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1.
Herz ; 45(1): 17-23, 2020 Feb.
Artigo em Alemão | MEDLINE | ID: mdl-32002564

RESUMO

Imaging of subclinical atherosclerosis is an integrated component of a preventive medicine algorithm; i.e. on the basis of a cardiovascular risk stratification patients with a low and intermediate risk qualify for further imaging (cave: Bayes' theorem). Imaging procedures for subclinical atherosclerosis have one thing in common: atherosclerosis is detected and localized directly, for which cardiac multidetector computed tomography (MDCT; coronary calcium scoring, CACS) and vascular ultrasound (carotid and/or femoral arteries) are used to measure the plaque burden. The result is viewed as a risk modifier. The risk assessment is not related to symptoms. In addition to the detection and localization of atherosclerosis this also enables assessment of the "risk age" according to the tables of the European Society of Cardiology (ESC) and even the biological age, which can be estimated based on nomograms. This knowledge can be used to promote patient compliance and adherence to medication.


Assuntos
Aterosclerose , Doença da Artéria Coronariana , Placa Aterosclerótica , Aterosclerose/diagnóstico por imagem , Teorema de Bayes , Doença da Artéria Coronariana/diagnóstico por imagem , Humanos , Placa Aterosclerótica/diagnóstico por imagem , Medição de Risco , Fatores de Risco
2.
Artigo em Japonês | MEDLINE | ID: mdl-31956186

RESUMO

In the tissue characterization of plaques using magnetic resonance imaging (MRI), T1-weighted imaging is important. However, T1-weighted imaging are obtained by various imaging methods, and show different contrasts depending on parameters such as repetition time, echo time, and inversion time. To evaluate the tissue characterization of plaques using MRI, the characteristics are estimated and evaluated using the strength of the plaque-to-muscle signal intensity ratio (PMR), which is the value obtained by dividing the signal intensity of the plaque by that of the sternocleidomastoid muscle or myocardium. In the present research, we aim to obtain the PMR by phantom experiment and grasp the image characteristics for T1 and T2 values of different T1-weighted imaging methods. In addition, since the PMR of the conventional spin echo (SE) method of T1-weighted imaging (two-dimensional (2D) T1WI SE) is reported to have high discrimination ability in plaque tissue characterization, the experimental results were compared with those of 2D T1WI SE. Among the protocols examined, 3D sampling perfection with application optimized contrasts using different flip angle evolutions, T1-variable, motion-sensitized driven equilibrium (1-axis 300 ms2*mT/m) + had the same tissue characterization ability as 2D T1 WI SE, and was the most suitable imaging method. Moreover, in the gradient echo method, the effect of T2 values was smaller than that of 2D T1 WI SE, and it was suggested that the PMR of the plaque may be lowered when there is a change in the tissue properties that the T2 value and T1 value are prolonged due to liquefaction. The results of this phantom experiment are expected help in selecting the imaging method aimed at optimization and the image characteristics of different T1-weighted imaging method can be grasped.


Assuntos
Imagem Tridimensional , Imagem por Ressonância Magnética , Placa Aterosclerótica , Meios de Contraste , Humanos , Imagens de Fantasmas , Placa Aterosclerótica/diagnóstico por imagem
3.
Eur J Endocrinol ; 182(3): 343-350, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31958313

RESUMO

Background: To investigate the association between fasting serum insulin and glucose levels with atherosclerotic plaque composition in the carotid artery. Impaired insulin and glucose levels are implicated in the etiology of cardiovascular disease; however, their influence on the formation and composition of atherosclerotic plaque remains unclear. Methods: In 1740 participants (mean age 72.9 years, 46% women, 14.4% diabetes mellitus) from the population-based Rotterdam Study, we performed carotid MRI to evaluate the presence of calcification, lipid core, and intraplaque hemorrhage in carotid atherosclerosis. All participants also underwent blood sampling to obtain information on serum insulin and glucose levels. Using logistic regression models, we assessed the association of serum insulin and glucose levels (per s.d. and in tertiles) with the different plaque components, while adjusting for sex, age, intima-media thickness, and cardiovascular risk factors. Results: Serum insulin levels were associated with the presence of intraplaque hemorrhage (adjusted odds ratio (OR): 1.42 (95% CI: 1.12-1.7)) We found no association with the presence of calcification or lipid core. Sensitivity analyses restricted to individuals without diabetes mellitus yielded similar results. No associations were found between serum glucose levels and any of the plaque components. Conclusions: Serum insulin levels are associated with the presence of vulnerable components of carotid plaque, specifically with intraplaque hemorrhage. These findings suggest a complex role for serum insulin in the pathophysiology of carotid atherosclerosis and in plaque vulnerability.


