Association of carotid atheroma plaque with IL-18 levels and with polymorphisms in the IL-18 receptor gene in a Mediterranean population. / Asociación de la placa de ateroma carotídea con los niveles plasmáticos de IL-18 y con polimorfismos en el gen del receptor de la IL-18 en la población mediterránea.

BACKGROUND: Atherosclerosis is an inflammatory disease. Interleukin 18 (IL-18) is an inflammatory molecule that has been linked to the development of atherosclerosis and cardiovascular disease. OBJECTIVE: To evaluate the possible relationship between plasma levels of IL-18 and the presence of atherosclerosis evaluated at the carotid level, as well as to analyze the possible modulation by different polymorphisms in a Mediterranean population. MATERIAL AND METHODS: Seven hundred and forty-six individuals from the metropolitan area of Valencia were included, recruited over a period of 2 years. Hydrocarbon and lipid metabolism parameters were determined using standard methodology and IL-18 using ELISA. In addition, carotid ultrasound was performed and the genotype of four SNPs related to the IL-18 signaling pathway was analyzed. RESULTS: Patients with higher plasma levels of IL-18 had other associated cardiovascular risk factors. Elevated IL-18 levels were significantly associated with higher carotid IMT and the presence of atheromatous plaques. The genotype with the A allele of the SNP rs2287037 was associated with a higher prevalence of carotid atheromatous plaque. On the contrary, the genotype with the C allele of the SNP rs2293224 was associated with a lower prevalence of atheromatous plaque. CONCLUSIONS: High levels of IL-18 were significantly associated with a higher carotid IMT and the presence of atheromatous plaques, which appear to be influenced by genetic factors, as evidenced by associations between SNPs in the IL-18 receptor gene and the presence of atheroma plaque.

Three-dimensional transesophageal echocardiographic evaluation of aortic plaque after cerebrovascular event.

INTRODUCTION AND OBJECTIVES: Transesophageal echocardiography (TEE) is crucial in order to assess aortic anatomy after stroke. Although routinely used to assess cardiovascular anatomy and function, three-dimensional echocardiography (3D TEE) is less used for aortic evaluation. We thus sought to assess prospectively whether additional information on aortic plaque morphology could be obtained with 3D TEE after an ischemic stroke. METHODS: Patients within one week of a stroke (confirmed by brain computed tomography/magnetic resonance) underwent TEE and 3D findings were compared with two-dimensional (2D) (aorta plaque number, dimensions, area and the presence of debris and ulcerations). Patients were followed for two years for death or a new stroke. RESULTS: We assessed 78 patients, 43 (55%) male, aged 62±14 years old, 92% in sinus rhythm. Aortic atheroma was found mainly in the descending aorta (50%); plaque thickness was similar for 2D TEE (0.29±0.03 cm) and 3D TEE (0.29±0.04 cm), whereas plaque area was slightly increased for 3D measurements (0.24±0.02 cm2 versus 0.37±0.03 cm2 respectively, p<0.05), with a strong correlation found both for aortic plaque thickness (r=0.91) and area (r=0.80) measurements. While aortic debris were equally seen with both techniques, 3D TEE defines the presence of ulcerations (six ulcerations unseen with 2D TEE better, p=0.03). There were 11 events (six deaths and five new strokes) during follow-up, unrelated to plaque characteristics. CONCLUSION: To evaluate aortic plaque morphology, 3D TEE is superior to 2D TEE due to improved detection of ulcerated aortic plaque; this might provide additional information in patients after ischemic stroke.

Lesión carotídea arteriosclerótica en pacientes con cirugía coronaria / Carotid atherosclerotic lesion in patients with coronary surgery

Introducción: Las enfermedades cardiovasculares isquémicas constituyen la primera causa de muerte en el mundo desarrollado o en vías de serlo, por encima de las oncológicas, de los accidentes del tránsito y de las enfermedades vásculo-cerebrales. El diagnóstico temprano de una lesión coronaria permite lograr la prevención del ataque isquémico agudo, y realizar el tratamiento revascularizador oportuno con evaluación de riesgo quirúrgico, que permita obtener cifras de morbimortalidad aceptables. Objetivo: Describir las características ultrasonográficas de las arterias carotídeas como riesgo de accidente cerebro-vascular en pacientes con revascularización miocárdica. Métodos: Se realizó un estudio observacional, descriptivo y longitudinal en 208 pacientes revascularizados del sector coronario, con estudio ultrasonográfico prequirúrgico de las arterias carotídeas como método predictivo de enfermedad vásculo-cerebral isquémica. Resultados: En 20 pacientes se presentaron síntomas cerebrales que se clasificaron en menores y mayores. Existió preponderancia de los menores y, entre ellos, de la agitación. Se evaluaron los factores de riesgo primarios y en las características de las placas ateroescleróticas se destacó el grado de irregularidad. Conclusiones: El estudio ultrasonográfico del árbol arterial carotídeo debe formar parte esencial del estudio predictivo del paciente que va a ser sometido a una revascularización coronaria(AU)

