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Matsuzono K, Suzuki M, Anan Y, Ozawa T, Mashiko T, Koide R, Tanaka R, Fujimoto S. Spontaneous Echo Contrast in the Left Atrium and Aortic-Arch Atheroma, Detected by Transesophageal Echocardiography, Was Negatively Correlated with Cognitive Function. J Alzheimers Dis 2023; 91:673-681. [PMID: 36463447 DOI: 10.3233/jad-220763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
BACKGROUND The relationship between transesophageal echocardiography findings and cognitive function. OBJECTIVE This study aimed to establish an association between transesophageal echocardiography findings and cognitive function in stroke survivors. METHODS A single-center study was conducted between April 1, 2017 and March 31, 2022. All subjects that were included had a past history of ischemic stroke and were admitted after >21 days from onset. The participants underwent cognitive function tests including a Mini-Mental State Examination, Revised Hasegawa Dementia Scale, Frontal Assessment Battery, and transesophageal echocardiography. RESULTS The results of 126 participants were analyzed. The cognitive function of participants with a spontaneous echo contrast (+) in the left atrium including appendage or of those with an aorta-arch plaque with a maximum thickness ≥4 mm significantly worse while neither the patent foramen ovale nor the branch extending plaque influenced cognitive function (The median cognitive scores of the spontaneous echo contrast (-) versus (+) were 26 versus 22, p < 0.01**, 26 versus 21, p < 0.001***, and 14 versus 11, p < 0.01**. Those of the aortic-arch plaque max thickness (<4 mm) versus (≥4 mm) were 26 versus 25, p < 0.05*, 27 versus 24, p < 0.05*, and 15 versus 13, p < 0.05*). CONCLUSION Our findings show that spontaneous echo contrast in the left atrium and aortic-arch atheroma detected by transesophageal echocardiography, were negatively associated with cognitive function.
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Affiliation(s)
- Kosuke Matsuzono
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Masayuki Suzuki
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Yuhei Anan
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Tadashi Ozawa
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Takafumi Mashiko
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Reiji Koide
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Ryota Tanaka
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shigeru Fujimoto
- Division of Neurology, Department of Medicine, Jichi Medical University, Tochigi, Japan
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Yang Y, Kong Q, Ma X, Wang C, Xue S, Du X. A Whole-Scope Evaluation of Cervicocephalic Atherosclerotic Burden is Essential to Predict 90-Day Functional Outcome in LargeArtery Atherosclerotic Stroke. J Atheroscler Thromb 2021; 29:1522-1533. [PMID: 34803087 PMCID: PMC9529387 DOI: 10.5551/jat.63226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
AIM Cervicocephalic atherosclerosis (AS) of patients with large-artery atherosclerotic (LAA) stroke might be more closely correlated to the functional outcome than patients with stroke of other etiologies. We aimed to investigate whether a whole-scope evaluation of cervicocephalic AS condition was better at predicting the 90-day functional outcome of LAA stroke than evaluation of intracranial or cervical AS condition alone. METHODS Patients with LAA stroke were consecutively enrolled in this study. Computed tomography angiography was performed to evaluate AS condition of various cervicocephalic arterial segments. AS conditions ranging from no AS plaque to complete arterial occlusion scored 0-4 points. Intracranial atherosclerotic burden (IAB) and cervical atherosclerotic burden (CAB) were in respective the sums of AS scores of all intracranial arterial segments and all cervical arterial segments. And the sum of them was intracranial and cervical atherosclerotic burden (ICAB). Relationships of these three scores with the 90-day unfavorable functional outcome (modified Rankin Scale[mRS] score >2 points) were compared. RESULTS Of 172 patients who finished 90-day follow-up, only ICAB (adjusted odds ratio[OR]=1.10, 95% confidence interval[CI]:1.00-1.21, p=0.044) predicted 90-day unfavorable functional outcome independently of clinical factors, National Institutes of Health Stroke Scale (NIHSS) and mRS scores at admission. ICAB (adjusted hazard ratio[HR]=1.16, 95%CI:1.02-1.32, p=0.029) was related to 90-day recurrent ischemic stroke/death independently of clinical factors and was independently, positively correlated with NIHSS score at admission (r=0.16, p=0.047), whereas IAB and CAB were not. CONCLUSION A whole-scope evaluation of cervicocephalic AS condition using ICAB outperformed evaluation of intracranial or cervical AS condition alone in predicting 90-day functional outcome of patients with LAA stroke.
