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1.
Vasc Health Risk Manag ; 16: 29-39, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32021226

RESUMEN

Objective: We suggested: 1) patients with idiopathic pulmonary hypertension (IPAH) have active factors which could damage not only the pulmonary but systemic arteries too as in arterial hypertensive patients; 2) if these changes were present, they might correlate with other parameters influencing on the prognosis. This study is the first attempt to use cardio-ankle vascular index (CAVI) for the evaluation of systemic arterial stiffness in patients with IPAH. Methods: A total of 112 patients were included in the study: group 1 consisted of 45 patients with new diagnosed IPAH, group 2 included 32 patients with arterial hypertension, and in the control group were 35 healthy persons adjusted by age. Right heart catheterization, ECG, a 6-minute walk test (6MWT), echocardiography, blood pressure (BP) measurement and ambulatory BP monitoring, pulse wave elastic artery stiffness (PWVe; segment carotid-femoral arteries) and muscular artery stiffness (PWVm; segment carotid-radial arteries), CAVI, and N-terminal pro-B-type natriuretic peptide (NT-proBNP) level were provided. The Spearman correlation, a linear regression and multivariable binary logistic analysis were performed to indicate the predictors associated with PWV and CAVI. Results: The groups were adjusted for principal characteristics influenced on arterial stiffness. IPAH patients had significantly (P<0.001 for all) shorter 6MWT distance and higher Borg dyspnea score than the patients with arterial hypertension (systolic/diastolic BP = 146.1±10.7/94.2±9.8 mmHg) and the control group = 330.2±14.6 vs 523.8±35.3 and 560.9±30.2 m respectively and 6.2±1.8 vs 1.2±2.1 and 0.9±2.8 points. The PWVm and PWVe were the highest in hypertensive patients (10.3±1.5 and 11.42±1.70 m/s). The control group and IPAH did not have significant differences in aorta BP, but PWVm/PWVe values were significantly (P<0.003/0.008) higher in IPAH patients than in the control group (8.1±1.9/8.49±1.92 vs 6.63±1.34/7.29±0.87 m/s). The CAVIs on both sides were significantly lower in the healthy subjects (5.91±0.99/5.98±0.87 right/left side). Patients with IPAH did not differ from the arterial hypertension patients by CAVIs in comparison with the control group (7.40±1.32/7.22±1.32 vs 7.19±0.78/7.2±1.1 PWVe) did not correlate with any parameters except uric acid. PWVm correlated with uric acid (r=0.58, P<0.001), NT-proBNP (r=0.33, P=0.03) and male gender (r=0.37, P=0.013) at Spearman analysis, but not at multifactorial linear regression analysis. The CAVI correlated with age and parameters characterized functional capacity (6MWT distance) and right ventricle function (NT-proBNP, TAPSE) at Spearman analysis and with age and TAPSE at multifactorial linear regression analysis. At binary logistic regression analysis CAVI > 8.0 at right and/or left side had a correlation with age, 6MWT distance, TAPSE, but an independent correlation was only with age (ß=1.104, P=0.008, CI 1.026-1.189) and TAPSE (ß=0.66, P=0.016, CI 0.474-0.925). Conclusion: In spite of equal and at normal range BP level, the age-adjusted patients with IPAH had significantly stiffer arteries than the healthy persons and they were comparable with the arterial hypertensive patients. Arterial stiffness evaluated by CAVI correlated with age and TAPSE in IPAH patients. Based on our results it is impossible to conclude the pathogenesis of arterial stiffening in IPAH patients, but the discovered changes and correlations suggest new directions for further studies, including pathogenesis and prognosis researches.


Asunto(s)
Presión Arterial , Arterias Carótidas/fisiopatología , Hipertensión Pulmonar Primaria Familiar/fisiopatología , Arteria Femoral/fisiopatología , Arteria Pulmonar/fisiopatología , Rigidez Vascular , Adulto , Estudios de Casos y Controles , Estudios Transversales , Hipertensión Pulmonar Primaria Familiar/diagnóstico , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pronóstico , Análisis de la Onda del Pulso
2.
J Stroke Cerebrovasc Dis ; 29(2): 104539, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31810722

RESUMEN

BACKGROUND AND PURPOSE: Previous studies suggested that turbulent flow is closely related to plaque vulnerability. Two-dimensional (2D) flow analysis is a novel modality that enables real-time blood flow analysis by picturing particle movement in the contrast medium. We evaluated flow patterns in the carotid plaque to investigate the correlation between blood flow and plaque vulnerability. MATERIAL AND METHODS: A total of 36 consecutive patients with cervical carotid artery stenosis were evaluated. The flow pattern of carotid artery stenosis was evaluated using 2D real-time flow analysis in the digital subtraction angiography (DSA). The flow pattern was classified into either turbulent or laminar flow as vectors. Plaque vulnerability was evaluated on MR plaque imaging. Univariate analysis was performed to assess the correlation between the flow pattern and plaque features. RESULTS: The turbulent pattern was identified in 28 of 36 plaques (77.8%). Turbulence around plaques was significantly associated with Gadolinium enhancement (P = .0004). The maximum degree of stenosis (P = .0005) and concomitant ulceration (P = .02) were significantly associated with the turbulent pattern. There was no relationship between the turbulent pattern and clinical neurological symptoms. CONCLUSIONS: In the present study, the majority of carotid plaques exhibited a turbulent flow pattern, which was significantly associated with Gadolinium enhancement on MR plaque imaging and morphologic factors. Thus, real-time flow analysis may clarify the pathophysiology of plaque instability and the formation of ulceration.


