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Yao B, Wang B, Yang J, Geng Y, Yu H, Liu Y, Liu G, Wang X. Clinical effects of atorvastatin combined with conbercept in the treatment of patients with macular edema secondary to retinal vein occlusion and carotid plaque: study protocol for a prospective randomized controlled trial. Trials 2024; 25:244. [PMID: 38589960 PMCID: PMC11000300 DOI: 10.1186/s13063-024-08082-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 04/01/2024] [Indexed: 04/10/2024] Open
Abstract
INTRODUCTION Intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) drugs have been widely used in patients with macular edema (ME) secondary to retinal vein occlusion (RVO); however, recurrence is a major concern. This study aims to observe the clinical effects of atorvastatin and intravitreal therapy in the treatment of patients with branch or central RVO-ME and coexistent carotid plaques (CP). METHODS AND ANALYSIS A prospective randomized controlled clinical trial will be conducted. Sixty-four patients diagnosed with branch or central RVO-ME and coexistent CP will be enrolled and randomly allocated in a 1:1 ratio to the control and experimental groups. The control group will be treated with intravitreal conbercept monthly for 3 months, followed by monthly evaluation and injection of pro re nata (PRN) for 12 months, while the experimental group will be treated with oral atorvastatin 20 mg daily combined with the control group treatment. If a drop of best-corrected visual acuity (BCVA) is more than five Early Treatment Diabetic Retinopathy Study (ETDRS) letters (one line) or an increment in central subfield thickness (CSFT) of 100 μm (or a 10% increment from the previous visit), intravitreal re-treatment will be performed. Outcome measurements include CSFT, BCVA, number of injections, and incidence of adverse events during the 12-month follow-up period. Differences between groups will be evaluated using Student's t-test, and comparisons between groups will be evaluated using repeated-measures analysis of variance. ETHICS AND DISSEMINATION The study has been approved by the Institutional Review Board of Nanjing Lishui People's Hospital, Nanjing, China (approval number 2023KY0418-12, dated 18 April 2023), and has been registered on chictr.org.cn. Written informed consent will be collected from each patient and the results of this trial will be submitted to a peer-reviewed journal. TRIAL REGISTRATION Chinese Clinical Trial Registry ChiCTR2300071359. Registered on 12 May 2023.
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Affiliation(s)
- Bangtao Yao
- Department of Ophthalmology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui branch, Southeast University, Nanjing, Jiangsu Province, China.
| | - Bei Wang
- Department of Ophthalmology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui branch, Southeast University, Nanjing, Jiangsu Province, China
| | - Jun Yang
- Department of Neurology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui branch, Southeast University, Nanjing, Jiangsu Province, China
| | - Yan Geng
- Department of Endocrinology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui branch, Southeast University, Nanjing, Jiangsu Province, China
| | - Hao Yu
- Department of Ophthalmology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui branch, Southeast University, Nanjing, Jiangsu Province, China
| | - Yuhui Liu
- Department of Ophthalmology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui branch, Southeast University, Nanjing, Jiangsu Province, China
| | - Gang Liu
- Department of Ophthalmology, Nanjing Lishui People's Hospital, Zhongda Hospital Lishui branch, Southeast University, Nanjing, Jiangsu Province, China
| | - Xiuying Wang
- Department of Ophthalmology, Jiangsu Province Hospital, The First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, China.
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Kronborg TM, Schierwagen R, Trošt K, Gao Q, Moritz T, Bendtsen F, Gantzel RH, Andersen ML, Teisner AS, Grønbæk H, Hobolth L, Møller S, Trebicka J, Kimer N. Atorvastatin for patients with cirrhosis. A randomized, placebo-controlled trial. Hepatol Commun 2023; 7:e0332. [PMID: 38051553 PMCID: PMC10697620 DOI: 10.1097/hc9.0000000000000332] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 09/15/2023] [Indexed: 12/07/2023] Open
Abstract
BACKGROUND Patients with cirrhosis and portal hypertension face a high risk of complications. Besides their anti-inflammatory and antifibrotic effects, statins may reduce portal pressure and thus the risk of complications and mortality. We aimed to investigate the effects of atorvastatin on hospital admissions, mortality, inflammation, and lipidomics in cirrhosis with portal hypertension. METHODS We performed a double-blinded, randomized, placebo-controlled clinical trial among patients with cirrhosis and portal hypertension. Atorvastatin (10-20 mg/d) was administered for 6 months. We measured splanchnic hemodynamics, analyzed inflammatory markers, and performed lipidomics at baseline and after 6 months. RESULTS Seventy-eight patients were randomized, with 38 patients allocated to atorvastatin and 40 patients to placebo. Fifty-nine patients completed 6 months of intervention. Comparisons between changes in each group were calculated. Liver-related complications and mortality were similar between the groups. The HVPG and Model for End-stage Liver Disease score did not change between groups (p=0.95 and 0.87, respectively). Atorvastatin decreased 3 of 42 inflammatory markers, CD62-L-selectin, matrix metalloproteinases-2, and TNF-α (p-values: 0.005, 0.011, and 0.023, respectively), while lipidomics was not significantly changed. CONCLUSIONS In patients with cirrhosis, atorvastatin was safe to use, but did not reduce mortality, the risk of liver-related complications, or the HVPG. Atorvastatin induced minor anti-inflammatory effects and minor effects on lipids during a 6-month treatment period.