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Affiliation(s)
- Yi Yang
- Department of Neurology, Xuanwu Hospital, Capital Medical University.,National Clinical Research Center for Geriatric Disorders.,Clinical Center for Cardio-cerebrovascular Disease of Capital Medical University
| | - Qi Kong
- Department of Neurology, Xuanwu Hospital, Capital Medical University.,National Clinical Research Center for Geriatric Disorders.,Clinical Center for Cardio-cerebrovascular Disease of Capital Medical University
| | - Xin Ma
- Department of Neurology, Xuanwu Hospital, Capital Medical University.,National Clinical Research Center for Geriatric Disorders.,Clinical Center for Cardio-cerebrovascular Disease of Capital Medical University
| | - Chen Wang
- Department of Radiology, Xuanwu Hospital, Capital Medical University
| | - Sufang Xue
- National Clinical Research Center for Geriatric Disorders.,Clinical Center for Cardio-cerebrovascular Disease of Capital Medical University.,Department of Neurology, Xuanwu Hospital, Capital Medical University
| | - Xiangying Du
- Department of Radiology, Xuanwu Hospital, Capital Medical University
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Sun Y, Wu D, Zeng W, Chen Y, Guo M, Lu B, Li H, Sun C, Yang L, Jiang X, Gao Q. The Role of Intestinal Dysbacteriosis Induced Arachidonic Acid Metabolism Disorder in Inflammaging in Atherosclerosis. Front Cell Infect Microbiol 2021; 11:618265. [PMID: 33816331 PMCID: PMC8012722 DOI: 10.3389/fcimb.2021.618265] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 01/28/2021] [Indexed: 12/12/2022] Open
Abstract
Background Aging induced chronic systemic inflammatory response is an important risk factor for atherosclerosis (AS) development; however, the detailed mechanism is yet to be elucidated. Objective To explore the underlying mechanism of how aging aggravates AS advancement. Methods A young (five-week-old, YM) and aged group (32-week-old, OM) male apoE-/- mice with a high fat diet were used as models, and age-matched male wild-type C57BL/6J (WT) mice were used as controls. AS lesion size, serum lipid profile, cytokines, and gut microbiota-derived LPS were analyzed after 32 weeks of diet intervention. A correlation analysis between the 16S rRNA sequencing of the feces and serum metabolomics profiles was applied to examine the effect of their interactions on AS. Results ApoE-/- mice developed severe atherosclerosis and inflammation in the aorta compared to the WT groups, and aged apoE-/- mice suffered from a more severe AS lesion than their younger counterparts and had low-grade systemic inflammation. Furthermore, increased levels of serum LPS, decreased levels of SCFAs production, as well as dysfunction of the ileal mucosal barrier were detected in aged mice compared with their younger counterparts. There were significant differences in the intestinal flora composition among the four groups, and harmful bacteria such as Lachnospiraceae_FCS020, Ruminococcaceae_UCG-009, Acetatifactor, Lachnoclostridium and Lactobacillus_gasseri were significantly increased in the aged apoE-/- mice compared with the other groups. Concurrently, metabolomics profiling revealed that components involved in the arachidonic acid (AA) metabolic pathway such as 20-HETE, PGF2α, arachidonic acid, and LTB4 were significantly higher in the aged AS group than in the other groups. This suggested that metabolic abnormalities and disorders of intestinal flora occurred in AS mice. Conclusions Aging not only altered the gut microbiome community but also substantially disturbed metabolic conditions. Our results confirm that AA metabolism is associated with the imbalance of the intestinal flora in the AS lesions of aged mice. These findings may offer new insights regarding the role of gut flora disorders and its consequent metabolite changed in inflammaging during AS development.