Assuntos
Glicemia/metabolismo , Doenças das Artérias Carótidas/diagnóstico por imagem , Insulina/sangue , Placa Aterosclerótica/diagnóstico por imagem , Calcificação Vascular/diagnóstico por imagem , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/sangue , Doenças das Artérias Carótidas/metabolismo , Espessura Intima-Media Carotídea , Feminino , Hemorragia/sangue , Hemorragia/diagnóstico por imagem , Hemorragia/metabolismo , Humanos , Modelos Logísticos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Países Baixos , Placa Aterosclerótica/sangue , Placa Aterosclerótica/metabolismo , Calcificação Vascular/sangue , Calcificação Vascular/metabolismo
4.
Angiology ; 71(2): 122-130, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31303025

RESUMO

The ability of carotid intima-media thickness (IMT) to predict risk beyond plaque is controversial. In 952 participants (critical limb ischemia [CLI] or stroke, n = 473; community, n = 479), we assessed whether relationships with events for IMT complement the impact of plaque in young patients depending on the extent of thrombotic versus atherosclerotic disease. The extent of atherosclerotic versus thrombotic occlusion was determined in 54 patients with CLI requiring amputations. Thrombotic occlusion in CLI was associated with younger age (P < .0001) and less plaque (P = .02). Independent relations between plaque and CLI were noted in older (>50 years; P < .005 to <.0001) but not younger (P > .38) participants, while independent relations between plaque and stroke (P < .005 to <.0001) and between IMT and CLI (P < .0001) were noted in younger participants. Although in performance (area under the receiver operating curve) for event detection, IMT thresholds failed to add to plaque alone in older patients (0.680 ± 0.020 vs 0.664 ± 0.017, P = .27), IMT improved performance for combined stroke and CLI detection when added to plaque in younger patients (0.719 ± 0.023 vs 0.631 ± 0.026, P < .0001). Because in younger participants the high prevalence of thrombotic occlusion in CLI is associated with less plaque, IMT adds information in associations with arterial vascular events.


Assuntos
Espessura Intima-Media Carotídea , Isquemia/complicações , Isquemia/diagnóstico por imagem , Perna (Membro)/irrigação sanguínea , Perna (Membro)/diagnóstico por imagem , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico por imagem , Acidente Vascular Cerebral/complicações , Acidente Vascular Cerebral/diagnóstico por imagem , Trombose/complicações , Trombose/diagnóstico por imagem , Fatores Etários , Idoso , Estado Terminal , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes
6.
Zhonghua Nei Ke Za Zhi ; 58(11): 808-813, 2019 Nov 01.
Artigo em Chinês | MEDLINE | ID: mdl-31665855

RESUMO

Objective: Positron emission tomography-computed tomography (PET-CT) has been used to quantify inflammatory response in the body. The aim of the present study was to explore the possibility of using this method to evaluate the stability of atherosclerotic plaques and the efficacy of atorvastatin in stabilizing atherosclerotic plaques. Methods: Twenty New Zealand male white rabbits were included and divided into the atorvastatin intervention group and the control group, with 10 rabbits in each group. Rabbits in both groups were fed with a high fat diet for 20 weeks, and treated with thoracoabdominal aortic balloon-pulling to establish atherosclerosis model at the end of the 2nd week. Rabbits in atorvastatin intervention group was given atorvastatin intragastrically once a day. At the 8th week, thoracoabdominal aortic ultrasound was used to detect plaques in all rabbits. Blood was drawn at the 3rd and the 20th week, respectively, to measure blood lipids, high-sensitive C-reactive protein (hs-CRP) and matrix metalloproteinase-9 (MMP-9). At the end of experiment, survival animals were scanned by (18)F-FDG PET-CT, and the average and maximum standard uptake values (SUVmean, SUVmax) of aortic segments were measured. Thereafter, the animals were sacrificed and aortic specimens of rabbits were taken and examined by immunohistochemistry. The pathological indexes were measured and compared. Results: At the end of experiment, the total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C), hs-CRP [ (4.58±0.51) ng/ml vs.(5.87±0.66) ng/ml, P<0.01], MMP-9[ (43.93±2.16) ng/ml vs. (50.77±2.32) ng/ml, P<0.01], SUVmean (0.59±0.15 vs. 0.68±0.20, P<0.05) , SUVmax (0.68±0.20 vs. 0.81±0.27, P<0.05) , plaque area [ (0.36±0.24) mm(2) vs. (0.50±0.34) mm(2), P<0.05) ] and density of macrophage[ (4.34±1.54) % vs. (5.65±1.89) %, P<0.01] in the atorvastatin intervention group were significantly lower than those in the control group. In contrast, fiber cap thickness of the plaque[ (4.12±0.66) µm vs. (2.96±0.37) µm, P<0.01] in the atorvastatin intervention group was higher than that of the control group, and the difference was statistically significant. The arterial plaque areas were positively correlated with SUVmean (r=0.27, P<0.05) and SUVmax (r=0.43, P<0.01) . Fiber cap thickness was negatively correlated with SUVmean (r=-0.38, P<0.05) and SUVmax (r=-0.47, P<0.01) . The density of macrophage were positively correlated with SUVmean (r=0.52, P<0.01) and SUVmax (r=0.51, P<0.01) . Conclusion: (18)F-FDG PET/CT can be used to evaluate the efficacy of atorvastatin by the stability of atherosclerotic plaques.