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Affiliation(s)
- Thit M. Kronborg
- Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark
| | - Robert Schierwagen
- Department of Internal Medicine B, University of Münster, Münster, Germany
| | - Kajetan Trošt
- Novo Nordisk Foundation Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Qian Gao
- Novo Nordisk Foundation Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Moritz
- Novo Nordisk Foundation Centre for Basic Metabolic Research, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Flemming Bendtsen
- Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus H. Gantzel
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, and Clinical Institute, Aarhus University, Aarhus, Denmark
| | - Mette L. Andersen
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital, Herlev, Denmark
| | - Ane S. Teisner
- Department of Gastroenterology and Hepatology, Copenhagen University Hospital, Herlev, Denmark
| | - Henning Grønbæk
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, and Clinical Institute, Aarhus University, Aarhus, Denmark
| | - Lise Hobolth
- Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark
| | - Søren Møller
- Department of Clinical Medicine, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Physiology and Nuclear Medicine, Centre of Functional Imaging and Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Jonel Trebicka
- Department of Internal Medicine B, University of Münster, Münster, Germany
| | - Nina Kimer
- Gastro Unit, Medical Division, Copenhagen University Hospital, Hvidovre, Denmark
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Zeng P, Zhang Q, Liang X, Zhang M, Luo D, Chen Z. Progress of Ultrasound Techniques in the Evaluation of Carotid Vulnerable Plaque Neovascularization. Cerebrovasc Dis 2023; 53:479-487. [PMID: 37812915 DOI: 10.1159/000534372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 09/25/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND The rupture and detachment of unstable plaques in the carotid artery can cause embolism in the cerebral artery, leading to acute cerebrovascular events. Intraplaque neovascularization (IPN) is a very important contributor to carotid plaque instability, and its evolution plays a key role in determining the outcome of vulnerable plaques. Ultrasound techniques, represented by contrast-enhanced ultrasound (CEUS) and superb microvascular imaging (SMI), are reported to be non-invasive, rapid, and effective techniques for the semi-quantitative or quantitative evaluation for IPN. Although ultrasound techniques have been widely applied in the detection of carotid plaque stability, it has been limited owing to the lack of unified IPN quantitative standards. SUMMARY This review summarizes the application and semi-quantitative/quantitative diagnostic standards of ultrasound techniques in evaluating IPN and looks forward to the prospects of the future research. With the development of novel techniques like artificial intelligence, ultrasound will offer appropriate selections for achieving more accuracy diagnosis. KEY MESSAGES A large number of studies have used CEUS and SMI to detect IPN and perform semi-quantitative grading to predict the occurrence of diseases such as stroke and to accurately assess drug efficacy based on rating changes. These studies have made great progress at this stage, but more accurate and intelligent quantitative imaging methods should become the future development goal.
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Affiliation(s)
- Penghui Zeng
- Institution of Medical Imaging, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
- Institution of Medical Imaging, University of South China, Hengyang, China
- Medical Imaging Centre, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
| | - Qing Zhang
- Institution of Medical Imaging, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
- Institution of Medical Imaging, University of South China, Hengyang, China
| | - Xiaowen Liang
- Institution of Medical Imaging, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
- Institution of Medical Imaging, University of South China, Hengyang, China
| | - Min Zhang
- Department of Ultrasound, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Dan Luo
- Department of Ultrasound, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
| | - Zhiyi Chen
- Institution of Medical Imaging, The Affiliated Changsha Central Hospital, Hengyang Medical School, University of South China, Changsha, China
- Institution of Medical Imaging, University of South China, Hengyang, China
- Medical Imaging Centre, The First Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, China
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Cui E, Kersche G, Grubic N, Hétu MF, Pang SC, Sillesen H, Johri AM. Effect of pharmacologic anti-atherosclerotic therapy on carotid intraplaque neovascularization: A systematic review. J Clin Lipidol 2023; 17:315-326. [PMID: 37173161 DOI: 10.1016/j.jacl.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 04/07/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023]
Abstract
Intraplaque neovascularization (IPN), a key feature of vulnerable carotid plaque, is associated with adverse cardiovascular (CV) events. Statin therapy has been shown to diminish and stabilize atherosclerotic plaque, but its effect on IPN is uncertain. This review investigated the effects of common pharmacologic anti-atherosclerotic therapies on carotid IPN. Electronic databases (MEDLINE, EMBASE and Cochrane Library) were searched from inception until July 13, 2022. Studies evaluating the effect of anti-atherosclerotic therapy on carotid IPN among adults with carotid atherosclerosis were included. Sixteen studies were eligible for inclusion. Contrast-enhanced ultrasound (CEUS) was the most common IPN assessment modality (n=8), followed by dynamic contrast-enhanced MRI (DCE-MRI) (n=4), excised plaque histology (n=3) and superb microvascular imaging (n=2). In fifteen studies, statins were the therapy of interest and one study assessed PCSK9 inhibitors. Among CEUS studies, baseline statin use was associated with a lower frequency of carotid IPN (median OR = 0.45). Prospective studies showed regression of IPN after 6-12 months of lipid-lowering therapy, with more regression observed in treated participants compared to untreated controls. Our findings suggest that lipid-lowering therapy with statins or PCSK9 inhibitors is associated with IPN regression. However, there was no correlation between change in IPN parameters and change in serum lipids and inflammatory markers in statin-treated participants, so it is unclear whether these factors are mediators in the observed IPN changes. Lastly, this review was limited by study heterogeneity and small sample sizes, so larger trials are needed to validate findings.
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Affiliation(s)
- Edward Cui
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri)
| | - Georgia Kersche
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri)
| | - Nicholas Grubic
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri)
| | - Marie-France Hétu
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri)
| | - Stephen C Pang
- Department of Biomedical and Molecular Sciences, Queen's University, Kingston, Canada (Dr Pang)
| | - Henrik Sillesen
- Department of Vascular Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark (Dr Sillesen); Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark (Dr Sillesen)
| | - Amer M Johri
- Department of Medicine, Cardiovascular Imaging Network at Queen's (CINQ), Queen's University, Kingston, Canada (Drs Cui, Kersche, Grubic, Hétu, Johri).
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Guo Y, Wang X, Wang L, Wei X, Duan Y, Yang X, Zhang M, Zhao B. The Value of Superb Microvascular Imaging and Contrast-enhanced Ultrasound for the Evaluation of Neovascularization in Carotid Artery Plaques. Acad Radiol 2023; 30:403-411. [PMID: 36123231 DOI: 10.1016/j.acra.2022.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Revised: 07/31/2022] [Accepted: 08/01/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare the consistency between superb microvascular imaging (SMI) and contrast-enhanced ultrasound (CEUS) for the detection of neovascularization in carotid plaques of different thicknesses and to evaluate the applied value of these two methods for detecting neovascularization in carotid plaques in the clinic. METHODS A total of 45 patients with carotid artery plaques who were diagnosed in our hospital involving 76 hypoechoic plaques with a thickness ≥2.0 mm were selected. According to thickness, the plaques were divided into three groups: 2.0-2.5 mm, 2.5-3.0 mm and ≥3.0 mm. Each group underwent both SMI and CEUS, and two experienced sonographers (A and B) analyzed the ultrasound images to evaluate the neovascularization of carotid plaques. The amount of the neovascular signal was assessed using a semi-quantitative grading scale (vascularity grade: grade 0-3). SMI and CEUS were graded respectively according to the visual methods as follows: grade 0: no blood flow signal/enhancement within plaques; grade 1: a few blood flow signals/enhancement within plaques; grade 2: medium blood flow signals/enhancement within plaques; and grade 3: extensive blood flow signals/enhancement within plaques. Kappa consistency test was used to analyze the consistency of the grade of neovascularization in plaques between SMI with CEUS. Gamma rank correlation analysis was used to examine the correlation between neovascularization grade by SMI and CEUS in plaque and plaque thickness. RESULTS Of these patients, 14 had unilateral plaques and 31 had bilateral plaques. The two sonographers were highly consistent in terms of applying SMI and CEUS methods for diagnosing neovascularization in carotid plaques (Kappa values were 0.736 and 0.680>0). Consistency was found between SMI and CEUS by sonographers (sonographer A: Kappa=0.823; sonographer B: Kappa=0.842) in evaluating the neovascular grade in the carotid plaques. SMI and CEUS grades were positively correlated with plaque thickness (sonographer A: γ = 0.735 and 0.772; sonographer B: γ = 0.805 and 0.798). CONCLUSION Neovascularization in carotid plaques was successfully detected by SMI in a manner that concurred well with CEUS results. Our data indicate that both CEUS and SMI have high diagnostic value for assessing the neovascularization of plaques.
