Carotid Intima-Media Roughness and Elasticity in Hypertensive Patients With Normal Carotid Intima-Media Thickness

Analysis of Risk Factors for Vulnerable Plaque Formation and Pathogenic in Carotid Artery

OBJECTIVES

The formation of vulnerable carotid artery plaque may be closely related to a single factor or caused by multiple factors. This paper discusses the pathogenic risk factors for vulnerable plaque in patients with severe internal carotid artery (ICA) stenosis who received endarterectomy through regression analysis.

MATERIALS AND METHODS

A total of 98 patients with a complete clinical and laboratory assessment underwent carotid endarterectomy. Metabolic syndrome (MetS) and MetS components, ICA plaque thickness and ICA peak systolic velocity, previous ischemic stroke or transient ischemic attack (TIA), and other risk factors were included in the pathogenic risk factor for vulnerable plaque. Univariate logistic regression analysis was used to determine vulnerable carotid plaque risk factors. If P <0.2, it was considered potential confounders. Binary logistic regression model was controlled for potential confounders.

RESULTS

Among the 98 patients, stable carotid plaques 38 (39%) and unstable carotid plaques 60 (61%), male 76 (77.6%) and female 22 (22.4%), and Han Chinese 68 (68.4%) and Mongols 30 (30.6%). Univariate logistic regression to P <0.2 has 6 risk factors, which are previous ischemic stroke or TIA, ICA peak systolic velocity, ICA plaque thickness, body mass index, total cholesterol, and alcohol consumption. The significant result of the binary logistic regression analysis was the previous ischemic stroke or TIA (OR=4.52; 95% CI, 1.67-12.09), P =0.003 and ICA peak systolic velocity (OR=1.01; 95% CI, 1.00-1.02), P =0.014.

CONCLUSIONS

The patients with previous ischemic stroke or TIA and higher ICA peak systolic velocity are associated with vulnerable plaque pathogenic features. There is no obligatory association between MetS and formation of carotid plaque vulnerability.

KD Diagnosis Does Not Increase Cardiovascular Risk in Children According to Dynamic Intima-Media Roughness Measurements

Background: Kawasaki Disease (KD) is a generalized vasculitis in childhood with possible long-term impact on cardiovascular health besides the presence of coronary artery lesions. Standard vascular parameters such as carotid intima–media thickness (cIMT) have not been established as reliable markers of vascular anomalies after KD. The carotid intima–media roughness (cIMR) representing carotid intimal surface structure is considered a promising surrogate marker for predicting cardiovascular risk even beyond cIMT. We therefore measured cIMR in patients with a history of KD in comparison to healthy controls to investigate whether KD itself and/or KD key clinical aspects are associated with cIMR alterations in the long-term. Methods: We assessed cIMR in this case-control study (44 KD, mean age in years (SD); 13.4 (7.5); 36 controls, mean age 12.1 (5.3)) approximately matched by sex and age. Different clinical outcomes such as the coronary artery status and acute phase inflammation data were analyzed in association with cIMR values. Results: When comparing all patients with KD to healthy controls, we detected no significant difference in cIMR. None of the clinical parameters indicating the disease severity, such as the persistence of coronary artery aneurysm, were significantly associated with our cIMR values. However, according to our marginally significant findings (p = 0.044), we postulate that the end-diastolic cIMR may be rougher than the end-systolic values in KD patients. Conclusions: We detected no significant differences in cIMR between KD patients and controls that could confirm any evidence that KD predisposes patients to a subsequent general arteriopathy. Our results, however, need to be interpreted in the light of the low number of study participants.

Evaluation of Common Carotid Stiffness via Echo Tracking in Hypertensive Patients Complicated by Acute Aortic Dissection

OBJECTIVES

To evaluate the common carotid stiffness via echo tracking in patients with hypertension and acute aortic dissection (AD) and to investigate the independent predictors for the occurrence of AD in hypertensive (HP) patients.

METHODS

Fifty HP patients complicated by acute AD (AD group), 50 HP patients without AD (HP group), and 50 age-matched healthy volunteers (control group) were enrolled to assess the common carotid stiffness index (β), single-point pulsed wave velocity (PWVβ), and arterial compliance (AC) via echo tracking.

