Circumferential Strain as a Marker of Vessel Reactivity in Patients with Intradialytic Hypotension.

Background and Objectives: Intradialytic hypotension (IDH) complicates 4 to 39.9% of hemodialysis (HD) sessions. Vessels' reactivity disturbances may be responsible for this complication. Two-dimensional speckle tracking is used to assess arterial circumferential strain (CS) as a marker of the effectiveness of the cardiovascular response to the reduction of circulating plasma. Materials and Methods: The common carotid artery (CCA) and common iliac artery (CIA) CSs were recorded using ultrasonography in 68 chronically dialyzed patients before and after one HD session. Results: In patients with IDH episodes (n = 26), the CCA-CS was significantly lower both before (6.28 ± 2.34 vs. 4.63 ± 1.74 p = 0.003) and after HD (5.00 (3.53-6.78) vs. 3.79 ± 1.47 p = 0.010) than it was in patients without this complication. No relationship was observed between CIA-CS and IDH. IDH patients had a significantly higher UF rate; however, they did not differ compared to complication-free patients either in anthropometric or laboratory parameters. Conclusions: Patients with IDH were characterized by lower pre- and post-HD circumferential strain of the common carotid artery. The lower CCA-CS showed that impaired vascular reactivity is one of the most important risk factors for this complication's occurrence.

The reaction of arteries to haemodialysis - can a change in the cross-sectional area be an important parameter in the assessment of the vessels' condition?

Purpose: The objectives of our study were to evaluate the changes in the cross-section area of carotid and femoral arteries caused by fluid loss during haemodialysis (HD) and to determine the direction and amount of these changes. Material and methods: Seventy-four HD patients (28 women and 46 men) were studied. We performed ultrasound exams of the distal common carotid and proximal femoral arteries in each patient before and after a HD session. Recorded exams were analysed using EchoPac software. Arterial cross-section area values were acquired for further analysis. Results: We found a statistically significant decrease in arterial systolic cross-section area values after HD sessions (carotid arteries area before HD equalled 0.6731 cm2 and 0.6333 cm2, p = 0.00001 after HD, femoral arteries area before HD equalled 0.8263 cm2 and 0.7635 cm2, p = 0.00001 after HD). The decrease of systolic carotid cross-section area correlated with the amount of fluid lost during HD sessions (correlation coefficient of 0.3122, p = 0.010) and the percentage of the body mass lost during HD (correlation coefficient of 0.3577, p = 0.003). No statistically significant changes were found in the femoral cross-section area. Conclusions: Our findings suggest that the arterial cross-section area may be used in the assessment of response to body fluid loss. We were able to measure changes due to fluid loss during the HD session. The carotid cross-section values decreased after the procedure and correlated with the amount of fluid lost during the HD session.

Renal-aortic ratio as an objective measure of renal artery diameter a computed tomography angiography study.

BACKGROUND: Considering vital role of renal arteries in many surgical procedures, diameter of renal arteries seems to be an important measure of kidney perfusion. In this study, we analyzed a new parameter, renal-aortic ratio (R-Ar) as an objective measure of the renal artery diameter. METHOD: The study included CT angiographic images from 254 patients (129 women and 125 men). R-Ar was calculated by dividing the diameter of the main renal artery for each kidney by the aortic diameter. RESULTS: R-Ar values for the whole study group ranged between 0.0863 and 0.5083; the ranges of R-Ar values for women and men patients were 0.1150-0.5083 and 0.0863-0.4449, respectively. In 412 cases (81.10%), the kidney was supplied by a single renal artery (RA variant) and in 96 (18.90%) by more than one artery (sRA variant). A significant difference was found in R-Ar values for RA and sRA variants (p = 0.0008). When the anatomical variant of renal perfusion was not considered on statistical analysis, a significant difference was found between the R-Ar values for women and men (p = 0.0259). No statistically significant difference was observed in R-Ar values for the right and left kidneys (p = 0.3123). Spearman's coefficient of rank correlation between patient age and renal-aortic ratio values for the whole study group equaled - 0.36. CONCLUSION: The analysis of the renal-aortic ratio values demonstrated that the diameter of renal arteries depended primarily on their number, and the relative diameter of renal arteries in women was larger than in men.