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Affiliation(s)
- Yanqin Guo
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xinghua Wang
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Lu Wang
- Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China
| | - Xiaoli Wei
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yinling Duan
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Xiaohuan Yang
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Min Zhang
- the Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Bin Zhao
- Shanxi Medical University School and Hospital of Stomatology, Shanxi Province Key Laboratory of Oral Diseases Prevention and New Materials, Taiyuan, China.
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Chen J, Liu D, Wang J, Song W, Ma F. Clinical application of super sensitive microflow ultrasound on the detection of intraplaque neovascularization in patients with atheromatous carotid artery plaque. Clin Hemorheol Microcirc 2022; 82:283-293. [PMID: 35912734 DOI: 10.3233/ch-221510] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND Contrast-enhanced ultrasound (CEUS) is a routine technique for detecting intraplaque neovascularization (IPN). However, the invasiveness and complexity of CEUS severely limit its clinical application. This article aims to investigate the application value of AngioPLUS (AP) technique in assessing IPN formation in patients with atheromatous (AS) carotid artery plaque. METHODS Patients diagnosed with carotid artery atherosclerosis combined plaque formation were recruited and their demographic characteristics including serum fasting blood glucose (FBG), triglyceride (TG), and low-density lipoprotein (LDL) were collected. AP was used to scoring intraplaque microvascular flow (IMVF), measuring the thickness and length of the plaque and determining the number of IPN of the plaque. RESULTS IMVF score evaluated by AP was positively correlated with plaque length, thickness, IPN number, serum TG, LDL and FBG levels in patients with carotid atherosclerosis with plaque. The evaluation results of CEUS score and IMVF classification detected by AP of plaques were consistent in patients with carotid atherosclerosis. CONCLUSION IMVF scoring by AP is a promising approach to assess IPN and plaque status in patients with atheromatous carotid artery plaque.
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Affiliation(s)
- Jin Chen
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
| | - Dandan Liu
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
| | - Jing Wang
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
| | - Wanji Song
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
| | - Fang Ma
- Department of Geriatrics, the Second People's Hospital of Hefei, Hefei Hospital Affiliated to Anhui Medical University, Anhui, Hefei, China
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Song Y, Xing H, Zhang Z, Felix LO. Detection of Carotid Atherosclerotic Intraplaque Neovascularization Using Superb Microvascular Imaging: A Meta-Analysis. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:2629-2638. [PMID: 33587302 DOI: 10.1002/jum.15652] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/31/2020] [Accepted: 01/20/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES Although superb microvascular imaging (SMI) (Toshiba/Canon, Tokyo, Japan) has enabled routine characterization of intraplaque neovascularization (IPN) features in patients with carotid stenosis, no reports have been published on the multicenter and large sample size research in this aspect. The efficacy of SMI in detecting carotid IPN has not been concluded. This study aimed to assess the efficacy of SMI comparing with contrast-enhanced carotid ultrasonography (CEUS) in the detection of carotid IPN or pathologic evaluations of IPN correlated with a history of stroke or transient ischemic attack (TIA). METHODS Web of Science, Cochrane Library, PubMed, Embase, and Scopus were searched up to August 2020 to identify peer-reviewed human studies on the diagnostic accuracy of SMI in detecting IPN. For the selected study, the correlation coefficient R and Kappa index between SMI and CEUS in detecting IPN were calculated. The correlation coefficient R between SMI in identifying IPN and pathologic evaluations of IPN and the odds ratio of IPN detected by SMI and history of stroke or TIA were also extracted. The subgroup analysis was performed to indicate the source of heterogeneity. RESULTS Our search identified 11 reports enrolling a total of 605 carotid stenosis patients. Carotid IPN detected by SMI was significantly correlated with which detected by CEUS (R, 0.89; 95% CI, 0.80-0.94; P = .00, and Kappa index, 0.73; 95% CI, 0.67-0.80; P = .00). Notably, a significant correlation was observed in SMI in detecting IPN and pathologic evaluations of IPN (R, 0.52; 95% CI, 0.40-0.62; P = .00). The odds ratio of IPN detected by SMI and history of stroke or TIA was pooled summary with statistical significance (OR, 3.33; 95% CI, 1.78-6.23; P = .00). In subgroup analysis, lower heterogeneity was associated with the degree of carotid stenosis, patients from which country, and types of equipment. CONCLUSIONS SMI and CEUS display an excellent agreement in detecting carotid IPN. IPN detected by SMI shows high consistency with pathologic evaluations of IPN. Individuals with carotid IPN are more likely to develop stroke or TIA than those without carotid IPN.
