Elevated hemoglobin A1c Is Associated with Carotid Plaque Vulnerability: Novel Findings from Magnetic Resonance Imaging Study in Hypertensive Stroke Patients

The Association Between Hemoglobin Glycation Index and Carotid Artery Plaque in Patients With Coronary Heart Disease

This study aimed to examine the association between the hemoglobin glycation index (HGI) and carotid artery plaque (CAP) in patients with coronary heart disease (CHD). We conducted a cross-sectional analysis of 10,778 patients with CHD. The participants were divided into three groups by HGI tertiles (T1 HGI<-0.44, T2 -0.44 ≤ HGI ≤ 0.15, T3 HGI>0.15). The presence of CAP was used to diagnose by carotid ultrasonography. Logistic regression analysis was used to analyze the association between the HGI and CAP. The association between HGI and CAP was also assessed according to sex, age, smoking status, and drinking status. We further assessed the association between HGI and the ultrasound characteristics of CAP. The baseline analysis showed substantial differences in relevant parameters between the three groups of patients with CHD according to the tertiles of the HGI. Multivariate logistic regression analysis showed that HGI was significantly associated with CAP (odds ratio [OR] 1.32; 95% confidence interval [CI] 1.26-1.39). The association between HGI and CAP exists among different sex, age, smoking, and drinking status. Furthermore, there was a significant and positive association between HGI and all four different echogenicities of the CAP.

Changes of Atherosclerotic Plaque in Cerebral Artery Stenosis According to High-Resolution MR Imaging

Atherosclerosis can affect multiple arteries, and result in stroke and heart disease. Clinical and conventional imaging is insufficient to predict the progression of atherosclerosis. This study investigates risk factors that rely on high-resolution magnetic resonance imaging (HR-MRI). Patients with cerebral artery stenosis who had undergone HR-MRI at least twice were included. The demographics, risk factors, and proportion of patients with cerebral artery stenosis were investigated. The association between atherosclerotic plaque characteristics and the progression or regression of artery stenosis was also analyzed. A total of 42 patients were analyzed, with a median follow-up of 16.88 ± 12.53 months. The mean age of all subjects was 63.1 ± 9.15 years, and 83.3% of them were male. The incidences of stenosis of the basilar, proximal internal carotid, and middle cerebral arteries were 21.4%, 61.9%, and 16.7%, respectively. Intraplaque hemorrhage (IPH) was detected in 20 (47.6%) patients. Multivariate analysis showed that age (odds ratio (OR), 0.87; p = 0.014), smoking (OR, 0.11; p = 0.033), and IPH regression (OR, 10.13; p = 0.027) were associated with stenosis regression. The progression of IPH (OR, 115.80; p = 0.007) was associated with stenosis progression. Results suggest that IPH on HR-MRI is associated with changes in cerebral atherosclerotic stenosis.

Correlation between HbA1C and Infarct Volume in Acute Ischemic Stroke

BACKGROUND: Stroke is second leading cause of death worldwide. Chronic hyperglycemia can promote neuronal toxicity. The previous study shows that acute hyperglycemia is correlated with infarct volume of ischemic stroke. AIM: This study aims to investigate the correlation between hemoglobin A1C (HbA1C) and infarct volume on acute ischemic stroke. METHODS: This is a cross-sectional study in acute ischemic stroke patient in Dr. Moewardi General Hospital, Surakarta, Indonesia. Data of infarct volume were collected from head computed tomography (CT)-scan and calculated with A × B × C/2 formula. We also collected lipid and patients’ glycemic profile from patients’ blood laboratory result. Head CT-scan and laboratory data of participants analyzed with Pearson and Spearman’s rho test for parametric and non-parametric data, respectively. We also performed multivariate analysis to evaluate confounding covariates. p < 0.05 was considered as statistically significant. RESULTS: A total of 38 participants were included in this study, with mean infarct volume was 0.46 ± 0.64cc and mean HbA1C was 6.96 ± 2.69%. Bivariate analysis shows strong positive correlation between infarct volume and HbA1C with r = 0.898 (p < 0.001). Other variable that showed a significant correlation with infarct volume were diabetes mellitus history (r = 0.671; p < 0.001), random blood su gar (r = 0.466; p = 0.003), fasting blood sugar (r = 0.636; p < 0.001), 2-h postprandial glucose level (r = 0.646; p ≤ 0.001), high density lipoprotein (r = −0.354; p = 0.029), and triglyceride (r = 0.429; p = 0.007). Based on multivariate analysis, HbA1C regression coefficient on infarct volume was B = 0.222 (p < 0.001), indicating that HbA1C as one of the variables contributing to volume of infarct. CONCLUSIONS: There is a strong positive correlation between infarct volume and HbA1C, and HbA1C is variable contribute to the volume of infarct.