A novel vision-based system for quantitative analysis of abdominal aortic aneurysm deformation.

BACKGROUND: In clinical diagnostics, combination of different imaging techniques is applied to assess spatial configuration of the abdominal aortic aneurysm (AAA) and deformation of its wall. As deformation of aneurysm wall is crucial parameter in assessing wall rupture, we aimed to develop and validate a Non-Invasive Vision-Based System (NIVBS) for the analysis of 3D elastic artificial abdominal aortic models. 3D-printed elastic AAA models from four patients were applied for the reconstruction of real hemodynamic. During experiments, the inlet boundary conditions included the injection volume and frequency of pulsation averaged from electrocardiography traces. NIVBS system was equipped with nine cameras placed at a constant distance to record wall movement from 360o angle and a dedicated set of artificial lights providing coherent illumination. Additionally, self-prepared algorithms for image acquisition, processing, segmentation, and contour detection were used to analyze wall deformation. Finally, the shape deformation factor was applied to evaluate aorta's deformation. Experimental results were confronted with medical data from AngioCT and 2D speckle-tracking echocardiography (2DSTE). RESULTS: Image square analyses indicated that the optimal distance between the camera's lens and the investigated object was in the range of 0.30-0.35 m. There was approximately 1.44% difference observed in aneurysm diameters between NIVBS (86.57 ± 5.86 mm) and AngioCT (87.82 ± 6.04 mm) (p = 0.7764). The accuracy of developed algorithm for the reconstruction of the AAA deformation was equal to 98.56%. Bland-Altman analysis showed that the difference between clinical data (2DSTE) and predicted wall deformation (NIVBS) for all patients was 0.00 mm (confidence interval equal to 0.12 mm) for aneurysm size, 0.01 mm (confidence interval equal to 0.13 mm) and 0.00 mm (confidence interval equal to 0.09 mm) for the anterior and posterior side, as well as 0.01 mm (confidence interval equal to 0.18 mm) and 0.01 mm (confidence interval equal to 0.11 mm) for the left and right side. The optimal range of camera's lens did not affect acquired values. CONCLUSIONS: The NIVBS with proposed algorithm that reconstructs the pressure from surrounding organs is appropriate to analyze the AAAs in water environment. Moreover, NIVBS allowed detailed quantitative analysis of aneurysm sac wall deformation.

Simulation of phase contrast angiography for renal arterial models.

BACKGROUND: With the development of versatile magnetic resonance acquisition techniques there arises a need for more advanced imaging simulation tools to enable adequate image appearance prediction, measurement sequence design and testing thereof. Recently, there is a growing interest in phase contrast angiography (PCA) sequence due to the capabilities of blood flow quantification that it offers. Moreover, as it is a non-contrast enhanced protocol, it has become an attractive option in areas, where usage of invasive contrast agents is not indifferent for the imaged tissue. Monitoring of the kidney function is an example of such an application. RESULTS: We present a computer framework for simulation of the PCA protocol, both conventional and accelerated with echo-planar imaging (EPI) readout, and its application to the numerical models of kidney vasculatures. Eight patient-specific renal arterial trees were reconstructed following vessel segmentation in real computed tomography angiograms. In addition, a synthetic model was designed using a vascular tree growth simulation algorithm. The results embrace a series of synthetic PCA images of the renal arterial trees giving insight into the image formation and quantification of kidney hemodynamics. CONCLUSIONS: The designed simulation framework enables quantification of the PCA measurement error in relation to ground-truth flow velocity data. The mean velocity measurement error for the reconstructed renal arterial trees range from 1.5 to 12.8% of the aliasing velocity value, depending on image resolution and flip angle. No statistically significant difference was observed between measurements obtained using EPI with a number of echos (NETL) = 4 and conventional PCA. In case of higher NETL factors peak velocity values can be underestimated up to 34%.