Introduction: Ischemic cardiovascular diseases are the leading cause of death in the developed world or in the process of becoming so, above oncological ones, traffic accidents and vascular-cerebral diseases. The early diagnosis of a coronary lesion allows to achieve the prevention of acute ischemic attack, and to perform the appropriate revascularization treatment with surgical risk assessment, which allows to obtain acceptable morbidity and mortality figures. Objective: To describe the ultrasonographic characteristics of carotid arteries as a risk of stroke in patients with myocardial revascularization. Methods: An observational, descriptive and longitudinal study was conducted in 208 coronary sector´s revascularized patients, with pre-surgical ultrasonographic study of the carotid arteries as a predictive method of ischemic cerebral vascular disease. Results: In 20 patients there were brain symptoms that were classified into minor and major. There was a predominance of minors and, among them, of agitation. The primary risk factors were evaluated and the degree of irregularity was highlighted in the characteristics of the atherosclerotic plaques. Conclusions: The ultrasonographic study of the carotid arterial tree should be an essential part of the predictive study of the patient who is undergoing coronary revascularization(AU)

Morphohistological analysis of the prevalence and distribution of atheroma in the abdominal aorta and its branches: a cadaveric study / Análise morfo-histológico sobre prevalência e distribuição de ateroma na aorta abdominal e em seus ramos: estudo em cadáveres

Abstract Background Aneurysms and atheromatous processes are prominent pathological features that are commonly associated with significant morbidity and mortality. Objectives This cadaveric study was conducted to evaluate the morphometric and histological aspects of atheromatous plaque formation in abdominal aortas and their branches and their associated morphological variations, if present, characterized by loops, kinking, or tortuosity. Methods The study was performed using 30 human cadavers (approx. 65-75 years). Frequency of occurrence of calcified plaques in the abdominal aorta and its branches and their morphometric measurements were noted and histological features were observed with the aid of Hematoxylin & Eosin staining. Results Variations in the abdominal aorta and the common iliac artery were observed in 16.6% of specimens. Atheromatous plaque formation was seen in 2 specimens (1 specimen was associated with kinking) while in 3 other specimens only variation in normal structure (kinking/ tortuous artery) was observed. Histological analysis showed foamy macrophages and dense calcification, giving an atheromatous appearance. Conclusions Cadaveric reports of the location, nature, and degree of plaque formation in the abdominal aorta and its branches are extremely important in clinical settings and for choosing treatment options.

Resumo Contexto Aneurismas e processos ateromatosos são características patológicas perceptíveis que costumam estar associadas a morbidade e mortalidade significativas. Objetivos Este estudo em cadáveres teve como objetivo avaliar os aspectos morfométricos e histológicos da formação de placa ateromatosa na aorta abdominal e em seus ramos com suas subsequentes variações morfológicas caracterizadas por enrolamentos, acotovelamentos ou tortuosidades, se presentes. Métodos O estudo foi realizado com 30 cadáveres humanos (aproximadamente 65-75 anos). Foi descrita a frequência de ocorrência de placas calcificadas na aorta abdominal e em seus ramos com as respectivas medidas morfométricas e características histológicas com auxílio da coloração por hematoxilina e eosina. Resultados Variações na aorta abdominal e na artéria ilíaca comum foram observadas em 16,6% dos espécimes. A formação de placa ateromatosa foi observada em dois espécimes (um espécime foi associado a acotovelamento), enquanto em outros três espécimes houve apenas variação na estrutura normal (acotovelamento/artéria tortuosa). A análise histológica mostrou macrófagos espumosos e calcificação densa, o que gerou uma impressão ateromatosa. Conclusões Os estudos em cadáveres sobre localização, natureza e grau de formação de placa na aorta abdominal e em seus ramos são extremamente importantes para os cenários clínicos e as opções de tratamento.

Factores pronósticos de aterosclerosis subclínica en pacientes dislipidémicos / Prognostic factors subclinical atherosclerosis in dyslipidemic patients

Introducción: La aterosclerosis subclínica es predictora de eventos vasculares futuros y es diagnosticada por imágenes y biomarcadores sin que existan manifestaciones clínicas. Objetivo: Identificar los factores pronósticos asociados con la aterosclerosis subclínica en pacientes dislipidémicos. Método: Se realizó un estudio de cohorte en el Hospital Hermanos Ameijeiras en 1028 pacientes en el periodo de 2016 al 2019. Resultados: La existencia de placa de ateroma fue de 26,9 por ciento. Existieron diferencias significativas relacionadas al tabaquismo (30,0 por ciento vs 23,7 por ciento). En las variables lipídicas, el promedio de los valores de la LDLc fue superior en los pacientes con placa de ateroma y la relación CT/LDL fue mayor en los que no tienen esta alteración. La frecuencia de engrosamiento del complejo íntima-media mayor de 1,0 mm fue de 37,1 por ciento. Existieron diferencias significativas relacionadas al tabaquismo (30,4 por ciento vs 22,4 por ciento) y la presencia de HTA (56,7 por ciento vs 48,8 por ciento ) en las variables lipídicas el promedio de los valores de la HDLc fue superior en los pacientes sin aumento del grosor del complejo íntima-media y la elevación CT/HDL fue mayor en los que presentan dicha alteración. Conclusiones: Los factores que influyen de manera independiente en la probabilidad de formación de las placas de ateroma son la LDLc (elevada), la edad, los triglicéridos y el sexo masculino y los que influyen en la probabilidad para el engrosamiento del complejo íntima-media son la HDLc (baja), el tabaquismo, y la hipertensión arterial(AU)

