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Mukaddim RA, Liu Y, Graham M, Eickhoff JC, Weichmann AM, Tattersall MC, Korcarz CE, Stein JH, Varghese T, Eliceiri KW, Mitchell C. In Vivo Adaptive Bayesian Regularized Lagrangian Carotid Strain Imaging for Murine Carotid Arteries and Its Associations With Histological Findings. ULTRASOUND IN MEDICINE & BIOLOGY 2023; 49:2103-2112. [PMID: 37400303 PMCID: PMC10527160 DOI: 10.1016/j.ultrasmedbio.2023.05.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 05/23/2023] [Accepted: 05/28/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVES Non-invasive methods for monitoring arterial health and identifying early injury to optimize treatment for patients are desirable. The objective of this study was to demonstrate the use of an adaptive Bayesian regularized Lagrangian carotid strain imaging (ABR-LCSI) algorithm for monitoring of atherogenesis in a murine model and examine associations between the ultrasound strain measures and histology. METHODS Ultrasound radiofrequency (RF) data were acquired from both the right and left common carotid artery (CCA) of 10 (5 male and 5 female) ApoE tm1Unc/J mice at 6, 16 and 24 wk. Lagrangian accumulated axial, lateral and shear strain images and three strain indices-maximum accumulated strain index (MASI), peak mean strain of full region of interest (ROI) index (PMSRI) and strain at peak axial displacement index (SPADI)-were estimated using the ABR-LCSI algorithm. Mice were euthanized (n = 2 at 6 and 16 wk, n = 6 at 24 wk) for histology examination. RESULTS Sex-specific differences in strain indices of mice at 6, 16 and 24 wk were observed. For male mice, axial PMSRI and SPADI changed significantly from 6 to 24 wk (mean axial PMSRI at 6 wk = 14.10 ± 5.33% and that at 24 wk = -3.03 ± 5.61%, p < 0.001). For female mice, lateral MASI increased significantly from 6 to 24 wk (mean lateral MASI at 6 wk = 10.26 ± 3.13% and that at 24 wk = 16.42 ± 7.15%, p = 0.048). Both cohorts exhibited strong associations with ex vivo histological findings (male mice: correlation between number of elastin fibers and axial PMSRI: rs = 0.83, p = 0.01; female mice: correlation between shear MASI and plaque score: rs = 0.77, p = 0.009). CONCLUSION The results indicate that ABR-LCSI can be used to measure arterial wall strain in a murine model and that changes in strain are associated with changes in arterial wall structure and plaque formation.
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Affiliation(s)
- Rashid Al Mukaddim
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Yuming Liu
- Laboratory for Optical and Computational Instrumentation, Center for Quantitative Cell Imaging, University of Wisconsin-Madison, Madison, WI, USA
| | - Melissa Graham
- Research Animal Resources and Compliance, Comparative Pathology Laboratory, University of Wisconsin-Madison, Madison, WI, USA
| | - Jens C Eickhoff
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Ashley M Weichmann
- Small Animal Imaging and Radiotherapy Facility, Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Claudia E Korcarz
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - James H Stein
- Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Tomy Varghese
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin W Eliceiri
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; Laboratory for Optical and Computational Instrumentation, Center for Quantitative Cell Imaging, University of Wisconsin-Madison, Madison, WI, USA; Small Animal Imaging and Radiotherapy Facility, Carbone Cancer Center, University of Wisconsin-Madison, Madison, WI, USA; Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA; Morgridge Institute for Research, Madison, WI, USA
| | - Carol Mitchell
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA; Department of Medicine, University of Wisconsin-Madison, Madison, WI, USA.
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Mocan Çağlar Y, Bekis Bozkurt H, İsal Tosun Ö, Cavkaytar Ö, Arga M. Assessment of Subclinical Atherosclerosis in Children with Atopic Dermatitis. Int Arch Allergy Immunol 2023; 184:1071-1078. [PMID: 37586351 DOI: 10.1159/000531057] [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: 01/24/2023] [Accepted: 05/11/2023] [Indexed: 08/18/2023] Open
Abstract
INTRODUCTION Data from studies conducted to date have evaluated clinical atherosclerotic conditions in adult patients with atopic dermatitis (AD). Subclinical atherosclerotic changes that are a precursor of atherosclerotic conditions may begin in childhood. The aim of this study was to investigate the presence of subclinical atherosclerosis in pediatric patients with AD and to determine the associated risk factors. METHODS A total of 59 patients who were referred to our department over a 6-month period and diagnosed with AD, and 53 healthy controls with a similar age and gender were included in the study. Subclinical atherosclerosis markers (carotid intima media thickness [CIMT], distensibility, stiffness, and strain) were measured using conventional echocardiography. The patients' age, SCORAD index, and duration of symptoms were recorded. Serum total immunoglobulin E, C-reactive protein (CRP), blood lipid profile, and complete blood count markers were measured. RESULTS The median age of the patients was 61 (10-103) months, and 59.3% of them were male. The patients with AD had a higher CIMT (1.60 ± 0.35 vs. 1.30 ± 0.50 mm) and a lower distensibility (0.006 ± 0.009 vs. 0.01 ± 0.008) and strain (0.10 ± 0.14 vs. 0.19 ± 0.14) than the healthy controls (p < 0.01 for all), but there was no significant difference with regard to stiffness (10.16 ± 21.75 vs. 8.99 ± 12.66). Significant correlations between CIMT and disease duration, age, and the SCORAD index were found (p < 0.01, p < 0.01, and p < 0.05, respectively). No correlation between the subclinical atherosclerosis markers and the other laboratory results was found (p > 0.05 for all). CONCLUSION This study demonstrates that pediatric patients with AD may express subclinical atherosclerosis markers. The evaluation of subclinical atherosclerosis in these patients revealed that CIMT may be the most important marker, as it displayed positive correlations with symptom duration, age, and disease severity.
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Affiliation(s)
- Yasemin Mocan Çağlar
- Department of Pediatrics, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Hayrunnisa Bekis Bozkurt
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Öykü İsal Tosun
- Department of Pediatric Cardiology, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Özlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
| | - Mustafa Arga
- Department of Pediatric Allergy and Immunology, Faculty of Medicine, İstanbul Medeniyet University, İstanbul, Turkey
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Gök M, Akdam H, Gürlek Akol Z, Tuzcu G, Yeniçerioğlu Y. Assessment of Arterial Stiffness in Hemodialysis Patients, Using Speckle Tracking Carotid Strain Ultrasonography. MEANDROS MEDICAL AND DENTAL JOURNAL 2022. [DOI: 10.4274/meandros.galenos.2022.92053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Tsai WC, Lee WH, Tsai HR, Huang MS. Carotid vascular strain predicts cardiovascular events in patients with hypertension. Echocardiography 2021; 38:1900-1906. [PMID: 34713483 DOI: 10.1111/echo.15231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/10/2021] [Accepted: 10/09/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND We aim to investigate prognostic effects of carotid strain (CS) and strain rate (CSR) in hypertension. METHODS We prospectively recruited 120 patients being treated for hypertension (65.8 ± 11.8 years, 58% male) in this observational study. Peak circumferential CS and peak CSR after ejection were identified using two-dimensional speckle tracking ultrasound. Major cardiovascular events were any admission for stroke, acute coronary syndrome, and heart failure. RESULTS After a mean follow-up period of 63.6 ± 14.5 months, 14 (12%) patients had cardiovascular events. Age (75.3 ± 9.2 vs 64.6 ± 11.6 years; p = 0.001), systolic blood pressure (131.8 ± 15.5 vs 143.1 ± 16.6 mm Hg; p = 0.021), diastolic blood pressure (74.6 ±11.4 vs 82.1 ± 12.2 mm Hg; p = 0.039), use of diuretics (71 vs 92%; p = 0.014), carotid CS (2.17 ± 1.02 vs 3.28 ± 1.14 %; p = 0.001), and CSR (.28 ± .17 vs .51 ± .18 1/s; p < 0.001) were significantly different between the patients who did and did not reach the end-points. Multivariate Cox regression analysis controlling for age, systolic blood pressure, diastolic blood pressure, and use of diuretics showed that CS (HR .425, 95%CI .223-.811, p = 0.009) and CSR (HR .001, 95%CI .000-.072, p = 0.001) were independent predictors for cardiovascular events. CONCLUSION In conclusions, decreased CS and CSR were associated with cardiovascular events in hypertension.