Assuntos
Aorta/diagnóstico por imagem , Fluordesoxiglucose F18/administração & dosagem , Placa Aterosclerótica/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Animais , Aorta/patologia , Masculino , Placa Aterosclerótica/patologia , Coelhos , Compostos Radiofarmacêuticos
7.
Expert Rev Cardiovasc Ther ; 17(10): 707-716, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31592685

RESUMO

Introduction: In CKD subjects, atherosclerotic cardiovascular disease (ASCVD) is a major cause of their morbidity and mortality (1-3). Current therapeutic guidelines recommend lowering LDL-C level to prevent ASCVD (4, 5). However, it remains uncertain how this therapeutic approach effectively modifies atherosclerosis of CKD. These findings suggest the need to further understand pathophysiology of atherosclerosis. Given that intravascular imaging modalities have contributed to characterize the natural history of coronary atherosclerosis (13-23), the integration of plaque imaging is expected to help to elucidate targets associated with stabilizing atheroma.Areas covered: This review will outline atherogenic stimuli in patients with CKD. In addition, the characteristics of their coronary atheroma will be presented from finding in clinical studies using a variety of intravascular imaging modalities. The efficacy of current guideline recommended anti-atherosclerotic therapies in CKD patients will be also summarized. All related articles were searched through PubMed.Expert opinion: Integration of intravascular imaging has a great potential to establish effective therapies for slowing progression of atherosclerosis in subjects with CKD. More efforts toward searching therapeutic target associated with atherosclerosis of CKD are required. In particular, identifying drivers associated with plaque calcification will lead to the development of new agents which regress calcium accumulation.


Assuntos
Aterosclerose/diagnóstico por imagem , Doença da Artéria Coronariana/diagnóstico por imagem , Insuficiência Renal Crônica/complicações , Humanos , Placa Aterosclerótica/diagnóstico por imagem
8.
Lancet ; 394(10209): 1629-1637, 2019 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-31570255

RESUMO

BACKGROUND: Near-infrared spectroscopy (NIRS) intravascular ultrasound imaging can detect lipid-rich plaques (LRPs). LRPs are associated with acute coronary syndromes or myocardial infarction, which can result in revascularisation or cardiac death. In this study, we aimed to establish the relationship between LRPs detected by NIRS-intravascular ultrasound imaging at unstented sites and subsequent coronary events from new culprit lesions. METHODS: In this prospective, cohort study (LRP), patients from 44 medical centres were enrolled in Italy, Latvia, Netherlands, Slovakia, UK, and the USA. Patients with suspected coronary artery disease who underwent cardiac catheterisation with possible ad hoc percutaneous coronary intervention were eligible to be enrolled. Enrolled patients underwent scanning of non-culprit segments using NIRS-intravascular ultrasound imaging. The study had two hierarchal primary hypotheses, patient and plaque, each testing the association between maximum 4 mm Lipid Core Burden Index (maxLCBI4mm) and non-culprit major adverse cardiovascular events (NC-MACE). Enrolled patients with large LRPs (≥250 maxLCBI4mm) and a randomly selected half of patients with small LRPs (<250 maxLCBI4mm) were followed up for 24 months. This study is registered with ClinicalTrials.gov, NCT02033694. FINDINGS: Between Feb 21, 2014, and March 30, 2016, 1563 patients were enrolled. NIRS-intravascular ultrasound device-related events were seen in six (0·4%) patients. 1271 patients (mean age 64 years, SD 10, 883 [69%] men, 388 [31%]women) with analysable maxLCBI4mm were allocated to follow-up. The 2-year cumulative incidence of NC-MACE was 9% (n=103). Both hierarchical primary hypotheses were met. On a patient level, the unadjusted hazard ratio (HR) for NC-MACE was 1·21 (95% CI 1·09-1·35; p=0·0004) for each 100-unit increase maxLCBI4mm) and adjusted HR 1·18 (1·05-1·32; p=0·0043). In patients with a maxLCBI4mm more than 400, the unadjusted HR for NC-MACE was 2·18 (1·48-3·22; p<0·0001) and adjusted HR was 1·89 (1·26-2·83; p=0·0021). At the plaque level, the unadjusted HR was 1·45 (1·30-1·60; p<0·0001) for each 100-unit increase in maxLCBI4mm. For segments with a maxLCBI4mm more than 400, the unadjusted HR for NC-MACE was 4·22 (2·39-7·45; p<0·0001) and adjusted HR was 3·39 (1·85-6·20; p<0·0001). INTERPRETATION: NIRS imaging of non-obstructive territories in patients undergoing cardiac catheterisation and possible percutaneous coronary intervention was safe and can aid in identifying patients and segments at higher risk for subsequent NC-MACE. NIRS-intravascular ultrasound imaging adds to the armamentarium as the first diagnostic tool able to detect vulnerable patients and plaques in clinical practice. FUNDING: Infraredx.


