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Zumbardo-Bacelis GA, Peponi L, Vargas-Coronado RF, Rodríguez-Velázquez E, Alatorre-Meda M, Chevallier P, Copes F, Mantovani D, Abraham GA, Cauich-Rodríguez JV. A Comparison of Three-Layer and Single-Layer Small Vascular Grafts Manufactured via the Roto-Evaporation Method. Polymers (Basel) 2024; 16:1314. [PMID: 38794507 PMCID: PMC11125268 DOI: 10.3390/polym16101314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/18/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024] Open
Abstract
This study used the roto-evaporation technique to engineer a 6 mm three-layer polyurethane vascular graft (TVG) that mimics the architecture of human coronary artery native vessels. Two segmented polyurethanes were synthesized using lysine (SPUUK) and ascorbic acid (SPUAA), and the resulting materials were used to create the intima and adventitia layers, respectively. In contrast, the media layer of the TVG was composed of a commercially available polyurethane, Pearlbond 703 EXP. For comparison purposes, single-layer vascular grafts (SVGs) from individual polyurethanes and a polyurethane blend (MVG) were made and tested similarly and evaluated according to the ISO 7198 standard. The TVG exhibited the highest circumferential tensile strength and longitudinal forces compared to single-layer vascular grafts of lower thicknesses made from the same polyurethanes. The TVG also showed higher suture and burst strength values than native vessels. The TVG withstood up to 2087 ± 139 mmHg and exhibited a compliance of 0.15 ± 0.1%/100 mmHg, while SPUUK SVGs showed a compliance of 5.21 ± 1.29%/100 mmHg, akin to coronary arteries but superior to the saphenous vein. An indirect cytocompatibility test using the MDA-MB-231 cell line showed 90 to 100% viability for all polyurethanes, surpassing the minimum 70% threshold needed for biomaterials deemed cytocompatibility. Despite the non-cytotoxic nature of the polyurethane extracts when grown directly on the surface, they displayed poor fibroblast adhesion, except for SPUUK. All vascular grafts showed hemolysis values under the permissible limit of 5% and longer coagulation times.
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Affiliation(s)
- Gualberto Antonio Zumbardo-Bacelis
- Unidad de Materiales, Centro de Investigación Científica de Yucatán, Calle 43 #130 x 32 y 34, Colonia Chuburná de Hidalgo, Mérida C.P. 97205, Mexico; (G.A.Z.-B.); (R.F.V.-C.)
- Department of Chemical Engineering, Laval University, Quebec, QC G1V 0A6, Canada
| | - Laura Peponi
- Instituto de Ciencia y Tecnología de Polímeros (ICTP-CSIC), C/Juan de la Cierva 3, 28006 Madrid, Spain
| | - Rossana Faride Vargas-Coronado
- Unidad de Materiales, Centro de Investigación Científica de Yucatán, Calle 43 #130 x 32 y 34, Colonia Chuburná de Hidalgo, Mérida C.P. 97205, Mexico; (G.A.Z.-B.); (R.F.V.-C.)
| | - Eustolia Rodríguez-Velázquez
- Facultad de Odontología, Universidad Autónoma de Baja California, Tijuana 22390, Mexico;
- Centro de Graduados e Investigación en Química-Grupo de Biomateriales y Nanomedicina, Tecnológico Nacional de México, Instituto Tecnológico de Tijuana, Tijuana 22510, Mexico
| | - Manuel Alatorre-Meda
- Centro de Graduados e Investigación en Química-Grupo de Biomateriales y Nanomedicina, CONAHCYT-Tecnológico Nacional de México, Instituto Tecnológico de Tijuana, Tijuana 22510, Mexico;
| | - Pascale Chevallier
- Laboratory for Biomaterials and Bioengineering (CRC-I), Department of Min-Met-Materials Engineering & CHU de Quebec Research Center, Laval University, Quebec, QC G1V0A6, Canada; (P.C.)
| | - Francesco Copes
- Laboratory for Biomaterials and Bioengineering (CRC-I), Department of Min-Met-Materials Engineering & CHU de Quebec Research Center, Laval University, Quebec, QC G1V0A6, Canada; (P.C.)
| | - Diego Mantovani
- Laboratory for Biomaterials and Bioengineering (CRC-I), Department of Min-Met-Materials Engineering & CHU de Quebec Research Center, Laval University, Quebec, QC G1V0A6, Canada; (P.C.)
| | - Gustavo A. Abraham
- Research Institute for Materials Science and Technology, INTEMA (UNMdP-CONICET). Av. Colón 10850, Mar del Plata B7606BWV, Argentina
| | - Juan Valerio Cauich-Rodríguez
- Unidad de Materiales, Centro de Investigación Científica de Yucatán, Calle 43 #130 x 32 y 34, Colonia Chuburná de Hidalgo, Mérida C.P. 97205, Mexico; (G.A.Z.-B.); (R.F.V.-C.)
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Storlund RL, Rosen DAS, Haulena M, Sanatani S, Vander Zaag J, Trites AW. Ultrasound images of the ascending aorta of anesthetized northern fur seals and Steller sea lions confirm that the aortic bulb maintains continuous blood flow. JOURNAL OF EXPERIMENTAL ZOOLOGY. PART A, ECOLOGICAL AND INTEGRATIVE PHYSIOLOGY 2024; 341:458-469. [PMID: 38409932 DOI: 10.1002/jez.2799] [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: 09/07/2023] [Revised: 02/02/2024] [Accepted: 02/09/2024] [Indexed: 02/28/2024]
Abstract
The increased size and enhanced compliance of the aortic bulb-the enlargement of the ascending aorta-are believed to maintain blood flow in pinnipeds during extended periods of diastole induced by diving bradycardia. The aortic bulb has been described ex vivo in several species of pinnipeds, but in vivo measurements are needed to investigate the relationship between structure and function. We obtained ultrasound images using electrocardiogram-gated transesophageal echocardiography during anesthesia and after atropine administration to assess the relationship between aortic bulb anatomy and cardiac function (heart rate, stroke volume, cardiac output) in northern fur seals (Callorhinus ursinus) and Steller sea lions (Eumetopias jubatus). We observed that the aortic bulb in northern fur seals and Steller sea lions expands during systole and recoils over the entire diastolic period indicating that blood flow is maintained throughout the entire cardiac cycle as expected. The stroke volumes we measured in the fur seals and sea lions fit the values predicted based on body size in mammals and did not change with increased heart rates, suggesting that greater stroke volumes are not needed for aortic bulb function. Overall, our results suggest that peripheral vasoconstriction during diving is sufficient to modulate the volume of blood in the aortic bulb to ensure that flow lasts over the entire diastolic period. These results indicate that the shift of blood into the aortic bulb of pinnipeds is a fundamental mechanism caused by vasoconstriction while diving, highlighting the importance of this unique anatomical adaptation.
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Affiliation(s)
- Rhea L Storlund
- Marine Mammal Research Unit, Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Zoology, University of British Columbia, Vancouver, British Columbia, Canada
| | - David A S Rosen
- Marine Mammal Research Unit, Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
- Vancouver Aquarium, Vancouver, British Columbia, Canada
| | | | - Shubhayan Sanatani
- Division of Cardiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
- Department of Pediatrics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jessica Vander Zaag
- Division of Cardiology, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Andrew W Trites
- Marine Mammal Research Unit, Institute for the Oceans and Fisheries, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Zoology, University of British Columbia, Vancouver, British Columbia, Canada
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Saleh C, Ilia TS, Schöpfer R, Seidl U, Deraita J, Todua-Lennigk S, Lieb J, Budincevic H, Trzcinska M, Hovhannisyan K, Boviatsis KA, Saleh FM. Atherosclerosis and depression: is carotid intima-media thicker in patients with depression compared to matched control individuals? A systematic review and meta-analysis. J Psychiatr Res 2024; 173:216-224. [PMID: 38552331 DOI: 10.1016/j.jpsychires.2024.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 03/04/2024] [Accepted: 03/08/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE To investigate if there is an association between atherosclerosis and depression by using as imaging biomarker the carotid intima media thickness (cIMT), a surrogate marker for atherosclerosis. METHODS PubMed/Medline, Embase and Cochrane databases were comprehensively searched to identify studies investigating the association between cIMT and depression. The results were pooled using a random-effects statistical model, appropriate for the expected high heterogeneity. Sensitivity and subgroup analyses were conducted where data was available. RESULTS Overall, 22 and 13 studies met inclusion criteria for the qualitative and the quantitative synthesis, respectively, with a total of 4466 patients and 21,635 control participants. Results showed that cIMT is significantly higher in the depression, compared to the control groups with an overall mean difference of 0.07 mm (95% CI 0.04-0.10, p < 0.01). Subgroup analysis showed that diabetes could present as a confounding factor in patients with depression and an increased cIMT. CONCLUSIONS This study confirms a significantly increased cIMT in patients with depression, compared with controls and suggests a possible bidirectional link between atherosclerosis and depression. An early screening of cardiovascular disease in individuals suffering with depression should be considered.
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Affiliation(s)
| | - Tatiani Soultana Ilia
- Child and Adolescent Psychiatric Clinic, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
| | | | - Ulrich Seidl
- Department of Psychiatry, Clinic for Psychiatry, Psychotherapy and Psychosomatics, SHG-Kliniken Sonnenberg, Saarbrücken, Germany
| | - Jasmine Deraita
- Department of Forensics, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
| | - Salome Todua-Lennigk
- Department of Forensics, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
| | - Johanna Lieb
- Division of Neuroradiology, Clinic of Radiology & Nuclear Medicine, Department of Theragnostics, University Hospital of Basel, Basel, Switzerland
| | - Hrvoje Budincevic
- Stroke and Intensive Care Unit, Department of Neurology, Sveti Duh University Hospital, Zagreb, Croatia; Faculty of Medicine, Department of Neurology and Neurosurgery, J.J. Strossmayer University of Osijek, Osijek, Croatia
| | - Maria Trzcinska
- Division of Substance Use Disorders, University Psychiatric Clinics Basel (UPK), Basel, Switzerland
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Seekircher L, Tschiderer L, Lind L, Safarova MS, Kavousi M, Ikram MA, Lonn E, Yusuf S, Grobbee DE, Kastelein JJP, Visseren FLJ, Walters M, Dawson J, Higgins P, Agewall S, Catapano A, de Groot E, Espeland MA, Klingenschmid G, Magliano D, Olsen MH, Preiss D, Sander D, Skilton M, Zozulińska-Ziółkiewicz DA, Grooteman MPC, Blankestijn PJ, Kitagawa K, Okazaki S, Manzi MV, Mancusi C, Izzo R, Desvarieux M, Rundek T, Gerstein HC, Bots ML, Sweeting MJ, Lorenz MW, Willeit P. Intima-media thickness at the near or far wall of the common carotid artery in cardiovascular risk assessment. EUROPEAN HEART JOURNAL OPEN 2023; 3:oead089. [PMID: 37840587 PMCID: PMC10575622 DOI: 10.1093/ehjopen/oead089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 08/03/2023] [Accepted: 09/12/2023] [Indexed: 10/17/2023]
Abstract
Aims Current guidelines recommend measuring carotid intima-media thickness (IMT) at the far wall of the common carotid artery (CCA). We aimed to precisely quantify associations of near vs. far wall CCA-IMT with the risk for atherosclerotic cardiovascular disease (CVD, defined as coronary heart disease or stroke) and their added predictive values. Methods and results We analysed individual records of 41 941 participants from 16 prospective studies in the Proof-ATHERO consortium {mean age 61 years [standard deviation (SD) = 11]; 53% female; 16% prior CVD}. Mean baseline values of near and far wall CCA-IMT were 0.83 (SD = 0.28) and 0.82 (SD = 0.27) mm, differed by a mean of 0.02 mm (95% limits of agreement: -0.40 to 0.43), and were moderately correlated [r = 0.44; 95% confidence interval (CI): 0.39-0.49). Over a median follow-up of 9.3 years, we recorded 10 423 CVD events. We pooled study-specific hazard ratios for CVD using random-effects meta-analysis. Near and far wall CCA-IMT values were approximately linearly associated with CVD risk. The respective hazard ratios per SD higher value were 1.18 (95% CI: 1.14-1.22; I² = 30.7%) and 1.20 (1.18-1.23; I² = 5.3%) when adjusted for age, sex, and prior CVD and 1.09 (1.07-1.12; I² = 8.4%) and 1.14 (1.12-1.16; I²=1.3%) upon multivariable adjustment (all P < 0.001). Assessing CCA-IMT at both walls provided a greater C-index improvement than assessing CCA-IMT at one wall only [+0.0046 vs. +0.0023 for near (P < 0.001), +0.0037 for far wall (P = 0.006)]. Conclusions The associations of near and far wall CCA-IMT with incident CVD were positive, approximately linear, and similarly strong. Improvement in risk discrimination was highest when CCA-IMT was measured at both walls.
