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Li Y, Yi M, Wang X, Zhang Y, Xiao K, Si J, Sun L, Zhang H, Sun J, Liu Z, Zhao J, Chu X, Li J. Association between triglyceride-glucose index and endothelial dysfunction. Endocrine 2024:10.1007/s12020-024-03785-5. [PMID: 38514591 DOI: 10.1007/s12020-024-03785-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/12/2024] [Indexed: 03/23/2024]
Abstract
BACKGROUND Triglyceride-glucose (TyG) index, a simple surrogate marker for insulin resistance (IR), has been reported as an independent predictor of arterial structural damage and future cardiovascular events. The association between TyG index and endothelial dysfunction remains uncertain. OBJECTIVE The purpose of this study was to investigate the association between TyG index and endothelial dysfunction. METHODS Endothelial dysfunction was measured using flow-mediated dilation (FMD). A total of 840 subjects, who voluntarily accepted FMD measurement at the Health Management Department of Xuanwu Hospital from October 2016 to January 2020, were included in this study. TyG index was calculated as Ln [fasting triglyceride (TG)(mg/dL) × fasting plasma glucose (FPG) (mg/dL)/2]. RESULTS The mean age was 59.92 ± 10.28 years and 559 (66.55%) participants were male. The TyG index was correlated with FMD values (P = 0.022). Each unit increment in TyG index was associated with lower FMD values (β = -0.330, 95%CI -0.609 to -0.052, P = 0.020) after adjusting for covariates. Age (β = -0.069, 95%CI -0.088 to -0.051, P < 0.001), female (β = 0.592, 95%CI 0.172 to1.012, P = 0.006), smoking (β = -0.430, 95%CI -0.859 to -0.002, P = 0.049) and hypertension (β = -0.741, 95%CI -1.117 to -0.365, P < 0.001) were also independent predictors for endothelial dysfunction. A significant association between the TyG index and endothelial dysfunction was found only in populations younger than 60 years (β = -0.843, 95%CI -1.371 to -0.316, P = 0.002), females (β = -0.612, 95%CI -1.147 to -0.077, P = 0.025), and populations without diabetes mellitus (DM) (β = -0.594, 95%CI -1.042 to -0.147, P = 0.009). CONCLUSIONS Subjects with an elevated TyG index are more likely to have endothelial dysfunction, particularly in populations without DM.
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Affiliation(s)
- Yan Li
- Department of Geriatrics, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
| | - Ming Yi
- Department of Geriatrics, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
| | - Xinyi Wang
- Department of Geriatrics, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
| | - Yinghua Zhang
- Department of Cardiology, Chui Yang Liu Hospital affiliated to Tsinghua University, Beijing, 100021, China
| | - Keling Xiao
- Department of Geriatrics, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
| | - Jin Si
- Department of Geriatrics, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
| | - Lijie Sun
- Department of Geriatrics, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
| | - Haoyu Zhang
- Department of Geriatrics, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
| | - Jinghao Sun
- Department of Geriatrics, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
| | - Zhaoli Liu
- Department of Geriatrics, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China
| | - Jing Zhao
- Health Management Center, Xuanwu hospital, Capital Medical University, Beijing, 100053, China
| | - Xi Chu
- Health Management Center, Xuanwu hospital, Capital Medical University, Beijing, 100053, China.
| | - Jing Li
- Department of Geriatrics, Xuanwu Hospital, National Clinical Research Center for Geriatric Diseases, Capital Medical University, Beijing, 100053, China.
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Li Y, Zhang Y, Xiao K, Si J, Zhang H, Sun L, Miao Z, Zhao T, Sun J, Sun X, Liu Z, Gao J, Zhao J, Chu X, Li J. The incidence of subclinical atherosclerosis in subjects with low and moderate cardiovascular risk. Clin Cardiol 2023; 46:1260-1267. [PMID: 37522647 PMCID: PMC10577528 DOI: 10.1002/clc.24087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/21/2023] [Accepted: 06/27/2023] [Indexed: 08/01/2023] Open
Abstract
BACKGROUND The cardiovascular risk models and subclinical atherosclerotic indicators are both recommended for cardiovascular risk stratification. The accordance between the incidence of subclinical atherosclerosis and subjects with low and moderate cardiovascular risk is unclear. HYPOTHESIS Subjects with low and moderate cardiovascular risk have a lower incidence of subclinical atherosclerosis compared with subjects with high risk. METHODS Brachial-ankle pulse wave velocity (BaPWV) and brachial flow-mediated dilation (BFMD) were measured in 421 subjects without a history of atherosclerotic cardiovascular disease (ASCVD) from October 2016 to January 2020. All subjects were classified into low, moderate, and high risk based on Framingham and China-par risk models respectively. RESULTS Mean age was 57.05 ± 9.35 years and 248 (58.9%) were male. In subjects with low, moderate, and high risk assessed by Framingham and China-par risk models, the percentage of abnormal BaPWV ( > 1400 cm/s) was 42.9%, 70.1%, 85.7%, and 40.4%, 71.4%, 89.7%, respectively. Meanwhile, the percentage of abnormal BFMD ( ≤ 7%) was 43.8%, 68.5%, 77.3%, and 44.9%,72.1%, and 76.6%. According to Framingham-based high-risk categories, positive predictive value (PPV), negative predictive value (NPV), sensitivity and specificity for BaPWV abnormality were 85.7%, 39.4%, 36.1%, and 87.5%, respectively. For BFMD abnormality, the values were 77.3%, 40.1%, 34.1%, and 81.8%, respectively. According to China-par high-risk categories, the values for BaPWV abnormality were 89.7%, 43.8%, 45.6%, and 89.0%, respectively. For BFMD abnormality, the values were 76.6%, 41.3%, 40.7%, and 77%, respectively. In multivariate analysis, age and blood pressure were the independent predictors for subclinical atherosclerosis in subjects with low-moderate risk. CONCLUSIONS More than one-half of subjects with low and moderate risk already have detectable subclinical atherosclerosis, indicating higher cardiovascular risk beyond the traditional stratification.