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Affiliation(s)
- Yi Song
- Department of Ultrasound, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan, 450052, China
| | - Hang Xing
- Division of Cardiothoracic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, 02903, USA
| | - Zhiqi Zhang
- Division of Cardiothoracic Surgery, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, 02903, USA
| | - Lewis Oscar Felix
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, RI, 02903, USA
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Iannuzzi A, Rubba P, Gentile M, Mallardo V, Calcaterra I, Bresciani A, Covetti G, Cuomo G, Merone P, Di Lorenzo A, Alfieri R, Aliberti E, Giallauria F, Di Minno MND, Iannuzzo G. Carotid Atherosclerosis, Ultrasound and Lipoproteins. Biomedicines 2021; 9:biomedicines9050521. [PMID: 34066616 PMCID: PMC8148516 DOI: 10.3390/biomedicines9050521] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 04/30/2021] [Accepted: 05/04/2021] [Indexed: 12/13/2022] Open
Abstract
Carotid artery plaques are considered a measure of atherosclerosis and are associated with an increased risk of atherosclerotic cardiovascular disease, particularly ischemic strokes. Monitoring of patients with an elevated risk of stroke is critical in developing better prevention strategies. Non-invasive imaging allows us to directly see atherosclerosis in vessels and many features that are related to plaque vulnerability. A large body of evidence has demonstrated a strong correlation between some lipid parameters and carotid atherosclerosis. In this article, we review the relationship between lipids and atherosclerosis with a focus on carotid ultrasound, the most common method to estimate atherosclerotic load.
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Affiliation(s)
- Arcangelo Iannuzzi
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy; (A.B.); (G.C.)
- Correspondence:
| | - Paolo Rubba
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Marco Gentile
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Vania Mallardo
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Ilenia Calcaterra
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Alessandro Bresciani
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy; (A.B.); (G.C.)
| | - Giuseppe Covetti
- Department of Medicine and Medical Specialties, A. Cardarelli Hospital, 80131 Naples, Italy; (A.B.); (G.C.)
| | - Gianluigi Cuomo
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Pasquale Merone
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Anna Di Lorenzo
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Roberta Alfieri
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Emilio Aliberti
- North Tees University Hospital, Stockton-on Tees TS19 8PE, UK;
| | - Francesco Giallauria
- Department of Translational Medical Sciences, Federico II University of Naples, 80131 Naples, Italy; (G.C.); (P.M.); (A.D.L.); (R.A.); (F.G.)
| | - Matteo Nicola Dario Di Minno
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
| | - Gabriella Iannuzzo
- Department of Clinical Medicine, Surgery Federico II University, 80131 Naples, Italy; (P.R.); (M.G.); (V.M.); (I.C.); (M.N.D.D.M.); (G.I.)
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Meng Q, Xie X, Li L, Jiang C, Zhao K, Bai Z, Zheng Z, Yang Y, Yu Y, Zhang H, Zhao X. Assessment of neovascularization of carotid artery atherosclerotic plaques using superb microvascular imaging: a comparison with contrast-enhanced ultrasound imaging and histology. Quant Imaging Med Surg 2021; 11:1958-1969. [PMID: 33936978 DOI: 10.21037/qims-20-933] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background This study aimed to investigate the usefulness of superb microvascular imaging (SMI), a novel non-contrast-enhanced ultrasound technique, in characterizing neovessels within carotid atherosclerotic plaques through comparison with contrast-enhanced ultrasound (CEUS) and histology. Methods Patients with carotid plaque were recruited and underwent SMI and CEUS ultrasound imaging of the carotid arteries. The maximum plaque thickness, length, and stenosis of each plaque were measured. Grade of the neovessels was determined by SMI and CEUS, respectively. Grade 0 was defined as no blood flow signal/microbubbles within plaques; grade 1 was defined as moderate blood flow signals/microbubbles confined to the shoulder and/or adventitial side of the plaque; and grade 2 was defined as extensive intraplaque signals/microbubbles. Patients with symptomatic carotid stenosis (stenosis ≥50%) or asymptomatic carotid stenosis (stenosis ≥70%) underwent endarterectomy, and plaque specimens were subjected to immunohistochemical analysis of CD31 expression. The neovessels were quantified by histology. The agreement of SMI with CEUS and histology in characterizing neovessels was analyzed using weighted Kappa statistic and Spearman's correlation analyses. Results Seventy-eight patients (mean age: 67.3±8.9 years old, 63 males) were recruited. Of these patients, 52 (66.7%) had a unilateral plaque and 26 (33.3%) had bilateral plaques in the carotid arteries. For the 104 carotid plaques detected, the mean plaque thickness and length were 4.3±1.1 and 18.8±6.6 mm, respectively. The prevalence of <50%, 50-69%, and ≥70% stenosis was 43.3%, 24.0%, and 32.7%, respectively. Excellent agreement was found between SMI and CEUS (κ=0.825 at the plaque level; κ=0.820 at the patient level) in evaluating the neovessel grade within the carotid plaques. Of the 25 patients who underwent carotid endarterectomy, a strong correlation (r=0.660, P<0.001) was found between SMI and histology in the evaluation of intraplaque neovessels. SMI had excellent scan-rescan (κ=0.857), intra-reader (κ=0.810), and inter-reader (κ=0.754) agreement in the assessment of intraplaque neovessels. Conclusions The SMI technique is capable of reliably characterizing neovessels within carotid atherosclerotic plaques and demonstrates good to excellent agreement with histology and CEUS.
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Affiliation(s)
- Qi Meng
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xia Xie
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Li Li
- Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Chao Jiang
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Keqiang Zhao
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhiyong Bai
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Zhuozhao Zheng
- Department of Radiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yu Yang
- Department of Vascular Surgery, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Yan Yu
- Department of Pathology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Huabin Zhang
- Department of Ultrasound, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China
| | - Xihai Zhao
- Center for Biomedical Imaging Research, Department of Biomedical Engineering, Tsinghua University School of Medicine, Beijing, China
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10
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Evaluation of Multimode Color Doppler Flow Imaging in the Diagnosis of Solid Renal Tumor. CONTRAST MEDIA & MOLECULAR IMAGING 2021; 2021:6656877. [PMID: 33880110 PMCID: PMC8032533 DOI: 10.1155/2021/6656877] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 03/16/2021] [Accepted: 03/23/2021] [Indexed: 11/18/2022]
Abstract
Background Renal cell carcinoma is one of the most common malignant tumors in urinary system, seriously affecting people's health and life. This study aimed to evaluate the clinical value of multi-mode color Doppler flow imaging for diagnosis of solid renal tumor. Methods Sixty-six renal solid tumors from 63 patients were examined by color Doppler flow imaging (CDFI), power Doppler flow imaging (PDFI), superb microvascular imaging (SMI), and contrast-enhanced ultrasound (CEUS) before surgery. The diagnostic efficacy of the four methods was compared by determining blood flow grade and ring-like blood flow with Adler's method. Chi-square test and Fisher's test were performed to compare the results of sensitivity and specificity among four methods. Results Statistically significant differences in blood flow grade and ring-like blood flow were observed between benign and malignant renal tumors as detected by SMI and CEUS (P < 0.05), whereas no difference was found as detected by CDFI and PDFI (P > 0.05). The results indicated that the sensitivity and specificity of SMI (82.46%, 88.89%) and CEUS (84.21%, 88.89%) were higher than those of CDFI (42.11%, 66.67%) and PDFI (47.37%, 77.78%). Compared with the abilities of CDFI and PDFI, SMI and CEUS can better display the micro-blood flow in the tumors and evaluate the blood flow grading, which indicated that SMI and CEUS may have high values in the differential diagnosis of benign and malignant solid renal tumors. Conclusion SMI and CEUS can improve the sensitivity and specificity of the diagnosis of benign and malignant renal tumors and have a high application value.