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Affiliation(s)
- Wei-Chuan Tsai
- Department of Internal Medicine, Kuo General Hospital, Tainan, Taiwan.,Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan
| | - Wen-Huang Lee
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan
| | - Huey-Ru Tsai
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan.,Department of Internal Medicine, Madou Sin-Lau Hospital, Tainan, Taiwan
| | - Mu-Shiang Huang
- Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan
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Lou L, Lopez KO, Nautiyal P, Agarwal A. Integrated Perspective of Scaffold Designing and Multiscale Mechanics in Cardiac Bioengineering. ADVANCED NANOBIOMED RESEARCH 2021. [DOI: 10.1002/anbr.202100075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Lihua Lou
- Department of Mechanical and Materials Engineering Florida International University Miami FL 33174 USA
| | - Kazue Orikasa Lopez
- Department of Mechanical and Materials Engineering Florida International University Miami FL 33174 USA
| | - Pranjal Nautiyal
- Mechanical Engineering and Applied Mechanics University of Pennsylvania Philadelphia PA 19104 USA
| | - Arvind Agarwal
- Plasma Forming Laboratory Advanced Materials Engineering Research Institute (AMERI) Mechanical and Materials Engineering College of Engineering and Computing Florida International University Miami FL 33174 USA
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Ustyniak S, Stefańczyk L, Kaczmarska M, Kurnatowska I, Goździk M. Peripheral arterial response during haemodialysis - is two-dimensional speckle-tracking a useful arterial reactivity assessment tool? J Ultrason 2021; 21:e213-e218. [PMID: 34540275 PMCID: PMC8439126 DOI: 10.15557/jou.2021.0034] [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] [Received: 03/10/2021] [Accepted: 05/04/2021] [Indexed: 11/25/2022] Open
Abstract
Aim: 2D speckle tracking is a method used in myocardial strain assessment. However, several studies have confirmed the suitability of its application in the assessment of arterial strain (a marker of arterial stiffness). The aims of our study were to evaluate whether 2D speckle tracking can assess the changes in carotid and femoral strain caused by fluid loss during haemodialysis, and to determine the direction and amount of these changes. Material and methods: We examined the distal common carotid and proximal femoral arteries in 74 haemodialysed patients (28 women and 46 men) before and after their haemodialysis sessions. EchoPac software was used to analyse the recorded ultrasound examinations. Circumferential strain values were acquired for further analysis. Results: We found a decrease in carotid circumferential strain values after haemodialysis sessions (5.916 ± 2.632% before haemodialysis and 4.909 ± 2.409% after haemodialysis, p = 0.000022). The amount of fluid lost during haemodialysis sessions correlated (correlation coefficient of 0.434, p = 0.000222) with the decrease of carotid circumferential strain. The correlation coefficients were slightly higher (0.445, p = 0.000146) when a ratio of fluid loss volume to the BMI was used. No statistically significant changes were found in femoral circumferential strain. Conclusions: Our findings suggest that arterial response to body fluid loss may be assessed by 2D speckle tracking. This method enabled us to measure carotid circumferential strain changes caused by fluid volume contraction during haemodialysis sessions. We found an important decrease in the carotid circumferential strain values after the procedure. The amount of this decrease correlated significantly with the decrease in the volume of fluid lost during the haemodialysis session.
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Affiliation(s)
- Sergiusz Ustyniak
- Department of Radiology and Diagnostic Imaging, Medical University of Łódź, Poland
| | - Ludomir Stefańczyk
- Department of Radiology and Diagnostic Imaging, Medical University of Łódź, Poland
| | - Magdalena Kaczmarska
- Department of Radiology and Diagnostic Imaging, Medical University of Łódź, Poland
| | - Ilona Kurnatowska
- Department of Internal Medicine and Transplantation Nephrology, 1st Chair of Internal Medicine, Medical University of Łódź, Poland
| | - Maciej Goździk
- Department of Internal Medicine and Transplantation Nephrology, 1st Chair of Internal Medicine, Medical University of Łódź, Poland
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Hill MA, Yang Y, Zhang L, Sun Z, Jia G, Parrish AR, Sowers JR. Insulin resistance, cardiovascular stiffening and cardiovascular disease. Metabolism 2021; 119:154766. [PMID: 33766485 DOI: 10.1016/j.metabol.2021.154766] [Citation(s) in RCA: 274] [Impact Index Per Article: 91.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 12/18/2022]
Abstract
The cardiometabolic syndrome (CMS) and obesity are typically characterized by a state of metabolic insulin resistance. As global and US rates of obesity increase there is an acceleration of the incidence and prevalence of insulin resistance along with associated cardiovascular disease (CVD). Under physiological conditions insulin regulates glucose homeostasis by enhancing glucose disposal in insulin sensitive tissues while also regulating delivery of nutrients through its vasodilation actions on small feed arteries. Specifically, insulin-mediated production of nitric oxide (NO) from the vascular endothelium leads to increased blood flow enhancing disposal of glucose. Typically, insulin resistance is considered as a decrease in sensitivity or responsiveness to the metabolic actions of insulin including insulin-mediated glucose disposal. However, a decreased sensitivity to the normal vascular actions of insulin, especially diminished nitric oxide production, plays an additional important role in the development of CVD in states of insulin resistance. One mechanism by which insulin resistance and attendant hyperinsulinemia promote CVD is via increases in vascular stiffness. Although obesity and insulin resistance are known to be associated with substantial increases in the prevalence of vascular fibrosis and stiffness the mechanisms and mediators that underlie vascular stiffening in insulin resistant states are complex and have only recently begun to be addressed. Current evidence supports the role of increased plasma levels of aldosterone and insulin and attendant reductions in bioavailable NO in the pathogenesis of impaired vascular relaxation and vascular stiffness in the CMS and obesity. Aldosterone and insulin both increase the activity of serum and glucocorticoid kinase 1 (SGK-1) which in turn is a major regulator of vascular and renal sodium (Na+) channel activity.The importance of SGK-1 in the pathogenesis of the CMS is highlighted by observations that gain of function mutations in SGK-1 in humans promotes hypertension, insulin resistance and obesity. In endothelial cells, an increase in Na+ flux contributes to remodeling of the cytoskeleton, reduced NO bioavailability and vascular stiffening. Thus, endothelial SGK-1 may represent a point of convergence for insulin and aldosterone signaling in arterial stiffness associated with obesity and the CMS. This review examines our contemporary understanding of the link between insulin resistance and increased vascular stiffness with emphasis placed on a role for enhanced SGK-1 signaling as a key node in this pathological process.