Assuntos
Síndrome Coronariana Aguda/etiologia , Placa Aterosclerótica/diagnóstico por imagem , Espectroscopia de Luz Próxima ao Infravermelho/métodos , Ultrassonografia de Intervenção/métodos , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/cirurgia , Idoso , Cateterismo Cardíaco/métodos , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/diagnóstico , Doença da Artéria Coronariana/cirurgia , Morte , Feminino , Humanos , Itália/epidemiologia , Letônia/epidemiologia , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/etiologia , Infarto do Miocárdio/cirurgia , Países Baixos/epidemiologia , Intervenção Coronária Percutânea/métodos , Placa Aterosclerótica/complicações , Placa Aterosclerótica/patologia , Eslováquia/epidemiologia , Reino Unido/epidemiologia , Estados Unidos/epidemiologia
9.
Gac Med Mex ; 155(4): 350-356, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31486781

RESUMO

Introduction: Atherosclerotic carotid artery disease (CAD) is a major risk factor for cerebrovascular disease. Objective: To analyze the association of major vascular risk factors with atherosclerotic CAD and white matter disease (WMD) in patients without a history of ischemic stroke. Method: Risk factors were assessed with carotid examination using Doppler duplex ultrasound. Cases with a history cerebral infarction or transient ischemic attack were not included. Subjects had brain magnetic resonance imaging scans available and those with large-artery ischemic lesions were excluded. Multivariate models were constructed for the prediction of atherosclerotic CAD, significant carotid stenosis, atheroma burden and WMD. Results: One-hundred and forty-five subjects were assessed (60.7% were females, mean age was 73 years). Atherosclerotic CAD was documented in 54.5%, carotid stenosis ≥ 50% in 9.0%, > 6 atheroma plaques in 7.6%, and periventricular or subcortical WMD in 28.3% (20.6% had atherosclerotic CAD and WMD concurrently). Risk factors independently associated with atherosclerotic CAD were age and hypertension; hypertension was associated with ≥ 50% carotid stenosis; age was associated with > 6 atheroma plaques; and age, diabetes and hypertension were associated with WMD. Obesity was not associated with any of the analyzed independent variables. Conclusions: In asymptomatic subjects without a history of ischemic stroke, age and hypertension were the most important risk factors for macrovascular disease. Diabetes mellitus was associated with microvascular disease. Obesity alone was not a major determinant of CAD or WMD.


Assuntos
Doenças das Artérias Carótidas/epidemiologia , Estenose das Carótidas/epidemiologia , Leucoencefalopatias/epidemiologia , Placa Aterosclerótica/epidemiologia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças das Artérias Carótidas/diagnóstico por imagem , Estenose das Carótidas/diagnóstico por imagem , Diabetes Mellitus/epidemiologia , Feminino , Humanos , Hipertensão/complicações , Hipertensão/epidemiologia , Leucoencefalopatias/diagnóstico por imagem , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Placa Aterosclerótica/diagnóstico por imagem , Estudos Retrospectivos , Fatores de Risco , Ultrassonografia Doppler Dupla
10.
Biomed Pharmacother ; 118: 109161, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31545223