Relationship of the Low-Density Lipoprotein Cholesterol/High-Density Lipoprotein Cholesterol Ratio with a Vulnerable Plaque in Patients with Severe Carotid Artery Stenosis: A Case-Control Study in the Han Chinese Population

BACKGROUND

Carotid plaque is often an important factor in ischemic stroke after it changes from stable to vulnerable, and low-density lipoprotein cholesterol (LDL-c) and high-density lipoprotein cholesterol (HDL-c) are associated with plaque vulnerability. We aimed to investigate whether the LDL-c/HDL-c ratio, an easily available and novel biomarker, is associated with vulnerable plaques and enhances the warning effect on vulnerability compared to LDL-c or HDL-c alone.

METHODS

We conducted a retrospective study of 187 patients with severe CAS admitted to the Department of Vascular Surgery at the Nanjing Drum Tower Hospital from January 2019 to July 2021. They were divided into a stable plaque group and a vulnerable plaque group according to carotid ultrasonography, carotid angiography (CTA), and plaque pathology. Baseline information was collected and compared between the two groups. Correlation analysis was used to determine the degree of correlation between clinical variables. Univariate and multifactor logistic regression analyses were used to examine independent risk factors for vulnerable plaque in patients with severe CAS. Receiver operating characteristic (ROC) curves were used to assess the capacity of LDL-c/HDL-c to predict the occurrence of vulnerable plaque.

RESULTS

The age of the vulnerable plaque group was 68.12 ± 8.90 years, with 85 males (89.91%); the age of the stable plaque group was 68.77 ± 8.43 years, with 70 males (89.74%). Multivariate logistic regression analysis showed that LDL-c/HDL-c, smoking and diabetes were independent risk factors for vulnerable plaque (all P <0.05). The risk of vulnerable plaque was 4.78-fold greater in the highest LDL-c/HDL-c quartile (≥ 2.63) than in the lowest quartile (≤ 1.31) (P-trend <0.001), and the area under the ROC curve for LDL-c/HDL-c (AUC=0.681, P <0.001) was higher than that for LDL-c and HDL-c.

CONCLUSION

LDL-c/HDL-c, smoking and diabetes were independent risk factors for vulnerable plaque in patients with severe CAS, and LDL-c/HDL-c had a higher predictive value for the presence of vulnerable plaque compared with other lipid parameters.

Plaque Characteristics in Young Adults With Symptomatic Intracranial Atherosclerotic Stenosis: A Preliminary Study

Purpose

To determine how intracranial vascular wall and atherosclerosis plaque characteristics differ between young and old adults with sICAS.

Methods

Eighty-four consecutive patients with sICAS who underwent high-resolution magnetic resonance imaging (HRMRI) from December 2017 to July 2020 were retrospectively collected. These participants were divided into young adult group (18–50 years, n = 28) and old adult group (>50 years, n = 56). Reviewers were blinded to any clinical information and HRMRI scans were analyzed for qualitative and quantitative indicators of vascular walls and plaque at the maximal lumen narrowing site using the independent-sample t-test, Mann–Whitney U-test, chi-square test or Fisher exact test, and logistic regression analysis.

Results

Young patients with sICAS had significantly smaller maximum wall thickness (1.45 ± 0.38 vs.1.75 ± 0.51 mm², P = 0.003), higher prevalence of positive remodeling (53.57 vs. 21.43%, P = 0.003), and lower prevalence of diabetes mellitus (14.29 vs. 35.71%, P = 0.04) than old patients. Plaque burden and other plaque features were comparable between young and old patients.