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Affiliation(s)
- Michael A Hill
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO 65211, USA; Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO 65212, USA.
| | - Yan Yang
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO 65211, USA
| | - Liping Zhang
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO 65211, USA; Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Zhe Sun
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO 65211, USA; Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Guanghong Jia
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO 65211, USA; Diabetes and Cardiovascular Center, University of Missouri School of Medicine, Columbia, MO 65212, USA; Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - Alan R Parrish
- Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO 65212, USA
| | - James R Sowers
- Dalton Cardiovascular Research Center, University of Missouri, Columbia, MO 65211, USA; Diabetes and Cardiovascular Center, University of Missouri School of Medicine, Columbia, MO 65212, USA; Department of Medical Pharmacology and Physiology, University of Missouri School of Medicine, Columbia, MO 65212, USA; Department of Medicine, University of Missouri School of Medicine, Columbia, MO 65212, USA.
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Cho DH, Choi JI, Choi J, Kim YG, Oh SK, Kook H, Lee KN, Shim J, Park SM, Shim WJ, Kim YH. Impact of carotid atherosclerosis in CHA2DS2-VASc-based risk score on predicting ischemic stroke in patients with atrial fibrillation. Korean J Intern Med 2021; 36:342-351. [PMID: 32088940 PMCID: PMC7969068 DOI: 10.3904/kjim.2019.099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 08/02/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Vascular disease is an established risk factor for stroke in patients with atrial fibrillation (AF), which is included in CHA2DS2-VASc score. However, the role of carotid atherosclerosis remains to be determined. METHODS Three hundred-ten patients with AF who underwent carotid sonography were enrolled. RESULTS During a median follow-up of 31 months, 18 events (5.8%) of stroke were identified. Patients with stroke had higher carotid intima-media thickness (CIMT) (1.16 ± 0.33 mm vs. 0.98 ± 0.25 mm, p = 0.017). CIMT was significantly increased according to the CHA2DS2-VASc score (p < 0.001) and it was correlated with left ventricular mass index and early diastolic mitral annular velocity (e'), a ratio of early transmitral flow velocity to e' (E/e') and pulmonary artery systolic pressure (all p < 0.05). Cox regression using multivariate models showed that carotid plaque was associated with the risk of stroke (hazard ratio, 3.748; 95% confidence interval [CI], 1.107 to 12.688; p = 0.034). C-statistics increased from 0.648 (95% CI, 0.538 to 0.757) to 0.716 (95% CI, 0.628 to 0.804) in the CHA2DS2-VASc score model after the addition of CIMT and carotid plaque as a vascular component (p = 0.013). CONCLUSION Increased CIMT and presence of carotid plaque are associated with a high risk of ischemic stroke, and CIMT is related to myocardial remodeling and diastolic dysfunction, suggesting that carotid atherosclerosis can improve risk prediction of stroke in patients with AF, when included under vascular disease in the CHA2DS2-VASc scoring system.
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Affiliation(s)
- Dong-Hyuk Cho
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Jong-Il Choi
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
- Correspondence to Jong-Il Choi, M.D. Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, 73 Inchon-ro, Seongbuk-gu, Seoul 02841, Korea Tel: +82-2-920-5445 Fax: +82-2-927-1478 E-mail:
| | - Jimi Choi
- Department of Biostatistics, Korea University College of Medicine, Seoul, Korea
| | - Yun Gi Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Suk-Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Hyungdon Kook
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Kwang No Lee
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Jaemin Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Seong-Mi Park
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Wan Joo Shim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
| | - Young-Hoon Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Medical Center, Seoul, Korea
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Cerit MN, Sendur HN, Bolayır B, Cerit ET, Cindil E, Yaşım Aktürk M, Baloş Törüner F, Özhan Oktar S. Evaluation of common carotid artery in type 1 diabetes mellitus patients through speckle tracking carotid strain ultrasonography. Diagn Interv Radiol 2021; 27:195-205. [PMID: 33599210 DOI: 10.5152/dir.2021.20025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
PURPOSE We aimed to evaluate the effectiveness of speckle tracking carotid strain (STCS) technique, which enables measurement of arterial stiffness and strain parameters, in the detection of early atherosclerotic findings in type 1 diabetes mellitus (T1DM). METHODS We prospectively enrolled 30 T1DM patients and 30 age- and sex-matched control participants with no history of cardiovascular disease. All study population underwent carotid ultrasonography. Radial and circumferential movement of the common carotid artery (CCA) in the transverse plane as the well as the radial movement of the CCA in the longitudinal plane were calculated automatically by using the STCS method. In addition, the strain (%), strain rate (per second), and peak circumferential and radial displacements (mm) were calculated. Arterial stiffness parameters, such as elastic modulus, distensibility, arterial compliance, and β-stiffness index, were calculated using the radial measurements. The mean value of the carotid intima media thickness (CIMT) was calculated semi-automatically for each CCA, in the longitudinal plane. We also analyzed the patients' overall body composition. RESULTS T1DM and control groups were compared in terms of strain and stiffness parameters and no statistically significant difference was found (p > 0.05). CIMT was higher in diabetic patients than in the control group (p = 0.039). In both groups, age was correlated with all arterial stiffness and strain parameters (p < 0.05). The duration of diabetes was also correlated with β-stiffness index, distensibility, and elastic modulus in the longitudinal plane (p < 0.05). In the diabetic group, abdominal fat ratio, whole body fat ratio, and fat mass were correlated with radial and circumferential displacement and strain parameters in transverse plane, and radial displacement in longitudinal plane (p < 0.05, for each). Diabetic patients were divided into subgroups according to the presence of nephropathy and dyslipidemia. Although no significant difference was found between the groups in terms of CIMT, patients with nephropathy had higher values for transverse and longitudinal elastic modulus, pulse-wave velocity, and longitudinal β-stiffness index, as well as lower values for longitudinal arterial compliance and distensibility, compared with patients without nephropathy (p < 0.05). Also, patients with dyslipidemia had higher longitudinal β-stiffness and elastic modulus values compared with patients without dyslipidemia (p < 0.05). CONCLUSION STCS ultrasonography is an effective, easy, and noninvasive method for evaluating the arterial elasticity. It may provide an early assessment of atherosclerosis in patients with T1DM, especially in the presence of nephropathy and dyslipidemia; thus, together with CIMT measurement, it may be used more frequently to detect subclinical damage and stratify atherosclerosis.