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Affiliation(s)
- Yingxin Sun
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Danbin Wu
- Department of Rheumatology, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China.,First Clinical Medical School, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Wenyun Zeng
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Yefei Chen
- Guangdong Key Laboratory for Biomedical Measurements and Ultrasound Imaging, School of Biomedical Engineering, Shenzhen University Health Science Center, Shenzhen, China
| | - Maojuan Guo
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Bin Lu
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Huhu Li
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Chun Sun
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Lin Yang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Xijuan Jiang
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
| | - Qing Gao
- School of Integrative Medicine, Tianjin University of Traditional Chinese Medicine, Tianjin, China
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Mamontov OV, Sokolov AY, Volynsky MA, Osipchuk AV, Zaytsev VV, Romashko RV, Kamshilin AA. Animal model of assessing cerebrovascular functional reserve by imaging photoplethysmography. Sci Rep 2020; 10:19008. [PMID: 33149189 PMCID: PMC7642404 DOI: 10.1038/s41598-020-75824-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 10/16/2020] [Indexed: 01/12/2023] Open
Abstract
Assessment of the cerebral blood-flow-reserve in patients with cerebrovascular diseases is extremely important in terms of making prognosis, determining treatment tactics, and controlling the revascularization outcome in the case of reconstructive interventions on the brain vessels. However, there is no easy-to-use, contactless method for either assessing the functional reserve of the cortical vascular network or intraoperative monitoring of surgical intervention. Our study aims to demonstrate feasibility of green-light imaging photoplethysmography (iPPG) to estimate cerebrovascular functional reserve in animal model of craniosurgical intervention. Custom-made iPPG system was exploited to visualize intracranial vessels in anesthetized Wistar rats (n = 15). Video frames of rat's cortex were recorded concurrently with systemic blood pressure, end-tidal CO2, and electrocardiogram. We found that injection of dorzolamide (carbonic-anhydrase inhibitor) significantly increased the blood-pulsations amplitude in all animals by 35 ± 19% (p < 0.001). Such an increase negatively correlated with significant decrease in end-tidal CO2 by 32 ± 7% (p < 0.001). It is noteworthy that the dorzolamide injection did not lead to significant changes in systemic blood pressure. Concluding, pulsations amplitude is a marker of the vascular tone that can be used to evaluate the functional cerebrovascular reserve. Imaging PPG is a simple and convenient method to assess cerebral blood flow, including during various neurosurgical interventions.
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Affiliation(s)
- Oleg V Mamontov
- Department of Circulation Physiology, Almazov National Medical Research Centre, Saint Petersburg, Russia.,Department of Departmental Therapy, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Alexey Y Sokolov
- Department of Neuropharmacology, Valdman Institute of Pharmacology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia.,Pavlov Institute of Physiology of the Russian Academy of Sciences, Saint Petersburg, Russia
| | - Maxim A Volynsky
- Faculty of Applied Optics, ITMO University, Saint Petersburg, Russia
| | - Anastasija V Osipchuk
- Department of Neuropharmacology, Valdman Institute of Pharmacology, Pavlov First Saint Petersburg State Medical University, Saint Petersburg, Russia
| | - Valery V Zaytsev
- Faculty of Applied Optics, ITMO University, Saint Petersburg, Russia
| | - Roman V Romashko
- Laboratory of High-Precision Optical Measurements, Institute of Automation and Control Processes FEB RAS, Vladivostok, Russia
| | - Alexei A Kamshilin
- Laboratory of High-Precision Optical Measurements, Institute of Automation and Control Processes FEB RAS, Vladivostok, Russia. .,Faculty of Photonics and Optical Information, ITMO University, Saint Petersburg, Russia.
