Peripheral atherosclerosis evaluation through ultrasound: A promising diagnostic tool for coronary artery disease.

Effective treatment, but also proper diagnosis of cardiovascular diseases, remains a major challenge in everyday practice. A quick, safe, and economically acceptable non-invasive procedure should play a leading role in cardiovascular risk assessment before invasive diagnostics is performed. The staging of subclinical atherosclerosis may help in further clinical decisions. Safe, widely available, and relatively inexpensive, ultrasonography is a promising examination that should find wider application in clinical practice. The latest ESC guidelines emphasize the usefulness of carotid ultrasound in the diagnosis of coronary artery disease (CAD) and subclinical assessment of atherosclerosis, which help to determine the level of cardiovascular risk. Ultrasound examination of peripheral arteries, especially superficial vessels such as the femoral arteries, is quite easy, quick, and accurate. Other vascular beds, such as iliac and renal, are more demanding to examine, but can also provide valuable information. This review summarizes important studies comparing the severity of atherosclerosis in ultrasound-visible vascular beds in patients with established CAD. We especially emphasize the benefits of the combined assessment of atherosclerosis features, which were characterized by high sensitivity and specificity in the diagnosis of CAD and other serious cardiovascular diseases.

A new threshold for kidney asymmetry improves association with abnormal renal-aortic ratio for diagnosis of renal artery stenosis.

BACKGROUND: Renal artery stenosis (RAS) reflects more widespread atherosclerosis deposition and is associated with high morbidity and mortality. According to the guidelines, a discrepancy in the size of the kidneys of over 15 mm found in an ultrasound should initiate the RAS diagnostic algorithm. This study aims to find the optimal threshold for renal asymmetry that better reflects the frequency of a significantly abnormal renal-aortic ratio (RAR), justifying further RAS diagnostic workup, than the currently used cut-off of 15 mm difference in renal diameters. METHODS: The analysis included 1175 patients (mean age: 52 years, IQR: 38-66, men/women: 597/578) who underwent Doppler ultrasonography screening of renal arteries with recorded kidney size and RAR calculation. Ultrasound features of RAS were defined as a RAR greater than 3.5 or signs of renal artery occlusion. Receiver operating characteristic (ROC) curves were created and analyzed for absolute differences in kidney size and abnormal RAR. We calculated the area under the curve (AUC) and optimal cut-off values for sensitivity and specificity analysis. RESULTS: The final analysis included 169 patients with a significant difference in renal dimension. RAS features were met in 61 patients. According to ROC curve analysis, the optimal index of renal asymmetry was 12 mm. The sensitivity and specificity for this method were 82.0% and 83.3%, respectively, and AUC was 86.3%. CONCLUSION: Changing the definition of a significant difference in kidney size from 15 mm to 12 mm increases sensitivity and specificity for abnormal RAR and this finding may accelerate the diagnosis of RAS.

Individuals with high-normal blood pressure have different metabolic and haemodynamic characteristics to those with optimal blood pressure.

BACKGROUND: The ESH classification of blood pressure includes the high-normal blood pressure (HNBP) category, which is within normal limits but associated with increased cardiovascular (CV) risk. AIM: To identify additional CV risk factors and early signs of target organ damage in healthy individuals with HNBP. METHODS: Healthy volunteers (n = 74) with optimal blood pressure or HNBP were compared with respect to metabolic and haemodynamic parameters. RESULTS: The HNBP was associated with higher serum uric acid (333.1 ± 65.4 vs 267.7 ± 65.4 µmol/L, p < 0.05) and glucose (4.7 ± 0.3 vs 4.5 ± 0.3 mmol/L, p < 0.01) concentrations, intima-media thickness (0.39 ± 0.06 vs 0.36 ± 0.04 mm, p < 0.05), systemic vascular resistance index (2,678.2 ± 955.9 vs 1,930.2 ± 625.5 dyn x s x m(2)/cm(5), p < 0.001), lower total arterial compliance index (1.04 ± 0.42 vs 1.44 ± 0.48 mL/[mm Hg x m(2)], p < 0.01) and baroreflex sensitivity (14.2 ± 3.8 vs 18.0 ± 8.8 mm Hg(2)/Hz, p = 0.05). CONCLUSIONS: The observed differences in metabolic and haemodynamic profile in HNBP may adversely affect CV risk in these individuals.

Different diagnostic criteria significantly affect the rates of hypertension in 18-year-old high school students.

INTRODUCTION: Childhood hypertension is defined based on the normative distribution of blood pressure (BP), but from the age of 18 years high BP is diagnosed using adult criteria. We compared the rates of diagnosis of hypertension in a group of 18-year-old subjects using BP percentiles and the adult criteria. MATERIAL AND METHODS: Blood pressure was measured by registered nurses in 1472 18-year-old high-school students (780 men and 692 women). Also weight, height and waist circumference were recorded. RESULTS: The prevalence of hypertension was 9% (16.2% in men and 0.9% in women, p < 0.001) using adult cut-off values and 14.7% (21.9% in men and 6.6% in women, p < 0.001) using percentile charts. Obesity was diagnosed in 2.4% and overweight in 13% of subjects, respectively. The relative risk ratio of diagnosing hypertension according to the adult criteria in overweight or obese subjects was 2.94 (95% CI 2.25-3.86) in men and 6.44 (95% CI 3.51-11.82) in women. CONCLUSIONS: Our study indicates high prevalence of hypertension in 18-year-old students - especially in men - and the importance of obesity as a risk factor of hypertension. The use of percentile charts instead of adult cut-off values increases the prevalence of hypertension in men by 35% from 16.2% to 21.9% and in women more than 7 times, i.e. from 0.9% to 6.6%. It seems reasonable to use higher (i.e. 98(th)) percentile values for definition of high blood pressure.