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Affiliation(s)
- Yan Li
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Yinghua Zhang
- Department of CardiologyChui Yang Liu Hospital affiliated to Tsinghua UniversityBeijingChina
| | - Keling Xiao
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Jin Si
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Haoyu Zhang
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Lijie Sun
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Zupei Miao
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Ting Zhao
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Jinghao Sun
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
| | - Xipeng Sun
- Department of Cardiology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Zhi Liu
- Department of Cardiology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Jing Gao
- Department of Cardiology, Xuanwu HospitalCapital Medical UniversityBeijingChina
| | - Jing Zhao
- Health Management Center, Xuanwu hospitalCapital Medical UniversityBeijingChina
| | - Xi Chu
- Health Management Center, Xuanwu hospitalCapital Medical UniversityBeijingChina
| | - Jing Li
- Department of Geriatrics, Xuanwu Hospital, Capital Medical UniversityNational Clinical Research Center for Geriatric DiseasesBeijingChina
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Nakamura T, Uematsu M, Horikoshi T, Yoshizaki T, Kobayashi T, Saito Y, Watanabe Y, Nakamura K, Obata JE, Kugiyama K. Improvement in Brachial Endothelial Vasomotor Function and Brachial-Ankle Pulse Wave Velocity Reduces the Residual Risk for Cardiovascular Events after Optimal Medical Treatment in Patients with Coronary Artery Disease. J Atheroscler Thromb 2021; 28:1133-1144. [PMID: 33229855 PMCID: PMC8592703 DOI: 10.5551/jat.57562] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim:
To examine whether improvement in flow-mediated endothelium-dependent dilatation (FMD) of the brachial artery and brachial-ankle pulse wave velocity (baPWV) has an additive effect on achieving optimal goals of traditional risk factors to reduce cardiovascular risk in patients with coronary artery disease (CAD).
Methods:
We assessed 323 patients with CAD and impaired vascular function, defined as an impaired FMD of the brachial artery (<5.5%) and increased baPWV (>1,440 cm/sec). After FMD and baPWV measurements at 24 weeks of optimal medical treatment (OMT), the study patients were followed up for <60 months or until a composite of cardiac death, nonfatal myocardial infarction (MI), unstable angina, or ischemic stroke occurs.
Results:
During the median follow-up period of 35 months, cardiovascular events occurred in 72 patients. Multivariate Cox hazards analysis showed that patients with an improvement in FMD and baPWV had the lowest probability of future cardiovascular events. In addition, the improvement in FMD and baPWV had a significant incremental effect on the predictive value of the achievement of optimal goals for blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), and hemoglobin A1c (HbA1c) using net reclassification improvement (NRI) and integrated discrimination improvement (IDI).
Conclusions:
The improvement in FMD and baPWV had additive effects on risk reduction of the achievement of the optimal goals of traditional risk factors in patients with CAD. Thus, serial measurements of FMD and baPWV may be useful for identifying CAD patients at residual risk for adverse cardiovascular events following OMT.
