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Bjergfelt SS, Sørensen IMH, Hjortkjær HØ, Landler N, Ballegaard ELF, Biering-Sørensen T, Kofoed KF, Lange T, Feldt-Rasmussen B, Sillesen H, Christoffersen C, Bro S. Carotid plaque thickness is increased in chronic kidney disease and associated with carotid and coronary calcification. PLoS One 2021; 16:e0260417. [PMID: 34813630 PMCID: PMC8610240 DOI: 10.1371/journal.pone.0260417] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2021] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Chronic kidney disease accelerates both atherosclerosis and arterial calcification. The aim of the present study was to explore whether maximal carotid plaque thickness (cPTmax) was increased in patients with chronic kidney disease compared to controls and associated with cardiovascular disease and severity of calcification in the carotid and coronary arteries. METHODS The study group consisted of 200 patients with chronic kidney disease stage 3 from the Copenhagen Chronic Kidney Disease Cohort and 121 age- and sex-matched controls. cPTmax was assessed by ultrasound and arterial calcification by computed tomography scanning. RESULTS Carotid plaques were present in 58% of patients (n = 115) compared with 40% of controls (n = 48), p = 0.002. Among participants with plaques, cPTmax (median, interquartile range) was significantly higher in patients compared with controls (1.9 (1.4-2.3) versus 1.5 (1.2-1.8) mm), p = 0.001. Cardiovascular disease was present in 9% of patients without plaques (n = 85), 23% of patients with cPTmax 1.0-1.9 mm (n = 69) and 35% of patients with cPTmax >1.9 mm (n = 46), p = 0.001. Carotid and coronary calcium scores >400 were present in 0% and 4%, respectively, of patients with no carotid plaques, in 19% and 24% of patients with cPTmax 1.0-1.9 mm, and in 48% and 53% of patients with cPTmax >1.9 mm, p<0.001. CONCLUSIONS This is the first study showing that cPTmax is increased in patients with chronic kidney disease stage 3 compared to controls and closely associated with prevalent cardiovascular disease and severity of calcification in both the carotid and coronary arteries.
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Affiliation(s)
- Sasha S. Bjergfelt
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ida M. H. Sørensen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Ø. Hjortkjær
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Nino Landler
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | | | - Tor Biering-Sørensen
- Department of Cardiology, Herlev-Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Klaus F. Kofoed
- Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Theis Lange
- Department of Public Health (Biostatistics), University of Copenhagen, Copenhagen, Denmark
| | - Bo Feldt-Rasmussen
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Sillesen
- Department of Vascular Surgery, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina Christoffersen
- Department of Clinical Biochemistry, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Bro
- Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Chen Y, Shang D, Shao J, Dai S, Ge X, Hao C, Zhu T. Prognostic significance of carotid plaque presence in peritoneal dialysis patients and its association with the apolipoprotein B/apolipoprotein A1 ratio. Nephrology (Carlton) 2020; 25:919-928. [PMID: 32691473 DOI: 10.1111/nep.13759] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/30/2020] [Accepted: 07/13/2020] [Indexed: 12/15/2022]
Abstract
AIM Atherosclerosis has been reported as a risk factor for cardiovascular disease in the general population. As a phenotype of atherosclerosis, carotid plaque and its influence factors are rarely discussed among dialysis patients. The study aimed to investigate the prognosis-predictive significance of carotid plaques in patients on peritoneal dialysis (PD), and explore risks factors for carotid plaque presence. METHODS It was an observational, prospective study. Patients that had undergone stable PD for at least 3 months were recruited and divided into two subgroups: group with carotid plaques and group without carotid plaques. Cox regression model was used to identify independent predictors of all-cause mortality, cardiovascular events (CVEs), and cardiovascular mortality. Pathogenic factors correlated to the plaque-occurrence were explored by logistic regression and verified by receiver operating characteristic (ROC) curve analysis. RESULTS A total of 233 PD patients were recruited. The cohort was followed for up to 86 months. The carotid plaque presence turned out to be an independent risk factor both of CVEs [hazard ratio (HR): 2.659; 95% confidence interval (CI): 1.231-5.741; P = .013] and cardiovascular mortality (HR: 3.716; 95% CI: 1.168-11.823; P = .026). The apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) ratio was significantly associated with the presence of carotid plaques. ROC analysis indicated that the area under the curve of the ApoB/ApoA1 ratio was higher than that of the traditional lipid metabolism index for detecting plaque presence. CONCLUSION Carotid plaque presence can predict CVEs and cardiovascular mortality in PD patients. The ApoB/ApoA1 ratio is significantly correlated to the carotid plaques and the ApoB/ApoA1 ratio had a greater sensitivity than traditional lipid indices for predicting plaque presence.