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Affiliation(s)
- Mahi Nur Cerit
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Halit Nahit Sendur
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Başak Bolayır
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey
| | | | - Emetullah Cindil
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Müjde Yaşım Aktürk
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Füsun Baloş Törüner
- Department of Endocrinology, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Suna Özhan Oktar
- Department of Radiology, Gazi University Faculty of Medicine, Ankara, Turkey
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Karakaya Z, Cavkaytar Ö, Tosun Ö, Arga M. Subclinical cardiovascular dysfunction in children and adolescents with asthma. J Asthma 2020; 59:451-461. [PMID: 33251886 DOI: 10.1080/02770903.2020.1856866] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND There is close association between asthma and cardiovascular functions as both diseases share common inflammatory pathways. The current study was aimed at investigating the risk factors, associated with endothelial and cardiac functions in children with newly-diagnosed mild-persistent asthma. METHODS A total of 33 steroid-naive asthmatic children [median(interquartile-range); 9.1 years(7.8-13.5)] and 16 healthy controls [11.5 years(9.9-13.6)] were included. Their demographic, clinical and laboratory findings were recorded. Carotid Artery intima-media thickness (CIMT), stiffness, distensibility and strain were measured as atheroclerosis markers. Conventional and tissue Doppler imaging was performed to evaluate ventricular function. RESULTS The patients with asthma had higher CIMT and stiffness and lower strain and distensibility compared to controls (p < 0.001 for all). There was a significant correlation between the duration of asthmatic symptoms and subclinical-atherosclerosis as well as peripheral eosinophil count (p < 0.001, p < 0.05). The patients had lower tricuspid-annular-plane-systolic-excursion (TAPSE), ejection time, and higher isovolumetric relaxation time (IRT), isovolumetric contraction time (ICT), and left ventricle myocardial performance index (LVMPI) than the control subjects (p < 0.001 for all). A positive correlation was also observed between the duration of asthmatic-symptoms and cardiac-function parameters. CONCLUSION Children with mild persistent asthma had subclinical atherosclerosis and ventricular dysfunction even in the early stage of disease. Symptom duration was closely associated with both subclinical atherosclerosis and ventricular dysfunction. Myocardial performance index was abnormal in the asthmatic children when assessed by tissue Doppler Imaging even though they had normal ejection fraction in conventional echocardiography. Future prospective studies with larger sample sizes are needed to confirm these findings and to assess the possible protective effect of ICSs in the prevention of subclinical atherosclerosis.
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Affiliation(s)
- Zeynep Karakaya
- Department of Pediatrics, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Özlem Cavkaytar
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Öykü Tosun
- Department of Pediatric Cardiology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
| | - Mustafa Arga
- Department of Pediatric Allergy and Immunology, Istanbul Medeniyet University Medical Faculty, İstanbul, Turkey
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Forsblad-d'Elia H, Law L, Bengtsson K, Smeds J, Ketonen M, Sundström B, Ljung L, Geijer M, Söderberg S, Lindqvist P. Biomechanical Properties of Common Carotid Arteries Assessed by Circumferential 2D Strain and β Stiffness Index in Patients With Ankylosing Spondylitis. J Rheumatol 2020; 48:352-360. [PMID: 32611672 DOI: 10.3899/jrheum.200146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/22/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Ankylosing spondylitis (AS) is associated with an elevated risk of cardiovascular disease (CVD) related to atherosclerosis, preceded by arterial stiffness. We aimed to examine common carotid artery (CCA) biomechanical properties using ultrasound to calculate β stiffness index (indicating arterial stiffness) and, a more recently developed technique, 2-dimensional (2D) speckle tracking strain (indicating arterial motion and deformation, strain) to (1) compare with age- and sex-matched controls, and (2) analyze relationships between strain and stiffness with disease characteristics and traditional risk factors for CVD in patients with AS. METHODS In this cross-sectional study, a cohort of 149 patients with AS, mean age 55.3 ± 11.2 years, 102 (68.5%) men, and 146 (98%) HLA-B27-positive, were examined. Bilateral CCA were examined for circumferential 2D strain and β stiffness index. A subgroup of 46 patients was compared with 46 age- and sex-matched controls, both groups without hypertensive disease, diabetes, myocardial infarction, or stroke. RESULTS Mean bilateral circumferential 2D strain was lower in AS patients compared with controls (7.9 ± 2.6% vs 10.3 ± 1.9%, P < 0.001), whereas mean bilateral β stiffness index was higher (13.1 ± 1.7 mmHg/mm vs 12.3 ± 1.3 mmHg/mm, P = 0.02). In multivariable linear regression analyses, strain was associated with age, erythrocyte sedimentation rate, history of anterior uveitis, and treatment with conventional synthetic disease-modifying antirheumatic drugs (DMARD) and/or biological DMARD (R2 0.33), while stiffness was associated with age (R2 0.19). CONCLUSION Both CCA circumferential 2D strain and β stiffness index differed between patients with AS and controls. Strain was associated with AS-related factors and age, whereas only age was associated with stiffness, suggesting that the obtained results reflect different pathogenic vascular processes.