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Affiliation(s)
- Takamitsu Nakamura
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Manabu Uematsu
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Takeo Horikoshi
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Toru Yoshizaki
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Tsuyoshi Kobayashi
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Yukio Saito
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Yosuke Watanabe
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Kazuto Nakamura
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Jun-Ei Obata
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Kiyotaka Kugiyama
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
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Effects of resistance training on endothelial function: A systematic review and meta-analysis. Atherosclerosis 2021; 333:91-99. [PMID: 34399984 DOI: 10.1016/j.atherosclerosis.2021.07.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/06/2021] [Accepted: 07/29/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND AIMS The effects of resistance training on flow-mediated dilation (FMD), which has been the gold standard non-invasive assessment of endothelial function and is associated with the risk of cardiovascular events, are not well known. We conducted a systematic review to analyze the effects of resistance training on FMD. METHODS We searched Pubmed, Embase, CINAHL, SPORTDiscuss, Scopus, Web of Science and PEDro databases for studies that met the following criteria: (a) randomized controlled trials of resistance exercise with a comparative non-exercise group or contralateral untrained limb in adults and/or elderly; (b) studies that measured post-occlusion brachial artery FMD by ultrasonography, before and after intervention. Mean differences (MDs) with 95 % confidence interval (95 % CI) were calculated using an inverse variance method with a random effects model. RESULTS Twenty-three studies were included in the meta-analysis (n = 785 participants; 53 % females). Resistance training on FMD responses showed a favorable result for the resistance training group (n = 366) compared to the control group (n = 358) (MD 2.39, 95%CI 1.65, 3.14; p<0.00001). Subgroup analysis indicated favorable results for the dynamic resistance training (n = 545; MD 2.12, 95 % CI 1.26, 2.98; p<0.00001) and isometric handgrip training (n = 179; MD 3.32, 95 % CI 1.68, 4.96; p<0.0001) compared to the control group. The effect of resistance training on FMD responses was also favorable regardless of the condition of the participants (Healthy [n = 261]: MD 2.11, 95 % CI 1.04, 3.18; p<0.0001; Cardiovascular disease [n = 310]: MD 2.89, 95 % CI 0.88, 4.90; p = 0.005; metabolic disease [n = 153]: MD 2.40, 95 % CI 1.59, 3.21; p<0.00001). CONCLUSIONS Resistance training improves FMD in healthy individuals and patients with cardiovascular and metabolic diseases.
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Multilevel Strip Pooling-Based Convolutional Neural Network for the Classification of Carotid Plaque Echogenicity. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:3425893. [PMID: 34457035 PMCID: PMC8390163 DOI: 10.1155/2021/3425893] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 07/12/2021] [Accepted: 08/02/2021] [Indexed: 12/29/2022]
Abstract
Carotid plaque echogenicity in ultrasound images has been found to be closely correlated with the risk of stroke in atherosclerotic patients. The automatic and accurate classification of carotid plaque echogenicity is of great significance for clinically estimating the stability of carotid plaques and predicting cardiovascular events. Existing convolutional neural networks (CNNs) can provide an automatic carotid plaque echogenicity classification; however, they require a fixed-size input image, while the carotid plaques are of varying sizes. Although cropping and scaling the input carotid plaque images is promising, it will cause content loss or distortion and hence reduce the classification accuracy. In this study, we redesign the spatial pyramid pooling (SPP) and propose multilevel strip pooling (MSP) for the automatic and accurate classification of carotid plaque echogenicity in the longitudinal section. The proposed MSP module can accept arbitrarily sized carotid plaques as input and capture a long-range informative context to improve the accuracy of classification. In our experiments, we implement an MSP-based CNN by using the visual geometry group (VGG) network as the backbone. A total of 1463 carotid plaques (335 echo-rich plaques, 405 intermediate plaques, and 723 echolucent plaques) were collected from Zhongnan Hospital of Wuhan University. The 5-fold cross-validation results show that the proposed MSP-based VGGNet achieves a sensitivity of 92.1%, specificity of 95.6%, accuracy of 92.1%, and F1-score of 92.1%. These results demonstrate that our approach provides a way to enhance the applicability of CNN by enabling the acceptance of arbitrary input sizes and improving the classification accuracy of carotid plaque echogenicity, which has a great potential for an efficient and objective risk assessment of carotid plaques in the clinic.
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Uematsu M, Nakamura T, Horikoshi T, Yoshizaki T, Watanabe Y, Kobayashi T, Saito Y, Nakamura K, Obata JE, Kugiyama K. Echolucency of carotid plaque is useful for selecting high-risk patients with chronic coronary artery disease who benefit from intensive lipid-lowering therapy. J Cardiol 2021; 77:590-598. [PMID: 33500186 DOI: 10.1016/j.jjcc.2021.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 11/24/2020] [Accepted: 12/19/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Ultrasound assessment of the carotid artery provides prognostic information on coronary events. This study examined whether ultrasound assessments of plaque echolucency of the carotid artery are useful for identifying patients with coronary artery disease (CAD) who are at high risk but could benefit from lipid-lowering therapy for secondary prevention. METHODS Ultrasound assessment of carotid plaque echolucency with integrated backscatter (IBS) analysis was performed in 393 chronic CAD patients with low-density lipoprotein cholesterol (LDL-C) levels <100 mg/dL on statin therapy. All patients were prospectively followed up for a maximum of 96 months or until the occurrence of one of the following coronary events: cardiac death, nonfatal myocardial infarction, or unstable angina pectoris requiring unplanned revascularization. RESULTS During the follow-up period, 45 coronary events occurred. Patients were stratified by IBS (≤-16.3 or >-16.3 dB, median value) and LDL-C level (<70 or 70-99 mg/dL). Multivariate Cox proportional hazards analysis showed that patients with lower IBS and LDL-C 70-99 mg/dL had significantly higher probabilities of coronary events compared with those with higher IBS and LDL-C <70 mg/dL, after adjustment for a baseline model of risk factors (hazard ratio 5.15; 95% confidence interval 1.21-22.0, p = 0.03). In contrast, patients with lower IBS and LDL-C <70 mg/dL had an improved prognosis comparable with those with higher IBS. Addition of LDL-C levels to the baseline model of risk factors improved net reclassification improvement (NRI) and integrated discrimination improvement (IDI) in patients with lower IBS (NRI, 0.44, p = 0.04; and IDI, 0.035, p < 0.01), but not in those with higher IBS. CONCLUSIONS Evaluation of echolucency of the carotid artery was useful for selecting CAD patients at high risk of secondary coronary events but who could benefit from lipid-lowering therapy.