RESUMO

This study investigated the value of using ultrasound-targeted microbubble destruction (UTMD) to deliver an IL-8 monoclonal antibody to inhibit the inflammatory response and increase plaque stability in a rabbit model of atherosclerosis (AS). An abdominal aortic atherosclerotic plaque model was established in sixty 4-week-old male New Zealand rabbits. The rabbits were fed a high-fat diet for 12 weeks. On the 12th week, the abdominal aorta was subjected to both balloon-induced mechanical injury and bovine serum albumin-induced immunological injury. After these injuries were established, the rabbits were fed a high-fat diet for 8 additional weeks. On the 20th week, the rabbits were divided into three groups: the pretreatment (PT) group, the control group, and the IL-8 group. The ultrasonic parameters and histological data associated with the plaques from the PT group were acquired on the 20th week after targeted contrast-enhanced ultrasonography (CEUS) was performed. The rabbits in the IL-8 and control groups received targeted CEUS and UTMD every 2 weeks. A targeted contrast agent carrying IL-8 monoclonal antibody was used for the IL-8 group, whereas normal saline was used for the control group. The rabbits in these two groups underwent the same procedure four times beginning during the 20th week. On the 26th week after UTMD, ultrasonic parameters and histological data were collected. The peak intensity (PI), microvessel density (MVD), and macrophage count of the PT group were significantly higher than those of both the control and IL-8 groups (P < 0.05). Additionally, these three parameters were higher in the control group than in the IL-8 group (P < 0.05). The two-dimensional (2D) ultrasonic parameters, including the maximum thickness of the plaque and the intima-media thickness (IMT), did not differ significantly among the three groups (P > 0.05). PI, MVD, and macrophage count were positively correlated with each other (r=0.564, r=0.6034, and r=0.536, respectively; P<0.05). UTMD-delivered IL-8 monoclonal antibodies alleviate inflammation within atherosclerotic plaques. UTMD is a novel and effective method for plaque stabilization.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Aorta Abdominal/diagnóstico por imagem , Interleucina-8/imunologia , Microbolhas , Placa Aterosclerótica/tratamento farmacológico , Ondas Ultrassônicas , Animais , Anticorpos Monoclonais/administração & dosagem , Aorta Abdominal/efeitos dos fármacos , Aorta Abdominal/imunologia , Meios de Contraste , Dieta Hiperlipídica , Modelos Animais de Doenças , Sistemas de Liberação de Medicamentos , Masculino , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/imunologia , Coelhos , Ultrassonografia
11.
Surgery ; 166(4): 601-606, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31405580

RESUMO

BACKGROUND: Difficult cephalad exposure during carotid endarterectomy in patients with high plaque (HP) may lead to increased incidence of complications after carotid endarterectomy. We report on our experience of carotid endarterectomy in patients with HP. METHODS: This is a retrospective review of 1,233 consecutive patients who underwent carotid endarterectomy by a single surgeon at 2 teaching hospitals between January 1989 to December 2018. Group A consisted of patients with HP (n = 100) diagnosed by computed tomography angiography of the neck in 90, catheter-based arteriography in 8, and an unexpected finding during carotid endarterectomy in 2 patients. Group B consisted of 1,133 consecutive carotid endarterectomies with plaque ending in Zone 1 non-high plaque (nHP). RESULTS: Both groups were similar in age (70.9 ± 8.7 vs 70.3 ± 9.1, P = .53). There was a preponderance of male patients in the HP group (78.0% vs 66.1%, P = .02). Associated risk factors, including coronary artery disease, hypertension, diabetes, chronic obstructive pulmonary disease, and hyperlipidemia, were similar in both groups. Indications for carotid endarterectomy in HP patients include recent stroke (<8 weeks) in 15 patients (15.0%), transient ischemic attack in 23 patients (23.0%), and asymptomatic in 62 patients (62.0%). Three patients (3.0%) with HP required shunt placement compared with 10.9% in the nHP group (P = .009). Completion carotid arteriogram was performed in 6 patients. Perioperative stroke and mortality were similar in both groups. The incidence of cranial nerve injury was higher in the HP group. CONCLUSION: Most patients with HP can be diagnosed with computed tomography angiography of the neck or catheter-based arteriography. Shunt requirement in patients with HP is significantly lower than in the nHP group. Perioperative stroke and mortality in patients with HP undergoing carotid endarterectomy is similar to the nHP group; however, there is a higher incidence of permanent cranial nerve injury. Carotid artery stenting should be considered in cases in which carotid endarterectomy may be challenging, such as in patients with HP. Overall, our results demonstrate that carotid endarterectomy can be safely performed in patients with HP, however, at an increased risk of permanent cranial nerve injury.