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Scullen T, Mathkour M, Carr C, Wang A, Amenta PS, Nerva JD, Dumont AS. Anatomical Considerations for Endovascular Intervention for Extracranial Carotid Disease: A Review of the Literature and Recommended Guidelines. J Clin Med 2020; 9:E3460. [PMID: 33121192 PMCID: PMC7693974 DOI: 10.3390/jcm9113460] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 09/15/2020] [Accepted: 10/16/2020] [Indexed: 12/17/2022] Open
Abstract
Patient selection for endovascular intervention in extracranial carotid disease is centered on vascular anatomy. We review anatomical considerations for non-traumatic disease and offer guidelines in patient selection and management. We conducted a systematic literature review without meta-analysis for studies involving anatomical considerations in extracranial carotid intervention for non-traumatic disease. Anatomical considerations discussed included aortic arch variants, degree of vessel stenosis, angulation, tortuosity, and anomalous origins, and atheromatous plaque morphology, composition, and location. Available literature suggests that anatomical risks of morbidity are largely secondary to increased procedural times and difficulties in intervention system delivery. We recommend the prioritization of endovascular techniques on an individual basis in cases where accessible systems and surgeon familiarity provide an acceptable likelihood of rapid access and device deployment.
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Affiliation(s)
- Tyler Scullen
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Mansour Mathkour
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Christopher Carr
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Arthur Wang
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Peter S. Amenta
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - John D. Nerva
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
| | - Aaron S. Dumont
- Department of Neurological Surgery, Tulane Medical Center, New Orleans, LA 70130, USA; (T.S.); (M.M.); (C.C.); (A.W.); (P.S.A.); (J.D.N.)
- Department of Neurological Surgery, Ochsner Medical Center, Jefferson, LA 70121, USA
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6
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Kong Q, Ma X, Wang C, Du X, Ren Y, Wan Y. Total Atherosclerosis Burden of Baroreceptor-Resident Arteries Independently Predicts Blood Pressure Dipping in Patients With Ischemic Stroke. Hypertension 2020; 75:1505-1512. [PMID: 32336234 PMCID: PMC7682798 DOI: 10.1161/hypertensionaha.120.15036] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Supplemental Digital Content is available in the text. Nighttime blood pressure (BP) generally dips by 10% to 20% of the daytime values, and abnormal BP dipping may affect vascular health independently of BP level. The regulation of BP dipping involves arterial baroreflex, whose receptors mainly reside in carotid sinuses and aortic arch. Atherosclerosis in these baroreceptor-resident arteries (BRAs) is frequent among patients with ischemic stroke (IS) and might impair their BP-regulating capacity. We aimed to examine associations between atherosclerosis of BRA and BP dipping in patients with IS. BP dipping ratio was measured by 24-hour ambulatory blood pressure monitoring on the sixth day after IS. With computed tomography angiography, atherosclerosis conditions in 10 segments of carotid sinuses and aortic arch were scored and summed as total atherosclerosis burden of BRA. Among the 245 patients with IS, 78.0% had atherosclerosis in BRA. The total AS burden of BRA was negatively correlated with systolic BP dipping ratio (r=−0.331; P<0.001) and diastolic BP dipping ratio (r=−0.225; P<0.001). After adjusting for age, sex, vascular risk factors, 24-hour BP means, cervical and intracranial atherosclerosis scores, the negative correlations still existed (adjusted β, −0.259 [95% CI, −0.416 to −0.102] and adjusted β, −0.178 [95% CI, −0.346 to −0.010], respectively). In conclusion, higher total atherosclerosis burden of BRA was independently indicative of more blunted dipping of systolic BP and diastolic BP in IS. The total atherosclerosis burden of BRA might be important for predicting and managing BP dipping in patients with IS.
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Affiliation(s)
- Qi Kong
- From the Department of Neurology (Q.K., X.M., Y.R.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xin Ma
- From the Department of Neurology (Q.K., X.M., Y.R.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chen Wang
- Department of Radiology (C.W., X.D.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiangying Du
- Department of Radiology (C.W., X.D.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yi Ren
- From the Department of Neurology (Q.K., X.M., Y.R.), Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Yungao Wan
- Department of Cardiology (Y.W.), Xuanwu Hospital, Capital Medical University, Beijing, China
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