Conclusion

Young patients with sICAS have smaller maximum wall thickness and greater ability to reconstruct, and are more likely to show positive remodeling, which may lead to some atherosclerotic lesions being missed. Young patients with evidence of vessel narrowing should be carefully examined for presence of high-risk atherosclerotic plaque.

Elevation of Hemoglobin A1c Increases the Atherosclerotic Plaque Vulnerability and the Visit-to-Visit Variability of Lipid Profiles in Patients Who Underwent Elective Percutaneous Coronary Intervention

Background

Increased plaque vulnerability and higher lipid variability are causes of adverse cardiovascular events. Despite a close association between glucose and lipid metabolisms, the influence of elevated glycated hemoglobin A1c (HbA1c) on plaque vulnerability and lipid variability remains unclear.

Methods

Among subjects undergoing percutaneous coronary intervention (PCI) from 2009 through 2019, 366 patients received intravascular optical coherence tomography (OCT) assessment and 4,445 patients underwent the scheduled follow-ups within 1 year after PCI. Vulnerability features of culprit vessels were analyzed by OCT examination, including the assessment of lipid, macrophage, calcium, and minimal fibrous cap thickness (FCT). Visit-to-visit lipid variability was determined by different definitions including standard deviation (SD), coefficient of variation (CV), and variability independent of the mean (VIM). Multivariable linear regression analysis was used to verify the influence of HbA1c on plaque vulnerability features and lipid variability. Exploratory analyses were also performed in non-diabetic patients.

Results

Among enrolled subjects, the pre-procedure HbA1c was 5.90 ± 1.31%, and the average follow-up HbA1c was 5.98 ± 1.16%. By OCT assessment, multivariable linear regression analyses demonstrated that patients with elevated HbA1c had a thinner minimal FCT (β = −6.985, P = 0.048), greater lipid index (LI) (β = 226.299, P = 0.005), and higher macrophage index (β = 54.526, P = 0.045). Even in non-diabetic patients, elevated HbA1c also linearly decreased minimal FCT (β = −14.011, P = 0.036), increased LI (β = 290.048, P = 0.041) and macrophage index (β = 120.029, P = 0.048). Subsequently, scheduled follow-ups were performed during 1-year following PCI. Multivariable linear regression analyses proved that elevated average follow-up HbA1c levels increased the VIM of lipid profiles, including low-density lipoprotein cholesterol (β = 2.594, P < 0.001), high-density lipoprotein cholesterol (β = 0.461, P = 0.044), non-high-density lipoprotein cholesterol (β = 1.473, P < 0.001), total cholesterol (β = 0.947, P < 0.001), and triglyceride (β = 4.217, P < 0.001). The result was consistent in non-diabetic patients and was verified when SD and CV were used to estimate variability.

Conclusion

In patients undergoing elective PCI, elevated HbA1c increases the atherosclerotic plaque vulnerability and the visit-to-visit variability of lipid profiles, which is consistent in non-diabetic patients.

Analysis of prevalence and influencing factors of stroke in elderly hypertensive patients: Based on the screening plan for the high-risk population of stroke in Jiading District, Shanghai

BACKGROUND

The purpose of this study is to investigate and analyze the prevalence and influencing factors of stroke in hypertensive patients aged 60 and above in Jiading District, Shanghai.

METHODS

The population-based study included 18,724 screened people with hypertension (age ≥ 60 years, 48.7% women). From 2016 to 2019, data on demographics, potential influencing factors and health status were collected through face-to-face interviews, physical examinations, and laboratory tests. Logistic multivariate logistic regression model was used to analyze the influencing factors associated with stroke.

RESULTS

Among the object of study from 2016 to 2019, 2,025 patients were screened for stroke, with the overall prevalence rate of 10.82% (10.41%-11.23%). Multivariate adjusted model analysis showed that dyslipidemia (OR:1.31,95%CI:1.19-1.45), lack of exercise (OR:1.91,95%CI:1.32-2.76), atrial fibrillation [OR:1.49,95%CI:1.35-1.65), family history of stroke (OR:2.18,95%CI:1.6-2.88) were the significant independent influencing factors of stroke in hypertensive patients over 60 years old. When these four factors were combined, compared with participants without any of these factors, the multi-adjusted odds ratios (95% confidence interval) of risk of stroke for persons concurrently having one, two and three or more of these factors were 1.89 (1.67-2.13), 2.15 (1.86-2.47) and 6.84 (4.90-9.55), respectively (linear trend P < 0.001); after multivariate adjustment, the family history of stroke had additive interaction with lack of exercise [RERI = 1.08(0.22-1.94), AP = 0.19(0.04-0.35), S = 1.31(1.02-1.69)], dyslipidemia [RERI = 0.87(0.41-1.33), AP = 0.23(0.08-0.38), S = 1.46(1.04-2.05)].