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Affiliation(s)
- Lisa Seekircher
- Institute of Health Economics, Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Lena Tschiderer
- Institute of Health Economics, Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
| | - Lars Lind
- Department of Medicine, Uppsala University, Uppsala, Sweden
| | - Maya S Safarova
- Division of Cardiovascular Medicine, Department of Medicine, Froedtert and Medical College of Wisconsin, Milwaukee, WI, USA
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Eva Lonn
- Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Salim Yusuf
- Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Diederick E Grobbee
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - John J P Kastelein
- Department of Vascular Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Matthew Walters
- School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - Jesse Dawson
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Peter Higgins
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Stefan Agewall
- Department of Clinical Sciences, Division of Cardiology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
- Institute of Clinical Sciences, University of Oslo, Oslo, Norway
| | - Alberico Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
- IRCCS Multimedica, Milan, Italy
| | - Eric de Groot
- Imagelabonline & Cardiovascular, Erichem, The Netherlands
- Department of Gastroenterology and Hepatology, Amsterdam UMC-Academic Medical Centre, Amsterdam, The Netherlands
| | - Mark A Espeland
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | | | - Dianna Magliano
- Department of Epidemiology and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, Australia
| | - Michael H Olsen
- Department of Internal Medicine, Holbaek Hospital, University of Southern Denmark, Odense, Denmark
| | - David Preiss
- Nuffield Department of Population Health, MRC Population Health Research Unit, Clinical Trial Service Unit, University of Oxford, Oxford, UK
| | - Dirk Sander
- Department of Neurology, Benedictus Hospital Tutzing & Feldafing, Feldafing, Germany
- Department of Neurology, Technische Universität München, Munich, Germany
| | - Michael Skilton
- Faculty of Medicine and Health, Charles Perkins Centre, University of Sydney, Sydney, NSW, Australia
| | | | - Muriel P C Grooteman
- Department of Nephrology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Amsterdam, The Netherlands
| | - Peter J Blankestijn
- Department of Nephrology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Shuhei Okazaki
- Department of Neurology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Maria V Manzi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Costantino Mancusi
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Raffaele Izzo
- Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy
| | - Moise Desvarieux
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
- METHODS Core, Centre de Recherche Epidémiologie et Statistique Paris Sorbonne Cité (CRESS), Institut National de la Santé et de la Recherche Médicale (INSERM) UMR 1153, Paris, France
| | - Tatjana Rundek
- Department of Neurology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Hertzel C Gerstein
- Department of Medicine and Population Health Research Institute, McMaster University, Hamilton, Ontario, Canada
- Hamilton General Hospital, Hamilton, Ontario, Canada
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Michael J Sweeting
- Department of Health Sciences, University of Leicester, Leicester, UK
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Papworth Road, Cambridge CB2 0BB, UK
| | - Matthias W Lorenz
- Department of Neurology, Goethe University, Frankfurt am Main, Germany
- Klinik für Neurologie, Krankenhaus Nordwest, Frankfurt am Main, Germany
| | - Peter Willeit
- Institute of Health Economics, Department of Medical Statistics, Informatics, and Health Economics, Medical University of Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Papworth Road, Cambridge CB2 0BB, UK
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Gao G, Kang D, Zhang J, Jiang Z, He X, Wu Y. Risk factors and a prediction model for unruptured intracranial aneurysms in patients with ischemic stroke using carotid intima-media thickness and systemic atherosclerosis. Front Neurol 2023; 14:1227673. [PMID: 37706007 PMCID: PMC10495834 DOI: 10.3389/fneur.2023.1227673] [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: 05/23/2023] [Accepted: 07/28/2023] [Indexed: 09/15/2023] Open
Abstract
Background Systemic atherosclerosis and carotid intima-media thickness (IMT) have been widely used in clinical practice for ischemic stroke; however, little is known about the risk factors for unruptured intracranial aneurysms (UIAs) in patients with ischemic stroke (IS). Therefore, we performed this study to identify the risk factors and construct a prediction model for UIA in patients with IS. Methods Data were retrospectively collected from patients with IS from 2015 to 2022 at the First Hospital of Quanzhou City, Quanzhou, Fujian, China. Risk factors for UIA in patients with IS were identified using a multivariate logistic regression model, and a receiver operating characteristic (ROC) curve was applied to construct the prediction model. Results Out of the 122 patients with IS, 52 who presented with UIA (ISUIA) were categorized into the study group and the remaining 70 IS patients without UIA into the control group. Patients in the ISUIA group had lower carotid IMT and carotid artery plaque scores than those in the IS group (P < 0.05). Multivariate analyses found that aspirin use (OR: 12.987; P = 0.031), elevated C-reactive protein (CRP) level (OR: 1.019; P = 0.004), and carotid IMT > 0.09 mm (OR: 0.218; P < 0.001) were significantly associated with the risk of UIA in patients with IS. However, UIA in patients with IS was unaffected by the carotid artery plaque score (P = 0.114). The constricted prediction model based on the abovementioned factors for UIA in IS patients was 0.79 (95% CI: 0.71-0.87). Conclusion The findings revealed that the risk factors for UIA in patients with IS included aspirin use, elevated CRP level, and smaller carotid IMT, and the predictive value of the prediction model was relatively better.
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Affiliation(s)
- Gaiming Gao
- Department of Neurosurgery, First Hospital of Quanzhou, Quanzhou, Fujian, China
| | - Dezhi Kang
- Department of Neurosurgery, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Jinning Zhang
- Department of Neurosurgery, First Hospital of Quanzhou, Quanzhou, Fujian, China
| | - Zhixian Jiang
- Department of Neurosurgery, First Hospital of Quanzhou, Quanzhou, Fujian, China
| | - Xueyang He
- Department of Neurosurgery, First Hospital of Quanzhou, Quanzhou, Fujian, China
| | - Yanyu Wu
- Department of Anesthesiology, First Hospital of Quanzhou, Quanzhou, Fujian, China
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Corti A, Migliavacca F, Berceli SA, Chiastra C. Predicting 1-year in-stent restenosis in superficial femoral arteries through multiscale computational modelling. J R Soc Interface 2023; 20:20220876. [PMID: 37015267 PMCID: PMC10072947 DOI: 10.1098/rsif.2022.0876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 03/13/2023] [Indexed: 04/06/2023] Open
Abstract
In-stent restenosis in superficial femoral arteries (SFAs) is a complex, multi-factorial and multiscale vascular adaptation process whose thorough understanding is still lacking. Multiscale computational agent-based modelling has recently emerged as a promising approach to decipher mechanobiological mechanisms driving the arterial response to the endovascular intervention. However, the long-term arterial response has never been investigated with this approach, although being of fundamental relevance. In this context, this study investigates the 1-year post-operative arterial wall remodelling in three patient-specific stented SFA lesions through a fully coupled multiscale agent-based modelling framework. The framework integrates the effects of local haemodynamics and monocyte gene expression data on cellular dynamics through a bi-directional coupling of computational fluid dynamics simulations with an agent-based model of cellular activities. The framework was calibrated on the follow-up data at 1 month and 6 months of one stented SFA lesion and then applied to the other two lesions. The calibrated framework successfully captured (i) the high lumen area reduction occurring within the first post-operative month and (ii) the stabilization of the median lumen area from 1-month to 1-year follow-ups in all the stented lesions, demonstrating the potentialities of the proposed approach for investigating patient-specific short- and long-term responses to endovascular interventions.
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Affiliation(s)
- Anna Corti
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering ‘Giulio Natta’, Politecnico di Milano, 20133 Milan, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering ‘Giulio Natta’, Politecnico di Milano, 20133 Milan, Italy
| | - Scott A. Berceli
- Department of Surgery, University of Florida, Gainesville, FL 32608, USA
- Malcom Randall VAMC, Gainesville, FL 32608, USA
| | - Claudio Chiastra
- PoliToMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129 Turin, Italy
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He R, Zhao L, Silberschmidt VV. Effect of balloon pre-dilation on performance of self-expandable nitinol stent in femoropopliteal artery. Biomech Model Mechanobiol 2023; 22:189-205. [PMID: 36282361 PMCID: PMC9957922 DOI: 10.1007/s10237-022-01641-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 09/19/2022] [Indexed: 11/24/2022]
Abstract
Balloon pre-dilation is usually performed before implantation of a nitinol stent in a femoropopliteal artery in a case of severe blockage or calcified plaque. However, its effect on performance of the nitinol stent in a diseased femoropopliteal artery has not been studied yet. This study compares the outcomes of stenting with pre-dilation and without it by modelling the entire processes of stent deployment. Fatigue deformation of the implanted stent is also modelled under diastolic-systolic blood pressure, repetitive bending, torsion, axial compression and their combination. Reduced level of stress in the stent occurs after stenting with pre-dilation, but causing the increased damage in the media layer, i.e. the middle layer of the arterial wall. Generally, pre-dilation increases the risk of nitinol stent's fatigue failure. Additionally, the development of in-stent restenosis is predicted based on the stenting-induced tissue damage in the media layer, and no severe mechanical irritation is induced to the media layer by pre-dilation, stent deployment or fatigue loading.
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Affiliation(s)
- Ran He
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK.
| | - Liguo Zhao
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Epinal Way, Loughborough, LE11 3TU UK ,College of Energy and Power Engineering, Nanjing University of Aeronautics and Astronautics, Nanjing, 210016 People’s Republic of China
| | - Vadim V. Silberschmidt
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Epinal Way, Loughborough, LE11 3TU UK
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Multiscale agent-based modeling of restenosis after percutaneous transluminal angioplasty: Effects of tissue damage and hemodynamics on cellular activity. Comput Biol Med 2022; 147:105753. [DOI: 10.1016/j.compbiomed.2022.105753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 04/13/2022] [Accepted: 05/13/2022] [Indexed: 11/17/2022]
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Bernini M, Colombo M, Dunlop C, Hellmuth R, Chiastra C, Ronan W, Vaughan TJ. Oversizing of self-expanding nitinol vascular stents – A biomechanical investigation in the superficial femoral artery. J Mech Behav Biomed Mater 2022; 132:105259. [DOI: 10.1016/j.jmbbm.2022.105259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 04/20/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
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10
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Corti A, Colombo M, Rozowsky JM, Casarin S, He Y, Carbonaro D, Migliavacca F, Rodriguez Matas JF, Berceli SA, Chiastra C. A predictive multiscale model of in-stent restenosis in femoral arteries: linking haemodynamics and gene expression with an agent-based model of cellular dynamics. J R Soc Interface 2022; 19:20210871. [PMID: 35350882 PMCID: PMC8965415 DOI: 10.1098/rsif.2021.0871] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
In-stent restenosis (ISR) is a maladaptive inflammatory-driven response of femoral arteries to percutaneous transluminal angioplasty and stent deployment, leading to lumen re-narrowing as consequence of excessive cellular proliferative and synthetic activities. A thorough understanding of the underlying mechanobiological factors contributing to ISR is still lacking. Computational multiscale models integrating both continuous- and agent-based approaches have been identified as promising tools to capture key aspects of the complex network of events encompassing molecular, cellular and tissue response to the intervention. In this regard, this work presents a multiscale framework integrating the effects of local haemodynamics and monocyte gene expression data on cellular dynamics to simulate ISR mechanobiological processes in a patient-specific model of stented superficial femoral artery. The framework is based on the coupling of computational fluid dynamics simulations (haemodynamics module) with an agent-based model (ABM) of cellular activities (tissue remodelling module). Sensitivity analysis and surrogate modelling combined with genetic algorithm optimization were adopted to explore the model behaviour and calibrate the ABM parameters. The proposed framework successfully described the patient lumen area reduction from baseline to one-month follow-up, demonstrating the potential capabilities of this approach in predicting the short-term arterial response to the endovascular procedure.
