Assessment of cardio-ankle vascular index in patients with abdominal aortic aneurysm: An observational study.

OBJECTIVES: Arterial stiffness is associated with major adverse cardiovascular events. The aim of this study is to investigate arterial stiffness by cardio-ankle vascular index (CAVI) in patients with abdominal aortic aneurysm (AAA). METHODS: This observational and cross-sectional study involved 59 subjects with AAA and 32 healthy subjects. All subjects underwent ultrasonography examination. CAVI was measured by VaSera-1000 CAVI instrument. RESULTS: Mean abdominal aortic diameter of AAA patients and controls were 43.88 ± 9.28 mm and 20.43 ± 3.14 mm, consecutively. Baseline clinical characteristics of the patients and controls were similar for age, presence of hypertension, diabetes, dyslipidemia, coronary artery disease and smoking. Left ventricle ejection fraction and Left ventricle mass index (LVMI) were similar between groups. CAVI was significantly higher in patients with AAA than controls (9.74 ± 1.50 vs. 7.60 ± 1.07, p < 0.001). CAVI was positively correlated with AAA diameter (r = 0.461, p < 0.001) and negatively correlated with left ventricle ejection fraction (r= -0.254, p = 0.015). CAVI >8.3 had a sensitivity 89.8% and a specificity of 78.1% for predicting the presence of AAA in ROC analysis (area under curve = 0.897, 95%CI = 0.816-0.951, p < 0.001). CONCLUSION: CAVI is increased in patients with AAA. Increased arterial stiffness may be a mechanical link between AAA, coronary artery disease and peripheral artery disease or a common mechanism effects the arterial stiffness, coronary artery disease, peripheral artery disease and AAA. Therefore, CAVI may be used as a valuable marker for risk stratification for the development of AAA in susceptible patients.

Assessment of cardiac mechanics and biomarkers during headache attack in migraine patients with aura: a prospective study.

Migraine with aura (MA) was found to be associated with increased cardiovascular events (CVE), whereas left ventricular (LV) mechanics were not previously studied in migraineurs. In this study, we aimed to assess LV functions with the utility of two-dimensional speckle tracking echocardiography (2D-STE) and cardiac biomarkers with respect to the headache-free and attack periods and frequency of migraine attacks. Sixty-eight patients with MA were enrolled. During headache-free and attack periods, all patients underwent echocardiographic examination including 2D-STE, and cardiac biomarkers, B-type natriuretic peptide (BNP) and high sensitive cTnT (hs-cTnT) were studied. The impact of headache periods and frequency of attacks on cardiac mechanics and biomarkers were investigated. The mean age of study population was 38.1 ± 7.7 years (56 female) and thirty-one patients (44.6%) had high-frequency migraine attacks. Patients who suffered headache-attack periods had higher frequency of detectable hs-cTnT levels and increased NT-proBNP values which did not differ between low- and high-frequency migraine groups in both periods. Headache attack periods had decreased global longitudinal strain (GLS), increased LV end-systolic volume (LVESV), E/Em ratio and LV torsion (LV-tor) during headache-attack periods. In multivariate analysis; LVESV, LV-tor and high frequency of migraine attacks were associated with decreased GLS (≤ - 20.8), (p 0.038, p 0.026 and p 0.013, respectively). Consequently, 2D-STE findings revealed that migraine attacks, especially with increasing frequencies, could have negative impact on LV mechanics, which adds a new perspective about increased CVE in subjects with MA.

Assessment of arterial stiffness in patients with venous thromboembolism: Separate or continuous circuits?

Objectives The aim of this study is to evaluate the association of venous thromboembolism with arterial stiffness by cardio-ankle vascular index method. Method We included 52 patients with a documented lower extremity venous thromboembolism within the last six months and 52 healthy subjects to this cross sectional observational study. Results Cardio-ankle vascular index (8.58 ± 1.60 versus 7.05 ± 1.44, p < 0.001, respectively) and systolic blood pressure (128.02 ± 7.13 mmHg versus 123.94 ± 8.12 mmHg, p = 0.008, respectively) were significantly higher among patients with venous thromboembolism than controls. Cardio-ankle vascular index was an independent predictor of venous thromboembolism in multivariate logistic regression analysis (p < 0.001, odds ratio = 1.864, 95% confidence interval = 1.370-2.536). Cardio-ankle vascular index value > 7.8 had a sensitivity of 82.7% and a specificity of 80.8% for predicting venous thromboembolism (area under curve = 0.789, 95% confidence interval = 0.698-0.863, p < 0.001) in receiver operating characteristic curve analysis. Conclusion We found that arterial stiffness was increased in patients with venous thromboembolism which highlights the fact that arterial and venous circulation is in continuum and an insult may affect both of these circuits.

Assessment of Silent Neuronal Injury Following Coronary Angiography and Intervention in Patients With Acute Coronary Syndrome.