Assuntos
Estenose das Carótidas/diagnóstico por imagem , Estenose das Carótidas/cirurgia , Angiografia por Tomografia Computadorizada/métodos , Endarterectomia das Carótidas/métodos , Segurança do Paciente , Placa Aterosclerótica/cirurgia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Angiografia/métodos , Estenose das Carótidas/mortalidade , Estudos de Coortes , Endarterectomia das Carótidas/efeitos adversos , Feminino , Hospitais de Ensino , Humanos , Ataque Isquêmico Transitório/prevenção & controle , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/diagnóstico por imagem , Prognóstico , Estudos Retrospectivos , Medição de Risco , Índice de Gravidade de Doença , Fatores Sexuais , Acidente Vascular Cerebral/prevenção & controle , Taxa de Sobrevida , Resultado do Tratamento , Ultrassonografia Doppler Dupla/métodos , Estados Unidos
12.
J Clin Neurosci ; 70: 72-78, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31447358

RESUMO

BACKGROUND: Atherosclerosis in stroke-related vascular beds is the major cause of stroke. Studies demonstrated that multivascular atherosclerosis is prevalent in stroke patients and those with multivascular plaques had higher risk of recurrent stroke. OBJECTIVES: This study investigated the relationship between homocysteine and multivascular atherosclerosis in stroke-related vascular beds using magnetic resonance imaging. METHODS: Patients with recent ischemic cerebrovascular symptoms were enrolled and underwent three-dimensional magnetic resonance vessel wall imaging for intracranial arteries, extracranial carotid arteries and aortic arch. Traditional risk factors and homocysteine were measured. Presence of multivascular plaques defined as plaques in at least two stroke-related vascular beds on magnetic resonance imaging was determined. The relationship between homocysteine and characteristics of multivascular plaques was determined. RESULTS: Of 49 enrolled patients (mean age: 56.3 ±â€¯13.8 years; 35 males), 23 had multivascular plaques. Homocysteine (odds ratio, 1.17; 95% confidence interval, 1.02-1.34; p = 0.022) and age (odds ratio, 1.71; 95% confidence interval, 1.22-2.41; p = 0.002) were significantly associated with presence of multivascular plaques. The adjusted associations remained significant (both p < 0.05). In discriminating presence of multivascular plaques, the area-under-the-curve of age, homocysteine and combination of them was 0.79, 0.70 and 0.87 respectively. CONCLUSIONS: Homocysteine is independently associated with stroke-related multivascular plaques and combination of age and homocysteine has stronger predictive value.


Assuntos
Aterosclerose/fisiopatologia , Biomarcadores/sangue , Homocisteína/sangue , Angiografia por Ressonância Magnética/métodos , Acidente Vascular Cerebral/patologia , Adulto , Idoso , Aterosclerose/sangue , Aterosclerose/diagnóstico por imagem , Aterosclerose/patologia , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Masculino , Pessoa de Meia-Idade , Placa Aterosclerótica/sangue , Placa Aterosclerótica/diagnóstico por imagem , Placa Aterosclerótica/patologia , Sensibilidade e Especificidade , Acidente Vascular Cerebral/sangue , Acidente Vascular Cerebral/diagnóstico por imagem
13.
Braz J Med Biol Res ; 52(8): e8711, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31389494

RESUMO

Carotid artery assessment by ultrasound is a non-invasive evaluation of subclinical atherosclerosis and a predictor of cardiovascular events. However, ultrasound examinations are operator-dependent. In the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), ultrasound images have been acquired from more than 10,000 participants. In this article, we describe the reproducibility of carotid intima-media thickness (CIMT), carotid plaque detection, and carotid plaque score (defined as the number of arterial sites with plaques) using ELSA-Brasil protocol, in a subset of 118 participants. Two board-certified radiologists and a trained technician read carotid images. We calculated intra- and inter-observer intraclass correlation (ICC) for CIMT values. We also present kappa coefficients for plaque detection and weighted kappa coefficients for carotid plaque score. Participants were aged 58.2±6.6 years, and 60 (50.8%) were men. For common carotid artery CIMT measurements, intra- and inter-observer ICC values were very good to excellent, ranging from 0.90 (95% confidence interval [95%CI]: 0.72-0.95) to 0.98 (95%CI: 0.97-0.99). For carotid plaque, intra- (0.96 [95%CI: 0.96-0.96]) and inter- (0.99 [95%CI: 0.99-0.99]) observer weighted kappa coefficients were very good. Intra- and inter-observer Kappa coefficients for the presence of plaques by site were good to very good, ranging from 0.69 to 1.00. In conclusion, we found very good reproducibility for carotid plaque score and CIMT measurements in the ELSA-Brasil at baseline. These results are comparable to the best findings from similar large cohorts that analyzed carotid ultrasound data.