CONCLUSION

The prevalence of stroke was high in hypertensive patients aged 60 and above in Jiading District, Shanghai. Dyslipidemia, lack of exercise, atrial fibrillation and family history of stroke were significantly associated with stroke in hypertensive population. Stroke risk can be increased especially when multiple factors coexisting, and family history of stroke combined with a lack of exercise or dyslipidemia.

Association of Type 2 Diabetes Mellitus and Glycemic Control With Intracranial Plaque Characteristics in Patients With Acute Ischemic Stroke

BACKGROUND

Type 2 diabetes mellitus (T2DM) has shown to be associated with carotid plaque vulnerability. However, the impact of T2DM on intracranial artery atherosclerosis is not well-understood.

PURPOSE

To evaluate the association of diabetes and glycemic control with intracranial atherosclerotic plaque characteristics identified by three-dimensional contrast enhanced MR vessel wall imaging in patients after acute ischemic stroke.

STUDY TYPE

Prospective.

POPULATION

Two hundred and eighty-eight symptomatic patients with acute ischemic stroke due to intracranial atherosclerotic plaque.

FIELD STRENGTH/SEQUENCE

T₁ WI volume isotropic turbo spin-echo acquisition sequence at 3.0 T.

ASSESSMENT

Clinical profiles, blood biomarkers, the number of intracranial plaques, plaque enhanced score, and the features (location, luminal stenotic rate, intraplaque hemorrhage, length, burden, enhancement grade, and ratio) of culprit plaque (defined as the most stenotic lesion ipsilateral to the ischemic event) and nonculprit plaque were analyzed by three radiologists.

STATISTICAL TESTS

Analysis of variance (ANOVA), Shapiro-Wilk normality test, Levene's test, ANOVA with Bonferroni post-hoc test, Kruskal Wallis H test with subsequent pairwise comparisons, chi-square with Bonferroni post-hoc test, generalized linear regression, Pearson correlation test, Kendall's W and intra-class correlation coefficient.

RESULTS

Two hundred and twenty-five participants (age 60 ± 10 years, 58.7% male) with 958 intracranial plaques were included. More intracranial plaques were found in the T2DM group than the non-T2DM group (4.80 ± 2.22 vs. 3.60 ± 1.78, P < 0.05). Patients with poorly-controlled T2DM exhibited higher culprit plaque enhancement ratio than patients with well-controlled T2DM and non-T2DM (2.32 ± 0.61 vs. 1.60 ± 0.62 and 1.39 ± 0.39; respectively, P < 0.05). After adjusting for other clinical variables, T2DM was independently associated with increased intracranial plaque number (β = 0.269, P < 0.05), and HbA1c level was independently associated with culprit plaque enhancement ratio (β = 0.641, P < 0.05) in multivariate analysis.

DATA CONCLUSION

T2DM is associated with an increased intracranial plaque number. Higher HbA1c is associated with stronger plaque enhancement. 3D contrast enhanced MR vessel wall imaging may help better understand the association of T2DM and glycemic control with intracranial plaque.

LEVEL OF EVIDENCE

1 TECHNICAL EFFICACY STAGE: 3.

Relationship between carotid intraplaque neovascularization and haemoglobin A1c in diabetic patients

INTRODUCTION

We aimed to evaluate the characteristics of carotid artery plaques and the relationship between intraplaque neovascularization (IPN) and hemoglobin A1c (HbA1c) in patients of <60 years old with diabetes mellitus (DM) by comparison with diabetes ≥60 years of age.

METHODS

One-hundred-and-one patients with DM were studied into two groups: those <60 and those ≥60 years of age. All the patients underwent standard carotid ultrasonography and contrast-enhanced ultrasonography, which we used to evaluate IPN.