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11
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Sluiter TJ, van Buul JD, Huveneers S, Quax PHA, de Vries MR. Endothelial Barrier Function and Leukocyte Transmigration in Atherosclerosis. Biomedicines 2021; 9:328. [PMID: 33804952 PMCID: PMC8063931 DOI: 10.3390/biomedicines9040328] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 12/24/2022] Open
Abstract
The vascular endothelium is a highly specialized barrier that controls passage of fluids and migration of cells from the lumen into the vessel wall. Endothelial cells assist leukocytes to extravasate and despite the variety in the specific mechanisms utilized by different leukocytes to cross different vascular beds, there is a general principle of capture, rolling, slow rolling, arrest, crawling, and ultimately diapedesis via a paracellular or transcellular route. In atherosclerosis, the barrier function of the endothelium is impaired leading to uncontrolled leukocyte extravasation and vascular leakage. This is also observed in the neovessels that grow into the atherosclerotic plaque leading to intraplaque hemorrhage and plaque destabilization. This review focuses on the vascular endothelial barrier function and the interaction between endothelial cells and leukocytes during transmigration. We will discuss the role of endothelial dysfunction, transendothelial migration of leukocytes and plaque angiogenesis in atherosclerosis.
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Affiliation(s)
- Thijs J. Sluiter
- Department of Vascular Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (T.J.S.); (P.H.A.Q.)
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Jaap D. van Buul
- Sanquin Research and Landsteiner Laboratory, Leeuwenhoek Centre for Advanced Microscopy, Swammerdam Institute for Life Sciences, University of Amsterdam, 1066 CX Amsterdam, The Netherlands;
| | - Stephan Huveneers
- Department of Medical Biochemistry, Amsterdam Cardiovascular Sciences, Amsterdam University Medical Center, Location AMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Paul H. A. Quax
- Department of Vascular Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (T.J.S.); (P.H.A.Q.)
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
| | - Margreet R. de Vries
- Department of Vascular Surgery, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands; (T.J.S.); (P.H.A.Q.)
- Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands
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12
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Baganha F, de Jong RCM, Peters EA, Voorham W, Jukema JW, Delibegovic M, de Vries MR, Quax PHA. Atorvastatin pleiotropically decreases intraplaque angiogenesis and intraplaque haemorrhage by inhibiting ANGPT2 release and VE-Cadherin internalization. Angiogenesis 2021; 24:567-581. [PMID: 33550461 PMCID: PMC8292290 DOI: 10.1007/s10456-021-09767-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Accepted: 01/04/2021] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Statins pleiotropically provide additional benefits in reducing atherosclerosis, but their effects on intraplaque angiogenesis (IPA) and hemorrhage (IPH) remain unclear. Therefore, we discriminated statin's lipid-lowering dependent and independent effects on IPA and IPH. APPROACH AND RESULTS ApoE3*Leiden mice are statin-responsive due to ApoE and LDLR presence, but also allow to titrate plasma cholesterol levels by diet. Therefore, ApoE3*Leiden mice were fed a high-cholesterol-inducing-diet (HCD) with or without atorvastatin (A) or a moderate-cholesterol-inducing-diet (MCD). Mice underwent vein graft surgery to induce lesions with IPA and IPH. Cholesterol levels were significantly reduced in MCD (56%) and HCD + A (39%) compared to HCD with no significant differences between MCD and HCD + A. Both MCD and HCD + A have a similar reduction in vessel remodeling and inflammation comparing to HCD. IPA was significantly decreased by 30% in HCD + A compared to HCD or MCD. Atorvastatin treatment reduced the presence of immature vessels by 34% vs. HCD and by 25% vs. MCD, resulting in a significant reduction of IPH. Atorvastatin's anti-angiogenic capacity was further illustrated by a dose-dependent reduction of ECs proliferation and migration. Cultured mouse aortic-segments lost sprouting capacity upon atorvastatin treatment and became 30% richer in VE-Cadherin expression and pericyte coverage. Moreover, Atorvastatin inhibited ANGPT2 release and decreased VE-Cadherin(Y685)-phosphorylation in ECs. CONCLUSIONS Atorvastatin has beneficial effects on vessel remodeling due to its lipid-lowering capacity. Atorvastatin has strong pleiotropic effects on IPA by decreasing the number of neovessels and on IPH by increasing vessel maturation. Atorvastatin improves vessel maturation by inhibiting ANGPT2 release and phospho(Y658)-mediated VE-Cadherin internalization.
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Affiliation(s)
- Fabiana Baganha
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Vascular Surgery/Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, PO Box 9600, 2300 RC, Leiden, The Netherlands.,Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, Aberdeen University, Aberdeen, UK
| | - Rob C M de Jong
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Vascular Surgery/Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Erna A Peters
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Vascular Surgery/Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Wietske Voorham
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Vascular Surgery/Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Mirela Delibegovic
- Aberdeen Cardiovascular and Diabetes Centre, Institute of Medical Sciences, Aberdeen University, Aberdeen, UK
| | - Margreet R de Vries
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands.,Department of Vascular Surgery/Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, PO Box 9600, 2300 RC, Leiden, The Netherlands
| | - Paul H A Quax
- Department of Vascular Surgery, Leiden University Medical Center, Leiden, The Netherlands. .,Department of Vascular Surgery/Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Leiden, PO Box 9600, 2300 RC, Leiden, The Netherlands.