Asunto(s)
Angiografía de Substracción Digital , Arterias Carótidas/diagnóstico por imagen , Estenosis Carotídea/diagnóstico por imagen , Angiografía por Resonancia Magnética , Placa Aterosclerótica , Anciano , Anciano de 80 o más Años , Velocidad del Flujo Sanguíneo , Arterias Carótidas/fisiopatología , Estenosis Carotídea/fisiopatología , Medios de Contraste/administración & dosificación , Femenino , Humanos , Masculino , Persona de Mediana Edad , Compuestos Organometálicos/administración & dosificación , Valor Predictivo de las Pruebas , Estudios Prospectivos , Flujo Sanguíneo Regional , Rotura Espontánea , Estrés Mecánico
3.
J Stroke Cerebrovasc Dis ; 29(2): 104512, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31786044

RESUMEN

BACKGROUND: Extracranial carotid artery (ECA) tortuosity may influences successful recanalization rates of mechanical thrombectomy in acute ischemic stroke (AIS), yet the relationship between ECA tortuosity and the prognosis of patients with anterior circulation AIS who cannot undergo endovascular treatment remains uncertain. We hypothesized that increased tortuosity of the ECA leads to unfavorable outcomes in such patients. METHODS: Patients with anterior circulation AIS who underwent computed tomography angiography of the head and neck in our hospital between March 2018 and November 2018 were retrospectively analyzed. The tortuosity of the bilateral ECA was measured, and functional outcomes were evaluated by a modified Rankin Scale (mRS) at 90 days. Multivariate logistic regression models were used to determine the association between ECA tortuosity and outcomes of patients. RESULTS: A total of 203 patients were enrolled in our study, including 140 patients (68.97%) with favorable outcomes (mRS, 0-2) and 63 patients (31.03%) with unfavorable outcomes (mRS, 3-6). After adjusting for age, atrial fibrillation, stroke territory, and posthospital antithrombotics/statins therapy in multivariate logistic regression model I, ECA tortuosity (odds ratio, 1.052; 95% confidence interval, 1.010-1.096; P = .015) was an independent risk of unfavorable outcomes in enrolled patients. In the other 2 models (II and III) which adjusted for age, sex, baseline National Institutes of Health Stroke Scale score, and with or without posthospital medication, ECA tortuosity was also showed independent relationship to unfavorable outcomes. The optimal cutoff was 12.5 to predict the unfavorable outcomes in a receiver operating characteristic curve. CONCLUSIONS: Our study demonstrated that the ECA tortuosity is an independent predictor of unfavorable outcomes for anterior circulation AIS patients who without undergoing endovascular treatment after hospital admission. ECA tortuosity values greater than 12.5 may indicate an unfavorable outcome.


Asunto(s)
Isquemia Encefálica/terapia , Arterias Carótidas/diagnóstico por imagen , Angiografía Cerebral/métodos , Circulación Cerebrovascular , Angiografía por Tomografía Computarizada , Procedimientos Endovasculares , Accidente Cerebrovascular/terapia , Anciano , Anciano de 80 o más Años , Anticoagulantes/uso terapéutico , Isquemia Encefálica/diagnóstico por imagen , Isquemia Encefálica/fisiopatología , Arterias Carótidas/fisiopatología , Evaluación de la Discapacidad , Procedimientos Endovasculares/efectos adversos , Femenino , Fibrinolíticos/uso terapéutico , Humanos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Recuperación de la Función , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Accidente Cerebrovascular/diagnóstico por imagen , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento
4.
Angiol Sosud Khir ; 25(3): 107-112, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31503254

RESUMEN

Computer-aided simulation appropriately using the method of computational fluid dynamics (CFD) makes it possible to determine the elevated-risk zones of most probable formation of restenosis. The main idea of the method described in our article consists in a possibility of creating by the model of the geometrical shape of the vessel and characteristics of the flow at inlets and outlets the parameters of flow in each point of a vessel. The curves of velocity are used to create the curves of pressure at inlets and outlets, which are used in a CFD model. The resulting from CFD simulation of blood flow are nonstationary three-dimensional fields of pressure and velocity in the area under study. Visual examination of the dynamics of these fields makes it possible to judge about possible problem zones inside the area of flow and on the internal wall of the vessel. This article also presents a clinical case report illustrating the use of this technique.