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Affiliation(s)
- Helena Forsblad-d'Elia
- H. Forsblad-d'Elia, MD, L. Law, BSc, J. Smeds, MD, B. Sundström, RPT, L. Ljung, MD, Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå;
| | - Lucy Law
- H. Forsblad-d'Elia, MD, L. Law, BSc, J. Smeds, MD, B. Sundström, RPT, L. Ljung, MD, Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå
| | - Karin Bengtsson
- K. Bengtsson, MD, Department of Rheumatology and Inflammation Research, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, and Region Västra Götaland, Sahlgrenska University Hospital, Department of Rheumatology, Gothenburg
| | - Johan Smeds
- H. Forsblad-d'Elia, MD, L. Law, BSc, J. Smeds, MD, B. Sundström, RPT, L. Ljung, MD, Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå
| | - Maria Ketonen
- M. Ketonen, MD, Department of Surgical and Perioperative Sciences, Clinical Physiology, Umeå University, Umeå
| | - Björn Sundström
- H. Forsblad-d'Elia, MD, L. Law, BSc, J. Smeds, MD, B. Sundström, RPT, L. Ljung, MD, Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå
| | - Lotta Ljung
- H. Forsblad-d'Elia, MD, L. Law, BSc, J. Smeds, MD, B. Sundström, RPT, L. Ljung, MD, Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Umeå
| | - Mats Geijer
- M. Geijer, MD, Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, and Region Västra Götaland, Sahlgrenska University Hospital, Department of Radiology, Gothenburg and Faculty of Medicine, Lund University, Lund
| | - Stefan Söderberg
- S. Söderberg, MD, Department of Public Health and Clinical Medicine, Medicine, Umeå University, Umeå
| | - Per Lindqvist
- P. Lindqvist, BSc, Department of Surgical and Perioperative Sciences, Clinical Physiology, Umeå University, Umeå, Sweden
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12
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Zhou KN, Sung KT, Yen CH, Su CH, Lee PY, Hung TC, Huang WH, Chien SC, Tsai JP, Yun CH, Chang SC, Yeh HI, Hung CL. Carotid arterial mechanics as useful biomarker of extracellular matrix turnover and preserved ejection fraction heart failure. ESC Heart Fail 2020; 7:1615-1625. [PMID: 32449609 PMCID: PMC7373904 DOI: 10.1002/ehf2.12714] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 02/10/2020] [Accepted: 03/31/2020] [Indexed: 11/12/2022] Open
Abstract
Aims We aimed to investigate the functional alterations, diagnostic utilization, and prognostic implication of carotid arterial deformations in subjects with cardiovascular risk factors and heart failure (HF) with preserved ejection fraction (HFpEF). Methods and results Among 251 prospectively participants (mean age 66.0 ± 9.8 years, 65.7% female) in a single centre between December 2011 and September 2014, carotid artery deformations including circumferential strain (CCS)/strain rate and radial strain were analysed by two‐dimensional speckle tracking. We further related these carotid artery deformation indices to HF biomarkers and cardiac structure and function by echocardiography and explored their prognostic values. Significant reductions of CCS, circumferential strain rate, and circumferential radial strain were observed across control (n = 52), high risk (n = 147), and HFpEF (n = 52) (trend P ≤ 0.001). Aging, hypertension, HFpEF, and higher pulse rate showed independent associations with reduced CCS by stepwise multivariate regressions (all P < 0.05). Higher CCS was inversely associated with better cardiac remodelling and functional indices, and lower multiple HF biomarkers (all P ≤ 0.005). After adjustment, higher CCS was independently associated with better global ventricular longitudinal strain/early diastolic strain rate, lower matrix metalloproteinase‐2, and N‐terminal propeptide of procollagen type III levels (adjusted coef: −0.08 and −19.9, all P < 0.05). During a median follow‐up of 1406 days (interquartile range: 1342‑1720 days), CCS less than 3.28% as a cut‐off had markedly higher HF events [Harrell's C: 0.72, adjusted HR: 2.20 (95% confidence interval: 1.24, 3.16), P = 0.008]. CCS also showed significantly improved risk prediction for HF over global ventricular longitudinal strain (net reclassification index: 48%, P = 0.001; integrated discrimination improvement: 1.8%, P < 0.001). Conclusions Carotid artery deformations using two‐dimensional speckle‐tracking imaging showed novel mechanistic insights on functional arterial alterations reflecting coupled arterial‐ventricular pathophysiology. Utilization of such measure may further provide additive prognostic value to advanced myocardial functional assessment.
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Affiliation(s)
- Kevin Ning Zhou
- Williams College Department of Biology, Williams College, 59 Lab Campus Drive, Williamstown, MA, 01267, USA
| | - Kuo-Tzu Sung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan
| | - Chih-Hsuan Yen
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Institute of Preventive Medicine, School of Public Health, National Taiwan University, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan
| | - Cheng-Huang Su
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan
| | - Ping-Ying Lee
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan
| | - Ta-Chuan Hung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan
| | - Wen-Hung Huang
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Institute of Preventive Medicine, School of Public Health, National Taiwan University, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan
| | - Shih-Chieh Chien
- Department of Critical Care Medicine, MacKay Memorial Hospital, Taipei, Taiwan
| | - Jui-Peng Tsai
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan
| | - Chun-Ho Yun
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan.,Department of Radiology, MacKay Memorial Hospital, Taipei, Taiwan
| | - Shun-Chuan Chang
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan
| | - Hung-I Yeh
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Institute of Preventive Medicine, School of Public Health, National Taiwan University, Taipei, Taiwan
| | - Chung-Lieh Hung
- Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.,Mackay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan.,Cardiovascular Division, Department of Internal Medicine, MacKay Memorial Hospital, Zhongshan North Road, Taipei, 104, Taiwan.,Institute of biomedical sciences, Mackay Medical College, New Taipei City, Taiwan
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13
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Patton DM, Li T, Hétu MF, Day AG, Preece E, Matangi MF, Johri AM. Speckle tracking carotid artery circumferential strain is a marker of arterial sclerosis but not coronary atherosis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2018; 46:575-581. [PMID: 30105752 DOI: 10.1002/jcu.22632] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 07/03/2018] [Accepted: 07/13/2018] [Indexed: 06/08/2023]
Abstract
PURPOSE Circumferential speckle tracking carotid artery strain is a novel method of quantifying vessel wall stiffness. We hypothesized that carotid wall stiffness would be associated with carotid intimal medial thickening (a medial process associated with risk factors), but not coronary artery disease (an intimal process). METHODS Bilateral carotid artery ultrasound was conducted on outpatients who had previously undergone elective coronary angiography. Mean carotid artery far wall circumferential strain (FWCS) was assessed for correlations with coronary angiographic stenosis, cardiac risk factors, carotid intima-media thickness (CIMT), and carotid plaque. RESULTS One hundred and sixty five (165) patients were studied. No significant association was found between the presence of coronary artery disease on angiography and mean FWCS. FWCS was higher in current tobacco smokers. In addition, carotid strain was found to decrease with increased age (r = -0.33, P < 0.001). When adjusted for pulse pressure (PP), FWCS/PP was negatively correlated with mean CIMT (r = -0.29, P = 0.002) and bulb maximum plaque height (r = -0.27, P = 0.004). Hypertension and diabetes were associated with decreased FWCS/PP (increased wall stiffness). CONCLUSIONS While no clear relationship between carotid strain and coronary artery disease was observed, increased CIMT, carotid plaque, and cardiac risk factors were associated with decreased carotid strain. Further work is required to explore the relationship between carotid strain and cardiovascular events.
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Affiliation(s)
- Daniel M Patton
- Division of Cardiology, Cardiovascular Imaging Network at Queen's, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Terry Li
- Division of Cardiology, Cardiovascular Imaging Network at Queen's, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Marie-France Hétu
- Division of Cardiology, Cardiovascular Imaging Network at Queen's, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Andrew G Day
- Division of Cardiology, Cardiovascular Imaging Network at Queen's, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - Erika Preece
- Division of Cardiology, Cardiovascular Imaging Network at Queen's, Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | | | - Amer M Johri
- Division of Cardiology, Cardiovascular Imaging Network at Queen's, Department of Medicine, Queen's University, Kingston, Ontario, Canada
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14
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Iino H, Okano T, Daimon M, Sasaki K, Chigira M, Nakao T, Mizuno Y, Yamazaki T, Kurano M, Yatomi Y, Sumi Y, Sasano T, Miyata T. Usefulness of Carotid Arterial Strain Values for Evaluating the Arteriosclerosis. J Atheroscler Thromb 2018; 26:476-487. [PMID: 30344204 PMCID: PMC6514172 DOI: 10.5551/jat.45591] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
AIM We investigated the clinical usefulness of carotid arterial strain and the strain rate for evaluating the progression of arteriosclerosis measured using a two-dimensional speckle-tracking method in carotid ultrasonography. METHODS We enrolled 259 participants (age: 64±12 years; men: 149; women: 110) in this retrospective analysis. The circumferential strain and the strain rate were measured in bilateral common carotid arteries, and the lowest values were used for the analyses. To assess the characteristics of strain and the strain rate, we investigated the associations between the strain values and gender, age, body mass index (BMI), blood pressure (BP), and the presence of hypertension, diabetes mellitus, and hyperlipidemia. We also examined the explanatory factors for the strain values using clinical parameters along with the intima-media thickness (IMT), the ankle brachial index (ABI), and the cardio-ankle vascular index (CAVI) as possible candidates. Finally, we investigated whether the strain values might be an independent predictor for vascular diseases using multivariate logistic regression analyses. RESULTS The carotid circumferential strain and the strain rate were significantly correlated with age, IMT, and the CAVI, but not with the BMI, BP, or ABI. Strain and the strain rates were lower in participants with hypertension or cerebrovascular disease and were selected as significant predictive factors for the presence of cerebrovascular diseases, together with diabetes and the CAVI. CONCLUSIONS Strain and the strain rate of carotid arteries, which could represent local arterial stiffness, might be associated with atherosclerosis and could possibly be used to predict cerebrovascular disease.