Introduction: Subclinical atherosclerosis is a predictor of future vascular events and is diagnosed by imaging and biomarkers without any clinical manifestations. Objective: To identify the prognostic factors that are associated with subclinical atherosclerosis in dyslipidemic patients. Method: A cohort study was carried out at the Hermanos Ameijeiras Hospital in 1028 patients in the period from 2016 to 2019. Results: The existence of atheroma plaque was 26.9 percent. There were significant differences related to smoking (30.0 percent vs 23.7 percent). In the lipid variables, the average of the LDLc values ​​is higher in patients with atheroma plaque and the CT/LDL ratio is higher in those without this alteration. Regarding the frequency of thickening of the intima-media complex greater than 1.0 mm, it was 37.1 percent. There were significant differences related to smoking (30.4 percent vs 22.4 percent) and the presence of HTA (56.7 percent vs 48.8 percent in the lipid variables, the average of the HDLc values ​​is higher in the patients without an increase in the thickness of the intima-media complex and the CT/HDL elevation is greater in those with said alteration. Conclusions: The factors that independently influence the probability of atheroma plaque formation are LDLc (elevated), age, triglycerides and male sex, and those that influence the probability of thickening of the intima-media complex. They are HDLc (low), smoking, and high blood pressure(AU)

Antiviral treatment does not improve subclinical atheromatosis in patients with chronic hepatitis caused by hepatitis C virus. / El tratamiento antiviral no mejora la ateromatosis subclínica en pacientes con hepatitis crónica por virus de la hepatitis C.

INTRODUCTION: Chronic infection with hepatitis C virus is a risk factor for developing atheromatous plaques, although the possible effect of virus clearance is unknown. Our aim was to determine whether or not subclinical atheromatosis improved and there was any modification in the composition of the plaques 12 months after eradication of hepatitis C virus by direct-acting antiviral agents. MATERIALS AND METHODS: Prospective study that included 85 patients with chronic hepatitis C virus infection in different stages of fibrosis who were on direct-acting antiviral agents. Patients with a cardiovascular history, diabetes and kidney disease were excluded. An arterial ultrasound (carotid and femoral) was performed to diagnose atheromatous plaques (defined as intima-media thickness ≥1.5mm) and the composition (percentage of lipids, fibrosis and calcium with HEMODYN4 software) was analysed at the beginning of the study and 12 months after stopping the therapy. RESULTS: After follow-up no changes were detected in the intima-media thickness (0.65mm vs. 0.63mm, P=.240) or in the presence of plaques (65.9% vs 71.8%, P=.063). There was also no significant change in their composition or affected vascular territory, with an increase in blood lipid profile (P<.001) after 12 months of treatment. These results were confirmed in subgroups by severity of liver disease. DISCUSSION: The eradication of hepatitis C virus by direct-acting antiviral agents does not improve the atheroma plaques and nor does it vary their composition, regardless of liver fibrosis. More prospective studies are needed to evaluate residual cardiovascular risk after virus eradication.

Chronic hepatitis C infection: An independent risk factor for subclinical atheromatosis. / Infección crónica por el virus de la hepatitis C: un factor de riesgo independiente para la ateromatosis subclínica.

BACKGROUND: The association between subclinical atheromatosis and chronic hepatitis C virus (HCV) infection is unknown but is relevant now that antivirals are improving the survival of patients with the infection. OBJECTIVES: To determine whether HCV is an independent risk factor for subclinical atheromatosis and to analyse the changes in lipid profiles according to viral RNA levels and hepatic fibrosis. PATIENTS AND METHODS: We conducted an observational, cross-sectional study that included 102 HCV-positive patients and 102 HCV-negative patients with parity in terms of sex and age, with no history of cardiovascular or kidney disease or diabetes. Atheromatosis (the presence of atheromatous plaques) and the carotid intima-media thickness (CIMT) were assessed using ultrasonography of the carotid and femoral arteries. RESULTS: There was a greater presence of atheromatosis in any vascular territory in HCV-positive patients than in the patients without infection (58.8% vs. 28.4%, p<.0001). In the multivariate analysis, the factors significantly associated with atheromatosis included HCV infection (OR, 14.37 [5.5-37.3]; p<.001), age (OR, 1.12 [1.1-1.2]; p<.001), male sex (OR, 4.32 [1.9-9.5]; p<.001) and the triglyceride/HDL cholesterol coefficient (TG/HDL-indirect indicator of insulin resistance) (OR, 1.34 [1.1-1.6]; p=.007). The HCV-positive patients with atheromatous plaques had a higher TG/HDL coefficient but no significant differences in terms of the viral load or degree of hepatic fibrosis and with a 'low risk' lipid profile. CONCLUSIONS: HCV infection is an independent risk factor for subclinical atheromatosis. Systemic arterial ultrasonography for this population improves the cardiovascular risk assessment beyond lipid profile abnormalities and the risk calculation using SCORE tables.