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Affiliation(s)
- Manabu Uematsu
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Takamitsu Nakamura
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Takeo Horikoshi
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Toru Yoshizaki
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Yosuke Watanabe
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Tsuyoshi Kobayashi
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Yukio Saito
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Kazuto Nakamura
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Jun-Ei Obata
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan
| | - Kiyotaka Kugiyama
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine, Chuo, Yamanashi, Japan.
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Improvement of endothelial dysfunction is mediated through reduction of remnant lipoprotein after statin therapy in patients with coronary artery disease. J Cardiol 2019; 75:270-274. [PMID: 31500961 DOI: 10.1016/j.jjcc.2019.08.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/29/2019] [Accepted: 08/13/2019] [Indexed: 01/01/2023]
Abstract
BACKGROUND Remnant lipoproteinemia with high levels of low-density lipoprotein cholesterol (LDL-C) is a high risk for endothelial dysfunction. Statins are the first-line lipid-lowering drugs for this combined hyperlipidemia. However, it remains undetermined whether reduction of remnant lipoprotein mediates the relationship between improvement in endothelial dysfunction and reduction of LDL-C level after statin treatment. METHODS A total of 122 coronary artery disease (CAD) patients with impaired flow-mediated dilation (FMD; <5.5%), high levels of LDL-C (≥100 mg/dL), and remnant-like lipoprotein particle cholesterol (RLP-C) (≥5 mg/dL) were examined in this study. The lipid profiles and FMD were measured before and after 6-9 months of statin treatment. The association between changes in LDL-C levels and its relationship with changes in FMD was investigated. Furthermore, mediation analysis was performed to assess the changes in RLP-C level as a mediator of the relationship between the reduction in LDL-C level and improvement of FMD. RESULTS Treatment with statins improved FMD in 69 (56.5%) patients. Patients with improved FMD showed lower percent changes of LDL-C, triglyceride (TG), RLP-C, RLP-C/TG, and C-reactive protein (CRP) levels, and higher percent change of HDL-C level, compared to patients who did not show improved FMD. The percent changes in FMD levels had a significant inverse correlation with the percent changes in LDL-C, (r = -0.18, p = 0.03), RLP-C (r = -0.39, p < 0.001), RLP-C/TG (r = -0.34, p < 0.001), and CRP (r = -0.27, p < 0.01). Mediation analysis showed that the relationship between reduction in LDL-C and improvement of FMD was mediated by reduction of RLP-C (34.5%), RLP-C/TG (24.4%), and CRP (24.9%) levels. CONCLUSION Improvement of remnant lipoproteinemia may be an important mediator for the relationship between improvement of endothelial dysfunction and LDL-lowering after statin treatment in patients with CAD.
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Effect of flaxseed consumption on flow-mediated dilation and inflammatory biomarkers in patients with coronary artery disease: a randomized controlled trial. Eur J Clin Nutr 2018; 73:258-265. [DOI: 10.1038/s41430-018-0268-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 05/18/2018] [Accepted: 07/05/2018] [Indexed: 12/23/2022]
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Echolucency of the carotid artery is associated with short-term plaque progression and positive remodeling in the culprit coronary artery in AMI survivors. J Cardiol 2017; 70:438-445. [DOI: 10.1016/j.jjcc.2017.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 01/05/2017] [Accepted: 01/13/2017] [Indexed: 11/20/2022]
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Huang X, Zhang Y, Meng L, Abbott D, Qian M, Wong KKL, Zheng R, Zheng H, Niu L. Evaluation of carotid plaque echogenicity based on the integral of the cumulative probability distribution using gray-scale ultrasound images. PLoS One 2017; 12:e0185261. [PMID: 28977008 PMCID: PMC5627908 DOI: 10.1371/journal.pone.0185261] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2017] [Accepted: 09/08/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVE Carotid plaque echogenicity is associated with the risk of cardiovascular events. Gray-scale median (GSM) of the ultrasound image of carotid plaques has been widely used as an objective method for evaluation of plaque echogenicity in patients with atherosclerosis. We proposed a computer-aided method to evaluate plaque echogenicity and compared its efficiency with GSM. METHODS One hundred and twenty-five carotid plaques (43 echo-rich, 35 intermediate, 47 echolucent) were collected from 72 patients in this study. The cumulative probability distribution curves were obtained based on statistics of the pixels in the gray-level images of plaques. The area under the cumulative probability distribution curve (AUCPDC) was calculated as its integral value to evaluate plaque echogenicity. RESULTS The classification accuracy for three types of plaques is 78.4% (kappa value, κ = 0.673), when the AUCPDC is used for classifier training, whereas GSM is 64.8% (κ = 0.460). The receiver operating characteristic curves were produced to test the effectiveness of AUCPDC and GSM for the identification of echolucent plaques. The area under the curve (AUC) was 0.817 when AUCPDC was used for training the classifier, which is higher than that achieved using GSM (AUC = 0.746). Compared with GSM, the AUCPDC showed a borderline association with coronary heart disease (Spearman r = 0.234, p = 0.050). CONCLUSIONS Our experimental results suggest that AUCPDC analysis is a promising method for evaluation of plaque echogenicity and predicting cardiovascular events in patients with plaques.