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Affiliation(s)
- Yun Chen
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Da Shang
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Jie Shao
- Division of Ultrasound, Huashan Hospital, Fudan University, Shanghai, China
| | - Shuqi Dai
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Xiaolin Ge
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Chuanming Hao
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
| | - Tongying Zhu
- Division of Nephrology, Huashan Hospital, Fudan University, Shanghai, China
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Revzin MV, Imanzadeh A, Menias C, Pourjabbar S, Mustafa A, Nezami N, Spektor M, Pellerito JS. Optimizing Image Quality When Evaluating Blood Flow at Doppler US: A Tutorial. Radiographics 2019; 39:1501-1523. [PMID: 31398088 DOI: 10.1148/rg.2019180055] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Doppler US is an essential component of nearly all diagnostic US procedures. In this era of increased awareness of the effects of ionizing radiation and the side effects of iodine- and gadolinium-based contrast agents, Doppler US is poised to play an even bigger role in medical imaging. It is safe, cost-effective, portable, and highly accurate when performed by an experienced operator. The sensitivities and specificities of Doppler US for detecting blood flow and determining the direction and velocity of blood flow in various organs and vascular systems have increased dramatically in the past decade. With use of advanced flow techniques that are available for use with most modern equipment, US can provide vascular information that is comparable to or even more accurate than that obtained with other cross-sectional and interventional modalities. However, there remains concern that US (including newer more advanced flow-evaluating techniques) will not be used to its full potential owing to dependence on operator skill and expertise. Thorough understanding of image optimization techniques and expanded knowledge of the physical principles, instrumentation, application, advantages, and limitations of this modality are of utmost importance. The authors provide a simple practical guide for optimizing images for vascular flow detection by reviewing various cases and focusing on the parameters that should be optimized. Online supplemental material is available for this article. ©RSNA, 2019 See discussion on this article by Pellerito.
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Affiliation(s)
- Margarita V Revzin
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
| | - Amir Imanzadeh
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
| | - Christine Menias
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
| | - Sarvenaz Pourjabbar
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
| | - Adel Mustafa
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
| | - Nariman Nezami
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
| | - Michael Spektor
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
| | - John S Pellerito
- From the Department of Diagnostic Radiology and Biomedical Imaging, Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520 (M.V.R., A.I., S.P., A.M., N.N., M.S.); Department of Radiology, Mayo Clinic Arizona, Phoenix, Ariz (C.M.); and Department of Radiology, Zucker School of Medicine at Hofstra/Northwell, Northwell Health System, Manhasset, NY (J.S.P.)
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Toida T, Toida R, Yamashita R, Komiya N, Uezono S, Komatsu H, Ishikawa T, Kitamura K, Sato Y, Fujimoto S. Grading of Left Ventricular Diastolic Dysfunction with Preserved Systolic Function by the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging Recommendations Contributes to Predicting Cardiovascular Events in Hemodialysis Patients. Cardiorenal Med 2019; 9:190-200. [PMID: 30844787 DOI: 10.1159/000496064] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 12/06/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Left ventricular diastolic dysfunction (LVDD) causes heart failure with a preserved left ventricular ejection fraction (LVEF) in the general population. OBJECTIVE To examine the relationships between the LVDD grades of the 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging (ASE/EACVI) recommendations and several arteriosclerotic parameters and major cardiovascular events (MACE) in hemodialysis patients with preserved LVEF. METHOD Sixty-three prevalent hemodialysis patients (median age [interquartile range], 69 [64-75] years, 31.7% female) with normal systolic function (LVEF > 50%) were enrolled. LVDD evaluated by echocardiography at baseline was divided into three groups according to ASE/EACVI recommendations (normal diastolic function [ND], n = 24; intermediate, n = 19; diastolic dysfunction [DD], n = 20). All patients underwent analyses of several arteriosclerotic parameters (carotid intima-media thickness [CIMT], plaque score [PS], ankle brachial index [ABI], and brachial-ankle pulse wave velocity [baPWV]). The presence or absence of postdialysis orthostatic hypotension was assessed in each dialysis session. MACE during the 1-year follow-up period was obtained from medical records. Kaplan-Meier and Cox's regression analyses were used to investigate the relationship between LVDD grades and MACE. RESULTS Postdialysis orthostatic hypotension and PS, but not CIMT, ABI, or baPWV, increased proportionally with LVDD grades. Eleven patients developed MACE, including 2 cardiovascular deaths. The Kaplan-Meier analysis showed that MACE frequently occurred in the DD grade (p = 0.002 by the log-rank test). Cox's regression analysis adjusted for potential confounders (age, sex, diabetes, systolic blood pressure, and body mass index) revealed that the DD grade was associated with MACE when the ND grade was set as a reference. CONCLUSIONS In maintenance hemodialysis patients with normal ventricular systolic function, a classification of LVDD by the 2016 ASE/EACVI recommendations may be a useful tool for predicting cardiovascular events.