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Affiliation(s)
- Hiroko Iino
- Department of Clinical Laboratory, The University of Tokyo Hospital.,Biofunctional Informatics, Biomedical Laboratory Sciences, Graduate School of Health Care Sciences, Tokyo Medical and Dental University
| | - Tomoko Okano
- Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Masao Daimon
- Department of Clinical Laboratory, The University of Tokyo Hospital.,Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Kazuno Sasaki
- Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Mayumi Chigira
- Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Tomoko Nakao
- Department of Clinical Laboratory, The University of Tokyo Hospital.,Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Yoshiko Mizuno
- Department of Cardiovascular Medicine, The University of Tokyo Hospital
| | - Tsutomu Yamazaki
- Innovation & Research Support Center, International University of Health and Welfare
| | - Makoto Kurano
- Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Yutaka Yatomi
- Department of Clinical Laboratory, The University of Tokyo Hospital
| | - Yuki Sumi
- Biofunctional Informatics, Biomedical Laboratory Sciences, Graduate School of Health Care Sciences, Tokyo Medical and Dental University
| | - Tetsuo Sasano
- Biofunctional Informatics, Biomedical Laboratory Sciences, Graduate School of Health Care Sciences, Tokyo Medical and Dental University.,Department of Cardiovascular Physiology, Tokyo Medical and Dental University
| | - Tetsuro Miyata
- Vascular Center, Sanno Hospital and Sanno Medical Center
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15
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Lee SE, Lee J, Yoo TH, Cho IJ, Chang HJ. End-Stage Renal Disease Impairs the Multidirectional Movements of the Common Carotid Artery: Assessment Using Dimensional Speckle-Tracking Carotid Strain Ultrasonography. J Cardiovasc Imaging 2018; 26:155-164. [PMID: 30310883 PMCID: PMC6160811 DOI: 10.4250/jcvi.2018.26.e16] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 09/03/2018] [Accepted: 09/04/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Arterial stiffening is a major contributing factor in the development of cardiovascular disease in patients with end-stage renal disease (ESRD). However, there is no gold standard for evaluating arterial stiffness. This study aimed to evaluate the newly developed speckle-tracking carotid strain imaging method in assessing arterial stiffness in patients with ESRD. METHODS In total, 85 patients with normal renal function (controls) and 36 with ESRD were enrolled in this single-center study. Carotid B-mode ultrasonography was performed for all patients. Arterial stiffness indices and strain parameters of the common carotid arteries were analyzed. Values were compared between the groups, and multivariate linear regression analysis was performed to assess the impact of ESRD on carotid strain. RESULTS There were no differences in the intima-media thickness, β stiffness index, and arterial compliance, but arterial distensibility was lower, and the elastic modulus and pulse wave velocity β (PWV) were higher among patients with ESRD (all p < 0.05), whether assessed in the longitudinal or transverse plane. Both longitudinal and transverse strain rates were reduced in patients with ESRD (all p < 0.05). In multivariate analyses, ESRD independently reduced both transverse radial strain and strain rate (all p < 0.05), and the transverse circumferential strain and strain rate (p < 0.05). However, all conventional aortic stiffness indices and longitudinal strain parameters were not associated with ESRD. CONCLUSIONS Speckle-tracking carotid strain ultrasonography was successfully performed in both normal subjects and patients with ESRD. Multidirectional carotid strain analyses may provide more value than conventional aortic stiffness indices for risk stratification in patients with ESRD.
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Affiliation(s)
- Sang-Eun Lee
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Jinyong Lee
- Medical Imaging Research Group, Samsung Medison, Seoul, Korea
| | - Tae-Hyun Yoo
- Department of Internal Medicine, Institute of Kidney Disease Research, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - In-Jeong Cho
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea
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16
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Bu Z, Ma J, Fan Y, Qiao Z, Kang Y, Zheng Y, Wang W, Du Y, Zheng Z, Shen X, He B, Pu J. Ascending Aortic Strain Analysis Using 2-Dimensional Speckle Tracking Echocardiography Improves the Diagnostics for Coronary Artery Stenosis in Patients With Suspected Stable Angina Pectoris. J Am Heart Assoc 2018; 7:JAHA.118.008802. [PMID: 29982229 PMCID: PMC6064841 DOI: 10.1161/jaha.118.008802] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background Arterial stiffening and atherosclerosis tend to coexist. Strain imaging, using a 2‐dimensional speckle tracking (2D‐ST) method, has been used for arterial stiffness assessment and early identification of atherosclerosis. We investigated whether the ascending aortic strain assessed by 2D‐ST echocardiography at rest can predict the presence of coronary artery disease (CAD). Methods and Results Two hundred seventy‐one consecutive patients with suspected stable angina pectoris sequentially underwent exercise treadmill testing, 2‐dimensional echocardiography, M‐mode echocardiography, 2D‐ST echocardiography, and coronary angiography. Circumferential ascending aortic strain (CAAS) and radial ascending aortic strain were assessed by 2D‐ST echocardiography. Ninety‐two patients with coronary lumen area stenosis ≥70% were categorized as having significant CAD. Global CAAS was significantly lower in patients with significant CAD (7.41±2.30% versus 11.54±4.03%; P<0.001) and remained an independent predictor of significant CAD (odds ratio, 0.64 [0.54–0.75]; P<0.001) after multivariate regression. Based on the receiver operating characteristic curve for diagnosing significant CAD, the optimal cut‐off value of global CAAS was ≤9.22% (sensitivity, 86%; specificity, 70%; area under curve=0.82; P<0.001). Global CAAS decreased with increasing severity of CAD and was significantly associated with 3‐vessel disease (odds ratio, 0.58 [0.42–0.79]; P<0.001). Diagnostics for significant CAD were remarkably better for global CAAS combined with exercise treadmill testing than for exercise treadmill testing alone (area under curve=0.88 versus 0.78; P<0.001). Conclusions Global CAAS assessed by 2D‐ST echocardiography at rest was able to predict the presence of significant CAD and identify multivessel disease. In addition, global CAAS combined with exercise treadmill testing remarkably improved the diagnostics for significant CAD.