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Affiliation(s)
- Xiaowei Huang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- Shenzhen College of Advanced Technology, University of Chinese Academy of Sciences, Shenzhen, China
| | - Yanling Zhang
- Department of Ultrasound, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Long Meng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Derek Abbott
- Centre for Biomedical Engineering, and School of Electrical and Electronic Engineering, University of Adelaide, Adelaide, Australia
| | - Ming Qian
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Kelvin K. L. Wong
- School of Medicine, Western Sydney University, Campbelltown, New South Wales, NSW, Australia
| | - Rongqing Zheng
- Department of Ultrasound, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Lili Niu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
- * E-mail:
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Huang X, Zhang Y, Meng L, Qian M, Wong KKL, Abbott D, Zheng R, Zheng H, Niu L, Huang X, Zheng R, Zheng H, Wong KKL, Qian M, Zhang Y, Abbott D, Niu L, Meng L. Identification of Ultrasonic Echolucent Carotid Plaques Using Discrete Fréchet Distance Between Bimodal Gamma Distributions. IEEE Trans Biomed Eng 2017; 65:949-955. [PMID: 28278452 DOI: 10.1109/tbme.2017.2676129] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Echolucent carotid plaques are associated with acute cardiovascular and cerebrovascular events (ACCEs) in atherosclerotic patients. The aim of this study was to develop a computer-aided method for identifying echolucent plaques. METHODS A total of 315 ultrasound images of carotid plaques (105 echo-rich, 105 intermediate, and 105 echolucent) collected from 153 patients were included in this study. A bimodal gamma distribution was proposed to model the pixel statistics in the gray scale images of plaques. The discrete Fréchet distance features (DFDFs) of each plaque were extracted based on the statistical model. The most discriminative features (MDFs) were obtained from DFDFs by the linear discriminant analysis, and a k-nearest-neighbor classifier was implemented for classification of different types of plaques. RESULTS The classification accuracy of the three types of plaques using MDFs can reach 77.46%. When a receiver operating characteristics curve was produced to identify echolucent plaques, the area under the curve was 0.831. CONCLUSION Our results indicate potential feasibility of the method for identifying echolucent plaques based on DFDFs. SIGNIFICANCE Our method may potentially improve the ability of noninvasive ultrasonic examination in risk prediction of ACCEs for patients with plaques.
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Huang X, Zhang Y, Qian M, Meng L, Xiao Y, Niu L, Zheng R, Zheng H. Classification of Carotid Plaque Echogenicity by Combining Texture Features and Morphologic Characteristics. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:2253-2261. [PMID: 27582533 DOI: 10.7863/ultra.15.09002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 01/05/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Anechoic carotid plaques on sonography have been used to predict future cardiovascular or cerebrovascular events. The purpose of this study was to investigate whether carotid plaque echogenicity could be assessed objectively by combining texture features extracted by MaZda software (Institute of Electronics, Technical University of Lodz, Lodz, Poland) and morphologic characteristics, which may provide a promising method for early prediction of acute cardiovascular disease. METHODS A total of 268 plaque images were collected from 136 volunteers and classified into 85 hyperechoic, 83 intermediate, and 100 anechoic plaques. About 300 texture features were extracted from histogram, absolute gradient, run-length matrix, gray-level co-occurrence matrix, autoregressive model, and wavelet transform algorithms by MaZda. The morphologic characteristics, including degree of stenosis, maximum plaque intima-media thickness, and maximum plaque length, were measured by B-mode sonography. Statistically significant features were selected by analysis of covariance. The most discriminative features were obtained from statistically significant features by linear discriminant analysis. The K-nearest neighbor classifier was used to classify plaque echogenicity based on statistically significant and most discriminative features. RESULTS A total of 30 statistically significant features were selected among the plaques, and 2 most discriminative features were obtained from the statistically significant features. The classification accuracy rates for 3 types of plaques based on statistically significant and most discriminative features were 72.03% (κ= 0.571; P < .001) and 88.14% (κ= 0.820; P < .001), respectively. The receiver operating characteristic curve for identifying anechoic plaques showed an area under the curve of 0.918 when the most discriminative features were used to train the classifier. CONCLUSIONS It is feasible to classify carotid plaque echogenicity by combining texture features extracted from sonograms by MaZda and morphologic characteristics.
