfáticas/patología , Vasos Linfáticos/patología , Colorantes Fluorescentes , Humanos , Verde de Indocianina , Enfermedades Linfáticas/diagnóstico , Linfocintigrafia/métodosRESUMEN
Venous thromboembolism is a frequent disease with an annual incidence of 0.75-2.69/1000 reaching 2-7/1000 > 70 years. Deep vein thrombosis (DVT) and pulmonary embolism are two manifestations of the same underlying disease. Most frequent localization of DVT is at lower limbs. The diagnostic workup begins with an estimation of DVT risk, a judicious use of D-Dimers, and compression venous ultrasound depending on DVT probability. The development of direct oral anticoagulants and recent data on interventional DVT treatment, in selected cases, have widened the therapeutic spectrum of DVT. The present article aims at informing the primary care physician of the optimized workup of patients with lower limb suspicion of DVT.
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Embolia Pulmonar/terapia , Tromboembolia Venosa/terapia , Trombosis de la Vena/terapia , Anticoagulantes/uso terapéutico , Productos de Degradación de Fibrina-Fibrinógeno/metabolismo , Humanos , Extremidad Inferior , Atención Primaria de Salud/métodos , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatología , Factores de Riesgo , Tromboembolia Venosa/diagnóstico , Tromboembolia Venosa/fisiopatología , Trombosis de la Vena/diagnóstico , Trombosis de la Vena/fisiopatologíaRESUMEN
Non atherogenic peripheral arterial diseases must be taken into consideration whenever lower limb obstructive peripheral disease is diagnosed. This is particularly important in absence of classical cardiovascular risk factors. Management and treatment of these non atherogenic arterial disease are dependant on their causes.
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Arteriopatías Oclusivas/fisiopatología , Enfermedad Arterial Periférica/fisiopatología , Arteriopatías Oclusivas/etiología , Arteriopatías Oclusivas/terapia , Humanos , Extremidad Inferior , Enfermedad Arterial Periférica/etiología , Enfermedad Arterial Periférica/terapia , Factores de RiesgoRESUMEN
Vascular anomalies are rare conditions that could be observed at all ages. They are classified, according to their histology, in vascular tumors or vascular malformations. The general practitioner plays a significant role in diagnosis and patient management, diagnosis being suspected on clinical history. In case of vascular anomaly, ultrasound-Doppler assessment is helpful to characterize morphologic and hemodynamic changes of the lesion and permits to monitor the evolution and to detect complications. Further investigations are often necessary prior to multidisciplinary management. In this article, a brief overview of vascular anomalies, their multidisciplinary management and the exemple of Klippel-Trenaunay syndrome are presented.
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Comunicación Interdisciplinaria , Síndrome de Klippel-Trenaunay-Weber/terapia , Malformaciones Vasculares/terapia , Médicos Generales/organización & administración , Humanos , Síndrome de Klippel-Trenaunay-Weber/diagnóstico , Síndrome de Klippel-Trenaunay-Weber/fisiopatología , Rol del Médico , Ultrasonografía Doppler , Malformaciones Vasculares/diagnóstico , Malformaciones Vasculares/fisiopatologíaRESUMEN
Scarce knowledge of vascular rare diseases, defined by prevalence lower than 1/2000, is accompanied by increased patients mis-management and impaired quality of life. Recent advances in clinical knowledge, molecular biology, and genetic evaluation of certain vascular rare diseases allows designing new management strategies. A tight coordinated collaboration between angiologists and other specialists is therefore necessary to optimize patient's care.