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Affiliation(s)
- Zhaohui Bu
- Institute of Biomedical Engineering, University of Shanghai for Science and Technology, Shanghai, China.,Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Jun Ma
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yibo Fan
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhiqing Qiao
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yu Kang
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ying Zheng
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Wei Wang
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Yongping Du
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zheng Zheng
- Institute of Biomedical Engineering, University of Shanghai for Science and Technology, Shanghai, China
| | - Xuedong Shen
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Ben He
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China .,Department of Cardiology, Shanghai Chest Hospital Shanghai Jiao Tong University, Shanghai, China
| | - Jun Pu
- Department of Cardiology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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17
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Yoon JH, Han D, Kim S, Cho IJ, Sung JM, Lee J, Ryoo H, Shim CY, Hong GR, Chang HJ. Assessment of multidirectional movements of the common carotid artery in atherothrombotic stroke using dimensional speckle tracking carotid ultrasonography: A prospective, controlled cohort study. Echocardiography 2018; 35:957-964. [PMID: 29600550 DOI: 10.1111/echo.13881] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
AIM We aimed to explore the relevance of multidirectional movements of the common carotid artery in atherothrombotic stroke. METHODS AND RESULTS We prospectively enrolled 69 patients with atherothrombotic stroke (stroke group) and 69 age-matched and sex-matched controls (control group) who underwent carotid ultrasonography. Based on the speckle tracking technique, circumferential and radial movements of the common carotid artery were analyzed from transverse and longitudinal B-mode images of the common carotid artery. Peak longitudinal and radial displacements, strain, and strain rate were measured. Mean age of the overall population was 64 ± 11 years, and 57% (78 patients) were men. In the transverse image, circumferential strain was significantly lower in the stroke group than in the control group (5.6 ± 1.6 vs 4.2 ± 1.7, P < .001). In multivariate logistic regression analysis, circumferential strain was independently associated with stroke (odds ratio: 0.60, P = .001). Compared with conventional risk factors, as well as carotid intima-media thickness and carotid plaque, the addition of a strain parameter appeared to improve discrimination of a stroke event (area under the receiver operating characteristic curve: 0.65 and 0.75 vs 0.84, respectively; P < .05 for both). CONCLUSIONS Circumferential strain of the common carotid artery might serve as a novel surrogate marker of atherothrombotic stroke. Multidirectional strain imaging of the common carotid artery may provide more information than conventional carotid ultrasonography and identify clinical risk factors for risk stratification of an acute stroke event.
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Affiliation(s)
- Ji Hyun Yoon
- Cardiology Division, Department of Internal Medicine, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea
| | - Donghee Han
- Cardiology Division, Department of Internal Medicine, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea
| | - Sujin Kim
- Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea
| | - In-Jeong Cho
- Cardiology Division, Department of Internal Medicine, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea
| | - Ji Min Sung
- Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jinyong Lee
- Medical Imaging Research Group, Samsung Medison, Seoul, Korea
| | - Hojin Ryoo
- Medical Imaging Research Group, Samsung Medison, Seoul, Korea
| | - Chi Young Shim
- Cardiology Division, Department of Internal Medicine, Seoul, Korea
| | - Geu-Ru Hong
- Cardiology Division, Department of Internal Medicine, Seoul, Korea
| | - Hyuk-Jae Chang
- Cardiology Division, Department of Internal Medicine, Seoul, Korea.,Yonsei-Cedars-Sinai Integrative Cardiovascular Imaging Research Center, Seoul, Korea.,Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
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18
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Hae Kim C, Wang S, Park JB, Jung KH, E Yoon Y, Lee SP, Kim HK, Kim YJ, Cho GY, Sohn DW. Assessing Impact of High-Dose Pitavastatin on Carotid Artery Elasticity with Speckle-Tracking Strain Imaging. J Atheroscler Thromb 2018. [PMID: 29515050 PMCID: PMC6224202 DOI: 10.5551/jat.42861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
AIM Speckle-tracking imaging has been introduced for the precise assessment of vessel mechanics. However, there are no data on the role of this imaging tool in assessing the changes in vasculature with statin therapy, which is known to enhance vascular elasticity. METHODS This study was a prospective study including 48 statin-naïve patients (age, 58.2±8.4 years; 29.2% male) with hypercholesterolemia. Circumferential carotid artery strain (CAS) and stiffness index (β2) were measured using speckle-tracking imaging before and after 3 months of high-dose pitavastatin treatment (4 mg daily). For the comparison, we measured conventional carotid elasticity parameters and intima-media thickness using B-mode ultrasound at the same time points. RESULTS Compared with baseline, there was significant improvement in circumferential CAS (2.98%±1.18% to 3.40%±1.43%, p=0.008) and β2 (0.19±0.07 to 0.17±0.08, p=0.047) after statin therapy. Contrariwise, there were no significant changes in all conventional carotid elasticity metrics and intima-media thickness. When stratifying patients into two subgroups by 10 year atherosclerotic cardiovascular disease (ASCVD) risk, speckle-tracking-derived circumferential CAS and β2 improved significantly only in patients with ASCVD risk ≥ 7.5%. CONCLUSIONS Short-term treatment with high-dose pitavastatin improved carotid artery elasticity measured by speckle-tracking method, but not conventional parameters by B-mode ultrasound. Speckle-tracking-based measurements may allow the early noninvasive assessment of statin effects on vascular function in hypercholesterolemic patients.
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Affiliation(s)
- Chee Hae Kim
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Hospital
| | - Shuang Wang
- Department of Cardiology, Xiangtan Central Hospital
| | - Jun-Bean Park
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Hospital
| | - Keun-Hwa Jung
- Department of Neurology, Seoul National University Hospital
| | - Yeonyee E Yoon
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Bundang Hospital
| | - Seung-Pyo Lee
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Hospital
| | - Hyung-Kwan Kim
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Hospital
| | - Yong-Jin Kim
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Hospital
| | - Goo-Yeong Cho
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Bundang Hospital
| | - Dae-Won Sohn
- Division of Cardiology, Seoul National University College of Medicine.,Cardiovascular Center, Seoul National University Hospital
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19
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Yoon JH, Cho IJ, Chang HJ, Sung JM, Lee J, Ryoo H, Shim CY, Hong GR, Chung N. The Value of Elastic Modulus Index as a Novel Surrogate Marker for Cardiovascular Risk Stratification by Dimensional Speckle-Tracking Carotid Ultrasonography. J Cardiovasc Ultrasound 2016; 24:215-222. [PMID: 27721952 PMCID: PMC5050310 DOI: 10.4250/jcu.2016.24.3.215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/21/2016] [Accepted: 07/26/2016] [Indexed: 11/25/2022] Open
Abstract
Background Carotid intima media thickness (CIMT) and the presence of carotid plaque have been used for risk stratification of cardiovascular disease (CVD). To date, however, the association between multi-directional functional properties of carotid artery and CVD has not been fully elucidated. We sought to explore the multi-directional mechanics of the carotid artery in relation to cardiovascular risk. Methods Four hundred one patients who underwent carotid ultrasound were enrolled between January 2010 and April 2013. A high risk of CVD was defined as more than 20% of 10-year risk based on the Framingham risk score. Using a speckle-tracking technique, the longitudinal and radial movements were analyzed in the B-mode images. Peak longitudinal and radial displacements, strain and strain rate were also measured. Beta stiffness and elastic modulus index were calculated from the radial measurements. Results Of the overall sample, 13% (52) of patients comprised the high-risk group. In multivariate logistic regression, CIMT and elastic modulus index were independently associated with a high-risk of CVD {odds ratio (OR): 1.810 [95% confidence interval (CI) 1.249–2.622] and OR: 1.767 (95% CI: 1.177–2.652); p = 0.002, 0.006, respectively}. The combination of CIMT and elastic modulus index correlated with a high-risk of CVD more so than CIMT alone. Conclusion The elastic modulus index of the carotid artery might serve as a novel surrogate marker of high-risk CVD. Measurement of the multi-directional mechanics of the carotid artery using the speckle tracking technique has potential for providing further information over conventional B-mode ultrasound for stratification of CVD risk.