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Affiliation(s)
- Xiaowei Huang
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yanling Zhang
- Department of Ultrasound, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ming Qian
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Long Meng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Yang Xiao
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Lili Niu
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Rongqin Zheng
- Department of Ultrasound, Third Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hairong Zheng
- Paul C. Lauterbur Research Center for Biomedical Imaging, Institute of Biomedical and Health Engineering, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
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Si NV, Fujioka D, Watanabe K, Watanabe Y, Watanabe K, Nakamura K, Yamaguchi K, Uematsu M, Kugiyama K. Phospholipase A 2 Receptor Gene Polymorphisms Alter its Functions and Present a Genetic Risk of an Increased Intima-Media Thickness of the Carotid Artery. J Atheroscler Thromb 2016; 23:1227-1241. [PMID: 27025682 PMCID: PMC5098923 DOI: 10.5551/jat.34330] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Aims: Phospholipase A2 receptor 1 (PLA2R) has multiple biological functions other than functioning as a receptor for secretory PLA2s. Two nonsynonymous polymorphisms in the C-type lectin-like domains (CTLD) 1 of PLA2R gene have been associated with idiopathic membranous nephropathy. This study examined whether the same PLA2R polymorphisms may alter functions of PLA2R in cells expressing the variant PLA2R. In addition, the clinical relevance of the experiment was examined. Methods: Two nonsynonymous polymorphisms (T/C at rs3749117 and G/C at rs35771982) in CTLD1 of PLA2R gene were completely linked. HEK293 cells expressing human wild-type PLA2R (T at rs3749117 and G at rs35771982) or human mutant PLA2R that had double mutations (C at rs3749117 and C at rs35771982) were constructed. Results: HEK293 cells expressing mutant PLA2R had lower migratory and proliferative responses to collagen I compared with cells expressing wild-type PLA2R. In 580 male patients, PLA2R gene polymorphisms were associated with an increase in maximum intima-media thickness (maxIMT) of the carotid artery. The multivariate regression model showed that PLA2R gene polymorphisms were a risk factor of an increased maxIMT that was independent of conventional risk factors (OR = 1.93, 95% CI: 1.17–3.19, p < 0.01). Conclusions: The nonsynonymous common variants of PLA2R gene altered biological functions in cells expressing variant PLA2R. PLA2R gene polymorphisms present a genetic risk of an increased IMT of the carotid artery in male. The functional changes in the variant PLA2R may potentially be responsible for its association with an increased IMT of the carotid artery.
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Affiliation(s)
- Nguyen Van Si
- Department of Internal Medicine Ⅱ, University of Yamanashi, Faculty of Medicine
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14
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Matsuzawa Y, Kwon T, Lennon RJ, Lerman LO, Lerman A. Prognostic Value of Flow-Mediated Vasodilation in Brachial Artery and Fingertip Artery for Cardiovascular Events: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2015; 4:e002270. [PMID: 26567372 PMCID: PMC4845238 DOI: 10.1161/jaha.115.002270] [Citation(s) in RCA: 352] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 09/22/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND Endothelial dysfunction plays a pivotal role in cardiovascular disease progression, and is associated with adverse events. The purpose of this systematic review and meta-analysis was to investigate the prognostic magnitude of noninvasive peripheral endothelial function tests, brachial artery flow-mediated dilation (FMD), and reactive hyperemia--peripheral arterial tonometry (RH-PAT) for future cardiovascular events. METHODS AND RESULTS Databases of MEDLINE, EMBASE, and the Cochrane Library were systematically searched. Clinical studies reporting the predictive value of FMD or RH-PAT for cardiovascular events were identified. Two authors selected studies and extracted data independently. Pooled effects were calculated as risk ratio (RR) for continuous value of FMD and natural logarithm of RH-PAT index (Ln_RHI) using random-effects models. Thirty-five FMD studies of 17 280 participants and 6 RH-PAT studies of 1602 participants were included in the meta-analysis. Both endothelial function tests significantly predicted cardiovascular events (adjusted relative risk [95% CI]: 1% increase in FMD 0.88 [0.84-0.91], P<0.001, 0.1 increase in Ln_RHI 0.79 [0.71-0.87], P<0.001). There was significant heterogeneity in the magnitude of the association across studies. The magnitude of the prognostic value in cardiovascular disease subjects was comparable between these 2 methods; a 1 SD worsening in endothelial function was associated with doubled cardiovascular risk. CONCLUSIONS Noninvasive peripheral endothelial function tests, FMD and RH-PAT, significantly predicted cardiovascular events, with similar prognostic magnitude. Further research is required to determine whether the prognostic values of these 2 methods are independent of each other and whether an endothelial function-guided strategy can provide benefit in improving cardiovascular outcomes.