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13
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Li Y, Zheng S, Zhang J, Wang F, Liu X, He W. Advance ultrasound techniques for the assessment of plaque vulnerability in symptomatic and asymptomatic carotid stenosis: a multimodal ultrasound study. Cardiovasc Diagn Ther 2021; 11:28-38. [PMID: 33708475 DOI: 10.21037/cdt-20-876] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Advanced carotid ultrasound techniques may be useful in characterizing plaque vulnerability, but comprehensive studies are still lacking. The aim of this study was to identify factors associated with vulnerable plaques using advanced ultrasound techniques. Methods This is a prospective observational study of patients with >50% internal carotid stenosis (ICA). All patients underwent conventional ultrasound, superb microvascular imaging (SMI) and shear wave elastography (SWE) examinations. Plaque size, echogenicity, stiffness and intraplaque neovascularization (IPN) were assessed and compared between symptomatic and asymptomatic groups. Receiver operating characteristic (ROC) curves were used to evaluate the diagnostic performance of SWE and SMI of the vulnerable plaques. Results The final analysis included 123 patients (78.9% male; mean age, 66±8 years), 65 were enrolled in the symptomatic group, and 58 were enrolled in the asymptomatic group. The mean elasticity was 78.1±25.4 kPa for asymptomatic and 51.5±18.3 kPa for symptomatic plaques. Symptomatic plaques showed higher visual IPN grades on SMI than asymptomatic plaques (P<0.001). Multivariate regression analysis showed that plaque stiffness (PS) (OR 0.95, 95% CI, 0.919-0.974) and IPN level (OR 4.17, 95% CI, 2.008-8.664) were independently associated with symptomatic plaques. The combination of the two factors had a preferable accuracy to discriminate symptomatic plaques (AUC 0.89, 95% CI, 0.827-0.944). Conclusions Advanced carotid ultrasound techniques can identify plaque characteristics that are associated with ischemic events and may be potentially indicative of plaque vulnerability. These factors may ultimately be used in the clinical management of carotid stenosis.
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Affiliation(s)
- Yi Li
- Department of Ultrasound, Capital Medical University, Beijing, China.,Department of Ultrasound, Beijing Tiantan Hospital, Beijing, China
| | - Shuai Zheng
- Department of Ultrasound, Capital Medical University, Beijing, China.,Department of Ultrasound, Beijing Tiantan Hospital, Beijing, China
| | - Jinghan Zhang
- Department of Ultrasound, Capital Medical University, Beijing, China.,Department of Ultrasound, Beijing Tiantan Hospital, Beijing, China
| | - Fumin Wang
- Department of Ultrasound, Capital Medical University, Beijing, China.,Department of Ultrasound, Beijing Tiantan Hospital, Beijing, China
| | - Xinyao Liu
- Department of Ultrasound, Capital Medical University, Beijing, China.,Department of Ultrasound, Beijing Tiantan Hospital, Beijing, China
| | - Wen He
- Department of Ultrasound, Capital Medical University, Beijing, China.,Department of Ultrasound, Beijing Tiantan Hospital, Beijing, China
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14
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Zhang X, Xing L, Jia X, Pang X, Xiang Q, Zhao X, Ma L, Liu Z, Hu K, Wang Z, Cui Y. Comparative Lipid-Lowering/Increasing Efficacy of 7 Statins in Patients with Dyslipidemia, Cardiovascular Diseases, or Diabetes Mellitus: Systematic Review and Network Meta-Analyses of 50 Randomized Controlled Trials. Cardiovasc Ther 2020; 2020:3987065. [PMID: 32411300 PMCID: PMC7201823 DOI: 10.1155/2020/3987065] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Revised: 01/30/2020] [Accepted: 03/18/2020] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVE The drug efficacy may differ among different statins, and evidence from head-to-head comparisons is sparse and inconsistent. The study is aimed at comparing the lipid-lowering/increasing effects of 7 different statins in patients with dyslipidemia, cardiovascular diseases, or diabetes mellitus by conducting systematic review and network meta-analyses (NMA) of the lipid changes after certain statins' use. METHODS In this study, we searched four electronic databases for randomized controlled trials (RCTs) published through February 25, 2020, comparing the lipid-lowering efficacy of no less than two of the included statins (or statin vs. placebo). Three reviewers independently extracted data in duplicate. Firstly, mixed treatment overall comparison analyses, in the form of frequentist NMAs, were conducted using STATA 15.0 software. Then, subgroup analyses were conducted according to different baseline diseases. At last, sensitivity analyses were conducted according to age and follow-up duration. The trial was registered with PROSPERO (number CRD42018108799). RESULTS As a result, seven statin monotherapy treatments in 50 studies (51956 participants) were used for the analyses. The statins included simvastatin (SIM), fluvastatin (FLU), atorvastatin (ATO), rosuvastatin (ROS), lovastatin (LOV), pravastatin (PRA), and pitavastatin (PIT). In terms of LDL-C lowering, rosuvastatin ranked 1st with a surface under cumulated ranking (SUCRA) value of 93.1%. The comparative treatment efficacy for LDL-C lowering was ROS>ATO>PIT>SIM>PRA>FLU>LOV>PLA. All of the other ranking and NMA results were reported in SUCRA plots and league tables. CONCLUSIONS According to the NMAs, it can be concluded that rosuvastatin ranked 1st in LDL-C, ApoB-lowering efficacy and ApoA1-increasing efficacy. Lovastatin ranked 1st in TC- and TG-lowering efficacy, and fluvastatin ranked 1st in HDL-C-increasing efficacy. The results should be interpreted with caution due to some limitations in our review. However, they can provide references and evidence-based foundation for drug selection in both statin monotherapies and statin combination therapies.