Asunto(s)
Arterias Carótidas , Endarterectomía Carotidea , Velocidad del Flujo Sanguíneo , Arterias Carótidas/fisiopatología , Hemodinámica , Humanos , Modelos Cardiovasculares
5.
Biomed Eng Online ; 18(1): 87, 2019 Aug 07.
Artículo en Inglés | MEDLINE | ID: mdl-31391047

RESUMEN

BACKGROUND: Carotid artery geometry is important for recapitulating a pathophysiological microenvironment to study wall shear stress (WSS)-induced endothelial dysfunction in atherosclerosis. Endothelial cells (ECs) cultured with hydrogel have been shown to exhibit in vivo-like behaviours. However, to date, studies using hydrogel culture have not fully recapitulated the 3D geometry and blood flow patterns of real-life healthy or diseased carotid arteries. In this study, we developed a gelatin-patterned, endothelialized carotid artery model to study the endothelium response to WSS. RESULTS: Two representative regions were selected based on the computational fluid dynamics on the TF-shaped carotid artery: Region ECA (external carotid artery) and Region CS (carotid sinus). Progressive elongation and alignment of the ECs in the flow direction were observed in Region ECA after 8, 16 and 24 h. However, the F-actin cytoskeleton remained disorganized in Region CS after 24 h. Further investigation revealed that expression of vascular cell adhesion molecule-1 (VCAM-1) and intercellular adhesion molecule-1 (ICAM-1) was greatly increased in Region CS relative to that in Region ECA. The physiological WSS in the carotid artery system was found to stimulate nitric oxide (NO) and prostacyclin (PGI2) release and inhibit endothelin-1 (ET-1) release after 24-h perfusion experiments. The effective permeability (E.P) of fluorescein isothiocyanate (FITC)-dextran 40 kDa in Regions ECA and CS was monitored, and it was found that the turbulence WSS value (in Region CS) was less than 0.4 Pa, and there was a significant increase in the E.P relative to that in Region ECA, in which laminar WSS value was 1.56 Pa. The tight junction protein (ZO-1) production was shown that the low WSS in Region CS induced ZO-1-level downregulation compared with that in Region ECA. CONCLUSIONS: The results suggested that the gelatin-based perfusable, endothelial carotid artery model can be effective for studying the pathogenesis of atherosclerosis by which flow dynamics control the endothelium layer function in vitro.


Asunto(s)
Aterosclerosis/patología , Biomimética/instrumentación , Arterias Carótidas/patología , Células Endoteliales/patología , Gelatina , Actinas/metabolismo , Aterosclerosis/fisiopatología , Arterias Carótidas/fisiopatología , Citoesqueleto/metabolismo , Células Endoteliales/metabolismo , Análisis de Elementos Finitos , Hemodinámica , Hidrodinámica , Permeabilidad
6.
Med Hypotheses ; 130: 109276, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31383320

RESUMEN

Cancer is the second cause of death worldwide, but current therapies are often insufficient or linked with toxicity. Initial evidence in scientific literature seems to support the role of non-pharmacological strategies, including hypoglycemia, in cancer treatment. The biological rationale for hypoglycemia-based treatment of cancer resides in the evidence that cancer cells predominantly utilize glucose as an energy source; notably, cancer cells seem to have damaged glycolysis regulation and few, defective mitochondria showing impaired oxidative phosphorylation. Preliminary data arising from both preclinical and human studies support the role of hypoglycemia in inducing apoptosis on cancer cells. In this paper, we describe how to induce and maintain severe hypoglycemia without causing damage to either the brain or the heart. Our hypothesis is that ExtraCorporeal Membrane Oxygenation (ECMO) and selective glucose perfusion of the carotid vessels are able to maintain severe hypoglycemia without causing cardiac or brain damage. This will allow physicians to study the effect of severe hypoglycemia on cancer cell apoptosis in vivo.


Asunto(s)
Lesiones Encefálicas/prevención & control , Cardiopatías/prevención & control , Hipoglucemia/fisiopatología , Neoplasias/terapia , Animales , Apoptosis , Glucemia/análisis , Encéfalo/metabolismo , Arterias Carótidas/fisiopatología , Oxigenación por Membrana Extracorpórea , Glucosa/metabolismo , Glucólisis , Humanos , Mitocondrias/metabolismo , Modelos Teóricos , Neoplasias/fisiopatología , Fosforilación Oxidativa , Seguridad del Paciente , Perfusión
7.
Blood Press Monit ; 24(5): 234-240, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31469693

RESUMEN

OBJECTIVE: Pulse pressure is strongly associated with the early development of large-vessel atherosclerotic disease. However, the relationship between pulse pressure and carotid plaque in China is unknown. Thus, we investigated the associations of pulse pressure and mean arterial pressure with the presence of carotid plaques in a low-income population in rural China. PARTICIPANTS AND METHODS: Residents, aged ≥45 years, without histories of stroke or cardiovascular disease were enrolled. Participant demographics, previous medical histories, and lifestyle information were collected; anthropometric measures, serum profiles, and B-mode ultrasonographic investigations were also performed. RESULTS: The mean age of participants (n = 3789) was 59.9 years overall (men 61.1 years; women, 59.1 years). The mean SBP (146.42 mmHg) and DBP (86.81 mmHg), pulse pressures (59.61 mmHg), and mean arterial pressures (106.68 mmHg) were high in this population. The odds ratio (95% confidence interval) for the association of pulse pressure with the presence of carotid plaques was 1.028 (1.023-1.033), in the univariate analysis. After gradual adjustment for demographic features, risk factors, and serum profile measurements, this positive association remained statistically significant (all, P < 0.001). However, there was no significant relationship between mean arterial pressure and the presence of carotid plaques. CONCLUSION: These findings suggest that an elevated pulse pressure is an independent risk factor for the presence of carotid plaque. These results suggest that enhanced monitoring of blood pressure components, among low-income residents, is crucial for decreasing the risk of stroke and other cardiovascular disease in China.