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Affiliation(s)
- Anna Corti
- LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Monika Colombo
- LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy.,Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zürich, Switzerland
| | - Jared M Rozowsky
- Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Stefano Casarin
- Department of Surgery, Houston Methodist Hospital, Houston, TX, USA.,Center for Computational Surgery, Houston Methodist Research Institute, Houston, TX, USA.,Houston Methodist Academic Institute, Houston, TX, USA
| | - Yong He
- Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Dario Carbonaro
- PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Francesco Migliavacca
- LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Jose F Rodriguez Matas
- LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Scott A Berceli
- Department of Surgery, University of Florida, Gainesville, FL, USA.,Malcom Randall VAMC, Gainesville, FL, USA
| | - Claudio Chiastra
- LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy.,PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
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11
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Olander RFW, Sundholm JKM, Suonsyrjä S, Sarkola T. Arterial health during early childhood following abnormal fetal growth. BMC Pediatr 2022; 22:40. [PMID: 35031019 PMCID: PMC8759262 DOI: 10.1186/s12887-021-02951-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/13/2021] [Indexed: 12/11/2022] Open
Abstract
Background Abnormal fetal growth is associated with increased cardiovascular risk in adulthood. We investigated the effect of fetal programming on arterial health and morphology during early childhood. Methods We examined 90 children (median age 5.81 years, interquartile range: 5.67; 5.95), born small for gestational age with fetal growth restriction, large or appropriate for gestational age (SGA, N = 23, LGA, N = 19, AGA N = 48). We measured body composition, anthropometrics, blood pressure, pulse wave velocity (PWV), lipids, glucose and inflammatory markers, and assessed carotid, brachial, radial and femoral arterial morphology and stiffness using very-high resolution ultrasound (46–71 MHz). Results LGA showed increased anthropometry, lean body mass and body mass index. SGA displayed decreased anthropometry and lean body mass. Blood pressure, PWV, carotid artery stiffness and blood work did not differ groupwise. Differences in lumen diameters, intima-media thicknesses (IMT) and adventitia thicknesses disappeared when adjusted for lean body mass and sex. In multiple regression models arterial dimensions were mainly predicted by lean body mass, with birth weight remaining associated only with carotid and brachial lumen dimensions, and not with IMTs. Carotid-femoral PWV was predicted by height and blood pressure only. No independent effect of adiposity was observed. Conclusions Arterial dimensions in childhood associate with current anthropometrics, especially lean body mass, and sex, explaining differences in arterial layer thickness. We found no signs of fetal programming of cardiovascular risk or arterial health in early childhood. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-021-02951-2.
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Affiliation(s)
- Rasmus F W Olander
- Children's Hospital, Pediatric Research Center, University of Helsinki, and Helsinki University Hospital, Stenbäckinkatu 9, POB 347, FIN-00029, Helsinki, Finland. .,Minerva Foundation Institute for Medical Research, Helsinki, Finland.
| | - Johnny K M Sundholm
- Children's Hospital, Pediatric Research Center, University of Helsinki, and Helsinki University Hospital, Stenbäckinkatu 9, POB 347, FIN-00029, Helsinki, Finland.,Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Sanna Suonsyrjä
- Children's Hospital, Pediatric Research Center, University of Helsinki, and Helsinki University Hospital, Stenbäckinkatu 9, POB 347, FIN-00029, Helsinki, Finland.,Minerva Foundation Institute for Medical Research, Helsinki, Finland
| | - Taisto Sarkola
- Children's Hospital, Pediatric Research Center, University of Helsinki, and Helsinki University Hospital, Stenbäckinkatu 9, POB 347, FIN-00029, Helsinki, Finland.,Minerva Foundation Institute for Medical Research, Helsinki, Finland
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12
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Tsivgoulis G, Safouris A, Alexandrov AV. Ultrasonography. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00046-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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13
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He R, Zhao L, Silberschmidt VV, Feng J, Serracino-Inglott F. Personalised nitinol stent for focal plaques: Design and evaluation. J Biomech 2021; 130:110873. [PMID: 34883344 DOI: 10.1016/j.jbiomech.2021.110873] [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: 09/20/2021] [Revised: 11/01/2021] [Accepted: 11/16/2021] [Indexed: 10/19/2022]
Abstract
The purpose of this study is to develop personalised nitinol stents for arteries with one and two opposite focal plaques. Novel designs are evaluated through comparison with a commercial stent design, in terms of lumen gain and shape as well as stress levels in the media layer after stenting. METHODS Personalised stents are developed for arteries with one and two opposite focal plaques, based on medical imaging of patients and computer simulations. In silico analysis is then carried out for assessment of stent performance in the diseased arteries. RESULTS Personalised designs significantly increase the lumen gain, reduce the stresses in the media layer, and improve the lumen shape compared to the commercial nitinol stent. CONCLUSION The personalised designs show outstanding performance compared to the commercial stent. SIGNIFICANCE This pilot study proves that personalised nitinol stents are able to deliver desirable treatment outcomes.
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Affiliation(s)
- Ran He
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Epinal Way, Loughborough LE11 3TU, UK.
| | - Liguo Zhao
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Epinal Way, Loughborough LE11 3TU, UK
| | - Vadim V Silberschmidt
- Wolfson School of Mechanical, Electrical and Manufacturing Engineering, Loughborough University, Epinal Way, Loughborough LE11 3TU, UK
| | - Jiling Feng
- Department of Engineering, Manchester Metropolitan University, Manchester M15 6BH, UK
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14
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Pioneering personalised design of femoropopliteal nitinol stents. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2021; 130:112462. [PMID: 34702537 DOI: 10.1016/j.msec.2021.112462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/20/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND/MOTIVATION Percutaneous femoropopliteal artery intervention moves towards personalised therapy, which requires design of unique lesion-specific stents. However, to date, not much progress has been made in the development of personalised stents. OBJECTIVE This paper aims to design personalised nitinol stents for femoropopliteal arteries based on medical imaging of patients and advanced computational mechanics, which is the first attempt to the authors' best knowledge. METHODS The design process is based on three objectives: (i) achieving the healthy lumen area; (ii) reducing the stress in the media layer; (iii) improving the lumen shape after stenting. The design parameters include the strut width and thickness, the crown length, the nominal radius and the number of strut units per crown. Using representative unit-cell models, the effects of the five geometric parameters on the stent performance are investigated thoroughly with numerical simulations. Then, design protocols, especially for the circumferentially varying strut size and the oval stent shape, are developed and fully evaluated for an asymmetric stenosis. RESULTS Using the design protocols, full personalised stents are designed for arteries with diffuse and focal plaques, based on medical imaging of patients. The personalised stent designs provide a double lumen gain, a reduced stress in the media layer and an improved lumen shape compared to a commercial stent. CONCLUSIONS The suggested protocols prove their high effectiveness in design of personalised stents, and the suggested approach can be applied to development of personalised therapies involving the use of stent technology including percutaneous coronary artery intervention, transcatheter aortic valve implantation, endovascular aneurysm repair and ureteric stenting.
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15
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Gianaros PJ, Kraynak TE, Kuan DCH, Gross JJ, McRae K, Hariri AR, Manuck SB, Rasero J, Verstynen TD. Affective brain patterns as multivariate neural correlates of cardiovascular disease risk. Soc Cogn Affect Neurosci 2021; 15:1034-1045. [PMID: 32301993 PMCID: PMC7657455 DOI: 10.1093/scan/nsaa050] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 03/18/2020] [Accepted: 04/06/2020] [Indexed: 01/27/2023] Open
Abstract
This study tested whether brain activity patterns evoked by affective stimuli relate to individual differences in an indicator of pre-clinical atherosclerosis: carotid artery intima-media thickness (CA-IMT). Adults (aged 30-54 years) completed functional magnetic resonance imaging (fMRI) tasks that involved viewing three sets of affective stimuli. Two sets included facial expressions of emotion, and one set included neutral and unpleasant images from the International Affective Picture System (IAPS). Cross-validated, multivariate and machine learning models showed that individual differences in CA-IMT were partially predicted by brain activity patterns evoked by unpleasant IAPS images, even after accounting for age, sex and known cardiovascular disease risk factors. CA-IMT was also predicted by brain activity patterns evoked by angry and fearful faces from one of the two stimulus sets of facial expressions, but this predictive association did not persist after accounting for known cardiovascular risk factors. The reliability (internal consistency) of brain activity patterns evoked by affective stimuli may have constrained their prediction of CA-IMT. Distributed brain activity patterns could comprise affective neural correlates of pre-clinical atherosclerosis; however, the interpretation of such correlates may depend on their psychometric properties, as well as the influence of other cardiovascular risk factors and specific affective cues.
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Affiliation(s)
- Peter J Gianaros
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Thomas E Kraynak
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA.,Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Dora C-H Kuan
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA 15260, USA
| | - James J Gross
- Department of Psychology, Stanford University, Stanford, CA, 94305, USA
| | - Kateri McRae
- Department of Psychology, University of Denver, Denver, CO, 80208, USA
| | - Ahmad R Hariri
- Department of Psychology and Neuroscience, Duke University, Durham, NC, 27708, USA
| | - Stephen B Manuck
- Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Javier Rasero
- Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
| | - Timothy D Verstynen
- Center for the Neural Basis of Cognition, University of Pittsburgh and Carnegie Mellon University, Pittsburgh, PA 15213, USA.,Department of Psychology, Carnegie Mellon University, Pittsburgh, PA 15213, USA
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16
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Influence of intrauterine growth status on aortic intima-media thickness and aortic diameter in near-term fetuses: a comparative cross-sectional study. J Dev Orig Health Dis 2021; 13:212-219. [PMID: 34127175 DOI: 10.1017/s2040174421000295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intrauterine undernutrition may lead to fetal vascular programming. We compared abdominal aortic intima-media thickness (aIMT) and aortic diameter (aD) between appropriate for gestational age (AGA) and growth-restricted fetuses (GRF). We recruited 136 singleton fetuses at 34-37 weeks of gestation from Fetal Medicine Unit of Aga Khan University Hospital, Karachi (January-November 2017). Subjects were classified as AGA (n = 102) and GRF (n = 34) using INTER-GROWTH 21st growth reference and standard ultrasound protocol. Their far- and near-wall aIMT and aD were compared after adjustment of maternal age, first-trimester body mass index, fetal gender, hypertension and hyperglycemia in pregnancy. As the severity of growth restriction increased in GRF, aIMT and aD showed an increasing and a decreasing trend, respectively. Both far- and near-wall aIMT in GRF [(adj. β = 0.082, 95% confidence interval [CI] 0.042-0.123) and (adj. β = 0.049, 95% CI 0.010-0.089)] were significantly greater with reference to AGA fetuses. GRF subgroup analysis into small for gestational age (SGA) fetuses and intrauterine growth restricted (IUGR) revealed highly significant difference between AGA and IUGR for far (0.142 mm, P-value < 0.001) and near-wall aIMT (0.115 mm, P-value < 0.001) and marginally significant aD difference (0.51 mm, P-value 0.05). These findings suggest that the extent of fetal aortic remodelling is influenced by the severity of growth restriction. Hence, the targeted interventions for the cardiovascular health promotion of IUGR and SGA born neonates are desirable during early childhood, particularly in set ups with high prevalence of low birth weight babies.
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17
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A computational study of fatigue resistance of nitinol stents subjected to walk-induced femoropopliteal artery motion. J Biomech 2021; 118:110295. [PMID: 33578053 DOI: 10.1016/j.jbiomech.2021.110295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 01/20/2021] [Accepted: 01/23/2021] [Indexed: 11/21/2022]
Abstract
Fatigue resistance of nitinol stents implanted in femoropopliteal arteries is a critical issue because of their harsh biomechanical environment. Limb flexions due to daily walk expose the femoropopliteal arteries and, subsequently, the implanted stents to large cyclic deformations, which may lead to fatigue failure of the smart self-expandable stents. For the first time, this paper utilised the up-to-date measurements of walk-induced motion of a human femoropopliteal artery to investigate the fatigue behaviour of nitinol stent after implantation. The study was carried out by modelling the processes of angioplasty, stent crimping, self-expansion and deformation under diastolic-systolic blood pressure, repetitive bending, torsion and axial compression as well as their combination. The highest risk of fatigue failure of the nitinol stent occurs under a combined loading condition, with the bending contributing the most, followed by compression and torsion. The pulsatile blood pressure alone hardly causes any fatigue failure of the stent. The work is significant for understanding and improving the fatigue performance of nitinol stents through innovative design and procedural optimisation.
