Impact of type 2 diabetes mellitus on diffuse inflammatory activation of de novo atheromatous lesions: Implications for systemic inflammation

The role of microwave radiometry in carotid artery disease. Diagnostic and clinical prospective

Atherosclerosis of the internal carotid artery is an important cause of disabling ischemic stroke and therefore constitutes a major medical, social, and economic issue. Although advances in vascular imaging modalities during the last decades allow to risk stratify patients not solely on the degree of carotid artery stenosis but also based on 'high risk' features, there still remains a controversy over patient selection for carotid artery revascularization. Among other features of plaque vulnerability, there is an increasing body of evidence that inflammation is a key factor in the initiation, progression and destabilization of atherosclerotic plaques. Microwave radiometry (MWR) is a new imaging method that is based on the ability to detect noninvasively, with high accuracy, the relative changes of temperature in human tissues reflecting inflammatory activation. This review article aims to: (1) give an overview of current clinical experience with MWR in carotid arteries and (2) present its potential role for risk stratification.

Nonculprit coronary plaque characteristics of chronic kidney disease

BACKGROUND

Chronic kidney disease (CKD) promotes the development of atherosclerosis and increases the risk of cardiovascular disease. The aim of the present study was to compare the coronary plaque characteristics of patients with and without CKD using optical coherence tomography.

METHODS AND RESULTS

We identified 463 nonculprit plaques from 287 patients from the Massachusetts General Hospital (MGH) optical coherence tomography registry. CKD was defined as estimated glomerular filtration rate <60 mL/min per 1.73 m(2). A total of 402 plaques (250 patients) were in the non-CKD group and 61 plaques (37 patients) were in the CKD group. Compared with non-CKD plaques, plaques with CKD had a larger lipid index (mean lipid arc×lipid length, 1248.4±782.8 mm° [non-CKD] versus 1716.1±1116.2 mm° [CKD]; P=0.003). Fibrous cap thickness was not significantly different between the groups. Calcification (34.8% [non-CKD] versus 50.8% [CKD]; P=0.041), cholesterol crystals (11.2% [non-CKD] versus 23.0% [CKD]; P=0.048), and plaque disruption (5.5% [non-CKD] versus 13.1% [CKD]; P=0.049) were more frequently observed in the CKD group. In the multivariate linear regression model, a lower estimated glomerular filtration rate and diabetes mellitus were independent risk factors for a larger lipid index.

CONCLUSIONS

Compared with non-CKD patients, the patients with CKD had a larger lipid index with a higher prevalence of calcium, cholesterol crystals, and plaque disruption. The multivariate linear regression model demonstrated that a lower estimated glomerular filtration rate was an independent risk factor for a larger lipid index.