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Affiliation(s)
- Ji Hyun Yoon
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - In-Jeong Cho
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Hyuk-Jae Chang
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea.; Severance Biomedical Science Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Ji Min Sung
- Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Jinyong Lee
- Infrastructure Technology Lab, Samsung Medison, Seoul, Korea
| | - Hojin Ryoo
- Infrastructure Technology Lab, Samsung Medison, Seoul, Korea
| | - Chi Young Shim
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Geu-Ru Hong
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Namsik Chung
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.; Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
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20
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Yang WI, Ha JW. Non-invasive assessment of vascular alteration using ultrasound. Clin Hypertens 2016; 21:25. [PMID: 26893935 PMCID: PMC4750810 DOI: 10.1186/s40885-015-0035-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 11/10/2015] [Indexed: 12/04/2022] Open
Abstract
It is well known that arterial function relates to cardiovascular morbidity and mortality. The noninvasive technology for the assessment of arterial function has developed as the importance of prevention of early cardiovascular disease has been emphasized. Over 2-D and Doppler echocardiography, speckle-tracking echocardiography has emerged as a valuable ultrasound imaging technique that allows for an objective and quantitative evaluation of global and regional myocardial function. Recently, several studies have extended its applicability beyond cardiac chambers, such as artery. Measurement of carotid arterial strain with speckle tracking ultrasound has been shown to be feasible and reliable. This review describes the new ultrasound techniques to assess arterial function and their clinical implications.
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Affiliation(s)
- Woo-In Yang
- Cardiology Division, CHA Bundang Medical Center, CHA University, Sungnam, Republic of Korea
| | - Jong-Won Ha
- Cardiology Division, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea ; Severance Biomedical Science Institute, Yonsei University College of Medicine, 134 Shinchon-dong, Seodaemun-gu Seoul, 120-752 Republic of Korea
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21
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Obstructive Sleep Apnea Is Related to Increased Arterial Stiffness in Ultrasound Speckle-Tracking Analysis. RESPIRATORY MEDICINE AND SCIENCE 2016; 910:9-14. [DOI: 10.1007/5584_2016_215] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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22
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Teixeira R, Vieira MJ, Gonçalves A, Cardim N, Gonçalves L. Ultrasonographic vascular mechanics to assess arterial stiffness: a review. Eur Heart J Cardiovasc Imaging 2015; 17:233-46. [DOI: 10.1093/ehjci/jev287] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Accepted: 10/04/2015] [Indexed: 12/21/2022] Open
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23
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Hu JL, Li X, Wang XM, Cheng ZP, Chen DF, Wang SC, Kong QX. Comparison of Elastic Properties of Bilateral Carotid Arteries in Relation to Site of Acute Ischemic Stroke Using Velocity Vector Imaging. Chin Med J (Engl) 2015; 128:2960-3. [PMID: 26521797 PMCID: PMC4756900 DOI: 10.4103/0366-6999.168075] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
| | | | - Xi-Ming Wang
- Shandong Provincial Key Laboratory of Diagnosis and Treatment of Cardio-Cerebral Vascular Diseases, Shandong Medical Imaging Research Institute, Shandong University, Jinan, Shandong 250021, China
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24
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Podgórski M, Grzelak P, Szymczyk K, Szymczyk E, Drożdż J, Stefańczyk L. Peripheral vascular stiffness, assessed with two-dimensional speckle tracking versus the degree of coronary artery calcification, evaluated by tomographic coronary artery calcification index. Arch Med Sci 2015; 11:122-9. [PMID: 25861298 PMCID: PMC4379369 DOI: 10.5114/aoms.2015.49205] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 11/21/2012] [Accepted: 12/20/2012] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Even in asymptomatic patients, the result of atherosclerosis progression is deterioration of the function and morphology of the artery wall. Two-dimensional speckle-tracking (2DST) is a sonographic technique that allows for precise evaluation of arterial wall compliance. Together with measurement of intima-media thickness (IMT), it can be applied for quick and non-invasive assessment of the progression of peripheral artery atherosclerosis. MATERIAL AND METHODS Fifty-eight patients of mean age 61 years (SD 10.6) underwent cardiac computed tomography (CT) and subsequent ultrasonographic evaluation of the left common carotid artery. The calcium score was calculated according to the Agatston method and compared with IMT, circumferential strain variables assessed by 2DST, conventional arterial stiffness parameters (β-stiffness index and elastic modulus) and clinical data. Intra-observer and inter-observer agreement was evaluated. RESULTS Strain variables and IMT differed significantly in patients with calcium score (CS) > 0 and CS = 0. Moreover, they correlated with CS, systolic blood pressure and age of patients. Conventional stiffness parameters were not able to identify the group of patients with calcifications present in the coronary arteries. For the 2DST technique, interclass and intraclass agreements were 84.83% and 94.42% respectively. CONCLUSIONS Circumferential strain variables assessed by 2DST and measurement of IMT can be used for evaluation of peripheral artery deterioration in patients until the 6(th) decade of life. These parameters reflect the development of calcifications in coronary arteries and, more importantly, can be used for a more detailed estimation of the atherosclerosis risk in patients with CS = 0.
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Affiliation(s)
- Michał Podgórski
- Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Lodz, Poland
| | - Piotr Grzelak
- Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Lodz, Poland
| | - Konrad Szymczyk
- Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Lodz, Poland
| | - Ewa Szymczyk
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Jarosław Drożdż
- Department of Cardiology, Medical University of Lodz, Lodz, Poland
| | - Ludomir Stefańczyk
- Department of Radiology and Diagnostic Imaging, Medical University of Lodz, Lodz, Poland
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25
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Song Y, Shim JK, Song JW, Shim CY, Kim EK, Kwak YL. Association of Carotid Arterial Circumferential Strain With Left Ventricular Function and Hemodynamic Compromise During Off-Pump Coronary Artery Bypass Surgery. Circ J 2014; 78:2422-30. [DOI: 10.1253/circj.cj-14-0378] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Young Song
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine
| | - Jae-Kwang Shim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine
| | - Jong-Wook Song
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine
| | - Chi-Young Shim
- Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine
| | - Eui-Kyung Kim
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
| | - Young-Lan Kwak
- Department of Anesthesiology and Pain Medicine, Yonsei University College of Medicine
- Anesthesia and Pain Research Institute, Yonsei University College of Medicine
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