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18
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Mitchell C, Korcarz CE, Zagzebski JA, Stein JH. Effects of ultrasound technology advances on measurement of carotid intima-media thickness: A review. Vasc Med 2020; 26:81-85. [PMID: 33203316 DOI: 10.1177/1358863x20969826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this review, we describe how technological advances in ultrasound imaging related to transducer construction and image processing fundamentally alter generation of ultrasound images to produce better quality images with higher resolution. However, carotid intima-media thickness (IMT) measurements made from images acquired on modern ultrasound systems are not comparable to historical population nomograms that were used to determine wall thickness thresholds that inform atherosclerotic cardiovascular disease risk. Because it is nearly impossible to replicate instrumentation settings that were used to create the reference carotid IMT nomograms and to place an individual's carotid IMT value in or above a clinically relevant percentile, carotid IMT measurements have a very limited role in clinical medicine, but remain a useful research tool when instrumentation, presets, image acquisition, and measurements can be standardized. In addition to new validation studies, it would be useful for the ultrasound imaging community to reach a consensus regarding technical aspects of ultrasound imaging acquisition, processing, and display for blood vessels so standard presets and imaging approaches could reliably yield the same measurements.
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Affiliation(s)
- Carol Mitchell
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Claudia E Korcarz
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - James A Zagzebski
- Department of Medical Physics, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, WI, USA
| | - James H Stein
- Department of Medicine, Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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19
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Gijsen FJH, Vis B, Barrett HE, Zadpoor AA, Verhagen HJ, Bos D, van der Steen AFW, Akyildiz AC. Morphometric and Mechanical Analyses of Calcifications and Fibrous Plaque Tissue in Carotid Arteries for Plaque Rupture Risk Assessment. IEEE Trans Biomed Eng 2020; 68:1429-1438. [PMID: 33186100 DOI: 10.1109/tbme.2020.3038038] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Atherosclerotic plaque rupture in carotid arteries is a major source of cerebrovascular events. Calcifications are highly prevalent in carotid plaques, but their role in plaque rupture remains poorly understood. This work studied the morphometric features of calcifications in carotid plaques and their effect on the stress distribution in the fibrous plaque tissue at the calcification interface, as a potential source of plaque rupture and clinical events. METHODS A comprehensive morphometric analysis of 65 histology cross-sections from 16 carotid plaques was performed to identify the morphology (size and shape) and location of plaque calcifications, and the fibrous tissue fiber organization around them. Calcification-specific finite element models were constructed to examine the fibrous plaque tissue stresses at the calcification interface. Statistical correlation analysis was performed to elucidate the impact of calcification morphology and fibrous tissue organization on interface stresses. RESULTS Hundred-seventy-one calcifications were identified on the histology cross-sections, which showed great variation in morphology. Four distinct patterns of fiber organization in the plaque tissue were observed around the calcification. They were termed as attached, pushed-aside, encircling and random patterns. The stress analyses showed that calcifications are correlated with high interface stresses, which might be comparable to or even above the plaque strength. The stress levels depended on the calcification morphology and fiber organization. Thicker calcification with a circumferential slender shape, located close to the lumen were correlated most prominently to high interface stresses. CONCLUSION Depending on its morphology and the fiber organization around it, a calcification in an atherosclerotic plaque can act as a stress riser and cause high interface stresses. SIGNIFICANCE This study demonstrated the potential of calcifications in atherosclerotic plaques to cause elevated stresses in plaque tissue and provided a biomechanical explanation for the histopathological findings of calcification-associated plaque rupture.
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20
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Schmitt VH, Schmitt C, Hollemann D, Mamilos A, Wagner W, Weinheimer O, Brochhausen C. Comparison of histological and computed tomographic measurements of pig lung bronchi. ERJ Open Res 2020; 6:00500-2020. [PMID: 33313303 PMCID: PMC7720685 DOI: 10.1183/23120541.00500-2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/14/2020] [Indexed: 12/03/2022] Open
Abstract
AIM Light microscopy is used as template in the evaluation and further development of medical imaging methods. Tissue shrinkage caused by histological processing is known to influence lung tissue dimensions. In diagnosis of COPD, computed tomography (CT) is widely used for automated airway measurement. The aim of this study was to compare histological and computed tomographic measurements of pig lung bronchi. METHODS Airway measurements of pig lungs were performed after freezing under controlled inflation pressure in a liquid nitrogen bath. The wall thickness of seven bronchi was measured via Micro-CT and CT using the integral-based method (IBM) and the full-width-at-half-maximum method (FWHM) automatically and histologically on frozen and paraffin sections. Statistical analysis was performed using the Wilcoxon test, Pearson's correlation coefficient with a significance level at p<0.05, scatter plots and Bland-Altman plots. RESULTS Bronchial wall thickness was smallest in frozen sections (median 0.71 mm) followed by paraffin sections (median 0.75 mm), Micro-CT (median 0.84 mm), and CT measurements using IBM (median 0.68 mm) and FWHM (median 1.69 mm). Statistically significant differences were found among all tested groups (p<0.05) except for CT IBM and paraffin and frozen sections and Micro-CT. There was high correlation between all parameters with statistical significance (p<0.05). CONCLUSIONS Significant differences in airway measurement were found among the different methods. The absolute measurements with CT IBM were closest to the histological results followed by Micro-CT, whereas CT FWHM demonstrated a distinct divergence from the other groups.
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Affiliation(s)
- Volker H. Schmitt
- Dept of Cardiology, University Medical Centre, Johannes Gutenberg University of Mainz, Mainz, Germany
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine Main, Mainz, Germany
- Joint first authors
| | | | - David Hollemann
- Institute of Clinical and Molecular Pathology, State Hospital Horn, Horn, Austria
| | - Andreas Mamilos
- REPAIR-lab, Institute of Pathology, University of Regensburg, Regensburg, Germany
| | - Willi Wagner
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Centre Heidelberg (TLRC), German Lung Research Centre (DZL), Heidelberg, Germany
| | - Oliver Weinheimer
- Dept of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- Translational Lung Research Centre Heidelberg (TLRC), German Lung Research Centre (DZL), Heidelberg, Germany
- Joint senior authors
| | - Christoph Brochhausen
- REPAIR-lab, Institute of Pathology, University of Regensburg, Regensburg, Germany
- Central Biobank Regensburg, University Regensburg and University Hospital Regensburg, Regensburg, Germany
- Joint senior authors
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21
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He R, Zhao L, Silberschmidt V, Liu Y, Vogt F. Patient-specific modelling of stent overlap: Lumen gain, tissue damage and in-stent restenosis. J Mech Behav Biomed Mater 2020; 109:103836. [DOI: 10.1016/j.jmbbm.2020.103836] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/09/2020] [Accepted: 04/26/2020] [Indexed: 10/24/2022]
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22
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Nagaoka R, Wilhjelm JE, Hasegawa H. Preliminary study on the separation of specular reflection and backscattering components using synthetic aperture beamforming. J Med Ultrason (2001) 2020; 47:493-500. [PMID: 32749560 DOI: 10.1007/s10396-020-01038-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 06/11/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE In the early stages of atherosclerosis, the luminal surface of the arterial wall becomes rough due to injury and detachment of endothelial cells. This roughening can potentially be estimated with ultrasound since the electrical echo signal from the transducer is sensitive to both the angle of incidence to an extended surface as well as the roughness of the surface. Specifically, as the roughness of an interface increases, specular reflection is substituted by scattering. We propose a method that attempts separation of reflection and backscattering components in the received echo signals. METHOD Assuming the predominant propagation directions of the reflected and scattered waves can be somewhat controlled by the emitted sound field, separation of those components was attempted using synthetic aperture imaging with a transmit beam, focused at a point more distant than the imaging depth. Specifically, two dedicated beamforming processes were used for generation of reflection-emphasized and backscattering-emphasized images. RESULT Experimental verifications on a phantom using an ultrasound system with a limited number of active transmit-receive channels yielded a difference between these two images of 8 dB. The results further showed a similar (slightly improved) lateral spatial resolution size of 0.41 mm for the backscattering-emphasized image compared with conventional B-mode imaging (0.47 mm). CONCLUSION A new technique for separation of the reflection and backscattering components using synthetic aperture beamforming with a transmit beam featuring a large focal distance was proposed. The technique demonstrated a partial separation of the reflection and backscattering components, which potentially may be used to estimate surface roughness.
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Affiliation(s)
- Ryo Nagaoka
- Graduate School of Science and Engineering for Research, University of Toyama, 3190 Gofuku, Toyama, 930-8555, Japan
| | - Jens E Wilhjelm
- Department of Health Technology, Technical University of Denmark, Building 349, 2800 Kgs., Lyngby, Denmark
| | - Hideyuki Hasegawa
- Graduate School of Science and Engineering for Research, University of Toyama, 3190 Gofuku, Toyama, 930-8555, Japan.
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23
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Lee J, Chen B, Kohl HW, Barlow CE, Lee CD, Radford NB, DeFina LF, Gabriel KP. The Association of Self-Reported Muscle-Strengthening Activities With Carotid Intima-Media Thickness in Older Adults: Cooper Center Longitudinal Study. J Aging Phys Act 2020; 28:534-539. [PMID: 31810061 PMCID: PMC8754400 DOI: 10.1123/japa.2019-0150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 10/18/2019] [Accepted: 10/23/2019] [Indexed: 11/18/2022]
Abstract
The purpose of the current investigation was to examine the cross-sectional associations of participation in muscle-strengthening activities (MSAs) with carotid intima-media thickness (CIMT) among older adults. The data are from 2,557 older adult participants enrolled in an observational cohort who reported no history of cardiovascular disease. MSA was determined using a questionnaire. Carotid ultrasound was performed to measure the CIMT of the common carotid artery bilaterally. Logistic regression models were constructed to estimate the association of MSA with CIMT after adjustment for potential confounders. The participants were aged 68.6 ± 7.0 years, and the majority were male (71.7%) and White (96.5%); 18% had abnormal CIMT. Meeting the physical activity guidelines for MSA was inversely associated with abnormal CIMT after adjustment for age and sex. However, this observed inverse relation became statistically null after further adjustment for cardiovascular disease risk factors, including aerobic physical activity.
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Lee J, Chen B, Kohl HW, Barlow CE, do Lee C, Radford NB, DeFina LF, Gabriel KP. The Association of Physical Activity With Carotid Intima Media Thickening in a Healthy Older Population: Cooper Center Longitudinal Study. J Aging Phys Act 2020; 28:448-454. [PMID: 31801110 PMCID: PMC7266725 DOI: 10.1123/japa.2019-0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/18/2022]
Abstract
The purpose of this study was to examine the association between self-reported physical activity (PA) and mean common carotid artery intima-media thickness (CCA IMT) among older adults. The data are from 1,811 Cooper Center Longitudinal Study participants, who were aged ≥60 years, with no history of cardiovascular disease. A medical history questionnaire was used to assess PA. Carotid ultrasound was performed to measure CCA IMT and the presence of plaque and stenosis. Logistic regression models were constructed to estimate the association between PA and CCA IMT after adjustment for covariates. The participants were aged 69.2 ± 5.9 years, and the majority were male (73.3%) and White (96.7%). The odds ratio of abnormal thickening of CCA IMT was 0.72 (95% confidence interval [0.54, 0.96]) in physically active participants (≥500 metabolic equivalent·min/week) after adjustment for covariates. In the current study, meeting PA guidelines in older adulthood was associated with lower odds of abnormal thickening of CCA IMT.