RESULTS

Diabetic complications were present in 41 of 50 patients (82 %) in the <60-year-old group, of whom 17 (34 %) had diabetes-related vascular complications. Of the 47 plaques in the <60-year-old group, six (13 %) had IPN Grade 0, 16 (34 %) had IPN Grade 1, and 25 (53 %) had IPN Grade 2. The AUC and RAUC of the plaque in the <60-year-old group were significantly higher than those of the ≥60-year-old group (P = 0.012 and 0.031, respectively). There were also differences in the AUC, RAUC and semi-quantitative grades between patients with and without diabetic macrovasculopathy and diabetic peripheral artery disease (all P < 0.05). The AUC, RAUC and semi-quantitative grading of IPN positively correlated with blood glucose and HbA1c (P < 0.05).

CONCLUSION

IPN is more common in DM patients who are younger, and have higher blood glucose and HbA1c concentrations, and these plaques are more vulnerable.

Impacts of Glycemic Control on Intracranial Plaque in Patients with Type 2 Diabetes Mellitus: A Vessel Wall MRI Study

BACKGROUND AND PURPOSE

The relationship between glycemic control in patients with type 2 diabetes mellitus and intracranial atherosclerotic plaque features has remained understudied. This study aimed to investigate the association of type 2 diabetes mellitus and glycemic control with the characteristics of intracranial plaques using vessel wall MR imaging.

MATERIALS AND METHODS

In total, 311 patients (217 [69.8%] men; mean age, 63.24 ± 11.44 years) with intracranial atherosclerotic plaques detected on vessel wall MR imaging were enrolled and divided into 3 groups according to type 2 diabetes mellitus and glycemic control statuses: the non-type 2 diabetes mellitus group, the type 2 diabetes mellitus with good glycemic control group, and the type 2 diabetes mellitus with poor glycemic control group. The imaging features of intracranial plaque were analyzed and compared among the groups. The clinical risk factors for atherosclerosis were also analyzed using logistic regression analysis.

RESULTS

The plaque length and thickness were significantly higher in the type 2 diabetes mellitus with poor glycemic control group than in the non-type 2 diabetes mellitus group. The prevalence of strongly enhanced plaques was significantly higher in the type 2 diabetes mellitus with poor glycemic control group than in the non-type 2 diabetes mellitus and type 2 diabetes mellitus with good glycemic control groups (92.9%, 63.4%, and 72.7%, respectively; P < .001). Multivariate logistic regression analysis showed a significant association of poor glycemic control with the plaque length (OR = 1.966; 95% CI, 1.170-3.303; P = .011), plaque thickness (OR = 1.981; 95% CI, 1.174-3.340; P = .010), and strongly enhanced plaque (OR = 5.448; 95% CI, 2.385-12.444; P < .001).

CONCLUSIONS

Poor glycemic control, compared with the history of diabetes, might have a greater impact on the burden and vulnerability of intracranial atherosclerotic plaques.

Assessment of carotid atherosclerotic disease using three-dimensional cardiovascular magnetic resonance vessel wall imaging: comparison with digital subtraction angiography

BACKGROUND

A three-dimensional (3D) cardiovascular magnetic resonance (CMR) vessel wall imaging (VWI) technique based on 3D T1 weighted (T1w) Sampling Perfection with Application-optimized Contrast using different flip angle Evolutions (SPACE) has recently been used as a promising CMR imaging modality for evaluating extra-cranial and intra-cranial vessel walls. However, this technique is yet to be validated against the current diagnostic imaging standard. We therefore aimed to evaluate the diagnostic performance of 3D CMR VWI in characterizing carotid disease using intra-arterial digital subtraction angiography (DSA) as a reference.

METHODS

Consecutive patients with at least unilateral > 50% carotid stenosis on ultrasound were scheduled to undergo interventional therapy were invited to participate. The following metrics were measured using 3D CMR VWI and DSA: lumen diameter of the common carotid artery (CCA) and segments C1-C7, stenosis diameter, reference diameter, lesion length, stenosis degree, and ulceration. We assessed the diagnostic sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) curve of 3D CMR VWI, and used Cohen's kappa, the intraclass correlation coefficient (ICC), and Bland-Altman analyses to assess the diagnostic agreement between 3D CMR VWI and DSA.