Cryptogenic stroke. A non-diagnosis. / Ictus criptogénico. Un no diagnóstico.

The term cryptogenic stroke refers to a stroke for which there is no specific attributable cause after a comprehensive evaluation. However, there are differences between the diagnostic criteria of etiological classifications used in clinical practice. An improvement in diagnostic tools such advances in monitoring for atrial fibrillation, advances in vascular imaging and evidence regarding the implication of patent foramen oval on the risk of stroke specially in young patients are reducing the proportion of stroke patients without etiological diagnosis. We carried out a critical review of the current concept of cryptogenic stroke, as a non-diagnosis, avoiding the simplification of it and reviewing the different entities that could fall under this diagnosis and reviewing the different entities that could fall under this diagnosis; and therefore avoid the same treatment for differents entities with uncertains results.

Ateromas como hallazgo incidental en tomografía computarizada de haz cónico (TCHC): reporte de un caso / Atheromas as incidental findings in cone beam computerized tomography: a case report

Los ateromas son lesiones focales que se desarrollan cuando las sustancias grasas, plaquetas, residuos celulares y el calcio se depositan en el revestimiento de las arterias, siendo la causa principal de los infartos de miocardio y accidentes cerebro vasculares. Estas enfermedades implican una secuencia de factores biológicos y mecanismos que pueden estar influenciados por diabetes mellitus, obesidad, hipertensión arterial, y una adecuada dieta. Se reporta el caso de una paciente de 76 años con imágenes nodulares hiperdensas bilaterales bien definidas sobre la TCHC, la cual permitió observar la localización exacta de las calcificaciones en los espacios de la orofaringe y carótida. Se llegó a un diagnóstico radiológico presuntivo de ateromas calcificados de carótidas. Este hallazgo incidental de calcificaciones bilaterales podría ser el indicador de una situación adversa en el futuro del paciente, ya que a menudo son manifestaciones de enfermedades silenciosas que pueden conducir a la muerte. (AU)

The atheromas are focal lesionsthat developed when fats, platelets, cellular debris and calcium substances are deposited on the lining of the arteries, being the cause pricipal of heart attacks and strokes. This diseases involves a sequence of biological factors and mechanisms which are influenced by diabetes mellitus, obesity, hipertension, poor diet and eating habits which are the classic risk factors that aggravate the disease. The case of a patient of 76 years is reported, with well-defined bilateral hyperdense nodular lesions on the CBCT, which allowed us to obsrve the exact location of calcifications in the spaces of the oropharynx and carotid. It was a presumptive radiological diagnosis of calcified carotid atheroma. This incidental finding of calcifications bilateral determines a powerful indicator of an adverse situation in the future of the patient, as they often are indicators of diseases quiet that can lead to death. (AU)

Randomised intervention study to assess the prevalence of subclinical vascular disease and hidden kidney disease and its impact on morbidity and mortality: The ILERVAS project. / Estudio de intervención aleatorizado para evaluar la prevalencia de enfermedad ateromatosa y renal ocultas y su impacto en la morbimortalidad: Proyecto ILERVAS.

BACKGROUND AND OBJECTIVES: Chronic kidney disease (CKD) and atherosclerosis are 2 interrelated diseases that increase the risk of cardiovascular morbidity and mortality. The objectives of the ILERVAS project are: 1) to determine the prevalence of subclinical arterial disease and hidden kidney disease; 2) to assess the impact of early diagnosis of both diseases on cardiovascular morbidity and mortality and also on the progression of CKD; 3) to have a platform of data and biological samples. METHODS: Randomized intervention study. From 2015 to 2017, 19,800 people (9,900 in the intervention group and 9,900 in the control group) aged between 45 and 70 years without previous history of cardiovascular disease and with at least one cardiovascular risk factor will be randomly selected from the primary health care centres across the province of Lérida. A team of experts will travel around in a mobile unit to carry out the following baseline tests on the intervention group: Artery ultrasound; (carotid, femoral, transcranial and abdominal aorta); ankle-brachial index; spirometry; determination of advanced glycation end products; dried blood spot and urine spot tests. Additionally, blood and urine samples will be collected and stored in the biobank to identify new biomarkers using omics studies. Participants will be followed up until 2025 for identification of cardiovascular events, treatment changes and changes in lifestyle. CONCLUSIONS: The ILERVAS project will reveal the prevalence of subclinical vascular disease and hidden kidney disease, determine whether or not their early diagnosis brings health benefits and will also allow investigation of new risk factors.