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Vascular, cardiac and renal target organ damage associated to arterial hypertension: which noninvasive tools for detection? J Hum Hypertens 2020; 34:420-431. [DOI: 10.1038/s41371-020-0307-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 01/04/2020] [Accepted: 01/27/2020] [Indexed: 01/16/2023]
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Modified high-resolution wavenumber analysis for detection of pulse wave velocity using coefficient of variation of arterial wall acceleration waveforms. J Med Ultrason (2001) 2020; 47:167-177. [PMID: 31894429 DOI: 10.1007/s10396-019-00998-4] [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] [Received: 09/13/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
PURPOSE In high-resolution wavenumber analysis for detection of pulse wave velocity (PWV), phase information of analytic signals is used to estimate the wavenumber. However, the phase information could be affected by the adjacent signals in the temporal direction. Therefore, we propose a modified high-resolution wavenumber analysis technique using real acceleration waveforms of the arterial wall. METHOD In the modified wavenumber analysis, we propose a new evaluation function that corresponds to the inverse of the squared coefficient of variation. The accuracy of estimation of PWV was investigated by performing simulations, and the feasibility was also examined in an in vivo experiment. RESULTS In the simulation experiments, the estimation accuracy using the proposed method was comparable to that using the previous method using phase information. However, when the pulse wave included the reflection components, the PWV estimated using the proposed method was more stable than that estimated using the previous method. Also, in the in vivo experiments, at opening of the aortic valve, the velocity estimated by the proposed method was almost equal to that estimated by the previous method (previous: 2.97 ± 1.2 m/s, proposed: 4.82 ± 1.4 m/s). Meanwhile, when the reflection components were present, the estimated PWV values yielded by the previous and proposed methods were - 1.13 and - 3.50 ± 0.9 m/s, respectively. The PWVs at those two time points estimated by the previous method were quite different, and the PWV estimate was considered to be more affected by the reflected waves. CONCLUSION The results of the simulations and in vivo experiments indicated that the modified high-resolution wavenumber analysis method was less affected by the reflected waves and more accurate in estimation of PWVs of both the forward and reflected waves.
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Natural History of Atherosclerosis and Abdominal Aortic Intima-Media Thickness: Rationale, Evidence, and Best Practice for Detection of Atherosclerosis in the Young. J Clin Med 2019; 8:jcm8081201. [PMID: 31408952 PMCID: PMC6723244 DOI: 10.3390/jcm8081201] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Revised: 08/01/2019] [Accepted: 08/06/2019] [Indexed: 12/21/2022] Open
Abstract
Atherosclerosis underlies most myocardial infarctions and ischemic strokes. The timing of onset and the rate of progression of atherosclerosis differ between individuals and among arterial sites. Physical manifestations of atherosclerosis may begin in early life, particularly in the abdominal aorta. Measurement of the abdominal aortic intima-media thickness by external ultrasound is a non-invasive methodology for quantifying the extent and severity of early atherosclerosis in children, adolescents, and young adults. This review provides an evidence-based rationale for the assessment of abdominal aortic intima-media thickness-particularly as an age-appropriate methodology for studying the natural history of atherosclerosis in the young in comparison to other methodologies-establishes best practice methods for assessing abdominal aortic intima-media thickness, and identifies key gaps in the literature, including those that will identify the clinical relevance of this measure.
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Lee J, Chen B, Kohl HW, Barlow CE, Lee CD, Radford NB, DeFina LF, Gabriel KP. The association of midlife cardiorespiratory fitness with later life carotid atherosclerosis: Cooper Center Longitudinal Study. Atherosclerosis 2019; 282:137-142. [PMID: 30731286 DOI: 10.1016/j.atherosclerosis.2019.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/19/2018] [Accepted: 01/10/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND AIMS While numerous cross-sectional studies have demonstrated an inverse relationship between cardiorespiratory fitness (CRF) and carotid atherosclerosis in middle age, much less is known about the association of midlife CRF with carotid atherosclerosis in later life. METHODS We studied 1094 participants, free of cardiovascular disease, who completed a maximal exercise test (GXT) for an objective measure of CRF between ages 40 and 59 and carotid ultrasound after the age of 59, with at least five years between studies. Carotid intima media thickness was measured. Assessments were also made regarding the presence of plaque and percent stenosis in four regions: common carotid, bulb, internal carotid and external carotid arteries. Multivariable logistic regression models were constructed to estimate the association of CRF with carotid artery disease. RESULTS At the time of GXT and carotid scan, participants were aged 50.7 ± 5.7 years and 69.3 ± 6.4 years, respectively. Almost half of participants had high midlife CRF (48.6%); 41.3% and 10.1% had moderate and low CRF, respectively. Over a mean follow-up period of 18.6 ± 8.5 years, the odds of having carotid artery disease in later life in the high CRF group was 0.50 (95% CI: 0.29-0.87) compared with the low CRF group. Each 1 MET increase in CRF was associated with 10% lower odds of having carotid artery disease (OR = 0.89, 95% CI: 0.80-0.98). CONCLUSIONS Midlife CRF was inversely associated with carotid artery disease measured almost two decades later. This may represent a mechanistic link between high midlife CRF and reduced risk of stroke in later life.
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Affiliation(s)
- Joowon Lee
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center (UTHeath) at Houston School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX, 78701, USA; Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, 801 Massachusetts Avenue Suite 470, Boston, MA, 02118, USA.
| | - Baojiang Chen
- Department of Biostatistics and Data Science, Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center (UTHealth) at Houston School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX, 78701, USA
| | - Harold W Kohl
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center (UTHeath) at Houston School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX, 78701, USA; Department of Kinesiology and Health Education, The University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA
| | | | - Chong do Lee
- School of Nutrition and Health Promotion, Arizona State University, 550 N. Third St, Phoenix, AZ, 85004, USA
| | - Nina B Radford
- Cooper Clinic, 12200 Preston Road, Dallas, TX, 75230, USA
| | - Laura F DeFina
- Cooper Institute, 12330 Preston Road, Dallas, TX, 75230, USA
| | - Kelley Pettee Gabriel
- Department of Epidemiology, Human Genetics and Environmental Sciences, Michael and Susan Dell Center for Healthy Living, The University of Texas Health Science Center (UTHeath) at Houston School of Public Health in Austin, 1616 Guadalupe St, Suite 6.300, Austin, TX, 78701, USA; Department of Kinesiology and Health Education, The University of Texas at Austin, 1912 Speedway, Stop D5000, Austin, TX, 78712, USA; Department of Women's Health Dell Medical School, The University of Texas at Austin, 1501 Red River Street, Austin, TX, 78712, USA
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Fok PW, Lanzer P. Media sclerosis drives and localizes atherosclerosis in peripheral arteries. PLoS One 2018; 13:e0205599. [PMID: 30365531 PMCID: PMC6203409 DOI: 10.1371/journal.pone.0205599] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/27/2018] [Indexed: 11/24/2022] Open
Abstract
Media sclerosis (MS) and peripheral artery disease (PAD) may coincide, particularly in type 2 diabetics (T2D) and in patients with chronic kidney disease (CKD). In contrast to non-diabetics, in T2D PAD is more severe and more distal. Although MS is suspected to play a role, the underlying pathophysiological reasons for the differences still remain elusive today. We tested the hypothesis that MS is a promoter of atherosclerosis as it occurs in T2D with PAD by interfering with arterial remodeling using an in-silico simulation. We confirmed that MS aggravates PAD by promoting negative remodeling. We found that the effect is more pronounced in smaller distal arteries compared to larger proximal ones. Our results suggest that the degree of this divergence depends on the ratio between the thickness of the intima relative to the thickness of the media/adventitia of the individually affected arteries.
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Affiliation(s)
- Pak-Wing Fok
- Department of Mathematical Sciences, University of Delaware, Newark, Delaware, United States of America
| | - Peter Lanzer
- Mitteldeutsches Herzzentrum, Standort Klinikum Bitterfeld, Bitterfeld, Germany
- * E-mail:
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Abstract
Carotid atherosclerosis (CAS) is associated with increased cardiovascular risk, and therefore, assessing the genetic versus environmental background of CAS traits is of key importance. Carotid intima-media-thickness and plaque characteristics seem to be moderately heritable, with remarkable differences in both heritability and presence or severity of these traits among ethnicities. Although the considerable role of additive genetic effects is obvious, based on the results so far, there is an important emphasis on non-shared environmental factors as well. We aimed to collect and summarize the papers that investigate twin and family studies assessing the phenotypic variance attributable to genetic associations with CAS. Genes in relation to CAS markers were overviewed with a focus on genetic association studies and genome-wide association studies. Although the role of certain genes is confirmed by studies conducted on large populations and meta-analyses, many of them show conflicting results. A great focus should be on future studies elucidating the exact pathomechanism of these genes in CAS in order to imply them as novel therapeutic targets.
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Epure AM, Leyvraz M, Mivelaz Y, Di Bernardo S, da Costa BR, Chiolero A, Sekarski N. Risk factors and determinants of carotid intima-media thickness in children: protocol for a systematic review and meta-analysis. BMJ Open 2018; 8:e019644. [PMID: 29866720 PMCID: PMC5988176 DOI: 10.1136/bmjopen-2017-019644] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
INTRODUCTION Carotid intima-media thickness (CIMT) is a surrogate marker of atherosclerosis that is measured in adults and children to better understand the natural history of cardiovascular disease (CVD). In adults, CIMT is predictive of myocardial infarction and stroke. In children and adolescents, CIMT is used to assess vascular changes in the presence of CVD risk factors (obesity, hypertension, smoking, etc) or clinical conditions associated with a high risk for premature CVD. However, there is no comprehensive overview, in a life-course epidemiology perspective, of the risk factors and determinants of CIMT in children. It is also important to evaluate between-study differences in CIMT measurement methods and take them into consideration when drawing conclusions. Our objective is to systematically review the evidence on the relationship between CIMT and prenatal and postnatal exposures or interventions in children, as well as documenting and discussing the CIMT measurement methods. METHODS AND ANALYSIS Systematic searches of the Medical Literature Analysis and Retrieval System Online (MEDLINE), Excerpta Medica (EMBASE)and Central Register of Controlled Trials (CENTRAL) databases will be conducted. The reference lists and other literatures sources will be browsed. Observational and experimental studies in children from birth up to 18 years will be included. Prenatal and postnatal exposures or interventions assessed in relationship with CIMT will be considered for inclusion. Examples might include gestational age, obesity, hypertension, tobacco exposure, specific at-risk conditions (chronic kidney disease, diabetes, etc) or statin treatment. The outcome will be CIMT assessed by ultrasonography. The setting, scanning and measurement methods for each included study will be described in detail. Results will be synthesised descriptively and, if appropriate, will be pooled across studies to perform meta-analyses. Separate meta-analyses for each exposure or intervention type will be conducted. ETHICS AND DISSEMINATION This systematic review will be published in a peer-reviewed journal. A report will be prepared for clinicians and other healthcare decision-makers. PROSPERO REGISTRATION NUMBER CRD42017075169.
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Affiliation(s)
- Adina Mihaela Epure
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Magali Leyvraz
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Yvan Mivelaz
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Stefano Di Bernardo
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
| | - Bruno R da Costa
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Arnaud Chiolero
- Institute of Social and Preventive Medicine (IUMSP), Lausanne University Hospital (CHUV), Lausanne, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Canada
| | - Nicole Sekarski
- Paediatric Cardiology Unit, Woman-Mother-Child Department, Lausanne University Hospital (CHUV), Lausanne, Switzerland
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McCloskey K, Vuillermin P, Carlin JB, Cheung M, Skilton MR, Tang ML, Allen K, Gilbert GL, Ranganathan S, Collier F, Dwyer T, Ponsonby AL, Burgner D. Perinatal microbial exposure may influence aortic intima-media thickness in early infancy. Int J Epidemiol 2018; 46:209-218. [PMID: 27059546 DOI: 10.1093/ije/dyw042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2016] [Indexed: 12/17/2022] Open
Abstract
Background The maternal and infant microbiome may influence infant cardiovascular risk through immune programming. The maternal vagino-enteric microbiome is often sampled for group B streptococcus (GBS) colonization during pregnancy. Our aim was to investigate the association between maternal GBS colonization, intrapartum antibiotics, antenatal pet exposure and infant aortic intima-media thickness (aIMT), an intermediate vascular phenotype, and whether this association varied by mode of delivery. Methods The Barwon Infant Study is a population-derived pre-birth cohort. Perinatal data were collected on participants. Women were tested for vagino-enteric group B streptococcus (GBS) colonization during third trimester. Six-week infant aIMT was measured by trans-abdominal ultrasound. Adjustment for confounders included maternal age, pre-pregnancy body mass index (BMI), smoking, socioeconomic status, gestational diabetes, length of gestation, infant sex, birthweight and aortic internal diameter. Results Data were available on 835 mother-infant pairs. Of these, 574 (69%) women delivered vaginally; of those, 129 (22%) were GBS-colonized; and of these women, 111 (86%) received prophylactic intrapartum antibiotics. An association between maternal GBS colonization and infant aIMT was observed among those delivered vaginally (β = 19.5 µm, 95% CI 9.5, 29.4; P < 0.0001) but not by Caesarean section ( P for interaction = 0.02). A similar pattern was seen for intrapartum antibiotics. There was a negative association between antenatal pet exposure and aIMT observed in those delivered vaginally. Conclusion Maternal GBS colonization and intrapartum antibiotics were associated with increased infant aIMT in those delivered vaginally, whereas antenatal pet exposure was associated with decreased aIMT. These data suggest that differences in early life microbial experience may contribute to an increased cardiovascular risk.