Diagnostic value of lateral ventricle ratio: a retrospective case-control study of 112 acute subdural hematomas after non-severe traumatic brain injury.

PRIMARY OBJECTIVE: To evaluate correlation between the lateral ventricle ratio (LVR) and the risk of conservative treatment failure (CTF) among patients with acute subdural hematoma (ASDH) after non-severe traumatic brain injury (TBI), we retrieved from the hospital database and performed a retrospective analysis of 1339 cases with TBI treated during the 2008-2016 period. METHODS AND PROCEDURES: 112 patients with ASDH, GCS≥ 9 and initial conservative treatment were enrolled. They were divided according to the final treatment method applied (surgical or conservative). Clinical and radiological data was evaluated. We used ROC curve analysis and multivariate logistic regression model to identify risk factors of CTF. MAIN OUTCOMES AND RESULTS: LVR higher than 1.48 calculated on admission CT scans was the strongest predictor of CTF, with sensitivity of 78.9% and specificity of 93.5% (AUC: 0.774-0.994). LVR, prolonged prothrombin time and coexisting traumatic subarachnoid hemorrhage were independent risk factors. CONCLUSIONS: Despite limitations, study results support the view that patients after non-severe TBI with ASDH and with lateral ventricle asymmetry, defined as LVR> 1.48, require surgical treatment. LVR seems to be indirect, but still the closest method to quantify intracranial compliance. Thus, in the selected group of patients without clinical symptoms of critically diminished compensatory reserve, LVR could indicate those who need a surgical decompression.

Arterio-biliary fistulas: What to choose as endovascular treatment?

Objectives Endovascular procedures are the treatment of choice in cases of intrahepatic fistulas. Arterio-biliary fistulas are the rarest and most difficult to treat, due to high risk of infection. Methods Eight cases of persistent hemobilia that developed as a result of arterio-biliary fistulas are presented. Five cases developed as a result of iatrogenic injury, two cases as a result of chronic infection, one case as a consequence of trauma. Results Patients were treated using endovascular embolization or combined endovascular and endoscopic biliary tract revision. The results were monitored after six to seven days and one month after embolization. The embolizations were considered effective in all cases. One patient had four asynchronous fistulas requiring separate treatments sessions. Four patients required a revision of their biliary ducts after embolization and restoration of patency. In one patient, a migration of the coil to biliary ducts occurred. Conclusion Endovascular treatment of arterio-biliary fistulas is safe and effective. The use of embolization with soft and biodegradable materials like histoacrylic glue or thrombin may be the optimal method of treatment in comparison with coils which have a risk of migration or chronic infection.

Feasibility of two-dimensional speckle tracking in evaluation of arterial stiffness: Comparison with pulse wave velocity and conventional sonographic markers of atherosclerosis.

Objective Arterial stiffening is an early marker of atherosclerosis that has a prognostic value for cardiovascular morbidity and mortality. Although many markers of arterial hardening have been proposed, the search is on for newer, more user-friendly and reliable surrogates. One such potential candidate has emerged from cardiology, the speckle-tracking technique. The aim of this study was to evaluate the feasibility of the two-dimensional speckle tracking for the evaluation of arterial wall stiffness in comparison with standard stiffness parameters. Methods Carotid ultrasound and applanation tonometry were performed in 188 patients with no cardiovascular risk factors. The following parameters were then evaluated: the intima-media complex thickness, distensibility coefficient, ß-stiffness index, circumferential strain/strain rate, and pulse wave velocity and augmentation index. These variables were compared with each other and with patient age, and their reliability was assessed with Bland-Altman plots. Results Strain parameters derived from two-dimensional speckle tracking and intima-media complex thickness correlated better with age and pulse wave velocity than standard makers of arterial stiffness. Moreover, the reliability of these measurements was significantly higher than conventional surrogates. Conclusions Two-dimensional speckle tracing is a reliable method for the evaluation of arterial stiffness. Therefore, together with intima-media complex thickness measurement, it offers great potential in clinical practice as an early marker of atherosclerosis.