RESULTS

The intima-media thickness, diameter, β and PWVβ of the common carotid artery (CCA) in the AD group were significantly higher than those in the HP and control groups, whereas AC in the AD group was significantly lower (P < .05). In a multivariate logistic regression analysis, the systolic blood pressure (SBP; odds ratio [OR], 2.316; 95% confidence interval [CI], 2.033-2.563; P < .001), β (OR, 2.140; 95% CI, 1.931-2.367; P < .001), PWVβ (OR, 1.212; 95% CI, 1.004-1.397; P = .023), and AC (OR, 0.565; 95% CI, 0.339-0.654; P < .001) were significantly related to the occurrence of AD in HP patients. The area under the curve values for the AC, SBP, β, and PWVβ were 0.822, 0.806, 0.778, and 0.741, respectively, and the area under the curve was up to 0.943 when these parameters were combined.

CONCLUSIONS

The compliance of the CCA decreased, and the stiffness of the CCA increased significantly in HP patients complicated by AD. The AC, β, and PWVβ of the CCA, together with the SBP, were independent predictors of the occurrence of AD in HP patients.

Non-invasive evaluation of the common carotid artery in normal adults using ultrasound radiofrequency data technology

AIM

To evaluate the changes in CCA-IMT and vascular elasticity in healthy subjects in relation to age using radiofrequency data technology, to produce reference values for potential clinical applications.

MATERIALS AND METHODS

The following variables were measured in 160 subjects using radiofrequency data techniques: CCA-IMT, carotid distensibility (CD), local pulse-wave velocity (PWVβ), and stiffness (β). The subjects were divided into four age groups (30-39, 40-49, 50-59, and 60-69 years), with 20 men and 20 women in each group. The above parameters were compared among the different age groups.

RESULTS

CCA-IMT increased significantly with age (p<0.05). CD decreased significantly in the 40-49-years compared with the 30-39-years age group (p<0.05). PWVβ showed a significant increase in the 30-39-, 40-49-, and 50-59-years age groups (p<0.05). β increased significantly in the 50-59- compared with the 40-49-years age group (p<0.05). Compared with the 50-59-years age group, CD, PWVβ, and β showed no significant changes in the 60-69-years age group (p>0.05), with mean values of 329.39 ± 102.06 μm, 7.22 ± 1.91 m/s, and 10.04 ± 4.91, respectively.

CONCLUSION

Ultrasound radiofrequency data technology provides a non-invasive method for quantitatively and accurately assessing increased CCA-IMT and reduced vascular elasticity in healthy subjects in different age groups. The reference values produced in this study will be useful in clinical practice.

Correlation between carotid intima-media roughness and cardiovascular risk factors

Arterial intima-media roughness (IMR) may indicate an early manifestation of atherosclerosis. To date, few studies have been performed to quantitatively evaluate carotid IMR by ultrasonography (US). The aim of the present study was to analyze the effect of cardiovascular risk factors on carotid IMR. A total of 185 subjects were enrolled for US examination of carotid arteries. Carotid intima-media thickness (IMT) and IMR were measured in US images by a novel automatic software. According to the number of combined high-risk factors for coronary heart disease, subjects were assigned to four groups (risk groups 0, 1, 2 and 3+). IMR was lowest in risk group 0 (32.9±2.7 µm), higher in risk group 1 (64.5±6.9 µm; P<0.01 vs. risk group 0) and highest in risk groups 2 and 3+ (89.1±7.4 and 92.0±6.7 µm, respectively; P<0.01 vs. risk groups 0 and 1). According to a multivariate regression analysis, age, systolic blood pressure, smoking status and the triglyceride/high-density lipoprotein cholesterol ratio were significant predictors of IMR. There was a progressive increase in carotid artery plaque with increasing tertiles of IMR (4.9, 33.9 and 53.2% in tertiles 1, 2 and 3, respectively; P<0.05). Compared with that of subjects in the lowest tertile of IMR, those in the highest tertile had a significantly elevated risk of the presence of plaque in the carotid tree (odds ratio=10.61, 95%CI: 2.15–52.49, P=0.004). Quantification of carotid IMR from US images with this software is feasible, and carotid IMR, which may help estimate the extent of atherosclerosis, may be used as a complementary factor to stratify patients with cardiovascular risk factors.