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Affiliation(s)
- Kate McCloskey
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Child Health Research Unit, University Hospital Barwon Health, Geelong, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Peter Vuillermin
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Child Health Research Unit, University Hospital Barwon Health, Geelong, VIC, Australia.,Department of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - John B Carlin
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Michael Cheung
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Michael R Skilton
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders
| | - Mimi Lk Tang
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Katie Allen
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Gwendolyn L Gilbert
- Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, WA, Australia
| | - Sarath Ranganathan
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Fiona Collier
- Child Health Research Unit, University Hospital Barwon Health, Geelong, VIC, Australia.,Department of Medicine, Deakin University, Waurn Ponds, VIC, Australia
| | - Terence Dwyer
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - Anne-Louise Ponsonby
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia
| | - David Burgner
- Murdoch Childrens Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, VIC, Australia.,Department of Paediatrics, Monash University, Melbourne, VIC, Australia
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Oxidative DNA Damage and Carotid Intima Media Thickness as Predictors of Cardiovascular Disease in Prediabetic Subjects. J Cardiovasc Dev Dis 2018. [PMID: 29518984 PMCID: PMC5872363 DOI: 10.3390/jcdd5010015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Prediabetes is considered as a risk factor for the development of diabetes mellitus and cardiovascular disease. The present study was conducted with the aim of finding out the relationship between oxidative DNA damage and carotid intima media thickness for the prediction of cardiovascular disease in prediabetic subjects. The study included 100 prediabetic subjects and 100 normal individuals as controls. In both cases and controls, 8-OHdG was measured by ELISA, and CIMT was measured by B mode ultrasonography. Both 8-OHdG and CIMT were significantly higher in subjects with prediabetes as compared to controls (185.80 ± 10.72 pg/mL vs. 126.13 ± 16.01 pg/mL, p < 0.001 and 0.70 ± 0.04 mm vs. 0.57 ± 0.03 mm, p < 0.001, respectively). There was significant and positive correlation of IGT with 8-OHdG (r = 0.783; p < 0.001) and CIMT (r = 0.787; p < 0.001) in prediabetic subjects. Moreover, 8-OHdG showed significant positive correlation with CIMT (r = 0.704; p < 0.001) in prediabetic subjects. In conclusion, increased 8-OHdG and CIMT in prediabetic subjects indicate that biochemical changes of atherosclerosis start even before the onset of diabetes mellitus. Hence, 8-OHdG and CIMT could be used as indicators of cardiovascular disease risk in these subjects.
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Segregating the Distinct Effects of Sedentary Behavior and Physical Activity on Older Adults' Cardiovascular Structure and Function: Part 1-Linear Regression Analysis Approach. J Phys Act Health 2018; 15:499-509. [PMID: 29485928 DOI: 10.1123/jpah.2017-0325] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Physical behavior [PB, physical activity (PA), and sedentary behavior (SB)] can adjust cardiovascular mortality risk in older adults. The aim of this study was to predict cardiovascular parameters (CVPs) using 21 parameters of PB. METHODS Participants [n = 93, 73.8 (6.23) y] wore a thigh-mounted accelerometer for 7 days. Phenotype of the carotid, brachial, and popliteal arteries was conducted using ultrasound. RESULTS Sedentary behavior was associated with one of the 19 CVPs. Standing and light-intensity PA was associated with 3 and 1 CVP, respectively. Our prediction model suggested that an hourly increase in light-intensity PA would be negatively associated with popliteal intima-media thickness [0.09 mm (95% confidence interval, 0.15 to 0.03)]. sMVPA [moderate-vigorous PA (MVPA), accumulated in bouts <10 min] was associated with 1 CVP. 10MVPA (MVPA accumulated in bouts ≥10 min) had no associations. W50% had associations with 3 CVP. SB%, alpha, true mean PA bout, daily sum of PA bout time, and total week 10MVPA each were associated with 2 CVP. CONCLUSIONS Patterns of PB are more robust predictors of CVP than PB (hours per day). The prediction that popliteal intima-media thickness would be negatively associated with increased standing and light-intensity PA engagement suggests that older adults could obtain health benefits without MVPA engagement.
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Carotid Intima-Media Thickness as a Cardiovascular Risk Factor and Imaging Pathway of Atherosclerosis. Crit Pathw Cardiol 2017; 15:152-160. [PMID: 27846007 DOI: 10.1097/hpc.0000000000000087] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Assessment of carotid intima-media thickness (IMT) has emerged as a simple and noninvasive technique for measuring atherosclerotic burden. Although serum biomarkers have been linked to the risk of developing atherosclerosis, carotid IMT has the theoretical advantage of directly visualizing a final consequence of the disease itself, namely atherosclerosis in the vessel wall. The current widespread application of carotid IMT measurements has been based on the validity, standardization, and reproducibility of the measurement and the evidence that an increased carotid IMT can be regarded as an attractive biomarker of atherosclerosis and of increased cardiovascular risk, potentially useful as a therapeutic target in those at increased cardiovascular risk. The utilization of carotid IMT measurements as a surrogate end point in clinical trials evaluating a specific drug intervention may result in considerably smaller efforts and costs than when using a hard end point such as myocardial infarction, stroke, or death. In addition, the use of carotid IMT measurement as a screening tool in clinical practice in association with traditional risk factors may improve risk classification and decisions regarding therapeutic interventions. However, although carotid IMT may be correlated with clinical outcomes, changes in surrogate end points over time that result from a particular therapy may not necessarily be predictive of future cardiovascular events. Therefore, it is necessary to perform more clinical studies to clearly define the relationship between the modifications in carotid IMT and the changes in cardiovascular events. In an era of economic burden, when there is a clear combination of limited resources with high expense of innovation in drug development, carotid IMT represents a reasonable, worthwhile surrogate trial end point with a history of nearly 30 years of technical progress and clinical research. Current data strongly suggest that carotid IMT will continue to successfully be used as a valuable tool in clinical atherosclerosis research.
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Cheng J, Ukwatta E, Shavakh S, Chow TWS, Parraga G, Spence JD, Chiu B. Sensitive three-dimensional ultrasound assessment of carotid atherosclerosis by weighted average of local vessel wall and plaque thickness change. Med Phys 2017; 44:5280-5292. [PMID: 28782187 DOI: 10.1002/mp.12507] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 07/17/2017] [Accepted: 07/19/2017] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Vitamin B deficiency has been identified as a risk factor for vascular events. However, the reduction of vascular events was not shown in large randomized controlled trials evaluating B-Vitamin therapy. There is an important requirement to develop sensitive biomarkers to be used as efficacy targets for B-Vitamin therapy as well as other dietary treatments and lifestyle regimes that are being developed. Carotid vessel-wall-plus-plaque thickness change (VWT-Change) measured from 3D ultrasound has been shown to be sensitive to atorvastatin therapies in previous studies. However, B-Vitamin treatment is expected to confer a smaller beneficial effect in carotid atherosclerosis than the strong dose of atorvastatin. This paper introduces a sensitive atherosclerosis biomarker based on the weighted mean VWT-Change measurement from 3D ultrasound with a purpose to detect statistically significant effect of B-Vitamin therapy. METHODS Of the 56 subjects analyzed in this study, 27 were randomized to receive a B-Vitamin tablet daily and 29 received a placebo tablet daily. Participants were scanned at baseline and 1.9 ± 0.8 yr later. The 3D VWT map at each scanning session was computed by matching the outer wall and lumen surfaces on a point-by-point basis. The 3D annual VWT-Change maps were obtained by first registering the 3D VWT maps obtained at the baseline and follow-up scanning sessions, and then taking the point-wise difference in VWT and dividing the result by the years elapsed from the baseline to the follow-up scanning session. The 3D VWT-Change maps constructed for all patients were mapped to a 2D carotid template to adjust for the anatomic variability of the arteries. A weight at each point of the carotid template was assigned based on the degree of correlation between the VWT-Change measurements exhibited at that point and the treatment received (i.e., B-Vitamin or placebo) quantified by mutual information. The weighted mean of VWT-Change for each patient, denoted by ΔVWT¯Weighted, was computed according to this weight. T-tests were performed to compare the sensitivity of ΔVWT¯Weighted with existing biomarkers in detecting treatment effects. These biomarkers included changes in intima-media thickness (IMT), total plaque area (TPA), vessel wall volume (VWV), unweighted average of VWT-Change (ΔVWT¯) and a previously described biomarker, denoted by ΔVWT¯S, that quantifies the mean VWT-Change specific to regions of interest identified by a feature selection algorithm. RESULTS Among the six biomarkers evaluated, the effect of B Vitamins was detected only by ΔVWT¯Weighted in this cohort (P=4.4×10-3). The sample sizes per treatment group required to detect an effect as large as exhibited in this study were 139, 178, 41 for ΔVWV, ΔVWT¯ and ΔVWT¯Weighted respectively. CONCLUSION The proposed weighted mean of VWT-Change is more sensitive than existing biomarkers in detecting treatment effects. This measurement tool will allow for many proof-of-principal studies to be performed for various novel treatments before a more costly study involving a larger population is held to validate the results.
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Affiliation(s)
- Jieyu Cheng
- Department of Electronic Engineering, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Eranga Ukwatta
- Department of Systems and Computer Engineering, Carleton University, Ottawa, Ontario, Canada
| | - Shadi Shavakh
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - Tommy W S Chow
- Department of Electronic Engineering, City University of Hong Kong, Kowloon Tong, Hong Kong
| | - Grace Parraga
- Imaging Research Laboratories, Robarts Research Institute, London, Ontario, Canada
| | - J David Spence
- Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, London, Ontario, Canada
| | - Bernard Chiu
- Department of Electronic Engineering, City University of Hong Kong, Kowloon Tong, Hong Kong
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HOEHMANN CHRISTOPHERL, FUTTERMAN BENNETT, BEATTY BRIANLEE. Peripheral Arteries May Be Reliable Indicators of Coronary Vascular Disease. Anat Rec (Hoboken) 2017; 300:1230-1239. [DOI: 10.1002/ar.23584] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 12/20/2016] [Accepted: 01/03/2017] [Indexed: 01/13/2023]
Affiliation(s)
- CHRISTOPHER L. HOEHMANN
- Department of Anatomy; New York Institute of Technology College of Osteopathic Medicine; Old Westbury New York
| | - BENNETT FUTTERMAN
- Department of Anatomy; New York Institute of Technology College of Osteopathic Medicine; Old Westbury New York
| | - BRIAN LEE BEATTY
- Department of Anatomy; New York Institute of Technology College of Osteopathic Medicine; Old Westbury New York
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38
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Shah BN, Chahal NS, Kooner JS, Senior R. Contrast-enhanced ultrasonography vs B-mode ultrasound for visualization of intima-media thickness and detection of plaques in human carotid arteries. Echocardiography 2017; 34:723-730. [PMID: 28317160 DOI: 10.1111/echo.13513] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Carotid intima-media thickness (IMT) and plaque are recognized markers of increased risk for cerebrovascular events. Accurate visualization of the IMT and plaques is dependent upon image quality. Ultrasound contrast agents improve image quality during echocardiography-this study assessed whether contrast-enhanced ultrasound (CEUS) improves carotid IMT visualization and plaque detection in an asymptomatic population. METHODS & RESULTS Individuals free from known cardiovascular disease, enrolled in a community study, underwent B-mode and CEUS carotid imaging. Each carotid artery was divided into 10 segments (far and near walls of the proximal, mid and distal segments of the common carotid artery, the carotid bulb, and internal carotid artery). Visualization of the IMT complex and plaque assessments was made during both B-mode and CEUS imaging for all enrolled subjects, a total of 175 individuals (mean age 65±9 years). Visualization of the IMT was significantly improved during CEUS compared with B-mode imaging, in both near and far walls of the carotid arteries (% IMT visualization during B-mode vs CEUS imaging: 61% vs 94% and 66% vs 95% for right and left carotid arteries, respectively, P<.001 for both). Additionally, a greater number of plaques were detected during CEUS imaging compared with B-mode imaging (367 plaques vs 350 plaques, P=.02). CONCLUSION Contrast-enhanced ultrasound improves visualization of the intima-media complex, in both near and far walls, of the common and internal carotid arteries and permits greater detection of carotid plaques. Further studies are required to determine whether there is incremental clinical and prognostic benefit related to superior plaque detection by CEUS.