Asunto(s)
Presión Sanguínea , Arterias Carótidas/fisiopatología , Enfermedades de las Arterias Carótidas/epidemiología , Placa Aterosclerótica/epidemiología , Adulto , Anciano , Determinación de la Presión Sanguínea , China/epidemiología , Estudios Transversales , Femenino , Humanos , Estilo de Vida , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Factores de Riesgo , Población Rural
8.
Med Sci Monit ; 25: 4933-4940, 2019 Jul 03.
Artículo en Inglés | MEDLINE | ID: mdl-31269009

RESUMEN

BACKGROUND We discuss the presentation and management of extracranial carotid artery aneurysms (ECAAs) and to develop a new type of classification. MATERIAL AND METHODS A retrospective review of 35 ECAAs patients who were admitted in our institution from January 2010 to June 2016 was conducted. The mean follow-up period was 25.58±22.13 months. RESULTS During the study period, 35 aneurysms were diagnosed and treated (mean age, 50.8±15.6 years; 15 men). There were 28 true aneurysms, 5 false aneurysms, and 2 dissecting aneurysms. A total of 16 patients with true aneurysms underwent open surgical treatment (group 1), whereas 15 received endovascular management, including all false and dissecting aneurysms (group 2). The remaining 4 true aneurysms were treated with hybrid operation (group 3). The patency rates of groups 1, 2, and 3 were 100%, 93.3%, and 100%, respectively. According to the Peking Union Medical College Hospital (PUMCH) Classification, all 24 cases of type Ia aneurysms were treated by either open surgery and/or endovascular treatment, whereas all 3 type Ib cases were treated solely by open surgery. All 5 type IIa patients were treated by endovascular treatment, with the exception of 1 failure that was transferred to hybrid operation. All 3 type IIb patients were treated by hybrid operation. CONCLUSIONS Open surgery was more frequently feasible in true aneurysms, and endovascular surgery was the first choice for false and dissecting aneurysms. Hybrid operation was available for complicated cases. The PUMCH classification may be helpful for selection of management strategies for ECAAs.


Asunto(s)
Aneurisma Disecante/cirugía , Arterias Carótidas/cirugía , Procedimientos Endovasculares/métodos , Adulto , Anciano , Aneurisma Disecante/clasificación , Aneurisma Disecante/fisiopatología , Implantación de Prótesis Vascular/efectos adversos , Arterias Carótidas/fisiopatología , Enfermedades de las Arterias Carótidas/cirugía , China , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento
9.
Int J Mol Sci ; 20(14)2019 Jul 15.
Artículo en Inglés | MEDLINE | ID: mdl-31311132

RESUMEN

Cardiovascular risk associated with fetal growth restriction (FGR) could result from an early impaired vascular function. However, whether this effect results in premature vascular aging has not been addressed. We studied the ex vivo reactivity of carotid and femoral arteries in fetal (near term), adults (eight months-old) and aged (16 months-old) guinea pigs in normal (control) and FGR offspring. Additionally, an epigenetic marker of vascular aging (i.e., LINE-1 DNA methylation) was evaluated in human umbilical artery endothelial cells (HUAEC) from control and FGR subjects. Control guinea pig arteries showed an increased contractile response (KCl-induced) and a progressive impairment of NO-mediated relaxing responses as animals get older. FGR was associated with an initial preserved carotid artery reactivity as well as a later significant impairment in NO-mediated responses. Femoral arteries from FGR fetuses showed an increased contractility but a decreased relaxing response compared with control fetuses, and both responses were impaired in FGR-adults. Finally, FGR-HUAEC showed decreased LINE-1 DNA methylation compared with control-HUAEC. These data suggest that the aging of vascular function occurs by changes in NO-mediated responses, with limited alterations in contractile capacity. Further, these effects are accelerated and imposed at early stages of development in subjects exposed to a suboptimal intrauterine environment.


Asunto(s)
Envejecimiento/patología , Endotelio Vascular/crecimiento & desarrollo , Retardo del Crecimiento Fetal/patología , Animales , Arterias Carótidas/crecimiento & desarrollo , Arterias Carótidas/patología , Arterias Carótidas/fisiopatología , Células Cultivadas , Metilación de ADN , Endotelio Vascular/metabolismo , Endotelio Vascular/patología , Femenino , Arteria Femoral/crecimiento & desarrollo , Arteria Femoral/patología , Arteria Femoral/fisiopatología , Retardo del Crecimiento Fetal/genética , Cobayas , Humanos , Elementos de Nucleótido Esparcido Largo/genética , Óxido Nítrico/metabolismo , Vasoconstricción , Vasodilatación
10.
PLoS One ; 14(6): e0218317, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31220141