Usefulness of Routine Coronary CT Angiography in Patients with Transposition of the Great Arteries After an Arterial Switch Operation.

Coronary complications in patients with transposition of the great arteries (TGA) after an arterial switch operation (ASO) are relatively rare, but of all the possible postoperative adverse events, they are potentially the most dangerous. The fate of the coronary arteries, which are transplanted during the neonatal ASO, remains uncertain. There is also no consensus regarding their postoperative evaluation, especially in asymptomatic patients. The aim of this study was to present the early results of routinely performed coronary computed tomography angiography (CCTA) in asymptomatic adolescents and young adults with TGA after an ASO. An initial series of 50 CCTAs performed in asymptomatic patients with TGA after an ASO were evaluated. In each case, a detailed examination of the coronary anatomy, its relationship to the surrounding structures, its exact position in the neoaortic sinus, and the presence of significant coronary abnormalities was performed. The CT scans revealed significant coronary abnormalities in 12 asymptomatic patients: three had acute proximal angulation and stenosis, four had an intra-arterial course, seven had a muscular bridge, one had a left anterior descending artery with an intramuscular course, and one had coronary fistulas to the pulmonary arteries. Additionally, in 25 patients, proximal acute angulation of at least one coronary artery was detected, and four of them had a high ellipticity index. Most of the potentially severe anatomical features were related to the left coronary artery or the left anterior descending artery. CCTA routinely performed on asymptomatic patients with TGA after an ASO provides accurate and useful information for postoperative management. The frequency of coronary anomalies and potentially dangerous anatomical features in this group of patients is high, and their impact on postoperative follow-up remains unknown.

The level of origin of renal arteries in horseshoe kidney vs. in separated kidneys: CT-based study.

PURPOSE: Horseshoe kidney is a rare congenital anomaly with potential clinical implications. The aim of this study was to determine the number of renal arteries and veins and the level at which the arteries branched off their parental vessels in individuals with horseshoe kidney (HSK) and in persons with separated kidneys (SK). MATERIALS AND METHODS: The analysis included computed tomography angiography studies of 331 patients (83 HSK and 248 SK). The number of renal vessels and diameters of renal arteries were determined, along with the level at which they branched in relation to other ramifications (four groups of origin were proposed) and their entrance of the vessels to the kidney. RESULTS: Number of renal arteries in HSK group was 4.57 ± 1.39 per patient and 2.4 ± 0.43 in SK group (p < 0.0001). The distribution of branching level of renal arteries in HSK group was: I group ~ 57%, II group ~ 27%, III group ~ 15% and IV group < 1%, whereas in SK group the distribution was respectively: I group ~ 99%, II group < 1%, III and IV group - 0% (p = 0.0001). In HSK group, diameter of renal arteries branching above the IMA was 4.61 ± 1.58 mm, as compared with 3.96 ± 1.34 mm for the arteries branching below (p = 0.0004). Number of veins was 566 in SK group (87.70% of kidneys were supplied by single vein) and 323 in HSK group (9.64% kidneys were supplied by two veins) (p < 0.0001). CONCLUSION: In HSK group, renal arteries significantly more often branch off their parental vessels below the origin of IMA and such vessels are usually smaller.

Does the type of renal artery anatomic variant determine the diameter of the main vessel supplying a kidney? A study based on CT data with a particular focus on the presence of multiple renal arteries.