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Affiliation(s)
- Benoy N Shah
- Wessex Cardiothoracic Centre, University Hospital Southampton, London, United Kingdom.,National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Navtej S Chahal
- Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
| | - Jaspal S Kooner
- National Heart and Lung Institute, Imperial College, London, United Kingdom.,Department of Cardiology, Ealing Hospital, London, United Kingdom
| | - Roxy Senior
- National Heart and Lung Institute, Imperial College, London, United Kingdom.,Department of Cardiology, Royal Brompton Hospital, London, United Kingdom
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39
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Skilton MR, Yeo SQ, Ne JYA, Celermajer DS, Caterson ID, Lee CMY. Weight loss and carotid intima-media thickness-a meta-analysis. Obesity (Silver Spring) 2017; 25:357-362. [PMID: 28026904 DOI: 10.1002/oby.21732] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 10/19/2016] [Accepted: 11/08/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Obesity is a risk factor for clinical cardiovascular disease, putatively via increased burden of atherosclerosis. It remains contentious as to whether weight loss in people with obesity is accompanied by a reduction in intima-media thickness, a noninvasive marker of subclinical atherosclerosis, consistent with a lowering of risk of cardiovascular events. METHODS A systematic literature search was performed to identify all surgical and nonsurgical weight loss interventions that reported intima-media thickness. A meta-analysis was undertaken to obtain pooled estimates for change in intima-media thickness. RESULTS From the 3,197 articles screened, 9 studies were included in the meta-analysis, with a total of 393 participants who lost an average of 16 kg (95% CI 9.4-22.5) of body weight over an average follow-up of 20 months. The pooled mean change in carotid intima-media thickness was -0.03 mm (95% CI -0.05 to -0.01), which was similar between surgical and nonsurgical interventions. CONCLUSIONS In people with obesity, weight loss was associated with a reduction in carotid intima-media thickness, consistent with a lowering in risk of cardiovascular events.
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Affiliation(s)
- Michael R Skilton
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Si Qin Yeo
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Jia Yi Anna Ne
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - David S Celermajer
- Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia
| | - Ian D Caterson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
| | - Crystal Man Ying Lee
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, University of Sydney, Sydney, New South Wales, Australia
- Charles Perkins Centre, University of Sydney, Sydney, New South Wales, Australia
- School of Public Health, Curtin University, Perth, Western Australia, Australia
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40
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Bots ML, Evans GW, Tegeler CH, Meijer R. Carotid Intima-media Thickness Measurements: Relations with Atherosclerosis, Risk of Cardiovascular Disease and Application in Randomized Controlled Trials. Chin Med J (Engl) 2017; 129:215-26. [PMID: 26830994 PMCID: PMC4799550 DOI: 10.4103/0366-6999.173500] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Advances in the field of carotid ultrasound have been incremental, resulting in a steady decrease in measurement variability. Improvements in edge detection algorithms point toward increasing automation of CIMT measurements. The major advantage of CIMT is that it is completely noninvasive and can be repeated as often as required. It provides a continuous measure since all subjects have a measurable carotid wall. It is also relatively inexpensive to perform, and the technology is widely available. A graded relation between raising LDL cholesterol and increased CIMT is apparent. Increased CIMT has been shown consistently to relate the atherosclerotic abnormalities elsewhere in the arterial system. Moreover, increased CIMT predicts future vascular events in both populations from Caucasian ancestry and those from Asian ancestry. Furthermore, lipid‑lowering therapy has been shown to affect CIMT progression within 12–18 months in properly designed trials with results congruent with clinical events trials. In conclusion, when one wants to evaluate the effect of a pharmaceutical intervention that is to be expected to beneficially affect atherosclerosis progression and to reduce CV event risk, the use of CIMT measurements over time is a valid, suitable, and evidence‑based choice.
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Affiliation(s)
- Michiel L Bots
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
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41
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Liu J, Zhu Y, Wu Y, Liu Y, Teng Z, Hao Y. Association of carotid atherosclerosis and recurrent cerebral infarction in the Chinese population: a meta-analysis. Neuropsychiatr Dis Treat 2017; 13:527-533. [PMID: 28260898 PMCID: PMC5325114 DOI: 10.2147/ndt.s124386] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Stroke, when poor blood flow to the brain results in cell death, is the third leading cause of disability and mortality worldwide, and appears as an unequal distribution in the global population. The cumulative risk of recurrence varies greatly up to 10 years after the first stroke. Carotid atherosclerosis is a major risk factor for stroke. The aim of this study was to investigate and estimate the relationship between carotid atherosclerosis and risk of stroke recurrence in the Chinese population. We performed a systematic review and meta-analysis of randomized controlled trials published from 2000 to 2013, using the following databases: PubMed, Embase, Medline, Wanfang, and the China National Knowledge Infrastructure. The odds ratios with 95% confidence intervals were calculated to examine this strength. A total of 22 studies, including 3,912 patients, 2,506 first-ever cases, and 1,406 recurrent cases, were pooled in this meta-analysis. Our results showed that the frequency of carotid atherosclerosis is higher in recurrent cases than that in the first-ever controls (78.88% vs 59.38%), and the statistical analysis demonstrated significant positive association between carotid atherosclerosis and recurrent cerebral infarction (odds ratio: 2.87; 95% confidence interval: 2.42-3.37; P<0.00001) in a fixed-effect model. No significant heterogeneity was observed across all studies. In conclusion, our results showed that carotid atherosclerosis was associated with increased risk of recurrent stroke. However, further well-designed research with large sample sizes is still needed to identify the clear mechanism.
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Affiliation(s)
- Jianping Liu
- Department of Science and Education, Nephrology, Orthopedic and Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, People's Republic of China
| | - Yun Zhu
- Department of Science and Education, Nephrology, Orthopedic and Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, People's Republic of China
| | - Yuhuai Wu
- Department of Science and Education, Nephrology, Orthopedic and Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, People's Republic of China
| | - Yan Liu
- Department of Science and Education, Nephrology, Orthopedic and Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, People's Republic of China
| | - Zhaowei Teng
- Department of Science and Education, Nephrology, Orthopedic and Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, People's Republic of China
| | - Yinglu Hao
- Department of Science and Education, Nephrology, Orthopedic and Cardiology, The People's Hospital of Yuxi City, The 6th Affiliated Hospital of Kunming Medical University, Yuxi, Yunan, People's Republic of China
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42
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Zeng Y, Cavalcante R, Tenekecioglu E, Suwannasom P, Sotomi Y, Collet C, Abdelghani M, Jonker H, Digne F, Horstkotte D, Zehender M, Indolfi C, Saia F, Fiorilli R, Chevalier B, Bolognese L, Goicolea J, Nie S, Onuma Y, Serruys PW. Comparative assessment of "plaque/media" change on three modalities of IVUS immediately after implantation of either everolimus-eluting bioresorbable vascular scaffold or everolimus-eluting metallic stent in Absorb II study. Int J Cardiovasc Imaging 2016; 33:441-449. [PMID: 28012050 PMCID: PMC5357282 DOI: 10.1007/s10554-016-1033-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 11/23/2016] [Indexed: 01/23/2023]
Abstract
The purpose of the study to assess the comparability of immediate changes in plaque/media volume (PV) on three modalities of intravascular ultrasound (IVUS) after implantation of either bioresorbable vascular scaffold (BVS) or everolimus-eluting metallic stent (EES) in Absorb II Study. The two devices have different device volume and ultrasound backscattering that may interfere with the “plaque/media” assessed by three modalities on IVUS: grayscale, backscattering of radiofrequency and brightness function. In a multicenter randomized controlled trial, 501 patients with stable or unstable angina underwent documentary IVUS pre- and post- implantation. The change in plaque/media volume (PV) was categorized into three groups according to the relative PV change in device segment: PV “increased” >+5% (PVI), PV unchanged ±5% (PVU), and PV decreased <−5% (PVD). The change in PV was re-evaluated three times: after subtraction of theoretical device volume, after analysis of echogenicity based on brightness function. In 449 patients, 483 lesions were analyzed pre- and post-implantation. “PVI” was more frequently observed in BVS (53.8%) than EES group (39.4%), p = 0.006. After subtraction of the theoretical device volume, the frequency of “PVI” decreased in both BVS (36.2%) and EES (32.1%) groups and became comparable (p = 0.581). In addition, the percentage of “PVI” was further reduced in both device groups after correction for either radiofrequency backscattering (BVS 34.4% vs. EES 22.6%) or echogenicity (BVS 25.2% vs. EES 9.7%). PV change in device segment was differently affected by BVS and EES devices implantation due to their differences in device volume and ultrasound backscattering. It implies that the lumen volume was also artifactually affected by the type of device implanted. Comparative IVUS assessment of lumen and plaque/media volume changes following implantation of BVS and EES requires specific methodological adjustment.
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Affiliation(s)
- Yaping Zeng
- ThoraxCentre, Erasmus Medical Center, Rotterdam, The Netherlands.,The Emergency & Critical Care Center of Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | | | | | | | - Yohei Sotomi
- Academic Medical Center, Amsterdam, The Netherlands
| | | | | | | | - Franck Digne
- The Cardiology Department, Centre Cardiologique du Nord, Saint Denis, France
| | - Dieter Horstkotte
- The Department of Cardiology, Heart and Diabetes Center North Rhine-Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany
| | - Manfred Zehender
- Department of Cardiology and Angiology, Heart Center University of Freiburg, Freiburg, Germany
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Sciences, University Magna Graecia, Campus di Germaneto, Catanzaro, Italy
| | - Francesco Saia
- Cardiology Institute, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy
| | | | | | - Leonardo Bolognese
- Cardiovascular and Neurological Department, Azienda Ospedaliera Arezzo, Arezzo, Italy
| | - Javier Goicolea
- Department of Interventional Cardiology, Puerta de Hierro University Hospital, Madrid, Spain
| | - Shaoping Nie
- The Emergency & Critical Care Center of Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yoshinobu Onuma
- ThoraxCentre, Erasmus Medical Center, Rotterdam, The Netherlands.,Cardialysis BV, Rotterdam, The Netherlands
| | - Patrick W Serruys
- International Centre for Circulatory Health, Imperial College London, South Kensington Campus, London, SW7 2AZ, UK. .,, Westblaak 98, 3012KM, Rotterdam, The Netherlands.