RESUMEN

Early detection of asymptomatic carotid stenosis may help identifying individuals at risk of stroke. We explore a new method based on laser Doppler vibrometry (LDV) which could allow the non-contact detection of stenosis from neck skin vibrations due to stenosis-induced flow disturbances. Experimental fluid dynamical tests were performed with water on a severely stenosed patient-specific carotid bifurcation model. Measurements were taken under various physiological flow regimes both in a compliant and stiff-walled version of the model, at 1 to 4 diameters downstream from the stenosis. An inter-arterial pressure catheter was positioned as reference. Increasing flow led to corresponding increase in power spectral density (PSD) of pressure and LDV recordings in the 0-500 Hz range. The stiff model lead to higher PSD. PSD of the LDV signal was less dependent on the downstream measurement location than pressure. The strength of the association between PSD and flow level, model material and measuring location was highest in the 0-50 Hz range, however useful information was found up to 200 Hz. This proof-of-concept suggests that LDV has the potential to detect stenosis-induced disturbed flow. Further computational and clinical validation studies are ongoing to assess the sensitivity and specificity of the technique for clinical screening.


Asunto(s)
Arterias Carótidas/diagnóstico por imagen , Estenosis Carotídea/diagnóstico , Flujometría por Láser-Doppler/métodos , Piel/fisiopatología , Angiografía/métodos , Presión Arterial/fisiología , Velocidad del Flujo Sanguíneo/fisiología , Arterias Carótidas/fisiopatología , Estenosis Carotídea/fisiopatología , Pruebas de Función Cardíaca/métodos , Humanos , Ultrasonografía Doppler/métodos , Vibración
11.
J Clin Neurosci ; 66: 220-225, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31176592

RESUMEN

The relationship between carotid blood flow and carotid intraplaque haemorrhage (IPH) is not fully understood. This study was to investigate the relationship between local haemodynamics and carotid plaques with IPH associated with severe artery stenosis. Fifty-nine patients with carotid atherosclerosis were enrolled in this study and underwent magnetic resonance imaging (MRI) measurement. IPH and non-IPH compositions were differentiated based on plaque sequences. Haemodynamic simulations were performed by using computational fluid dynamics (CFD). All the carotids were categorised into IPH and non-IPH groups. In each group, the artery stenosis was divided into mild (<50%), moderate (50-70%) and severe (>70%) subgroups. Maximum wall shear stress (mWSS) was calculated and comparisons made between IPH and non-IPH groups using independent t-test. Furthermore, the relationship between mWSS and IPH volume was examined using Pearson's correlation. The mWSS result calculated from the IPH group was significantly higher than that of the non-IPH group; at mild stenosis (P = 0.001) and moderate stenosis (P = 0.002) respectively. However, there was no significant difference in cases of severe stenosis (P = 0.42). Furthermore, the results showed a positive correlation between mWSS and IPH volume (r = 0.763, P < 0.001) in the cases of stenosis of less than 70%. mWSS was found to be significantly associated with IPH for carotids with stenosis of less than 70%. This highlights that mWSS is a potential quantitative parameter for the risk diagnosis of the carotid atherosclerosis.


Asunto(s)
Estenosis Carotídea/diagnóstico por imagen , Hemodinámica/fisiología , Hemorragia/diagnóstico por imagen , Hidrodinámica , Imagen por Resonancia Magnética/métodos , Índice de Severidad de la Enfermedad , Anciano , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/fisiopatología , Estenosis Carotídea/fisiopatología , Femenino , Hemorragia/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Estrés Mecánico
12.
J Med Ultrason (2001) ; 46(4): 389-397, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31187302

RESUMEN

The number of patients with heart failure has been dramatically increasing in Japan in association with aging of the society. This phenomenon is referred to as a heart failure pandemic. The fundamental origin of heart failure is cardiac dysfunction. Echocardiography is widely used to assess cardiac function, as well as to diagnose heart diseases that cause cardiac dysfunction. However, the severity of heart failure is not necessarily correlated with that of cardiac dysfunction. This is partly explained by the fact that heart failure induces dysfunction of organs other than the heart through hemodynamic deterioration and neurohumoral changes. In addition, one of the characteristics of patients with heart failure, particularly elderly patients, is the presence of numerous comorbidities. Symptoms of heart failure are not specific, and assessment of cardiac function, particularly left ventricular diastolic function, has not been established. Thus, ultrasonographic assessment of organs other than the heart helps the diagnosis of heart failure, assessment of the severity of heart failure, and development of our understanding of the pathophysiology in each patient. This review summarizes current knowledge about the usefulness of ultrasonographic assessment of organs other than the heart in heart failure.