BACKGROUND: An in-depth knowledge of renal vascular anatomy is essential when planning many surgical procedures; however, a few data exists regarding renal artery diameter. The aim of this study was to assess this morphological feature and to investigate whether a correlation exists between renal artery diameter and the type of arterial supply, with a particular emphasis on variant anatomy and the presence of multiple renal arteries. MATERIALS AND METHODS: Computed tomography angiography (CTA) studies of 248 patients, i.e., a total of 496 kidneys, were evaluated. The mean age of the patients was 66.4 ± 15.01 years. Renal artery diameter was measured based on the type of arterial blood supply. RESULTS: The frequency of occurrence of three anatomic variants of renal arterial supply was established: single renal artery (RA) 43.35%, single artery with prehilar branching (pRA) 37.30%, and multiple renal artery (mRA) 19.35%. The diameter of single renal arteries, with either prehilar or hilar branching, was significantly larger than when multiple arteries were present. A detailed analysis of just the mRA variant demonstrated that the diameter of the renal arteries in men was larger (p = 0.012) than those in women and that there was no difference in diameter with regard to the side of the body (p = 0.219). CONCLUSIONS: The classification described in our study containing a detailed description of renal artery diameter. It may be helpful in clinical practice, especially for transplantologists, surgeons, and vascular surgeons.

Computational Fluid Dynamics as an Engineering Tool for the Reconstruction of Hemodynamics after Carotid Artery Stenosis Operation: A Case Study.

Background and objectives: Brain ischemic stroke is caused by impaired or absolutely blocked blood flow into the brain regions. Despite the large number of possible origins, there is no general strategy for preventive treatment. In this paper, we aimed to predict the hemodynamics in a patient who experienced a critical stenosis operation in the carotid artery. This is a unique study where we used medical data together with the computational fluid (CFD) technique not to plan the surgery, but to predict its outcome. Materials and Methods: AngioCT data and blood perfusion of brain tissue (CT-perfusion) together with CFD technique were applied for stroke formation reconstruction in different clinical conditions. With the use of self-made semiautomatic algorithm for image processing and 3DDoctror software, 3D-vascular geometries before and after surgical intervention were reconstructed. As the paper is focused on the analysis of stroke appearance, apparent stroke was simulated as higher and lower pressure values in the cranial part due to different outcomes of the surgical intervention. This allowed to investigate the influence of spatial configuration and pressure values on blood perfusion in the analyzed circulatory system. Results: Application of CFD simulations for blood flow reconstruction for clinical conditions in the circulatory system accomplished on average 98.5% and 98.7% accuracy for CFD results compared to US-Doppler before and after surgical intervention, respectively. Meanwhile, CFD results compared to CT-perfusion indicated an average 89.7% and 92.8% accuracy before and after surgical intervention, respectively. Thus, the CFD is a reliable approach for predicting the patient hemodynamics, as it was confirmed by postoperative data. Conclusions: Our study indicated that the application of CFD simulations for blood flow reconstruction for clinical conditions in circulatory system reached 98% and 90% accuracy for US-Doppler and CT-perfusion, respectively. Therefore, the proposed method might be used as a tool for reconstruction of specific patients' hemodynamics after operation of critical stenosis in the carotid artery. However, further studies are necessary to confirm its usefulness in clinical practice.

Right aortic arch analysis - Anatomical variant or serious vascular defect?

BACKGROUND: The right-sided aortic arch (RAA) is a rare congenital defect of the aorta. The aim of the study was to assess the occurrence of RAA in diagnoses performed by the University Radiology Department and analyze the frequency of concomitant vascular abnormalities. METHODS: The database of the Radiology Department was retrospectively analyzed between January 2008 and May 2016 with the keyword "right aortic arch". Twenty patients with this diagnosis were identified from a total of 11,690 CT examinations of the chest area, 19,623 CT examinations of brain-supplying vessels, and 1863 MRI examinations of the heart and aortic arch or brain-supplying arteries. The type of aortic arch, the occurrence of Kommerell's diverticulum and possible other vascular abnormalities, such as stenosis, kinking or occlusion, were then investigated. RESULTS: The analysis identified nine patients with type I and 11 patients with type II RAA. Eight of the 11 type II patients presented Kommerell's diverticulum. Concomitant vascular abnormalities were detected in four patients with type II RAA. In two cases, the right common carotid artery (RCCA) was narrowed by up to 80%, with steal phenomenon confirmed in one of them. In the second coincident right subclavian artery (RSA) stenosis was depicted. In two other cases, the aberrant left subclavian arteries (ALSA) were found to be narrowed at the level of origin by up to 70%. One patient was found with type B aortic dissection including ALSA and Kommerell's diverticulum. CONCLUSIONS: Our observations indicate that concomitant vascular abnormalities may occur more often than reported in literature. Patients diagnosed with type II RAA should be examined with Doppler ultrasonography to identify coincident vascular disorders, especially stenosis of the common carotid arteries or subclavian arteries.