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Enfermedades Raras/diagnóstico , Enfermedades Vasculares/diagnóstico , Vasos Sanguíneos/diagnóstico por imagen , Humanos , Enfermedades Raras/complicaciones , Enfermedades Raras/genética , Ultrasonografía , Enfermedades Vasculares/complicaciones , Enfermedades Vasculares/genéticaRESUMEN
BACKGROUND: Lower limb peripheral arterial disease (PAD) is a leading atherosclerotic disease in the elderly. However, awareness of the disease is poor, particularly in women. METHODS: In this retrospective, cross-sectional study, postmenopausal women referred to our Angiology Division were tested for PAD, defined as an "ankle-brachial index" (ABI) ≤0.9 or ≥1.4 (in the latter case with a "toe-brachial index" <0.7), or a history of lower limb arterial revascularization. Aim of our study was to assess cardiovascular (CV) risk profile in postmenopausal women with and without PAD, and to evaluate the role of PAD and six classic CV risk factors (CVRFs), namely age, current smoking, hypertension, dyslipidaemia, severe chronic renal failure, and diabetes in predicting CV disease (CVD), defined as coronary artery disease and/or cerebrovascular disease. RESULTS: Overall, 850 patients were included, 39.4% of whom with PAD. Compared with women without PAD, those with PAD were older (75.2 vs 66 years, respectively; p <0.001), and displayed higher rates of other CVRFs (p <0.001 for each). A personal history of CVD was reported in 18.8% of women with PAD and in 6.1% of those without PAD (p <0.001). At multivariate regression analysis, PAD (odds ratio [OR]: 2.15; 95% confidence interval [CI]: 1.33-3.47), and hypertension (OR: 2.20; 95%CI: 1.24-3.88) were the strongest factors associated with CVD presence. CONCLUSIONS: PAD is a strong marker of CVD in this selected series of postmenopausal women. If confirmed in the general population, PAD screening through ABI calculation may be considered for CV risk assessment in postmenopausal women.
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Enfermedades Cardiovasculares , Hipertensión , Enfermedad Arterial Periférica , Anciano , Índice Tobillo Braquial , Enfermedades Cardiovasculares/epidemiología , Enfermedades Cardiovasculares/prevención & control , Estudios Transversales , Femenino , Factores de Riesgo de Enfermedad Cardiaca , Humanos , Hipertensión/epidemiología , Extremidad Inferior , Enfermedad Arterial Periférica/diagnóstico , Enfermedad Arterial Periférica/epidemiología , Posmenopausia , Prevalencia , Estudios Retrospectivos , Factores de RiesgoRESUMEN
Everything must be done to prevent and take care of lymphoedema as soon as possible to avoid its progression and its negative impact on patient's psychology and quality of life. The physical limitations and the socio-occupational incidence of lymphoedema must not be neglected. For theses reasons, it is important to promote the education of lymphology and its therapy. Since April 2008, the service of angiology of our university hospital (CHUV) has developed a multidisciplinary consultation for diagnosing and managing oedemas particularly primary and secondary lymphoedemas.
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Linfedema/complicaciones , Linfedema/terapia , Humanos , Linfedema/diagnóstico , Linfedema/psicología , Grupo de Atención al Paciente , Calidad de VidaRESUMEN
Lipedema is a chronic progressive disease characterized by abnormal fat distribution resulting in disproportionate, painful limbs. It almost exclusively affects women, leading to considerable disability, daily functioning impairment, and psychosocial distress. Literature shows both scarce and conflicting data regarding its prevalence. Lipedema has been considered a rare entity by several authors, though it may be a far more frequent condition than thought. Despite the clinical impact on women's health, lipedema is in fact mostly unknown, underdiagnosed, and too often misdiagnosed with other similarly presenting diseases. Polygenic susceptibility combined with hormonal, microvascular, and lymphatic disorders may be partly responsible for its development. Furthermore, consistent information on lipedema pathophysiology is still lacking, and an etiological treatment is not yet available. Weight loss measures exhibit minimal effect on the abnormal body fat distribution, resulting in eating disorders, increased obesity risk, depression, and other psychological complaints. Surgical techniques, such as liposuction and excisional lipectomy, represent therapeutic options in selected cases. This review aims to outline current evidence regarding lipedema epidemiology, pathophysiology, clinical presentation, differential diagnosis, and management. Increased awareness and a better understanding of its clinical presentation and pathophysiology are warranted to enable clinicians to diagnose and treat affected patients at an earlier stage.