Asunto(s)
Arterias Carótidas/diagnóstico por imagen , Diafragma/diagnóstico por imagen , Sistema Digestivo/diagnóstico por imagen , Insuficiencia Cardíaca/fisiopatología , Riñón/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Ultrasonografía/métodos , Anciano , Arterias Carótidas/fisiopatología , Diafragma/fisiopatología , Sistema Digestivo/fisiopatología , Humanos , Japón , Riñón/fisiopatología , Pulmón/fisiopatología
13.
PLoS One ; 14(6): e0217271, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31170183

RESUMEN

Wall shear stress (WSS), the frictional force exerted on endothelial cells by blood flow, is hypothesised to influence atherosclerotic plaque growth and composition. We developed a methodology for image registration of MR and histology images of advanced human carotid plaques and corresponding WSS data, obtained by MRI and computational fluid dynamics. The image registration method requires four types of input images, in vivo MRI, ex vivo MRI, photographs of transversally sectioned plaque tissue and histology images. These images are transformed to a shared 3D image domain by applying a combination of rigid and non-rigid registration algorithms. Transformation matrices obtained from registration of these images are used to transform subject-specific WSS data to the shared 3D image domain as well. WSS values originating from the 3D WSS map are visualised in 2D on the corresponding lumen locations in the histological sections and divided into eight radial segments. In each radial segment, the correlation between WSS values and plaque composition based on histological parameters can be assessed. The registration method was successfully applied to two carotid endarterectomy specimens. The resulting matched contours from the imaging modalities had Hausdorff distances between 0.57 and 0.70 mm, which is in the order of magnitude of the in vivo MRI resolution. We simulated the effect of a mismatch in the rigid registration of imaging modalities on WSS results by relocating the WSS data with respect to the stack of histology images. A 0.6 mm relocation altered the mean WSS values projected on radial bins on average by 0.59 Pa, compared to the output of original registration. This mismatch of one image slice did not change the correlation between WSS and plaque thickness. In conclusion, we created a method to investigate correlations between WSS and plaque composition.


Asunto(s)
Arterias Carótidas , Enfermedades de las Arterias Carótidas , Endarterectomía , Hemorreología , Angiografía por Resonancia Magnética , Placa Aterosclerótica , Resistencia al Corte , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/fisiopatología , Arterias Carótidas/cirugía , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/fisiopatología , Enfermedades de las Arterias Carótidas/cirugía , Femenino , Humanos , Masculino , Placa Aterosclerótica/diagnóstico por imagen , Placa Aterosclerótica/fisiopatología , Placa Aterosclerótica/cirugía
14.
J Clin Ultrasound ; 47(8): 477-485, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31168787

RESUMEN

OBJECTIVE: Ultrasound Lagrangian carotid strain imaging (LCSI) utilizes physiological deformation caused by arterial pressure variations to generate strain tensor maps of the vessel walls and plaques. LCSI has been criticized for the lack of normalization of magnitude-based strain indices to physiological stimuli, namely blood pressure. We evaluated the impact of normalization of magnitude-based strain indices to blood pressure measured immediately after the acquisition of radiofrequency (RF) data loops for LCSI. MATERIALS AND METHODS: A complete clinical ultrasound examination along with RF data loops for LCSI was performed on 50 patients (30 males and 20 females) who presented with >60% carotid stenosis and were scheduled for carotid endarterectomy. Cognition was assessed using the 60-minute neuropsychological test protocol. RESULTS: For axial strains correlation of maximum accumulated strain indices (MASI), cognition scores were -0.46 for non-normalized and -0.45, -0.49, -0.37, and -0.48 for systolic, diastolic, pulse pressure, and mean arterial pressure normalized data, respectively. The corresponding area under the curve (AUC) values for classifiers designed using maximum likelihood estimation of a binormal distribution with a median-split of the executive function cognition scores were 0.73, 0.70, 0.71, 0.70, and 0.71, respectively. CONCLUSIONS: No significant differences in the AUC estimates were obtained between normalized and non-normalized magnitude-based strain indices.


Asunto(s)
Presión Sanguínea/fisiología , Arterias Carótidas/diagnóstico por imagen , Estenosis Carotídea/diagnóstico , Placa Aterosclerótica/diagnóstico , Ultrasonografía/métodos , Anciano , Arterias Carótidas/fisiopatología , Estenosis Carotídea/etiología , Estenosis Carotídea/fisiopatología , Femenino , Humanos , Masculino , Placa Aterosclerótica/complicaciones , Placa Aterosclerótica/fisiopatología
15.
Ultrasound Med Biol ; 45(7): 1691-1707, 2019 07.
Artículo en Inglés | MEDLINE | ID: mdl-31079874

RESUMEN

Visualization and quantification of blood flow are considered important for early detection of atherosclerosis and patient-specific diagnosis and intervention. As conventional Doppler imaging is limited to 1-D velocity estimates, 2-D and 3-D techniques are being developed. We introduce an adaptive velocity compounding technique that estimates the 2-D velocity vector field using predominantly axial displacements estimated by speckle tracking from dual-angle plane wave acquisitions. Straight-vessel experiments with a 7.8-MHz linear array transducer connected to a Verasonics Vantage ultrasound system revealed that the technique performed with a maximum velocity magnitude bias and angle bias of -3.7% (2.8% standard deviation) and -0.16° (0.41° standard deviation), respectively. In vivo, complex flow patterns were visualized in two healthy and three diseased carotid arteries and quantified using a vector complexity measure that increased with increasing wall irregularity. This measure could potentially be a relevant clinical parameter which might aid in early detection of atherosclerosis.