Inhaled Corticosteroids in Asthma: Promoting or Protecting Against Atherosclerosis?

BACKGROUND Bronchial asthma is an inflammatory disease of the respiratory system. However, it may also induce systemic effects. Although reports suggest patients with asthma are at increased risk of cardiovascular events, the association between asthma and atherosclerosis is unclear. The aim of the present study was to compare the progression of atherosclerosis between patients with asthma treated with inhaled corticosteroids and healthy controls. MATERIAL AND METHODS In 102 adult patients with asthma, markers of arterial stiffness (pulse wave velocity and augmentation index) were evaluated by applanation tonometry. Structural atherosclerotic changes (intima-media complex thickness and presence of atherosclerotic plaque) were assessed sonographically. Lipid profile and fasting glucose level were measured. Clinical data concerning the course of asthma, its severity, and management strategy were obtained. A group of 102 healthy, age-matched controls were examined according to the same protocol. RESULTS The majority of patients presented well-controlled asthma of moderate severity. When adjusted for weight, age, and systolic blood pressure, no significant differences were observed in pulse wave velocity, in augmentation index, or in intima-media complex thickness between groups. In controls, atherosclerotic plaque occurred significantly more often than in patients with asthma (p=0.0226). Moreover, in patients with asthma, the intima-media complex thickness of the right common carotid artery was significantly correlated with forced expiratory volume in 1 second (R²=-0.2951, p=0.0083). There was no significant difference in any of the atherosclerosis markers between different types and doses of administered inhaled corticosteroids. CONCLUSIONS Patients with bronchial asthma presented a decreased risk of atherosclerosis in comparison to healthy controls.

Radio-opaque polyethylene for personalized craniomaxillofacial implants.

OBJECTIVE: This study aimed to present a new possibility to create radio-opaque implant material for craniomaxillofacial reconstruction. MATERIALS AND METHODS: The test disks made of the own compound of polyethylenes with addiction of 2, 4, and 6 % of weight TiO2 was investigated for cytotoxicity [each group 15 disks respectively]. Next, computed tomography of the disks was performed in environment of muscle and fat. Hardness, tensile modulus and strength, and compressive modulus and strength were tested too. RESULTS: Deterioration of mechanical properties of the composites containing titanium dioxide was observed [hardness, tensile modulus and strength, compressive modulus and strength, respectively: 56.7 ± 1.6 shore D, 354 ± 52, 22.5 ± 1.3, 21.8 ± 1.1, and 2995 ± 327 MPa as addiction of 2 % TiO2; 52.0 ± 0.9 shore D, 347 ± 66, 18.0 ± 0.7, 14.2 ± 0.9, and 1396 ± 477 MPa as 4 % TiO2; 51.3 ± 1.3 shore D, 316 ± 9, 17.4 ± 0.2, 13.6 ± 0.6, and 1100 ± 144 MPa as 6 % TiO2 added]. The test disks revealed no cytotoxicity effect on human osteoblasts. The new material presents mild radio-opacity which was enough to observe the implant in relation to fat and muscle, but with no visible effect of beam hardening. CONCLUSION: In view of the performed tests, the polyethylene enriched by titanium dioxide seems to be a proper material to consider manufacturing of craniomaxillofacial implants. CLINICAL RELEVANCE: Maxilloafacial surgery is still looking for new implantologic materials. The proposed one is a new way to manufacture an implant visible in computed tomography which does not interfere with its shape in radiological examination and makes it possible to observe the surrounding soft tissues.

Reorganization of language centers in patients with brain tumors located in eloquent speech areas - A pre- and postoperative preliminary fMRI study.