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43
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Poredos P. Intima-media thickness: indicator of cardiovascular risk and measure of the extent of atherosclerosis. Vasc Med 2016; 9:46-54. [PMID: 15230488 DOI: 10.1191/1358863x04vm514ra] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The measurement of intima-media thickness (IMT) of large superficial arteries, especially the carotid, using high-resolution B-mode ultrasonography has emerged as one of the methods of choice for determining the anatomic extent of atherosclerosis and for assessing cardiovascular risk. IMT measurement obtained by ultrasonography correlates very well with pathohistologic measurements and the reproducibility of this technique is good. Population studies have shown a strong correlation between carotid IMT and several cardiovascular risk factors, and it has also been found to be associated with the extent of atherosclerosis and end-organ damage of high-risk patients. Therefore, increased carotid IMT is a measure of athero-sclerotic burden and a predictor of subsequent events. Because of its quantitative value, carotid IMT measurement is more and more frequently used in clinical trials to test the effects of different preventive measures, including drugs. More recently, there has been interest in the clinical use of this technique for detecting preclinical (asymptomatic) atherosclerosis and for identifying subjects at high risk. Measurement of carotid IMT could influence a clinician to intervene with medication and to use more aggressive treatment of risk factors in primary prevention, and in patients with atherosclerotic disease in whom there is evidence of progression and extension of atherosclerotic disease. For more extensive use of this method in clinical practice a consensus concerning the standardization of methods of measurement and precise definition of threshold between normal and pathologic IMT value is urgently needed.
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Affiliation(s)
- Pavel Poredos
- Department for Vascular Disease, University Medical Centre, Ljubljana, Slovenia.
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44
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Macioch JE, Katsamakis CD, Robin J, Liebson PR, Meyer PM, Geohas C, Raichlen JS, Davidson MH, Feinstein SB. Effect of contrast enhancement on measurement of carotid artery intimal medial thickness. Vasc Med 2016; 9:7-12. [PMID: 15230482 DOI: 10.1191/1358863x04vm522oa] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Previous studies have used standard B-mode ultrasound to quantify the aggregate mean intimal medial thickness (IMT) of the near and far wall of the common carotid artery (CCA). Many investigators have had difficulty in accurately evaluating the near wall IMT secondary to difficulty in discerning the vessel lumen and intima. The purpose of this study is to determine the effect of contrast enhanced ultrasound on IMT measurement when compared with non-enhanced images. Twenty-six patients who had standard carotid ultrasounds completed over a 6-month period were evaluated, with 24 imaged by the same sonographer. Five to six measurements of the near and far walls were obtained over a 1 cm distance, beginning and ending 0.5 cm and 1.5 cm proximal to the carotid bifurcation. The measurements were made with and without the contrast agent OptisonTM (perflutren protein type-A microspheres), which was given as an IV bolus (0.5-0.7 cc). Of those imaged by the same sonographer, 40 carotid arteries were examined and a total of 867 measurements were obtained. A total of 10% of the carotid ultrasounds were restudied approximately 1 month after the initial interpretation to assess observer accuracy. The near wall CCA mean (SD) IMT was 0.075 (0.019)cm for left with contrast versus 0.067 (0.023)cm for left without contrast and 0.089 (0.024)cm for right with versus 0.071 (0.022)cm for right without, p 0.0001 both sides. For the far wall of the CCA, the mean (SD) IMT comparison was 0.075 (0.021)cm for left with versus 0.070 (0.016)cm for left without, p = 0.005, and 0.070 (0.023)cm for right with versus 0.070 (0.016) cm for right without, p = 0.68. In conclusion, contrast-enhanced IMT measurement showed a highly statistically significant difference in near carotid wall thickness determinations versus non-contrast values. The thicker measurement is in agreement with previously reported data showing that non-contrast images underestimated near wall common carotid IMT in histologic samples.
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Affiliation(s)
- James E Macioch
- Section of Cardiology, Rush-Presbyterian-St Luke's Medical Center, Rush University, Chicago, IL 60612-3833, USA
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45
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Abstract
Cardiovascular disease (CVD) primarily caused by atherosclerosis is a major cause of death and disability in developed countries. Sonographic carotid intima-media thickness (CIMT) is widely studied as a surrogate marker for detecting subclinical atherosclerosis for risk prediction and disease progress to guide medical intervention. However, there is no standardized CIMT measurement methodology in clinical studies resulting in inconsistent findings, thereby undermining the clinical value of CIMT. Increasing evidences show that CIMT alone has weak predictive value for CVD while CIMT including plaque presence consistently improves the predictive power. Quantification of plaque burden further enhances the predictive power beyond plaque presence. Sonographic carotid plaque characteristics have been found to be predictive of cerebral ischaemic events. With advances in ultrasound technology, enhanced assessment of carotid plaques is feasible to detect high-risk/vulnerable plaques, and provide risk assessment for ischemic stroke beyond measurement of luminal stenosis.
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Affiliation(s)
- Stella Sin Yee Ho
- Department of Imaging and Interventional Radiology, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China
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46
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Weberruß H, Pirzer R, Dalla Pozza R, Netz H, Oberhoffer R. Intima-Media Thickness Does Not Differ between Two Common Carotid Artery Segments in Children. PLoS One 2016; 11:e0149057. [PMID: 26968038 PMCID: PMC4788416 DOI: 10.1371/journal.pone.0149057] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 01/25/2016] [Indexed: 11/30/2022] Open
Abstract
Carotid intima-media thickness (cIMT) is a surrogate marker of early atherosclerotic changes in children. cIMT-studies are hard to compare, due to variations in ultrasound protocols, especially regarding the common carotid artery (CCA) segment measured in relation to the bulb. This study’s purpose was therefore to compare two distinct CCA segments in children, to see if cIMT values differ substantially according to the site of measurement. cIMT was assessed after power calculation in 30 children (15 girls) aged 8–17, using B-Mode ultrasound (5–13 MHz) at two CCA locations. The first measurement was performed over a distance of 1 cm immediately after the bulb (A), the second 1cm proximal the bulb (B) over the same distance of 1cm length. Means of end-diastolic far wall cIMT were compared between measurement A and B. cIMT in 30 participants was 0.51±0.06 mm for measurement A and 0.51±0.05 mm for measurement B. Results did not differ significantly (p = .947) over a distance of 2 cm after the bulb. According to our results, studies measuring CCA IMT within the first 2 cm, either close to the bulb or further proximal, can be compared. This will improve interpretation of data and application of reference values.
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Affiliation(s)
- Heidi Weberruß
- Institute of Preventive Pediatrics, Technische Universität München, Munich, Germany
| | - Raphael Pirzer
- Department of Pediatric Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Robert Dalla Pozza
- Department of Pediatric Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Heinrich Netz
- Department of Pediatric Cardiology, Ludwig-Maximilians-University, Munich, Germany
| | - Renate Oberhoffer
- Institute of Preventive Pediatrics, Technische Universität München, Munich, Germany
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47
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Haršány M, Tsivgoulis G, Alexandrov AV. Ultrasonography. Stroke 2016. [DOI: 10.1016/b978-0-323-29544-4.00046-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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48
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Infant adiposity at birth and early postnatal weight gain predict increased aortic intima-media thickness at 6 weeks of age: a population-derived cohort study. Clin Sci (Lond) 2015; 130:443-50. [PMID: 26666445 DOI: 10.1042/cs20150685] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 12/14/2015] [Indexed: 11/17/2022]
Abstract
Infant body composition and postnatal weight gain have been implicated in the development of adult obesity and cardiovascular disease, but there are limited prospective data regarding the association between infant adiposity, postnatal growth and early cardiovascular parameters. Increased aortic intima-media thickness (aortic IMT) is an intermediate phenotype of early atherosclerosis. The aim of the present study was to investigate the relationship between weight and adiposity at birth, postnatal growth and aortic IMT. The Barwon Infant Study (n=1074 mother-infant pairs) is a population-derived birth cohort. Infant weight and other anthropometry were measured at birth and 6 weeks of age. Aortic IMT was measured by trans-abdominal ultrasound at 6 weeks of age (n=835). After adjustment for aortic size and other factors, markers of adiposity including increased birth weight (β=19.9 μm/kg, 95%CI 11.1, 28.6; P<0.001) and birth skinfold thickness (β=6.9 μm/mm, 95%CI 3.3, 10.5; P<0.001) were associated with aortic IMT at 6 weeks. The association between birth skinfold thickness and aortic IMT was independent of birth weight. In addition, greater postnatal weight gain was associated with increased aortic IMT, independent of birth weight and age at time of scan (β=11.3 μm/kg increase, 95%CI 2.2, 20.3; P=0.01). Increased infant weight and adiposity at birth, as well as increased early weight gain, were positively associated with aortic IMT. Excessive accumulation of adiposity during gestation and early infancy may have adverse effects on cardiovascular risk.
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49
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Hong EG, Ohn JH, Lee SJ, Kwon HS, Kim SG, Kim DJ, Kim DS. Clinical implications of carotid artery intima media thickness assessment on cardiovascular risk stratification in hyperlipidemic Korean adults with diabetes: the ALTO study. BMC Cardiovasc Disord 2015; 15:114. [PMID: 26438201 PMCID: PMC4595332 DOI: 10.1186/s12872-015-0109-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Accepted: 09/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The primary objective was to investigate prevalence of subclinical atherosclerosis in Korean individuals with diabetes and hyperlipidemia. Association of subclinical atherosclerosis with cardiovascular risk was assessed. METHODS Assessments of carotid artery intima media thickness (cIMT) and atheromatous plaque were done using B-mode ultrasonography. Subclinical atherosclerosis was diagnosed based on presence of plaque, and/or increased cIMT versus mean cIMT reference values for Korean healthy controls. Atherosclerosis risk factors were analyzed using United Kingdom Prospective Diabetes Study (UKPDS) risk engine and Framingham Risk Score. RESULTS In total, 355 patients were included; increased mean cIMT was observed in 15.3 % of patients, 69 % had >1 carotid artery plaque, and 72.7 % were diagnosed with subclinical atherosclerosis. In total, 60 % of subjects were taking statins, with low-density lipoprotein cholesterol level maintained ~80 mg/dL at enrollment. Carotid artery measures were well correlated with UKPDS and Framingham risk scores. Prevalence of subclinical atherosclerosis in the low risk group (<15 % 10-year UKPDS-predicted coronary heart disease risk) was 64.7 %; higher than predicted in previous studies. In multivariate analysis, advanced age was a significant risk factor for subclinical atherosclerosis in men and women, while increased waist circumference and longer diabetes duration were independent predictors only in women. CONCLUSION Subclinical atherosclerosis is more prevalent among individuals with both diabetes and hyperlipidemia than in diabetic patients without additional cardiovascular risk factors. As conventional risk engines, based on modifiable risk factors may underestimate cardiovascular risk, early non-invasive carotid artery imaging screening may be warranted for patients with diabetes and hyperlipidemia, especially if they are elderly, have central obesity or have long duration of diabetes. TRIAL REGISTRATION www.clinicaltrials.gov NCT01264263.
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Affiliation(s)
- Eun-Gyoung Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
| | - Jung Hun Ohn
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
| | - Seong Jin Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea.
| | - Hyuk Sang Kwon
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary's Hospital, Seoul, Korea.
| | - Sin Gon Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, Korea University, Seoul, Korea.
| | - Dong Jun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Inje University College of Medicine, Goyang, Korea.
| | - Dong Sun Kim
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Hanyang University Hospital, 222-1 Wangsimni-ro, Seoul, Seongdong-gu, 133-792, Korea.
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50
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Maloberti A, Meani P, Varrenti M, Giupponi L, Stucchi M, Vallerio P, Giannattasio C. Structural and Functional Abnormalities of Carotid Artery and Their Relation with EVA Phenomenon. High Blood Press Cardiovasc Prev 2015; 22:373-9. [PMID: 25986075 DOI: 10.1007/s40292-015-0100-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 05/09/2015] [Indexed: 10/23/2022] Open
Abstract
Early vascular aging is a process characterized by a reduction in arterial elastin with an increase in collagen that has been related to cardiovascular risk factor and can determine an increased arterial stiffness and central blood pressure. It can be measured by several non invasive methods and in different arterial segment. The present paper will focus on functional (local stiffness parameter) and structural (intima media thickness) carotid arteries alterations typically evaluated by ultrasound methods. Methodological, research and clinical issue has been reviewed.
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Affiliation(s)
| | - Paolo Meani
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.,Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Marisa Varrenti
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.,Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Luca Giupponi
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.,Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Miriam Stucchi
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.,Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Paola Vallerio
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy.,Health Science Department, Milano-Bicocca University, Milan, Italy
| | - Cristina Giannattasio
- Cardiologia IV, Dipartimento A. De Gasperis, Ospedale Niguarda Ca' Granda, Piazza Ospedale Maggiore 3, 20159, Milan, Italy. .,Health Science Department, Milano-Bicocca University, Milan, Italy.
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