Asunto(s)
Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/diagnóstico por imagen , Enfermedades de las Arterias Carótidas/fisiopatología , Interpretación de Imagen Asistida por Computador/métodos , Ultrasonografía Doppler/métodos , Velocidad del Flujo Sanguíneo/fisiología , Arterias Carótidas/fisiopatología , Humanos
16.
Monaldi Arch Chest Dis ; 89(2)2019 May 20.
Artículo en Inglés | MEDLINE | ID: mdl-31107040

RESUMEN

Increasing survival from cystic fibrosis show untypical systems involvement, such as cardiocirculatory. In particular, the presence of CFTR in smooth muscle and endothelial cells, systemic inflammation and oxidative stress could explain vascular alterations in these patients. We aimed at noninvasely evaluating macro- and microvascular dysfunction in cystic fibrosis adults without cardiovascular risk factors. Twenty-twoadults affected by cystic fibrosis and 24 healthy volunteers matched for age and sex were enrolled. None had known cardiovascular risk factors. All people underwent blood pressure measurement, microvascular function assessment by EndoPAT-2000 device (calculating RH-PAT index) and macrovascular evaluation by pulse wave velocity (PWV). RH-PAT index was significantly lower in patients than in controls (1.74±0.59 vs 2.33±0.34; p<0.001). Thirteen patients of 22 had a value inferior to the threshold of 1.67 (59.1%), while no controls had (p<0.001). Carotid-femoral PWV did not differ between the two groups (5.2±1.5 m/s vs 5.4±1.1; p=0.9), while brachial-ankle one did (11.0±2.2 m/s vs 10.1±0.8 m/s; p=0.04).Adults patients affected by cystic fibrosis show peripheral endothelial dysfunction, which is the first alteration in atherosclerotic phenomenon. Moreover, arterial stiffness measured by PWV unclearly seems to differ respect of healthy people, perhaps because PWV alterations are typical of above 50 years old people. It is unclear what prognostic role of future developing of atherosclerotic disease these findings could be, but it seems evident that cystic fibrosis directly affects cardiovascular system itself.


Asunto(s)
Arterias/fisiopatología , Fibrosis Quística/fisiopatología , Endotelio/fisiopatología , Microvasos/fisiopatología , Adulto , Índice Tobillo Braquial , Presión Sanguínea , Arteria Braquial/fisiopatología , Arterias Carótidas/fisiopatología , Estudios de Casos y Controles , Femenino , Arteria Femoral/fisiopatología , Humanos , Masculino , Análisis de la Onda del Pulso , Factores de Riesgo , Arterias Tibiales/fisiopatología , Rigidez Vascular , Adulto Joven
17.
J R Army Med Corps ; 165(6): e2, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31133623

RESUMEN

BACKGROUND: Traumatic carotid artery thrombosis is uncommon and it usually results from penetrating injuries and less commonly secondary to blunt trauma. It can lead to delayed clinical presentation, which leads to delay in the diagnosis. Soldiers in combat scenario also can present with such an illness, which results from varied modes of injuries. Our case illustrates an unusual cause of carotid thrombosis. CASE PRESENTATION: Our patient is a 37-year-old soldier who developed neck pain and headache following a 5 km training run with rifle on the shoulder and subsequently developed left upper limb weakness and evaluation revealed extracranial right internal carotid thrombosis. He was managed with anticoagulants and antiplatelets with complete resolution of the thrombosis and complete recovery of the weakness. CONCLUSION: Blunt trauma to the neck in the form of carrying a rifle for a prolonged duration can result in injury to the carotid vessels leading to delayed neurological presentation. Educating the troops regarding such a mode of illness will prevent such a catastrophic nature of vascular injury resulting in ischaemic stroke.


Asunto(s)
Arterias Carótidas , Trombosis de las Arterias Carótidas , Personal Militar , Adulto , Anticoagulantes/uso terapéutico , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/fisiopatología , Infarto Cerebral/tratamiento farmacológico , Infarto Cerebral/etiología , Armas de Fuego , Humanos , Masculino , Medicina Militar , Dolor de Cuello/etiología , Ultrasonografía Doppler en Color
18.
Stroke ; 50(6): 1531-1538, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31136292

RESUMEN

Background and Purpose- Cardiogenic emboli account for 15% to 20% of acute ischemic stroke cases worldwide. However, the chance of such emboli, of varying sizes, causing a stroke under various flow types has not been evaluated. Methods- A patient-specific aortic arch model was fabricated from a medical image dataset of a 77-year-old male case, with atrial fibrillation and distal occlusion of the right M1 vessel. One hundred and eighty mammalian embolus analogs (EAs) were released one by one into the model under normal and atrial fibrillation flow conditions. A further 270 clots were fabricated using varying levels of thrombin (5-20 National Institutes of Health units thrombin). The effect of releasing several clots simultaneously was also examined by grouping EAs into 18 multiples of 5, 4, 3, and 2 clots, resulting in 504 EAs released. Results- EAs with a length of ≤10 mm were the most common geometry to travel through the common carotid arteries (44%); however, longer clots also traveled through these narrow vessels. Twenty two percent of EAs ranged from 10-20mm in length, 27% from 20-30mm and 7% were >30 mm in length. Higher density clots increased the propensity for clots to travel along the cerebral vessels ( P<0.05). Releasing more clots during each test, increased the probability of at least one clot traveling through an aortic arch branching vessel. Conclusions- Embolus trajectory through the branching vessels of the aortic arch is not exclusively dependent on embolus size. EAs tend to travel proportionally with outlet flow rates, with a greater chance of a stroke caused by multiple breakaway emboli.