INTRODUCTION: The aim of this study was to determine in pre- and postsurgical fMRI studies the rearrangement of the Broca's and Wernicke's areas and the lateralization index for these areas in patients with brain tumors located near speech centers. Impact of the surgical treatment on the brain plasticity was evaluated. MATERIALS AND METHODS: Pre- and postoperative fMRI examinations were performed in 10 patients with low grade glial, left-sided brain tumors located close to the Broca's (5 patients) or Wernicke's area (5 patients). BOLD signal was recorded in regions of interest: Broca's and Wernicke's areas, and their anatomic right-sided homologues. RESULTS: In the preoperative fMRI study the left Broca's area was activated in all cases. The right Broca's area was activated in all the patients with no speech disorders. In the postoperative fMRI the activation of both Broca's areas increased in two cases. In other two cases activation of one of the Broca's area increased along with the decrease in the contralateral hemisphere. In all patients with temporal lobe tumors, the right Wernicke's area was activated in the pre- and postsurgical fMRI. After the operation, in two patients with speech disorder, the activation of both Broca's areas decreased and the activation of one of the Wernicke's areas increased. CONCLUSIONS: In the cases of tumors localized near the left Broca's area, a transfer of the function to the healthy hemisphere seems to take place. Resection of tumors located near Broca's or Wernicke's areas may lead to relocation of the brain language centers.

Assessment of aortic valve in regard to its anatomical variants morphology in 2053 patients using 64-slice CT retrospective coronary angiography.

BACKGROUND: Bicuspid aortic valve (BAV) is the most common congenital cardiac anomaly. Other aortic valve variants are rare but are associated with an increased incidence of various pathologies of the aortic valve (AV). The aim of this study was to assess the AV function in regard to its anatomical variants morphology in patients who underwent 64-slice coronary computed tomography angiography (CCTA) for suspected or known coronary artery disease. METHODS: The results of 64-detector retrospective ECG-gated CCTA of 2053 patients (mean age 58 years; 1265 males) were analyzed retrospectively by experienced cardiovascular radiologist. Coronary anatomy (with coronary artery dominance) and the extent of occlusion in the coronary arteries were assessed. Furthermore morphological and functional status of AV variants were analyzed. Among measured parameters were area at the level of AV annulus, orifice and tubular portion of the ascending aorta. RESULTS: The AV was visualized in all CCTA studies and the analysis of its morphology and function was done in all patients. BAV was found in 19 patients (0.9 %), from which type 0 was diagnosed in five patients (0.2 %) and type 1 in 14 patients (0.7 %) - there was no patient with BAV type 2. Unicuspid (UAV) and quadricuspid (QAV) variant were both observed each in one patient (0.05 %). In rest of the patients from the study group tricuspid AV variant was recognized. Function of AV variants was mostly affected in BAV0 and UAV. Among patients with BAV1 there were patients with normal and abnormal function of AV. QAV variant did not deteriorate AV function. There was no difference in coronary artery disease and dominancy between different anatomical variants of AV. CONCLUSIONS: During CCTA different valve variants can be detected and detailed analysis of valvular function can be proceeded. Larger values of annulus area, wider diameters of ascending aorta and more stenotic profile were observed in BAV 0, BAV 1 and UAV. Among AV variants morphology and function was mostly affected in patients with BAV 0 and UAV variants, while subjects with BAV1 had normal or abnormal function of the AV. Moreover, we noticed that QAV variant did not deteriorate AV function.

Plasma Desphospho-Uncarboxylated Matrix Gla Protein as a Marker of Kidney Damage and Cardiovascular Risk in Advanced Stage of Chronic Kidney Disease.