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Affiliation(s)
| | - Taek‐Geun Kwon
- Division of Cardiovascular DiseasesMayo ClinicRochesterMN
| | - Ryan J. Lennon
- Division of Biomedical Statistics and InformaticsMayo ClinicRochesterMN
| | | | - Amir Lerman
- Division of Cardiovascular DiseasesMayo ClinicRochesterMN
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15
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Matsuzawa Y, Guddeti RR, Kwon TG, Lerman LO, Lerman A. Secondary prevention strategy of cardiovascular disease using endothelial function testing. Circ J 2015; 79:685-94. [PMID: 25740088 DOI: 10.1253/circj.cj-15-0068] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Over the past decades, secondary prevention of cardiovascular (CV) disease has improved and considerably reduced mortality rates. However, there remains a high-rate of new or recurrent CV events in those with established atherosclerotic vascular diseases. Although most of the prevailing therapies target the conventional risk factors, there is notable interindividual heterogeneity in adaptation to risk factors and response to therapies, which affects efficacy. It is desirable to have a methodology for directly assessing the functional significance of atherogenesis, and for managing individual patients based on their comprehensive vascular health. Endothelial function plays a pivotal role in all stages of atherosclerosis, from initiation to atherothrombotic complication. Endothelial function reflects the integrated effect of all the atherogenic and atheroprotective factors present in an individual, and is therefore regarded as an index of active disease process and a significant risk factor for future CV events. Moreover, improvement in endothelial function is associated with decreased risk of CV events, even in the secondary prevention setting. The introduction of endothelial function assessment into clinical practice may trigger the development of a more tailored and personalized medicine and improve patient outcomes. In this review, we summarize current knowledge on the contribution of endothelial dysfunction to atherosclerotic CV disease in the secondary prevention setting. Finally, we focus on the potential of an endothelial function-guided management strategy in secondary prevention.
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Irace C, Padilla J, Carallo C, Scavelli F, Gnasso A. Delayed vasodilation is associated with cardiovascular risk. Eur J Clin Invest 2014; 44:549-56. [PMID: 24738967 DOI: 10.1111/eci.12268] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 04/11/2014] [Indexed: 12/31/2022]
Abstract
BACKGROUND Flow-mediated dilation (FMD) of the brachial artery is widely used to assess cardiovascular risk. In recent years, much attention has been paid to the kinetics of vasodilation in an attempt to better characterize the endothelial function. Here, we investigated whether FMD magnitude and/or latency are most related to individual cardiovascular risk. MATERIALS AND METHODS Four hundred subjects were recruited. Individual risk prediction was estimated by Framingham cardiovascular risk score and CUORE project calculator. Subjects were divided into Early dilators (peak FMD at 50 s), Late dilators (peak FMD over 50 s) and No dilators. RESULTS Cardiovascular risk was highest in No dilators and significantly higher in Late than Early dilators despite comparable peak FMD. When divided according to peak FMD quintiles, Early and Late dilators showed decreased cardiovascular risk with increasing magnitude of vasodilation. However, subjects in the first three quintiles of Late dilators had a markedly higher risk score despite a peak vasodilation similar to that of Early dilators. CONCLUSION These results suggest that the magnitude of the FMD and its latency are both important for identifying patients at risk of cardiovascular disease. Subjects with a delayed though significant vasodilation associated with a blunted early response exhibit the highest cardiovascular risk.
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Affiliation(s)
- Concetta Irace
- Department of Clinical and Experimental Medicine, University Magna Graecia, Catanzaro, Italy
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17
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Sugamata W, Nakamura T, Uematsu M, Kitta Y, Fujioka D, Saito Y, Kawabata KI, Obata JE, Watanabe Y, Watanabe K, Kugiyama K. Combined assessment of flow-mediated dilation of the brachial artery and brachial-ankle pulse wave velocity improves the prediction of future coronary events in patients with chronic coronary artery disease. J Cardiol 2014; 64:179-84. [PMID: 24556367 DOI: 10.1016/j.jjcc.2014.01.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 12/05/2013] [Accepted: 01/06/2014] [Indexed: 10/25/2022]
Abstract
BACKGROUND AND PURPOSE Measurement of either flow-mediated endothelium-dependent dilatation (FMD) of the brachial artery, brachial-ankle pulse wave velocity (baPWV), or intima-media thickness (IMT) of the carotid artery is useful for risk assessment of future cardiovascular events. This study examined whether combination of these vascular parameters may have an additive effect on the ability of traditional risk factors to predict coronary events in patients with chronic coronary artery disease (CAD). METHODS Patients (n=923) with stable CAD had measurements of FMD, baPWV, and maximum IMT (maxIMT), and were prospectively followed up for <8.5 years or until a coronary event - cardiac death, non-fatal myocardial infarction (MI) or unstable angina pectoris (uAP) requiring unplanned coronary revascularization. RESULTS During the follow-up period, 116 events occurred (29 cardiac deaths, 46 non-fatal MIs and 41 cases of uAP). A multivariate Cox proportional hazards analysis showed that FMD (HR 0.50, 95% CI 0.38-0.66) and baPWV (HR 1.52, 95% CI 1.27-1.82) but not maxIMT were significant predictors of coronary events. Based on the concordance statistics, the predictive value of traditional risk factors [area under the receiver operating characteristic curve (AUC), 0.67] was increased more by the addition of FMD and baPWV combined (AUC, 0.75) compared with the addition of either maxIMT, FMD, or baPWV alone, or the combination of maxIMT and FMD or maxIMT and baPWV (AUC, 0.67, 0.71, 0.71, 0.71 and 0.71, respectively). CONCLUSIONS The combined addition of FMD and baPWV to the risk assessment algorithms may be useful for risk stratification of chronic CAD patients.