Asunto(s)
Aorta Torácica/fisiopatología , Arterias Carótidas/fisiopatología , Embolia/fisiopatología , Hemodinámica , Modelos Cardiovasculares , Modelación Específica para el Paciente , Anciano , Humanos , Masculino
19.
J Stroke Cerebrovasc Dis ; 28(8): 2201-2206, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-31122713

RESUMEN

BACKGROUND: The purpose of this study was to assess whether carotid ultrasonography indices detect arterial stenosis progression in patients with vertebral artery (VA) dissection. METHODS: This was a retrospective, single-center, observational study that enrolled patients with intracranial VA dissection who were admitted from January 2011 to June 2017. Magnetic resonance angiography (MRA) was done on admission and followed up at a median 20 days after onset (interquartile range [IQR] 9-58 days), and ultrasonography was performed at a median of 22 (interquartile range 7-56) days. Peak systolic velocity (PSV), end-diastolic velocity (EDV), mean velocity (MV), and pulsatility index (PI) were measured by ultrasonography, and the ratio of each follow-up value to the baseline (follow-up/baseline) value was calculated. Two stroke neurologists categorized into 3 groups by morphological changes of the dissected vessel: patients with stenosis progression (progression group: P-group); those with no remarkable change or dilatation improved (stable group: S-group); and those with stenosis regression or dilatation enlargement (enlargement group: E-group). Ultrasonography indices were compared among the groups. RESULTS: Of the 42 patients who were enrolled to this study, 39 patients underwent ultrasonography and MRA on both admission and follow-up. The PI ratio was significantly higher in the P-group than in the S-group (1.96 ± .80 versus .98 ± .44, P = .02) and in the E-group (versus .65 ± .35, P < .01). There were no significant differences in the PSV ratio, EDV ratio, and MV ratio. CONCLUSIONS: In patients with VA dissection, the PI ratio on ultrasonography is a promising index to detect stenosis progression.


Asunto(s)
Arterias Carótidas/diagnóstico por imagen , Ultrasonografía/métodos , Disección de la Arteria Vertebral/diagnóstico por imagen , Arteria Vertebral/diagnóstico por imagen , Adulto , Velocidad del Flujo Sanguíneo , Arterias Carótidas/fisiopatología , Angiografía Cerebral/métodos , Circulación Cerebrovascular , Constricción Patológica , Progresión de la Enfermedad , Femenino , Humanos , Japón , Angiografía por Resonancia Magnética , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Flujo Pulsátil , Sistema de Registros , Estudios Retrospectivos , Índice de Severidad de la Enfermedad , Arteria Vertebral/fisiopatología , Disección de la Arteria Vertebral/fisiopatología
20.
Hypertension ; 73(5): 1018-1024, 2019 05.
Artículo en Inglés | MEDLINE | ID: mdl-30929514

RESUMEN

We examined the influence of arterial stiffening and ventricular ejection dynamics on the age-related increase in central pulse pressure. A total of 2033 women aged 18 to 91 years from the Twins UK cohort were studied. Aortic flow and central blood pressure were measured by Doppler sonography and carotid tonometry, respectively. Measured values of central pulse pressure were compared with values predicted from aortic pulse wave velocity and ventricular ejection characteristics. Central pulse pressure at the first shoulder ( P1) increased with age from 29.2±8.0 in those <40 years to 44.2±13.8 mm Hg in those >70 years (means±SD; P<0.001), an increase explained almost entirely by the concomitant increase in aortic pulse wave velocity. Pulse pressure, at the second pressure peak ( P2, usually equal to peak central pulse pressure) increased to a greater extent with age: from 29.1±7.8 mm Hg for those <40 years to 60.2±20.5 mm Hg for those >70 years ( P<0.001). The ratio of P2/P1 closely mirrored the ratio of ejection volume to ejection velocity at corresponding time points, and the proportionately greater increase in P2 compared with P1 was explained by increased ventricular ejection up to the time of P2. This increased from 52.5±13.1 to 59.3±17.8 mL ( P<0.001) in parallel with an age-related increase in stroke volume and body mass index. These results suggest that the age-related change in central pulse wave morphology is driven mainly by an increase in arterial stiffening and altered pattern of ventricular ejection.


Asunto(s)
Velocidad del Flujo Sanguíneo/fisiología , Presión Sanguínea/fisiología , Enfermedades en Gemelos , Hipertensión/fisiopatología , Rigidez Vascular/fisiología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Arterias Carótidas/diagnóstico por imagen , Arterias Carótidas/fisiopatología , Femenino , Humanos , Hipertensión/epidemiología , Incidencia , Persona de Mediana Edad , Análisis de la Onda del Pulso , Arteria Radial/diagnóstico por imagen , Arteria Radial/fisiopatología , Estudios Retrospectivos , Volumen Sistólico/fisiología , Ultrasonografía Doppler , Reino Unido/epidemiología , Adulto Joven
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