BACKGROUND/AIMS: Desphospho-uncarboxylated matrix Gla protein (dp-ucMGP) is formed as a result of vitamin K insufficiency. The aim of this study was to investigate the association between plasma dp-ucMGP, kidney function and cardiovascular risk factors before and after 9-months substitution of vitamin K2 in non-dialysis patients with chronic kidney disease (CKD) stage 4 and 5. METHODS: 38 CKD patients were supplemented for 270±12 days with 90 µg vitamin K2 and 10 µg cholecalciferol or 10 µg cholecalciferol alone. At baseline and at follow-up circulating calcium, phosphate, lipids, hemoglobin, albumin and total protein, dp-ucMGP, osteoprotegerin, fetuin A, osteocalcin and fibroblast grown factor 23 (FGF-23) were assessed. Proteinuria was assessed in the first morning void. RESULTS: Baseline plasma dp-ucMGP was 1018.6±498.3 pmol/l and was significantly higher in patients at stage 5 CKD (1388.3 ±505.4 pmol/l) than at stage 4 (885.1±419.7 pmol/l), p=0.04. Vitamin K2 supplementation resulted in a decrease of dp-ucMGP level by 10.7%. Plasma dp-ucMGP was positively associated with proteinuria, serum creatinine, PTH and FGF-23; and inversely associated with glomerular filtration rate, serum hemoglobin and albumin. CONCLUSIONS: High dp-ucMGP level, reflecting a poor vitamin K status seems to be associated with kidney damage and may be also a marker of cardiovascular risk in CKD patients. Supplementation with vitamin K2 may improve the carboxylation status of MGP.

Does the internal jugular vein affect the elasticity of the common carotid artery?

BACKGROUND: Arterial stiffness is an early marker of atherosclerosis. The carotid arteries are easily accessible by ultrasound and are commonly used for the evaluation of atherosclerosis development. However, this stiffness assessment is based on the elastic properties of the artery, which may be influenced by the adjacent internal jugular vein (IJV). The aim of the present study is to evaluate the influence of internal jugular vein morphology on the stiffness of the common carotid artery. METHODS: Bilateral carotid ultrasound was performed in 248 individuals. When no carotid plaque was detected (90.9 % cases), the distensibility coefficient and ß - stiffness index were calculated. The global and segmental circumferential strain parameters of the carotid wall were evaluated with 2D-Speckle Tracking. The cross-sectional area of the IJV and degree of its adherence to the carotid wall (angle of adherence) were measured. RESULTS: The morphology of the IJV did not influence the standard stiffness parameters nor the global circumferential strain. However, segmental analysis found the sector adjacent to the IJV to have significantly higher strain parameters than its opposite counterpart. In addition, the strain correlated significantly and positively with IJV cross-sectional area and angle of adherence. CONCLUSIONS: The movement of the carotid artery wall caused by the passage of the pulse wave is not homogeneous. The greatest strain is observed in a segment adjacent to the IJV, and the degree of wall deformation is associated with the size of the vein and the degree of its adherence.

Anatomical anomalies of the V3 segment of the vertebral artery in the Polish population.

PURPOSE: The aim of this study is to evaluate the incidence of the anatomical anomalies of the V3 segment of the vertebral artery in the Polish population. There is conflicting evidence on the incidence of these anomalies: Asian-based studies show high incidence of 10 %, whereas the North American study identifies these anomalies in less than 1 % of patients. METHODS: 1800 computed tomography angiographies (CTA) obtained at the Barlicki University Hospital in Lodz, Poland, were reviewed retrospectively. RESULTS: All the patients were Caucasians. There were 968 males and 832 females. The mean age of the patients was 58. CTAs were obtained for the following reasons: stroke 1312, trauma 25, vascular/aneurysm 216, and intracranial haemorrhage 247. Vertebral artery hypoplasia was present in 360 cases (20 %). Persistent intersegmental artery (type I anomaly) was not found in any study. Fenestration of the V3 vertebral artery (type II) was recognized in three angiograms (0.16 %). Vertebral artery ending up as posterior inferior cerebellar artery (type III anomaly) was seen in 11 patients (0.61 %). CONCLUSIONS: Very low incidence of V3 segment anomalies does not justify in our opinion routine vascular imaging in patients undergoing posterior cervical instrumented procedures.