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Affiliation(s)
- Xiaodan Zhang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
| | - Lu Xing
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
- Department of Pharmacy, China Pharmaceutical University, Nanjing 210000, China
| | - Xiaona Jia
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Xiaocong Pang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
| | - Qian Xiang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
| | - Xia Zhao
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
| | - Lingyue Ma
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
| | - Zhiyan Liu
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, China
| | - Kun Hu
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
| | - Zhe Wang
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
| | - Yimin Cui
- Department of Pharmacy, Base for Clinical Trial, Peking University First Hospital, Beijing 100034, China
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmaceutical Sciences, Peking University Health Science Center, Beijing 100191, China
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15
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Zamani M, Skagen K, Scott H, Russell D, Skjelland M. Advanced ultrasound methods in assessment of carotid plaque instability: a prospective multimodal study. BMC Neurol 2020; 20:39. [PMID: 31996153 PMCID: PMC6990506 DOI: 10.1186/s12883-020-1620-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Accepted: 01/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background A significant proportion of ischemic strokes are caused by emboli from atherosclerotic, unstable carotid artery plaques. The selection of patients for endarterectomy in current clinical practice is primarily based on the degree of carotid artery stenosis and clinical symptoms. However, the content of the plaque is known to be more important for stroke risk. Intraplaque neovascularization (IPN) has recently emerged as a possible surrogate marker for plaque instability. Neo-microvessels from the adventitial vasa vasorum grow into the full thickness of the vessel wall in an adaptive response to hypoxia, causing subsequent intraplaque haemorrhage and plaque rupture. Conventional ultrasound cannot detect IPN. Contrast-enhanced ultrasound and Superb Microvascular Imaging (SMI), have, however, shown promise in IPN assessment. Recent research using Shear Wave Elastography (SWE) has also reported reduced tissue stiffness in the artery wall (reduced mean Young’s modulus) in unstable compared to stable plaques. The purpose of this study is to identify unstable carotid artery plaques at risk of rupture and future ischemic stroke risk using multimodal assessments. Methods Forty five symptomatic and 45 asymptomatic patients > 18 years, with > 50% carotid stenosis referred to Oslo University Hospital ultrasound lab will be included in this on-going project. Patients will undergo contrast enhanced ultrasound, SMI, carotid-MRI and PET-(18F-FDG). Contrast enhanced ultrasound will be analyzed semi-quantitatively (5-levels visual classification) and quantitatively by plotting time-intensity curve analyses to obtain plaque peak contrast enhancement intensity. Plaques removed at carotid endarterectomy will be assessed histologically and the number of microvessels, areas of inflammation, granulation, calcification, lipid and fibrosis will be measured. Discussion This multimodality study will primarily provide information on the clinical value of advanced ultrasound methods (SMI, SWE) for the detection of unstable carotid artery plaque in comparison with other methods including contrast-enhanced ultrasound, carotid-MRI and PET-(18F-FDG) using histology as the gold standard. Secondly, findings from the methods mentioned above will be related to cerebrovascular symptoms, blood tests (leukocytes, CRP, ESR, lipoproteins and inflammatory markers) and cardiovascular risk factors at inclusion and at 1-year follow-up. The overall aim is to optimize detection of plaque instability which can lead to better preventive decisions and reduced stroke rate.
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Affiliation(s)
- M Zamani
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen 0424, Oslo, Norway. .,Department of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - K Skagen
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen 0424, Oslo, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - H Scott
- Department of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Pathology, Oslo University Hospital, Rikshospitalet, Norway
| | - D Russell
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen 0424, Oslo, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - M Skjelland
- Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen 0424, Oslo, Norway.,Department of Clinical Medicine, University of Oslo, Oslo, Norway
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16
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Shen TT, Xue JL. Impact of a novel ultrasound microvascular imaging and elastography on prostate cancer classification. Transl Androl Urol 2019; 8:696-702. [PMID: 32038966 DOI: 10.21037/tau.2019.11.15] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Background This study was aimed to compare the sensitivity of transrectal ultrasound (TRUS) guided systematic biopsy (TRUS-SB), superb microvascular imaging guided targeted biopsy (SMI-TB), and elastography ultrasound guided targeted biopsy (EU-TB) in detecting prostate cancer (PCa). Methods One hundred and eighty-four patients with suspicious PCa were randomly divided into two groups, SMI-TB group (n=92) and EU-TB group (n=92). All the patients received a 2-core SMI-TB or a 2-core EU-TB before receiving a 12-core TRU-SB depending on the group. The 2-core SMI-TB was conducted at the most increased vascularity areas rated by a radiologist on a semi-quantitative criterion. The 2-core EU-TB was performed at the dark blue areas that identified as suspicious areas. The PCa detection rate was compared among TRUS-SB, SMI-TB, and EU-TB in the total population and in two groups. Results PCa was detected in 65 out of 184 patients. The SMI-TB group patients received 1,272 cores in total with a positive rate of 23.81% (40/168) for SMI-TB cores and 4.17% (46/1,104) for TRUS-SB cores. The EU-TB group patients received a total of 1,262 cores with a positive rate of 31.01% (49/158) for EU-TB cores and 5.34% (59/1,104) for TRUS-SB cores. Targeted cores (27.30%, 89/326) achieved significantly higher sensitivity in PCa detection than systematic cores (4.76%, 105/2,208) (SMI-TB vs. TRUS-SB: OR 7.188, P<0.001; EU-TB vs. TRUS-SB: OR 7.962, P<0.001). Conclusions Superb microvascular imaging and elastography ultrasound guided targeted biopsy may result in higher prostate cancer detection rate as adjunct to gray-scale ultrasound guided systematic biopsy. However, targeted biopsy alone is not sufficient to detect PCa, compared with systematic biopsy.
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Affiliation(s)
- Ting-Ting Shen
- Department of Ultrasound, Shanghai Ji Ai Genetics & IVF Institute, Shanghai 200011, China
| | - Jun-Li Xue
- Department of Oncology, Shanghai Oriental Hospital, Shanghai 200120, China
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17
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Wang Y, Yao M, Zou M, Li S, Ge Z, Hong Y, Cai S, Wang H, Li J. Assessment of Carotid Intraplaque Neovascularization Using Superb Microvascular Imaging in High Risk of Stroke Individuals: Results From a Community-Based Study. Front Neurol 2019; 10:1146. [PMID: 31787918 PMCID: PMC6854025 DOI: 10.3389/fneur.2019.01146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 10/14/2019] [Indexed: 12/19/2022] Open
Abstract
Background: Improved stroke risk stratification may improve stroke prevention. We aimed to study the value of a novel Doppler method, superb microvascular imaging (SMI), in correlating plaque thickness and evidence of intra-plaque neovascularization with a history stroke and TIA involving any cerebrovascular territory among community residents considered at high stroke risk. Methods: We selected residents aged at least 40 years from the Donghuashi community in China who had at least three stroke risk factors (including a history of stroke or TIA) and carotid plaque thickness of at least 1.5 mm (but without heavy calcification) and no history of carotid endarterectomy or stenting. In this cross-sectional study, each subject underwent carotid plaque examination with standard ultrasound and SMI. SMI evidence of plaque neovascularization was categorized as none or mild (Grade 1) or moderate or marked (Grade 2) and correlated with past history of stroke or TIA. Results: A total of 131 individuals (mean age 69 ± 8 years, 63% male) met the study inclusion criteria. SMI revealed no or mild neovascularization in 74 subjects (56.5%) and moderate or marked neovascularization in 57 subjects (43.5%). Subjects with moderate or marked neovascularization were more likely to have a history of any territory stroke or TIA, 43.9 vs. 17.6% (P = 0.001). Multivariate logistic regression analyses showed a thicker plaque (odds ratio: 2.272, 95% CI: 1.351–3.822, P = 0.002) and a history of stroke or TIA (odds ratio: 4.017, 95% CI: 1.719–9.387, P = 0.001) significantly correlated with evidence of moderate to marked intra-plaque neovascularization. Conclusions: Moderate to marked intraplaque neovascularization detected by SMI was more likely in subjects with a history of any territory stroke or TIA or thicker plaque. This indicates a potential new role of SMI in stratifying future risk of stroke or other arterial disease complications.