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Lipedema , Distribución de la Grasa Corporal , Diagnóstico Diferencial , Femenino , Humanos , Lipectomía/métodos , Lipectomía/normas , Lipedema/diagnóstico , Lipedema/epidemiología , Lipedema/etiología , Lipedema/terapia , Masculino , Obesidad/complicaciones , Obesidad/diagnóstico , Obesidad/epidemiología , Obesidad/terapiaRESUMEN
The screening of vascular pathologies in physician offices starts with precise medical history and clinical exam. Tools like the Edinburgh Claudication Questionnaire for the peripheral artery disease or the Wells score for the probability of a thromboembolic event are useful. The measure of the ankle brachial index, the D-dimers or any other biological screening are complementary. In the presence of pathological features, it is recommended to organise a specialised consultation in order to precise diagnosis, treatment and follow-up. The screening of a vascular disease is interesting not only for the management of local symptoms, but also for the associated systemic pathologies to provide a preventive medicine of good quality.
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Tamizaje Masivo , Enfermedades Vasculares/diagnóstico , HumanosRESUMEN
Lipedema, the Unknown Abstract. Lipoedema patients suffer from the widespread ignorance of their pathology. Considering its chronic, progressive and invalidating character, the early diagnosis of the disease must constitute the challenge of their caregivers in order to limit medical wanderings and the occurrence of complex clinical pictures. Treatments allow the reduction of lipedema and its long-term control. Management must be individualized according to the stage of the disease. The adherence of the patient, the supervision and the support of the practitioner are essential for obtaining the best results.
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Lipedema/diagnóstico , Adipocitos/patología , Adipocitos/fisiología , Adolescente , Adulto , Permeabilidad Capilar/fisiología , Niño , Diagnóstico Diferencial , Diagnóstico Precoz , Femenino , Humanos , Hiperplasia , Comunicación Interdisciplinaria , Colaboración Intersectorial , Lipedema/etiología , Lipedema/fisiopatología , Lipedema/terapia , Masculino , Persona de Mediana Edad , Embarazo , Factores de Riesgo , Resultado del Tratamiento , Adulto JovenRESUMEN
Context: Subclinical hypothyroidism (SHypo) has been associated with atherosclerosis, but no conclusive clinical trials assessing the levothyroxine impact on carotid atherosclerosis exist. Objective: To assess the impact of treatment of SHypo with levothyroxine on carotid atherosclerosis. Design and Setting: Randomized, double-blind, placebo-controlled trial nested within the Thyroid Hormone Replacement for Subclinical Hypothyroidism trial. Participants: Participants aged ≥65 years with SHypo [thyroid-stimulating hormone (TSH), 4.60 to 19.99 mIU/L; free thyroxine level within reference range]. Intervention: Levothyroxine dose-titrated to achieve TSH normalization or placebo, including mock titrations. Main Outcome Measures: Carotid intima media thickness (CIMT), maximum plaque thickness measured with ultrasound. Results: One hundred eighty-five participants (mean age 74.1 years, 47% women, 96 randomized to levothyroxine) underwent carotid ultrasound. Overall mean TSH ± SD was 6.35 ± 1.95 mIU/L at baseline and decreased to 3.55 ± 2.14 mIU/L with levothyroxine compared with 5.29 ± 2.21 mIU/L with placebo (P < 0.001). After a median treatment of 18.4 months (interquartile range 12.2 to 30.0 months), mean CIMT was 0.85 ± 0.14 mm under levothyroxine and 0.82 ± 0.13 mm under placebo [between-group difference = 0.02 mm; 95% CI, -0.01 to 0.06; P = 0.30]. The proportion of carotid plaque was similar (n = 135; 70.8% under levothyroxine and 75.3% under placebo; P = 0.46). Maximum carotid plaque thickness was 2.38 ± 0.92 mm under levothyroxine and 2.37 ± 0.91 mm under placebo (between-group difference -0.03; 95% CI, -0.34 to 0.29; P = 0.86). There were no significant interactions between levothyroxine treatment and mean CIMT, according to sex, baseline TSH (categories 4.6 to 6.9, 7.0 to 9.9, and ≥10 mIU/L), or established cardiovascular disease (all P for interaction ≥ 0.14). Conclusion: Normalization of TSH with levothyroxine was associated with no difference in CIMT and carotid atherosclerosis in older persons with SHypo.