RESULTS

The ICC (all ICCs ≥0.96) and Bland-Altman plots indicated excellent inter-reader agreement in all individual morphologic measurements by 3D CMR VWI. Excellent agreement in all individual morphologic measurements were also found between 3D CMR VWI and DSA. In addition, 3D CMR VWI had high sensitivity (98.4, 97.4, 80.0, 100.0%), specificity (100.0, 94.5, 99.1, 98.0%), and Cohen's kappa (0.99, 0.89, 0.84, 0.96) for detecting stenosis > 50%, stenosis > 70%, ulceration, and total occlusion, respectively, using DSA as the standard. The AUC of 3D CMR VWI for predicting stenosis > 50 and > 70% were 0.998 and 0.999, respectively.

CONCLUSIONS

The 3D CMR VWI technique enables accurate diagnosis and luminal feature assessment of carotid artery atherosclerosis, suggesting that this imaging modality may be useful for routine imaging workups and provide comprehensive information for both the vessel wall and lumen.

Relation of infarction location and volume to vertigo in vertebrobasilar stroke

OBJECTIVE

Vertigo is a common presentation of vertebrobasilar stroke. Anecdotal reports have shown that vertigo occurs more often in multiple than in single brainstem or cerebellar infarctions. We examined the relation between the location and volume of infarction and vertigo in patients with vertebrobasilar stroke.

METHODS

Consecutive patients with vertebrobasilar stroke were prospectively recruited. The infarction location and volume were assessed in the diffusion-weighted magnetic resonance imaging.

RESULTS

Fifty-nine patients were included, 32 (54.2%) with vertigo and 27 (45.8%) without vertigo. The infarction volume did not correlate with National Institute of Health Stroke Scale (NIHSS) score on admission (Spearman ρ = .077, p = .56) but correlated with modified Rankin Scale (ρ = .37, p = .004) on discharge. In the vertigo group, the proportion of men was lower (53.1% vs. 77.8%, p = .049), fewer patients had focal neurological deficits (65.6% vs. 96.3%, p = .004), patients tended to present later (median [IQR] was 7.5 [4-46] vs. 4 [2-12] hours, p = .052), numerically fewer patients received intravenous thrombolysis (15.6% vs. 37%, p = .06), and the total infarction volume was larger (5.6 vs. 0.42 cm³ , p = .008) than in nonvertigo group. In multivariate logistic regression, infarction location either in the cerebellum or in the dorsal brainstem (odds ratio [OR] 16.97, 95% CI 3.1-92.95, p = .001) and a total infarction volume of >0.48 cm³ (OR 4.4, 95% CI 1.05-18.58, p = .043) were related to vertigo. In another multivariate logistic regression, after adjusting for age, sex, intravenous thrombolysis, serum level of white blood cells, and atrial fibrillation, vertigo independently predicted a total infarction volume of >0.48 cm³ (OR 5.75, 95% CI 1.43-23.08, p = .01).

CONCLUSION

Infarction location in the cerebellum and/or dorsal brainstem is an independent predictor of vertigo. Furthermore, larger infarction volume in these structures is associated with vertigo. A considerable proportion of patients with vascular vertigo present without focal neurological deficits posing a diagnostic challenge. National Institute of Health Stroke Scale is not sensitive for vertebrobasilar stroke.

Circulating plasma microRNA-126, microRNA-145, and microRNA-155 and their association with atherosclerotic plaque characteristics

AIMS

Circulating microRNAs (miRNAs) have been identified as biomarkers for several diseases. Dysregulation of miRNA-126, microRNA-145, and microRNA-155 has been shown to be associated with atherosclerotic lesion formation. The aim of this study was to evaluate the association between atherosclerosis-related miRNAs and unfavorable atherosclerotic plaque characteristics.