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Affiliation(s)
- Ying Wang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Yao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Mi Zou
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Shengde Li
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhitong Ge
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuehui Hong
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Siman Cai
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongyan Wang
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jianchu Li
- Department of Ultrasound, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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Zamani M, Skagen K, Scott H, Lindberg B, Russell D, Skjelland M. Carotid Plaque Neovascularization Detected With Superb Microvascular Imaging Ultrasound Without Using Contrast Media. Stroke 2019; 50:3121-3127. [PMID: 31510899 DOI: 10.1161/strokeaha.119.025496] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Background and Purpose- A significant proportion of ischemic strokes are caused by emboli from unstable carotid artery plaques with intraplaque neovascularization (IPN) as a key feature of plaque instability. IPN is not detectable with conventional Doppler ultrasound. Contrast-enhanced ultrasound (CEUS) can visualize IPN, but its use is limited in clinical practice because it requires an intravenous injection of contrast. Superb microvascular imaging (SMI) without contrast uses an algorithm to remove clutter and motion wall artifacts while preserving low-velocity blood flow signals, enabling visualization of IPN. Our aim was to assess the feasibility of SMI for the detection of IPN. Methods- Thirty-one patients with >50% carotid stenosis were included: 22 patients were symptomatic and 9 asymptomatic. All patients underwent conventional carotid ultrasound, CEUS, SMI, and blood tests. CEUS and SMI findings were compared and correlated to histological plaque assessments after endarterectomy. Results- There was significant positive correlation between an IPN visual 5-level classification of SMI and a semiquantitative analysis of CEUS (P<0.001, r=0.911). Plaques with higher SMI grades had higher numbers of neovessels quantified at histology (P=0.041, r=0.460). Hypoechoic plaques had higher grades of IPN on both CEUS and SMI (P<0.001). Higher visual IPN counts on SMI were associated with (1) increased areas of inflammation (P=0.043, r=0.457), (2) combined rank scores of granulation tissue, inflammation and lipids (P=0.02, r=0.494) at histology, and (3) higher peak-intensity values on quantitative CEUS (P=0.042, r=0.514). Conclusions- SMI ultrasound can detect neovascularization with accuracy comparable to CEUS, suggesting SMI to be a promising noninvasive alternative to CEUS for the assessment of carotid plaque stability.
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Affiliation(s)
- Mahtab Zamani
- From the Department of Neurology (M.Z., K.S., D.R., M.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
| | - Karolina Skagen
- From the Department of Neurology (M.Z., K.S., D.R., M.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
| | - Helge Scott
- Department of Pathology (H.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
| | - Beate Lindberg
- Department of Cardiothoracic Surgery (B.L.), Oslo University Hospital, Rikshospitalet, Norway
| | - David Russell
- From the Department of Neurology (M.Z., K.S., D.R., M.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
| | - Mona Skjelland
- From the Department of Neurology (M.Z., K.S., D.R., M.S.), Oslo University Hospital, Rikshospitalet, Norway.,Institute of Clinical Medicine, University of Oslo, Norway (M.Z., K.S., H.S., D.R., M.S.)
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Zu DM, Feng LL, Zhang L, Ma SL, Zhu YC. Evaluation of Mesenteric Lymph Nodes in a Pediatric Population with Mesenteric Lymphadenitis Using Superb Microvascular Imaging. Med Sci Monit 2019; 25:5336-5342. [PMID: 31318849 PMCID: PMC6659467 DOI: 10.12659/msm.914903] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Background This study aimed to evaluate superb microvascular imaging (SMI) as an adjunctive imaging method to evaluate mesenteric lymph nodes in children with mesenteric lymphadenitis compared with healthy children. Material/Methods A retrospective study compared children with mesenteric lymphadenitis (n=27) and healthy children (n=30). Lymph node size was determined using grayscale ultrasonography and parameters of lymph node vascularity were compared using color Doppler flow imaging (CDFI) and SMI. The diagnostic performance of ultrasound (US), US combined with SMI, and US combined with CDFI were compared. Results Lymph nodes from children with mesenteric lymphadenitis (n=77) and normal lymph nodes (n=84) were evaluated by SMI, which showed that the least diameter of lymph nodes in cases of mesenteric lymphadenitis was 0.58±0.15 mm and of normal mesenteric lymph nodes was 0.47±0.08 mm (p<0.001). SMI identified 92.6% of abnormal mesenteric lymph nodes while CDFI detected 85.2%. US combined with SMI had the highest sensitivity (81.5%), and specificity (78.9%) compared with US alone (sensitivity, 63.0%; specificity, 64.9%), and compared with US combined with CDFI (sensitivity, 74.1%; specificity, 75.4%). US combined with SMI and US combined with CDFI achieved the same specificity (76.7%), which was higher than that of US alone (66.7%). Conclusions SMI was superior to color Doppler flow imaging in evaluating the microvasculature in lymphadenopathy in mesenteric lymphadenitis. SMI may be used as an adjunct to grayscale ultrasonography to assist in identifying mesenteric lymphadenopathy in pediatric patients.
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Affiliation(s)
- Dao-Ming Zu
- Department of Pediatrics, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Ling-Ling Feng
- Department of Gynecology and Obstetrics, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Lei Zhang
- Department of Pediatrics, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Su-Li Ma
- Department of Pediatrics, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
| | - Yi-Cheng Zhu
- Department of Ultrasound, Pudong New Area Peoples' Hospital Affiliated to Shanghai University of Medicine and Health Sciences, Shanghai, China (mainland)
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