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Affiliation(s)
- Tatsunori Toida
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan, .,Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka City, Japan,
| | - Reiko Toida
- Department of Cardiology, Chiyoda Hospital, Hyuga City, Japan
| | - Risa Yamashita
- Department of Internal Medicine, Miyazaki Prefectural Nobeoka Hospital, Nobeoka City, Japan
| | - Norihiro Komiya
- Department of Cardiology, Chiyoda Hospital, Hyuga City, Japan
| | | | - Hiroyuki Komatsu
- Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, University of Miyazaki, Miyazaki City, Japan
| | - Tetsunori Ishikawa
- Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, University of Miyazaki, Miyazaki City, Japan
| | - Kazuo Kitamura
- Division of Circulatory and Body Fluid Regulation, Department of Internal Medicine, University of Miyazaki, Miyazaki City, Japan
| | - Yuji Sato
- Dialysis Division, University of Miyazaki Hospital, Miyazaki City, Japan
| | - Shouichi Fujimoto
- Department of Hemovascular Medicine and Artificial Organs, Faculty of Medicine, University of Miyazaki, Miyazaki City, Japan.,Dialysis Division, University of Miyazaki Hospital, Miyazaki City, Japan
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Dighe MK, Moshiri M, Jolley J, Thiel J, Hippe D. B-Flow imaging of the placenta: A feasibility study. ULTRASOUND (LEEDS, ENGLAND) 2018; 26:160-167. [PMID: 30147740 PMCID: PMC6099763 DOI: 10.1177/1742271x18768841] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 03/09/2018] [Indexed: 11/16/2022]
Abstract
B-Flow imaging directly displays the flowing intravascular echoes during real-time gray-scale ultrasound without using Doppler techniques. The objective of our study was to evaluate the feasibility of B-Flow imaging in the placenta and to evaluate the artifacts seen on B-Flow imaging. After IRB approval, 36 women (17 normal and 19 high risk women) were enrolled in our study. B-Flow images were acquired on GE LOGIC E9 machine. Retrospective analysis of the B-Flow and cine capture images was performed for artifacts and for vessels visualized. Pregnant women enrolled in the study ranged from 19 to 43 years of age with an average age of 31.7 years. Gestational age varied from 17 weeks and five days to 36 weeks and three days with an average of 26 weeks and three days. From a total of 161 B-Flow images reviewed by one researcher, 15 images were acceptable with no evidence of artifact. The remainder of the images had some artifact in them. For the 36 women with color Doppler and B-Flow images reviewed by the two independent blinded reviewers, a total of 144 reads were obtained. More small horizontal (p = 0.046) and small vertical running vessels (p < 0.001) were identified with B-Flow than color Doppler images. B-Flow is capable of showing perfusion in a human placenta; however, recognizing artifacts and modifying the image acquisition to reduce artifacts is necessary with this new technique to acquire the best images for interpretation.
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Affiliation(s)
- Manjiri K Dighe
- Department of Radiology, Body Imaging Section, University of Washington, Seattle, USA
| | - Mariam Moshiri
- Department of Radiology, Body Imaging Section, University of Washington, Seattle, USA
| | - Jennifer Jolley
- School of Medicine, University of California, Irvine, Irvine, USA
| | - Jeff Thiel
- Department of Radiology, Body Imaging Section, University of Washington, Seattle, USA
| | - Dan Hippe
- Department of Radiology, Body Imaging Section, University of Washington, Seattle, USA
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