Assuntos
Aterosclerose/diagnóstico por imagem , Artérias Carótidas/diagnóstico por imagem , Espessura Intima-Media Carotídea , Placa Aterosclerótica/diagnóstico por imagem , Adulto , Idoso , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Variações Dependentes do Observador , Estudos Prospectivos , Reprodutibilidade dos Testes , Ultrassonografia
15.
J Clin Neurosci ; 68: 194-200, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31301929

RESUMO

Carotid artery disease which includes carotid artery stenosis, plaques, clots and increased intima media thickness, have been reported by many studies to be associated with dementia. Dementia is an end stage of usually asymptomatic cognitive impairment. Risk factors of carotid artery disease include; age, atherosclerosis, arteriosclerosis, shorter years in school, history of hypertension, diabetes mellitus, stroke and depression. This study set out to determine the prevalence of abnormal carotid ultrasound findings and their association with cognitive function among the adults ≥60 years in Wakiso district, Uganda in 2018. A total of 210 participants were included. Carotid artery stenosis, presence of plaque, stenosis and intima-media thickness were assessed by ultrasound. Cognitive status was assessed using a Mini Mental State Exam (MMSE) test. The prevalence of plaque was 21.4%. Variables which included; presence of plaque, age, education, gender, marital status, whether participant stayed alone or with someone else, care for self, occupation status, division of staying and history of smoking. The presence of plaque was associated with an abnormal cognitive function at both univariate and multivariate analysis with respective OR = 3.8 (95% CI = 1.90-7.54, p-value = 0.0001) and OR = 3.4 (95% CI = 1.38-8.15, p-value = 0.007). The cognitive function distribution was 43.8%, 19%, 34.3% and 2.9% within the normal, mild, moderate, and severe cognitive function status respectively. This study showed that prevalence of carotid artery plaque was high in this elderly population in Wakiso district Uganda. Also, carotid artery plaque was associated with abnormal cognitive function.


Assuntos
Estenose das Carótidas/complicações , Estenose das Carótidas/epidemiologia , Disfunção Cognitiva/etiologia , Placa Aterosclerótica/complicações , Placa Aterosclerótica/epidemiologia , Idoso , Espessura Intima-Media Carotídea/psicologia , Estenose das Carótidas/diagnóstico por imagem , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Placa Aterosclerótica/diagnóstico por imagem , Prevalência , Fatores de Risco , Uganda/epidemiologia , Ultrassonografia
16.
Rinsho Shinkeigaku ; 59(8): 525-529, 2019 Aug 29.
Artigo em Japonês | MEDLINE | ID: mdl-31341128

RESUMO

We herein experienced one patient with typical branch atheromatous disease (BAD) type infarction. Digital subtraction angiography (DSA) and MRI fusion imaging revealed the relationship between atheromatous plaque and perforating branches. A 66-year-old male presented acute onset of dysarthria, the left side hemiparesis and sensory disturbance. Diffusion-weighted MR imaging (DWI) showed the right pontine acute infarction. We started to treat with dual antiplatelet therapy. However, the left-side hemiparesis was worsening on 4 days after admission. DWI showed infarct growth and plaque imaging revealed the atheromatous plaque in the basilar artery. We fused DSA and MRI T2 weighted imaging (DSA-MR fusion imaging) to illustrate the relationship between the atheromatous plaque and the perforating branches. DSA-MR fusion imaging showed that the paramedian artery and the short circumferential artery ran around and into the pontine infarct lesion. Additionally, one of the paramedian arteries was occluded. Those neuroradiological findings coincided with the pathological concept of BAD. DSA-MR fusion imaging can prove the pathological concept of BAD.


Assuntos
Angiografia Digital , Infarto Cerebral/diagnóstico por imagem , Infarto Cerebral/etiologia , Imagem de Tensor de Difusão , Placa Aterosclerótica/complicações , Placa Aterosclerótica/diagnóstico por imagem , Idoso , Infarto Cerebral/terapia , Clopidogrel/administração & dosagem , Humanos , Masculino , Neuroimagem , Placa Aterosclerótica/terapia , Inibidores da Agregação de Plaquetas/administração & dosagem , Resultado do Tratamento
18.
Arterioscler Thromb Vasc Biol ; 39(7): 1369-1378, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31242032

RESUMO

Noninvasive imaging technologies offer to identify several anatomic and molecular features of high-risk plaques. For the noninvasive molecular imaging of atherosclerotic plaques, nuclear medicine constitutes one of the best imaging modalities, thanks to its high sensitivity for the detection of probes in tissues. 18F-fluorodeoxyglucose (FDG) is currently the most widely used radiopharmaceutical for molecular imaging of atherosclerotic plaques with positron emission tomography. The intensity of FDG uptake in the vascular wall correlates closely with the degree of macrophage infiltration in atherosclerotic plaques. FDG positron emission tomographic imaging has become a powerful tool to identify and monitor noninvasively inflammatory activities in atherosclerotic plaques over time. This review examines how FDG positron emission tomographic imaging has given us deeper insight into the role of inflammation in atherosclerotic plaque progression and discusses perspectives for alternative radiopharmaceuticals to FDG that could provide a more specific and simple identification of high-risk lesions and help improve risk stratification of atherosclerotic patients. Visual Overview- An online visual overview is available for this article.