METHODS AND RESULTS

Forty patients with stable coronary artery disease admitted for elective percutaneous coronary intervention (PCI) were enrolled in a prospective study. After PCI, intravascular ultrasound (IVUS), and iMAP-IVUS analysis were performed to assess the proportion of fibrotic, necrotic, lipidic, and calcific tissue within atherosclerotic plaques. Total RNA was isolated from plasma to evaluate the expression of circulating miRNA-126, miRNA-145, and miRNA-155. Plasma lipid and glucose metabolism-related variables were measured to determine any association with plaque characteristics or miRNA expression. Expression of miRNA-126 was negatively correlated with plaque fibrotic tissue (r=-0.28; P=0.044), while positively correlated with plaque necrotic tissue (r=0.31; P=0.029) and necrolipidic tissue (r=0.31; P=0.031). MiRNA-145 was positively correlated with plaque lipidic (r=0.32; P=0.023) and necrolipidic tissue (r=0.31; P=0.029). Patient age was associated with plaque fibrotic tissue (r=-0.41; P=0.005), necrotic tissue (r=0.33; P=0.022), and lipid content (r=0.33; P=0.022). High-density lipoprotein cholesterol was positively correlated with plaque necrotic (r=0.28; P=0.042) and calcific (r=0.28; P=0.044) tissue volume. Calcific tissue volume was positively correlated with C-peptide (r=0.34; P=0.033). After multivariate logistic regression analysis, both miRNA-126 and miRNA-145 expressions were associated with increased necrolipidic tissue content (β=0.34; P=0.050; and β=0.35; P=0.037, respectively).

CONCLUSIONS

Expressions of miRNA-126 and miRNA-145 were associated with increased plaque necrolipidic tissue content.

RELEVANCE FOR PATIENTS

Although further research is needed to support the study data, miRNA-126 and miRNA-145 may serve as potential plaque vulnerability biomarkers in the future.

Correlation of Glycosylated Hemoglobin Levels with Histological and Ultrasound Characteristics of the Carotid Plaque in Diabetic and Nondiabetic Patients

BACKGROUND

The purpose of this study is to investigate the correlation of glycosylated hemoglobin (HbA1c) levels with histological characters of atherosclerotic plaque that makes it vulnerable, as well as ultrasound (US) criteria that can contribute to the prognosis of carotid disease.

MATERIAL AND METHODS

This is a single-center prospective study. Our study population consists of 74 diabetic and nondiabetic patients with carotid atherosclerosis who underwent carotid endarterectomy in our department. Patient categorization was based on the following criteria: levels of HbA1c, gender, and risk factors (smoking, hypertension), carotid stenosis rate, symptomatic or asymptomatic carotid disease, histological examination of the atherosclerotic plaque, and US morphological criteria of the plaque.

RESULTS

The mean age of the patients was 68.2 years (standard deviation = 7.8); 58.1% were smokers, 71.6% had arterial hypertension, 37.8% had symptomatic carotid disease, and 64.9% had atherosclerotic plaque type 6. Futhermore, 95.9% of the patients had a carotid stenosis rate more than 70% and 4.1% had from 50% to 69%. Older patients had more frequent type 7 and 8 atherosclerotic plaque based on American Heart Association scoring system than younger patients (P = 0.041). The relative likelihood of atherosclerotic plaque type 7 and 8 was 1.12 times higher in older patients (Odds ratio [OR] = 1.12, P = 0.029). Patients with higher levels of HbA1cwere more likely to have type 6 atherosclerotic plaque than those with atherosclerotic lesions type 7 and 8 (P < 0.001). Specifically, increasing the level of HbA1c by 1 mg/dl increases the likelihood of the presence of vulnerable plaque by 2.55%. Moreover, the relative likelihood of a type 6 atherosclerotic plaque was 10.4 times higher in the older patients (OR = 10.4, P < 0.001).

CONCLUSIONS

This study demonstrates that levels of HbA1c and advanced age are 2 factors that may be correlated with the presence of vulnerable carotid plaques in diabetic population. Moreover, HbA1c is an independent factor that could possibly be used as a prognostic marker for carotid artery disease, although further studies are needed to explore this association to elucidate the precise role of HbA1c.

Echolucency-based phenotype in carotid atherosclerosis disease for risk stratification of diabetes patients

AIM

The study investigated the association of carotid ultrasound echolucent plaque-based biomarker with HbA1c, measured as age-adjusted grayscale median (AAGSM) as a function of chronological age, total plaque area, and conventional grayscale median (GSM_conv).