Composición y biomecánica de placas de ateroma carotídeas / Composition and biomechanics of carotid atheroma plaques

Introducción: la enfermedad aterosclerótica y sus complicaciones constituyen la causa más frecuente de muerte en el mundo. Un análisis de la relación entre parámetros estructurales y mecánicos de las placas de ateroma carotídea (PAC) es mandatorio a la hora de aumentar nuestros conocimientos en torno a los mecanismos que favorecerían la fatiga mecánica del material de la placa y su complicación. Objetivos: analizar la distensibilidad carotídea en sujetos sanos y con PAC según su composición estructural. Métodos: se estudiaron 100 sujetos asintomáticos con PAC (n=36) y sin PAC (n=64). Se clasificaron las PAC según la mediana de niveles de grises y mapeo por color en lipídicas (L), fibrolipídicas (FL) y fibrosas/calcificadas (FC). Se combinó ultrasonido modo-B con tonometría de aplanamiento y se cuantificó la distensibilidad a lo largo del eje longitudinal en cinco sectores a nivel de la PAC y de la arteria carótida normal. Resultados: se clasificaron 71 PAC (35 L, 16 FL y 20 FC), todas se encontraron en segmentos arteriales con menores niveles de distensibilidad comparado con las arterias sanas. Las PAC FC mostraron mayor rigidez a nivel del hombro proximal en comparación con las L y FL que se comportan de manera más homogénea en todos sus sectores. Conclusión: las PAC L y FL (consideradas de mayor riesgo) no presentaron el cambio significativo de rigidez parietal observado en las PAC FC, consideradas de menor riesgo de complicación. Estas diferencias biomecánicas relacionadas con la composición global de la PAC podrían tener una implicancia en la patogenia de la complicación de placa.

Introduction: the aterosclerotic disease and its complications are the most frequent cause of death in the world. An analysis of the relationship between structural and mechanic parameters of the carotid aterome plaque (CAP) is mandatory in the need of improving our knowledge concerning the mechanisms that would favor the mechanic fatigue of the plaque material and its complication. Objectives: analize the carotid distensibility in healthy persons and with patients with CAP according to their structural composition. Methods: 100 asymptomatic individuals were studied, with CAP (n=36) and without CAP (n=64). CAP persons were classified according to the standard levels of greys and color mapping in lipidic (L), fibrolipidic (FL) and fibrous/calcified (FC). B-mode Ultrasound with applanation tonometry were combined and the distensibility was quantified along the longitudinal axis in five sectors to the level of the CAP and in the normal carotid artery. Results: 71 CAP (35 L, 16 FL y 20 FC) were classified all in low-level distensibility arterial segments compared to healthy arteries. The FC CAP showed more rigidity in the proximal shoulder compared to the L and FL that behave more homogeneously in all their sectors. Conclusion: the L and FL CAPs (considered of major risk) did not present the parietal rigidity significant change observed in the FC CAP, considered of low complication risk. These biomechanic differences related to the global composition of the CAP could have an implication in the pathogenesis of the plaque complication.

Estimación del riesgo cardiovascular y detección de ateromatosis carotídea subclínica en mujeres posmenopáusicas de mediana edad / Estimation of Cardiovascular Risk and Detection of Subclinical Carotid Atheromatosis in Middle-aged Postmenopausal Women

Introducción La incidencia de enfermedad cardiovascular en la mujer aumenta luego de la menopausia.Los puntajes de riesgo tradicionales subestiman el riesgo en la mujer posmenopáusica. El diagnóstico de placa aterosclerótica carotídea (PAC) podría mejorar la estratificación del riesgo. Objetivos 1) Estimar el riesgo cardiovascular en mujeres posmenopáusicas de mediana edad en prevención primaria. 2) Conocer la prevalencia de PAC. 3) Calcular la precisión de los puntajes de riesgo para detectar PAC. Material y métodos Se calcularon el puntaje de Framingham a 10 años (PF10) y el puntaje recomendado por la Organización Mundial de la Salud (POMS), evaluando la concordancia entre ellos. Se determinó la prevalencia de PAC mediante ultrasonido. Se realizó un análisis ROC. Resultados Se incluyeron 334 mujeres (edad 57 ± 5 años). El 96% y el 91% de la población se clasificó como de "riesgo bajo" según el PF10 y el POMS, respectivamente. La concordancia entre los dos puntajes fue regular (kappa 0,31). La prevalencia de PAC fue del 29%. Se observó una correspondencia entre el riesgo estimado por los puntajes y la prevalencia de PAC. Las mujeres con PAC presentaron una prevalencia mayor de hipertensión arterial y tabaquismo, mostrando más frecuentemente un patrón "metabólico" que las mujeres sin PAC. El área bajo la curva del PF10 para detectar PAC fue de 0,79 (IC 95% 0,73-0,84), siendo el punto de corte óptimo = 3%. Conclusiones En esta población clasificada en su mayoría como de riesgo bajo, la prevalencia de PAC fue considerable. Ante un PF10 = 3%, la solicitud de una ecografía carotídea podría optimizar la estratificación del riesgo cardiovascular.

Background Cardiovascular disease in women increases after menopause. Traditional risk scores underestimate the risk in postmeno-pausal women. The diagnosis of carotid atherosclerotic plaque (CAP) could improve risk stratification. Objectives The aim of the study was: 1) To estimate cardiovascular risk in middle-aged postmenopausal women in primary preven-tion. 2) To find CAP prevalence. 3) To assess the precision of risk scores used to detect CAP. Methods The level of agreement between the 10-year Framingham risk score (10-FRS) and the score recommended by the World Health Organization (WHOS) was assessed. Ultrasound was used to determine CAP occurrence. A ROC analysis was performed. Results The study included a total of 334 women with mean age 57 ± 5 years. According to 10-FRS and WHOS, 96% and 91% of the population were respectively classified as "low risk". An adequate level of agreement between both scores was found (kappa 0.31). CAP occurred in 29% of cases. Score estimated risk correlated with CAP prevalence. Women with CAP presented higher incidence of hypertension and smoking, evidencing a more frequent "metabolic" pattern than women without CAP. The area under the curve of 10-FRS to detect CAP was 0.79 (95% CI 0.73-0.84), with an optimal cut-off point = 3%. Conclusions In this population, mostly classified as low risk, there was considerable CAP prevalence. A carotid ultrasound might help to stratify cardiovascular risk when 10-FRS is = 3%.