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Affiliation(s)
- Wataru Sugamata
- University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan
| | - Takamitsu Nakamura
- University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan.
| | - Manabu Uematsu
- University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan
| | - Yoshinobu Kitta
- University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan
| | - Daisuke Fujioka
- University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan
| | - Yukio Saito
- University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan
| | - Ken-ichi Kawabata
- University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan
| | - Jun-ei Obata
- University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan
| | - Yosuke Watanabe
- University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan
| | - Kazuhiro Watanabe
- University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan
| | - Kiyotaka Kugiyama
- University of Yamanashi, Department of Internal Medicine II, Yamanashi, Japan
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18
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Yun L, Xu R, Zhang L, Li G, Huang S, Yao Y, Li J. The Role of Microalbuminuria in Arterial Endothelial Dysfunction in Hypertensive Patients With Carotid Plaques. Int Heart J 2014; 55:153-9. [DOI: 10.1536/ihj.13-232] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Lin Yun
- Department of Cardiology, Qianfoshan Hospital of Shandong Province, Shandong University
- Shandong Academy of Medical Sciences
| | - Rui Xu
- Department of Cardiology, Qianfoshan Hospital of Shandong Province, Shandong University
| | - Li Zhang
- Department of Ultrasound, Qianfoshan Hospital of Shandong Province, Shandong University
| | - Guohua Li
- Department of Cardiology, Qianfoshan Hospital of Shandong Province, Shandong University
| | - Shuai Huang
- Department of Cardiology, Qianfoshan Hospital of Shandong Province, Shandong University
| | - Yucai Yao
- Department of Cardiology, Qianfoshan Hospital of Shandong Province, Shandong University
| | - Jiamin Li
- Department of Cardiology, Qianfoshan Hospital of Shandong Province, Shandong University
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Uematsu M, Nakamura T, Sugamata W, Kitta Y, Fujioka D, Saito Y, Kawabata KI, Obata JE, Watanabe Y, Watanabe K, Kugiyama K. Echolucency of Carotid Plaque Is Useful for Assessment of Residual Cardiovascular Risk in Patients With Chronic Coronary Artery Disease Who Achieve LDL-C Goals on Statin Therapy. Circ J 2014; 78:151-8. [DOI: 10.1253/circj.cj-13-0783] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Manabu Uematsu
- Department of Internal Medicine II, Yamanashi University Hospital
| | | | - Wataru Sugamata
- Department of Internal Medicine II, Yamanashi University Hospital
| | - Yoshinobu Kitta
- Department of Internal Medicine II, Yamanashi University Hospital
| | - Daisuke Fujioka
- Department of Internal Medicine II, Yamanashi University Hospital
| | - Yukio Saito
- Department of Internal Medicine II, Yamanashi University Hospital
| | | | - Jun-ei Obata
- Department of Internal Medicine II, Yamanashi University Hospital
| | - Yosuke Watanabe
- Department of Internal Medicine II, Yamanashi University Hospital
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Suessenbacher A, Dörler J, Wanitschek M, F Alber H, Pachinger O, Frick M. Prognostic value of peripheral arterial tonometry in patients with coronary artery disease and a high cardiovascular risk profile. J Atheroscler Thromb 2013; 21:230-8. [PMID: 24140729 DOI: 10.5551/jat.18986] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Data regarding the prognostic value of peripheral endothelial function testing in patients with cardiovascular disease are conflicting. Peripheral arterial tonometry(PAT) is increasingly used to measure the peripheral endothelial function. The prognostic value of this method has not been investigated thus far in patients with cardiovascular disease and/or a high cardiovascular risk profile. METHODS In 96 patients with significant coronary artery disease(CAD) or<70% stenosis and ≥ three cardiovascular risk factors, reactive hyperemia was induced following upper arm occlusion and the PAT-ratio between baseline and hyperemia was calculated. The patients were followed for cardiovascular events(revascularization, acute coronary syndrome, ischemic stroke, cardiovascular death, repeat coronary angiography due to chest pain) for 44±14 months. The first event was included in the combined end point. RESULTS The study cohort was divided according to the median PAT-ratio(1.91). The combined end point occurred in 14 patients with a PAT-ratio below the median(1.91) and in 12 patients with a PAT-ratio of ≥1.91 (p=0.65). In a subgroup of 76 patients, the PAT-ratio was reassessed after six months. No differences in the event rate were found between the patients who exhibited deterioration(n=50) and those who exhibited an improvement in the PAT-ratio of >0.1(n=26; 22 vs. 32%, p=0.32). The combined end point occurred earlier in the patients with a PAT-ratio within the 1st tertile than in those with a PAT-ratio within the 2nd/3rd tertile(11.3±11.0 vs. 27.5±18.6 months, p=0.03). CONCLUSIONS In patients with established CAD or a high cardiovascular risk profile, the PAT-ratio cannot be used to predict the risk of future cardiovascular events. However, a lower PAT-ratio may be associated with the earlier occurrence of cardiovascular events.
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