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Aterosclerosis/complicaciones , Hipotiroidismo/complicaciones , Hipotiroidismo/tratamiento farmacológico , Tiroxina/uso terapéutico , Anciano , Anciano de 80 o más Años , Enfermedades Asintomáticas , Aterosclerosis/sangre , Aterosclerosis/diagnóstico , Aterosclerosis/tratamiento farmacológico , Método Doble Ciego , Femenino , Terapia de Reemplazo de Hormonas , Humanos , Hipotiroidismo/sangre , Masculino , Pruebas de Función de la Tiroides , Hormonas Tiroideas/sangre , Tirotropina/sangreRESUMEN
Ultrasonographic detection of subclinical atherosclerosis improves cardiovascular risk stratification, but uncertainty persists about the most discriminative method to apply. In this study, we found that the "atherosclerosis burden score (ABS)", a novel straightforward ultrasonographic score that sums the number of carotid and femoral arterial bifurcations with plaques, significantly outperformed common carotid intima-media thickness, carotid mean/maximal thickness, and carotid/femoral plaque scores for the detection of coronary artery disease (CAD) (receiver operating characteristic (ROC) curve area under the curve (AUC) = 0.79; P = 0.027 to <0.001 with the other five US endpoints) in 203 patients undergoing coronary angiography. ABS was also more correlated with CAD extension (R = 0.55; P < 0.001). Furthermore, in a second group of 1128 patients without cardiovascular disease, ABS was weakly correlated with the European Society of Cardiology chart risk categories (R(2) = 0.21), indicating that ABS provided information beyond usual cardiovascular risk factor-based risk stratification. Pending prospective studies on hard cardiovascular endpoints, ABS appears as a promising tool in primary prevention.
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Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedad de la Arteria Coronaria/etiología , Técnicas de Apoyo para la Decisión , Arteria Femoral/diagnóstico por imagen , Enfermedad Arterial Periférica/diagnóstico por imagen , Placa Aterosclerótica , Adulto , Anciano , Área Bajo la Curva , Enfermedades de las Arterias Carótidas/complicaciones , Grosor Intima-Media Carotídeo , Angiografía Coronaria , Enfermedad de la Arteria Coronaria/diagnóstico por imagen , Femenino , Humanos , Masculino , Persona de Mediana Edad , Enfermedad Arterial Periférica/complicaciones , Valor Predictivo de las Pruebas , Pronóstico , Curva ROC , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Adulto JovenRESUMEN
PURPOSE: The optimal approach to diagnosing deep venous thrombosis is not entirely clear. In this prospective cohort study, we aimed to evaluate the yield of two methods of assessing the pretest probability of deep venous thrombosis-the treating physician's implicit assessment and the Wells score, a validated prediction rule that incorporates signs, symptoms, and the presence or absence of an alternative diagnosis-used in isolation and in combination with D-dimer measurement. SUBJECTS AND METHODS: We studied 278 patients who were referred for suspicion of deep venous thrombosis. All patients were stratified into groups of low, moderate, or high risk of deep venous thrombosis on the basis of the clinical assessment and Wells score, and underwent rapid quantitative D-dimer testing (with a cutoff of 500 microg/mL), ultrasound examination, and follow-up for the occurrence of venous thromboembolism. RESULTS: Eighty-two patients (29%) had a deep venous thrombosis. The accuracy of both methods was good (area under the receiver operating characteristic curve = 0.72), despite only fair agreement at the level of individual patients (weighted kappa = 0.31; 95% confidence interval [CI]: 0.23 to 0.40). The negative predictive value of D-dimer measurement was 96% (95% CI: 91% to 100%). When restricted to patients with low pretest probability, the negative predictive value of D-dimer measurement was 100% (95% CI: 96% to 100%) with the use of the Wells score and 96% (95% CI: 88% to 100%) with the physician's assessment. Our results were unchanged in analyses restricted to patients with proximal deep venous thrombosis or outpatients. CONCLUSION: Clinical assessment to stratify a patient's likelihood of having deep venous thrombosis should be taught to physicians.