Diagnóstico diferencial de cartilagem tritícea calcificada com doença ateroesclerótica- ateroma / Differential diagnosis of cartilage tritici and calcified atherosclerotic disease - atheroma

A radiografia panorâmica continua sendo o exame mais solicitado pelo cirurgião dentista. Com certa frequência, o Radiologista pode observar a presença de imagens radiopacas localizadas em áreas de tecido mole. Dentre tantas estruturas anatômicas e entidades patológica que fornecem tais imagens, a imagem de um ateroma, calcificação na artéria carótida, e dascartilagens tritíceas, localizadas nos ligamentos tireohioideos, fornecem imagens na radiografia panorâmica muito semelhante quanto ao tamanho, à forma, à radiopacidade e, principalmente,à localização, região do pescoço no espaço intervertebral C3 e C4. Com base na literatura e ocorrência de casos nas Clínicas de Radiologia da Faculdade de Odontologia de Piracicaba- UNICAMP e Faculdade de Odontologia da PUC-Minas, o objetivo deste trabalho é elucidar os profissionais no procedimento de diagnóstico dessas condições, permitindo identificar pacientes de risco em desenvolver doença encéfalo vascular.

Panoramic radiography remains the most requested examination by a dentist. Not infrequently, the radiologist can observe the presence of radiopaque images located in areas of soft tissue. Among many anatomical and pathological entities that provide such images, the image of an atheroma, calcification inthe carotid artery, and cartilage tritici, located in the ligaments tireohioideos provide images in panoramic radiography very similarin size, shape, and the radiopacity mainly to the location, the neck intervertebral space C3 and C4. Based on the literature and the occurrence of cases in the Clinic of Radiology, Facultyof Dentistry of Piracicaba - UNICAMP and Faculty of Dentistry, PUC-Minas, the aim of this study is to elucidate the professional diagnostic procedure in these conditions, to identify patients a trisk develop brain vascular disease.

Avaliação da prevalência de ateromas na artéria carótida por radiografias panorâmicas / Evaluation of the prevalence of carotid artery atheromas on panomamic radiographs

O objetivo deste estudo foi avaliar a presença de imagens de ateromas em radiografias panorâmicas de acordo com a idade do paciente na data do exame, dividindo em cinco grupos etários. Foi observado que as imagens de ateromas podem ser encontradas em todos os grupos etários selecionados, exibindo prevalência de 1,65 por cento no total de 1.500 exames. A maior incidência foi em pacientes com mais de 61 anos (11.53 por cento). A prevalência de imagens de ateromas em artéria carótida em radiografia panorâmica aumenta de acordo com a idade do paciente, e esse exame possibilita um diagnóstico precoce das calcificações em carótida, promovendo antecipação de tratamentos, reduzindo morbidade e mortalidade

Identificação de bactérias periodontopatogênicas em placas ateromatosas de carótidas humanas / Identification of periodontopathogens in human carotids atherosclerotic plaque

Estudos recentes sugeriram associação entre doença periodontal e doenças cardiovasculares e respiratórias. O objetivo deste estudo foi investigar a presença de bactérias periodontopatogênicas em placas ateromatosas humanas. Foram incluídos no estudo 24 pacientes de ambos os sexos, 40-60 anos de idade, internados na UTI do Hospital Nossa Senhora da Conceição em Tubarão-SC com indicação para endarterectomia. Após a coleta das placas ateromatosas, procedeu-se a identificação de sete diferentes espécies bacterianas periodontopatógenos por meio da reação em cadeia da polimerase em tempo real (RT-PCR). Para realização da análise estatistica foi verificada a associação entre as duas variáveis qualitativas nominais (presença ou ausência de bácterias X tipo de bactérias) por meio do teste Qui-quadrado, com nível designificância de 5 %. Os resultados desse trabalho mostraram haver associação entre presença ou ausência de bactérias e dos diferentes tipos de bactérias nos ateromas analisados (p = 0001). Dos ateromas avaliados 75% apresentaram Porphyromonas gingivalis., 58,3% Treponema denticola., 37,5% apresentaram Fusobacteriumnucleatum., 33,3% Prevotella intermedia., 20,8% Agreggatibacter actinomycetencomitanse. 0,4% de Prevotella nigrescens. Esses achados permitem concluir que bactérias periodontopatogênicas apresentam a capacidade de invadir a parede das artérias, podendo ter papel significativo no desenvolvimento ou ruptura das placas ateroescleróticas.