METHODS

Two stages were developed: (a) automated measurement of carotid parameters such as total plaque area (TPA); (b) computing the AAGSM as a function of GSM_conv, age, and TPA. Intra-operator (novice and experienced) analysis was conducted.

RESULTS

IRB approved, 204 patients' left/right CCA (408 images) ultrasound scans were collected: mean age: 69 ± 11 years; mean HbA1c: 6.12 ± 1.47%. A moderate inverse correlation was observed between AAGSM and HbA1c (CC of -0.13, P = 0.01), compared to GSM (CC of -0.06, P = 0.24). The RCCA and LCCA showed CC of -0.18, P < 0.01 and -0.08; P < 0.24. Female and males showed CC of -0.29, P < 0.01 and -0.10, P = 0.09. Using the threshold for AAGSM and HbA1c as: low-risk (AAGSM > 100; HbA1c < 5.7%), moderate-risk (40 < AAGSM < 100; 5.7% < HbA1c < 6.5%) and high-risk (AAGSM < 40; HbA1c > 6.5%), the area under the curve showed a better performance of AAGSM over GSM_conv. A paired t-test between operators and expert (P < 0.0001); inter-operator CC of 0.85 (P < 0.0001).

CONCLUSIONS

Echolucent plaque in patients with diabetes can be more accurately characterized for risk stratification using AAGSM compared to GSM_conv.

Imaging pathobiology of carotid atherosclerosis with ultrasmall superparamagnetic particles of iron oxide: an update

Purpose of review

To provide brief overview of the developments regarding use of ultrasmall superparamagnetic particles of iron oxide in imaging pathobiology of carotid atherosclerosis.

Recent findings

MRI is a promising technique capable of providing morphological and functional information about atheromatous plaques. MRI using iron oxide particles, called ultrasmall superparamagnetic iron oxide (USPIO) particles, allows detection of macrophages in atherosclerotic tissue. Ferumoxytol has emerged as a new USPIO agent, which has an excellent safety profile. Based on the macrophage-selective properties of ferumoxytol, there is increasing number of recent reports suggesting its effectiveness to detect pathological inflammation.

Summary

USPIO particles allow magnetic resonance detection of macrophages in atherosclerotic tissue. Ferumoxytol has emerged as a new USPIO agent, with an excellent safety profile. This has the potential to be used for MRI of the pathobiology of atherosclerosis.

Association between carotid plaque characteristics and acute cerebral infarction determined by MRI in patients with type 2 diabetes mellitus

BACKGROUND

Type 2 diabetes mellitus (T2DM) might aggravate the carotid plaque vulnerability, and increase the risk for ischemic stroke. Few studies reported the acute stroke subtype with carotid plaque characteristics in T2DM patients. This study aimed to investigate the association between carotid plaque characteristics and acute cerebral infarct (ACI) lesion features determined by MRI in T2DM patients.

METHODS

Patients with acute cerebrovascular syndrome in internal carotid artery territory were recruited. All patients were stratified into T2DM and non-T2DM groups and underwent both carotid and brain MRI scans. Ipsilateral carotid plaque morphological and compositional characteristics, intracranial and extracranial carotid artery stenosis were also determined. Stroke subtype based on the Trial of ORG 10172 in Acute Stroke Treatment classification and ACI lesion patterns were evaluated.

RESULTS

Of the recruited 140 patients, 68 (48.6%) patients had T2DM (mean age 64.16 ± 11.38 years, 40 males). T2DM patients exhibited higher prevalence of carotid type IV-VI lesions, larger plaque burden as well as larger lipid-rich necrotic core (LRNC) compared with non-T2DM patients. Among the patients with carotid LRNC on symptomatic side, more concomitant large perforating artery infarct patterns and larger ACI size in the internal carotid artery territory were found in T2DM group than those in non-T2DM group. Carotid plaque with LRNC% > 22.0% was identified as an independent risk factor for the presence of ACI lesions confined to the carotid territory in T2DM patients, regardless of other risk factors.

CONCLUSIONS

This study shows that more concomitant large perforating artery infarct patterns and larger ACI size in the internal carotid artery territory were found in the T2DM patients with ipsilateral carotid LRNC plaque than those in non-T2DM patients. Quantification of the carotid plaque characteristics, particularly the LRNC% by MRI has the potential usefulness for stroke risk stratification.