The aim of this study is to evaluate the incidence and predictors of silent neuronal injury (SNI) after coronary angiography (CAG) and intervention by serial measurement of serum neuron-specific enolase (NSE) in patients presented with acute coronary syndrome (ACS). Ninety-eight consecutive patients presented with ACS and underwent CAG and intervention were included in the study. The NSE levels significantly increased after CAG and intervention compared to baseline levels (22.03 ± 27.70 and 10.08 ± 3.15 consecutively). Left ventricular ejection fraction in the SNI+ group was significantly lower than that in the SNI- group (43.71% ± 12.51%, 50.84% ± 9.34%, P = .002). Maximal creatinine kinase myocardial band, troponin I, and SYNTAX score of the SNI+ group were significantly higher than those of the SNI- group (103.83 ± 99.22, 51.92 ± 78.33, P = .006; 50.04 ± 66.18, 19.18 ± 30.50, P = .002; 103.83 ± 99.22, 51.92 ± 78.33, P = .006; and 50.04 ± 66.18, 19.18 ± 30.50, P = .002 successively). SYNTAX score and performing percutaneous coronary intervention were the independent predictors of SNI (P = .009, odds ratio [OR] = 1.06, 95% confidence interval [CI] = 1.014-1.107, P = .036, OR = 4.262, 95% CI = 1.097-16.56). Percutaneous coronary intervention and coronary artery lesion complexity may increase the risk of SNI in patients with ACS.

Assessment of arterial stiffness in patients with chronic lower extremity venous disease: An observational study.

OBJECTIVES: Arterial stiffness is associated with major adverse cardiovascular events. Chronic venous insufficiency (CVI) is severe form of chronic venous disease (CVD). The aim of this study is to investigate arterial stiffness by cardio-ankle vascular index (CAVI) in patients with CVI. METHODS: This observational and cross-sectional study involved 87 subjects with CVI and 86 healthy subjects. All subjects underwent ultrasonography examination. CAVI was measured by VaSera-1000 CAVI instrument. RESULTS: High density lipoprotein cholesterol (HDL) was significantly lower in patients with CVI than controls (46.83 ± 9.25 mg/dl vs 51.33 ± 11.13 mg/dl, p = 0.004). Body mass index (BMI) was significantly higher in CVI patients than controls (28.53 ± 4.10 kg/m(2) vs 26.37 ± 5.16 kg/m(2), p = 0.003). Ankle brachial index (ABI) was significantly lower in patients with CVI compared to controls (1.08 ± 0.08 vs 1.14 ± 0.11, p < 0.001). CAVI was significantly higher in patients with CVI than controls (7.94 ± 1.37 vs 6.73 ± 1.16, p < 0.001). Mean arterial pressure (MAP) was significantly higher in patients with CVI than control group (105.41 ± 10.77 mmHg vs 99.70 ± 11.17 mmHg, p = 0.001). CAVI (p < 0.001, Odds ratio (OR) = 2.033, 95% Confidence interval (CI) = 1.493-2.768), ABI (p = 0.003, OR = 0.003, 95% CI = 0.001-0.137), female sex (p < 0.001, OR = 3.949, 95% CI = 1.613-9.663), and HDL (p < 0.001, OR = 0.923, 95% CI = 0.883-0.964) were the independent predictors of CVI. A CAVI value > 7.9 had a sensitivity 64.4% and a specificity of 94.7% for predicting the presence of CVI in ROC analysis (area under curve = 0.791, 95% CI = 0.723-0.849, p < 0.001). CONCLUSION: CAVI is independently increased in CVI patients. Therefore CVI may be accepted a form of vascular sclerosis and vascular system should be evaluated in continuum not isolated.

Assessment of vascular dysfunction after transradial coronary angiography. Is a single catheter better?

BACKGROUND: The aim of this study was to investigate the midterm effects of transradial coronary angiography (TRCAG) on the radial and brachial artery diameter, the vasodilator characteristics, as well as to assess the factors determining functional recovery. METHODS: This study included 136 consecutive patients who underwent TRCAG. The radial artery was evaluated with ultrasonography before and 1 month after the procedure. RESULTS: The basal right radial artery diameter (2.97 ± 0.46 vs. 2.82 ± 0.51, p < 0.001), after flow-mediated dilatation (FMD; 3.18 ± 0.45 vs. 2.99 ± 0.54, p < 0.001) and after nitroglycerin-mediated dilatation (NMD; 3.32 ± 0.45 vs. 3.11 ± 0.54, p < 0.001), and the percentage change in diameter after FMD (7.50 ± 3.62 vs. 5.89 ± 3.04, p < 0.001) and NMD (12.42 ± 4.96 vs. 10.54 ± 4.47, p < 0.001) were significantly decreased 1 month after TRCAG. The mean basal diameter of the right brachial artery (4.41 ± 0.58 vs. 4.40 ± 0.58, p = 0.012) after FMD (4.61 ± 0.60 vs. 4.59 ± 0.59, p < 0.001) and the percentage change in diameter after FMD (4.53 ± 2.29 vs. 4.33 ± 2.56, p = 0.038) were significantly decreased 1 month after TRCAG. The number of catheters used (B = 0.372, p < 0.001, 95 % CI = 0.006-0.013), basal radial artery diameter (B = - 0.217, p = 0.001, 95 % CI = - 0.021- 0.006), presence of hypertension (B = - 0.151, p = 0.011, 95 % CI = - 0.015 - 0.002), and pain score (B = 0.493, p < 0.001, 95 % CI = 0.007 - 0.012) were independent predictors of radial artery FMD change in multivariate regression analysis. The number of catheters used (B = 0.378, p < 0.001, 95 % CI = 0.009 - 0.020), basal radial artery diameter (B = - 0.210, p = 0.010, 95 % CI = - 0.034 - 0.005), and pain score (B = 0.221, p < 0.001, 95 % CI = 0.002-0.011) were independent predictors of radial artery NMD change in multivariate regression analysis. CONCLUSION: Basal radial artery diameter, the number of catheters used during TRCAG, and the pain perceived during the procedure seem to be important predictors of vascular functional changes after TRCAG.