Assuntos
Imagem Molecular/métodos , Placa Aterosclerótica/diagnóstico por imagem , Fluordesoxiglucose F18 , Radioisótopos de Gálio , Humanos , Tomografia por Emissão de Pósitrons , Compostos Radiofarmacêuticos
19.
Neuroradiology ; 61(9): 1093-1101, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31203414

RESUMO

PURPOSE: Arteriosclerosis of the vascular system is associated with many accompanying diseases. Especially cerebral arteriosclerosis is a main risk factor for ischemic strokes. We want to verify the practicability of intravascular imaging like intravascular ultrasound and optical coherence tomography for the assessment of cerebral vessel walls and plaques. METHODS: We examined 18 Circuli arteriosi willisii postmortem. The data contained 48 plaques from 48 different vessel parts. The samples underwent intravascular and histological imaging to conduct a quantitative assessment of vessel wall parameters (healthy vessel wall, thinnest vessel wall, plaque thickness and vessel diameter) as well as to qualitatively evaluate the healthy vessel wall, fibrotic plaques, calcifications and cholesterol deposits in diseased vessels. RESULTS: The comparison showed statistically significant smaller measurements for thinnest vessel walls, normal vessel walls and vessel diameters in histology than in imaging. No statistically significant difference was reached for plaque diameters. Fibrotic plaques were characterized as hyper-intense with dorsal attenuation and calcifications as hypo-intense with dorsal attenuation in optical coherence tomography. In intravascular ultrasound, fibrotic plaques showed a homogeneous echogenicity without distal attenuation and calcifications were depicted as hyperechoic with dorsal sound shadows. Cholesterol deposits were hyper-intense in optical coherence tomography with strongly attenuated signals and in intravascular ultrasound; the deposits were hyper-intense with almost no attenuation. CONCLUSION: Both intravascular methods allow for plaque characterization and quantification of plaque diameter in cerebral vessel walls. When compared with histology, a statistically significant bias was obtained for the ex vivo measurements of the normal vessel wall diameters.


Assuntos
Arteriosclerose Intracraniana/diagnóstico por imagem , Placa Aterosclerótica/diagnóstico por imagem , Tomografia de Coerência Óptica , Ultrassonografia de Intervenção , Idoso , Cadáver , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
Zhonghua Yi Xue Za Zhi ; 99(21): 1656-1659, 2019 Jun 04.
Artigo em Chinês | MEDLINE | ID: mdl-31189266

RESUMO

Objective: The identification of neovascularization in carotid plaque in carotid artery stenosis by contrast-enhanced ultrasound (CEUS) provides other risk markers for stroke besides carotid artery stenosis -intraplaque neovascularization. Methods: From January 2017 to September 2017, 40 patients with carotid atherosclerosis plaque were examined by contrast-enhanced ultrasound in China-Japanese Friendship Hospital. The enhancement intensity (EI) measured by contrast-enhanced ultrasound was compared with the micro-vessel density (MVD) measured by histopathology after carotid endarterectomy (CEA). Contrast-enhanced ultrasound was used to observe whether there was enhancement in the plaque and the enhancement was divided into 0-2 grades. The EI in plaque, the ratio of EI in plaque to EI in carotid artery lumen were calculated by time intensity curve quantitative analysis software. Pathological sections of carotid plaques after CEA were stained with CD34 and neovascularization density was measured. Results: There were significant differences in age, EI1, EI1/EI2 and CD34 among patients with different grades of plaque enhancement (P<0.05), but no significant differences in gender and EI2 (P>0.05). The density of neovascularization obtained by CD34 staining was highly positively correlated with EI1 (r=0.836, P<0.001), EI1/EI2 (r=0.955, P<0.001), but not with age (r=0.066, P=0.684), EI2 (r=0.159, P=0.328). Conclusions: Contrast-enhanced ultrasound can observe the neovascularization in carotid plaque, which is a simple and non-invasive method to evaluate the stability of carotid plaque. CEUS may also help to extract features of vulnerable plaques, such as acute intraplaque hemorrhage.


Assuntos
Estenose das Carótidas , Placa Aterosclerótica , Artérias Carótidas , Estenose das Carótidas/diagnóstico por imagem , China , Meios de Contraste , Humanos , Neovascularização Patológica , Placa Aterosclerótica/diagnóstico por imagem , Ultrassonografia
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