Recent studies suggested an association between periodontal disease and cardiovascular and respiratory diseases. The aim of this study was to investigate the presence of periodontopathogens in human atherosclerotic plaque. It were included in this study 24 non-smoking patients, both genders, 40-60 years, admitted at intensive unit care with indication of endarterectomy. After collection of carotid samples containing the lesions, the identification of seven different bacterial species was performed by real time polymerase chain reaction (RT-PCR). For statistical analysis, the association between two nominal qualitative variables (presence or absence of bactérias vs. bacterial specieis) was verified by Chi-squared test, with a 5% significance level. The results obtained showed an association between the presence or absence and bacterial species found in atheroma (p= .0001). Among the atheroma examined, 75% showed the presence of Porphyromonas gingivalis, 58.3% showed Treponema denticola, 37.5% showed Fusobacteriumnucleatum, 33.3% showed Prevotella intermedia, 20.8% Agreggatibacter actinomycetencomitans and 0.4% Prevotella nigrescens. These findings suggest that periodontopatoghens are capable of invading artery wall and could play a significant role in the development or rupture of atherosclerotic lesions.

Identificação de bactérias periodontopatogênicas em placas ateromatosas de carótidas humanas / Identification of periodontopathogens in human carotids atherosclerotic plaque

Estudos recentes sugeriram associação entre doença periodontal e doenças cardiovasculares e respiratórias. O objetivo deste estudo foi investigar a presença de bactérias periodontopatogênicas em placas ateromatosas humanas. Foram incluídos no estudo 24 pacientes de ambos os sexos, 40-60 anos de idade, internados na UTI do Hospital Nossa Senhora da Conceição em Tubarão-SC com indicação para endarterectomia. Após a coleta das placas ateromatosas, procedeu-se a identificação de sete diferentes espécies bacterianas periodontopatógenos por meio da reação em cadeia da polimerase em tempo real (RT-PCR). Para realização da análise estatistica foi verificada a associação entre as duas variáveis qualitativas nominais (presença ou ausência de bácterias X tipo de bactérias) por meio do teste Qui-quadrado, com nível designificância de 5 %. Os resultados desse trabalho mostraram haver associação entre presença ou ausência de bactérias e dos diferentes tipos de bactérias nos ateromas analisados (p = 0001). Dos ateromas avaliados 75% apresentaram Porphyromonas gingivalis., 58,3% Treponema denticola., 37,5% apresentaram Fusobacteriumnucleatum., 33,3% Prevotella intermedia., 20,8% Agreggatibacter actinomycetencomitanse. 0,4% de Prevotella nigrescens. Esses achados permitem concluir que bactérias periodontopatogênicas apresentam a capacidade de invadir a parede das artérias, podendo ter papel significativo no desenvolvimento ou ruptura das placas ateroescleróticas.

Recent studies suggested an association between periodontal disease and cardiovascular and respiratory diseases. The aim of this study was to investigate the presence of periodontopathogens in human atherosclerotic plaque. It were included in this study 24 non-smoking patients, both genders, 40-60 years, admitted at intensive unit care with indication of endarterectomy. After collection of carotid samples containing the lesions, the identification of seven different bacterial species was performed by real time polymerase chain reaction (RT-PCR). For statistical analysis, the association between two nominal qualitative variables (presence or absence of bactérias vs. bacterial specieis) was verified by Chi-squared test, with a 5% significance level. The results obtained showed an association between the presence or absence and bacterial species found in atheroma (p= .0001). Among the atheroma examined, 75% showed the presence of Porphyromonas gingivalis, 58.3% showed Treponema denticola, 37.5% showed Fusobacteriumnucleatum, 33.3% showed Prevotella intermedia, 20.8% Agreggatibacter actinomycetencomitans and 0.4% Prevotella nigrescens. These findings suggest that periodontopatoghens are capable of invading artery wall and could play a significant role in the development or rupture of atherosclerotic lesions.

Características clínicas y epidemiológicas de la isquemia cerebral transitoria en pacientes egresados de un hospital provincial universitario / Clinical and epidemiological characteristics of the little stroke in patients discharged from a provincial university hospital

Se realizó un estudio observacional, descriptivo y transversal de los 139 pacientes egresados del Servicio de Cerebrovascular del Hospital Provincial Clinicoquirúrgico Docente Saturnino Lora Torres de Santiago de Cuba con el diagnóstico de ataque transitorio de isquemia , en el período comprendido de enero a diciembre de 2007, a fin de caracterizar a la población analizada según variables de interés e identificar los hallazgos tomográticos más frecuentes, así como precisar las características ecográficas de la placa de ateroma y el grado de estenosis presente en quienes se indicó el eco Doppler carotídeo. En la serie, los factores de riesgo más frecuentes fueron: sexo femenino, edad de 65 y más años, hipertensión arterial, tabaquismo, soplo carotídeo y antecedente de un ataque transitorio de isquemia, ocurrido 3 meses antes de efectuar esta investigación.

An observational, descriptive and cross-sectional study was carried out in 139 patients with the diagnosis of a little stroke, discharged from the Cerebrovascular Service at Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital in Santiago de Cuba from January to December, 2007, with the aim of characterizing the population analyzed according to interest variables and identifying the most frequent tomographic findings, as well as specifying the echographic characteristics of atheroma and the stenosis degree in those who had a carotid Doppler ultrasonography indication. The most frequent risk factors in the series were: female sex, 65 years old and over, hypertension, smoking habit, carotid bruit and history of a little stroke suffered 3 months before carrying out this investigation.

Variation of the origin of aortic arch branches: in relationship with plates of atheroma / Variación del origen de las ramas del arco aórtico: relación con placas de ateromas

The aortic arch branches variations have called the attention of several authors, who have handled studies and classifications, both human and in different animals. The common trunk, which is between the brachiocephalic trunk and the common left carotid artery, is the most common variation. We conducted a descriptive and randomized study of the presence of the trunk mentioned before, trying to establish the possible relationship between this variation and the distribution plates of atheroma. The lumen observation makes it possible to define and check the distribution of the ostium, among the common ostium and the ones with common trunks. Regarding the plates of atheroma, it was found that there is a slight prevalence in common trunks cases, with respect to the classics (no variety) or the ones who had common ostium. In all cases, the presence of a plaque in the distal aortic arch was certified near the left subclavian artery. The knowledge of the existence of the common trunk sets up an act of academic interest, as practice interventions and diagnostic imaging and clinical work, since the presence of the common trunk might be related to the prevalence of the plates of atheroma at the level of its origin.

Las variaciones de las ramas del arco aórtico han llamado la atención de diversos autores, quienes han realizados estudios y clasificaciones, tanto en humanos, como en diferentes animales. El tronco común, entre el tronco braquiocefálico y la arteria carótida común izquierda, es la variación más frecuente. Realizamos un estudio descriptivo y randomizado de la presencia del mencionado tronco, tratando de verificar la posible relación entre dicha variación y la distribución de placas de ateroma. La observación luminal permitió precisar, entre los casos de ostios comunes y aquellos con troncos comunes, y comprobar la distribución de los ostios. En cuanto a las placas de ateroma, se observó una leve prevalencia en los casos de troncos comunes respecto de los clásicos (sin variedad) o de los que presentaron ostios comunes. En todos los casos se verificó la presencia de una placa en el arco aórtico distal, inmediato a la arteria subclavia izquierda. El conocimiento de la existencia del tronco común, constituye un hecho de interés académico, como práctico en intervencionismo, diagnóstico por imagen y la clínica. La presencia del tronco común pareciera estar relacionada con cierta prevalencia de placas de ateroma a nivel de su origen.

Estudio integral no invasivo de la estructura y función arterial: discusión de aspectos teóricos y prácticos del abordaje implementado en CUiiDARTE (centro universitario de investigación, innovación y diagnóstico arterial): [revisión] / Non-invasive integral study of arterial structure and function: discussion of theoretical and practical features of the approach implemented at CUiiDARTE (centro universitario de investigación, innovación y diagnóstico arterial): [review]

Los sistemas de prevención cardiovascular basados en la determinación de factores de riesgo presentan limitaciones para cuantificar el riesgo de un sujeto. Los factores de riesgo son predictores de aterosclerosis en la población, pero fallan en identificar qué sujetos desarrollarán la enfermedad y/o tendrán eventos cardiovasculares; los que frecuentemente se presentan en sujetos de riesgo bajo o intermedio. En este contexto, guías/consensos sugieren realizar estudios no invasivos en sujetos asintomáticos para estratificar el riesgo individual, detectar y tratar la aterosclerosis en etapa subclínica. Para ello se han propuesto diferentes abordajes que permiten caracterizar la estructura y/o función arterial por métodos no invasivos, brindando información complementaria, que adiciona a la obtenida con la determinación de los factores de riesgo. En Uruguay, recientemente se creó un centro universitario interdisciplinario (CUiiDARTE, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial), que tiene entre sus objetivos implementar técnicas no invasivas para la evaluación integral de la estructura y función arterial, posibilitando dar respuesta a la necesidad de estratificación individualizada del riesgo cardiovascular y detección de aterosclerosis subclínica. En este trabajo se presenta el abordaje de evaluación vascular empleado en CUiiDARTE y basados en nuestra experiencia, se discuten aspectos teóricos y prácticos de los test no invasivos utilizados y parámetros estudiados.

Traditional risk factors-guided cardiovascular prevention/treatment has clear limitations in individual subjects management. Often, individuals with similar risk factor profiles have differences in the atherosclerosis development and are at different cardiovascular risk. Therefore, while risk factors are good predictors of atherosclerosis in a population, they cannot identify who will develop the disease and/or will have a cardiovascular event. In this context, there have been published guidelines calling for non-invasive atherosclerosis screening and risk stratification in asymptomatic subjects. Several approaches have been proposed for the vascular evaluation, and although the screening tests used vary among laboratories, in general terms their are underused. In Uruguay, it was recently created an interdisciplinary university center (CUiiDARTE, Centro Universitario de Investigación, Innovación y Diagnóstico Arterial), which has as a main aim the implementation of non-invasive techniques to evaluate the arterial structural and functional properties, that could allow stratifying the individual cardiovascular risk and identifying sub-clinical atherosclerosis. In this work we present the integral vascular approach used in CUiiDARTE and based in our experience we discuss, theoretical and practical issues related with the tests performed and parameters calculated.