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Associations of atherosclerosis in the descending thoracic aorta on CTA with arterial stiffness and chronic kidney disease in asymptomatic patients with diabetes mellitus. Int J Cardiovasc Imaging 2014; 30:1151-9. [PMID: 24816844 DOI: 10.1007/s10554-014-0441-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2013] [Accepted: 04/29/2014] [Indexed: 10/25/2022]
Abstract
The relation between atherosclerosis in the descending thoracic aortic (DTA), arterial stiffness and chronic kidney disease (CKD) in patients with diabetes mellitus (DM) remains unclear. The current aim was to evaluate associations of DTA atherosclerosis with arterial stiffness and parameters of CKD in asymptomatic patients with DM. A total of 213 asymptomatic patients with diabetes (mean age 52 years, 56% men) underwent cardiovascular risk assessment including multi-slice computed tomography (for non-invasive coronary angiography, from which DTA atherosclerosis can be derived), non-invasive assessment of arterial stiffness with applanation tonometry and assessment of renal function. Measurements of DTA atherosclerosis included assessment of DTA thickening and calcium score. Arterial stiffness was determined by the carotid-femoral pulse wave velocity (PWV), parameters of CKD included estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (UACR). DTA atherosclerosis was present in 180 (84%) patients. Patients with DTA atherosclerosis had increased arterial stiffness, lower eGFR and higher UACR values. After multivariate correction, DTA calcium score was independently associated with PWV (β = 0.18, p = 0.04). Furthermore, both DTA maximal wall thickness and DTA calcium score were independently associated with eGFR (β = -7.37, p < 0.001 and β = -1.99, p < 0.003, respectively), but not with UACR. The increase in arterial stiffness by atherosclerosis seemed to be mediated by arterial calcification, while the DTA calcium score was independently associated with arterial stiffness, but not DTA maximal wall thickness. Furthermore, parameters of CKD in patients with DM had a distinct relationship with DTA atherosclerosis: DTA atherosclerosis was associated with eGFR but not with UACR.
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Katsanos AH, Giannopoulos S, Kosmidou M, Voumvourakis K, Parissis JT, Kyritsis AP, Tsivgoulis G. Complex atheromatous plaques in the descending aorta and the risk of stroke: a systematic review and meta-analysis. Stroke 2014; 45:1764-70. [PMID: 24788969 DOI: 10.1161/strokeaha.114.005190] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND AND PURPOSE Proximal aortic plaques, especially in the aortic arch, have already been established as an important cause of stroke and peripheral embolism. However, aortic plaques situated in the descending thoracic aorta have recently been postulated as a potential embolic source in patients with cryptogenic cerebral infarction through retrograde aortic flow. The aim of the present study was to evaluate the potential association of descending aorta atheromatosis with cerebral ischemia. METHODS We conducted a systematic review and meta-analysis of all available prospective observational studies reporting the prevalence of complex atheromatous plaques in the descending aorta in patients with stroke and in unselected populations undergoing examination with transesophageal echocardiography. RESULTS We identified 11 eligible studies including a total of 4000 patients (667 patients with stroke and 3333 unselected individuals; mean age, 65 years; 55% men). On baseline transesophageal echocardiograpic examination, the prevalence of complex atheromatous plaques in the descending aorta was higher (P=0.001) in patients with stroke (25.4%; 95% confidence interval, 14.6-40.4%) compared with unselected individuals (6.1%; 95% confidence interval, 3.4-10%). However, no significant difference (P=0.059) in the prevalence of complex atheromatous plaques in the descending aorta was found between patients with cryptogenic (21.8%; 95% confidence interval, 17.5-26.9%) and unclassified (28.3%; 95% confidence interval, 23.9-33.1%) cerebral infarction. CONCLUSIONS Our findings indicate that the presence of complex plaques in the descending aorta is presumably a marker of generalized atherosclerosis and high vascular risk. The present analyses do not provide any further evidence for a direct causal relationship between descending aorta atherosclerosis and cerebral embolism.
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Affiliation(s)
- Aristeidis H Katsanos
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and First Division of Internal Medicine (M.K.), School of Medicine, University of Ioannina, Ioannina, Greece; Second Department of Neurology (K.V., G.T.) and Second Department of Cardiology (J.T.P.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; and International Clinical Research Center, Department of Neurology, St Anne's University Hospital in Brno, Brno, Czech Republic (G.T.)
| | - Sotirios Giannopoulos
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and First Division of Internal Medicine (M.K.), School of Medicine, University of Ioannina, Ioannina, Greece; Second Department of Neurology (K.V., G.T.) and Second Department of Cardiology (J.T.P.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; and International Clinical Research Center, Department of Neurology, St Anne's University Hospital in Brno, Brno, Czech Republic (G.T.)
| | - Maria Kosmidou
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and First Division of Internal Medicine (M.K.), School of Medicine, University of Ioannina, Ioannina, Greece; Second Department of Neurology (K.V., G.T.) and Second Department of Cardiology (J.T.P.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; and International Clinical Research Center, Department of Neurology, St Anne's University Hospital in Brno, Brno, Czech Republic (G.T.)
| | - Konstantinos Voumvourakis
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and First Division of Internal Medicine (M.K.), School of Medicine, University of Ioannina, Ioannina, Greece; Second Department of Neurology (K.V., G.T.) and Second Department of Cardiology (J.T.P.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; and International Clinical Research Center, Department of Neurology, St Anne's University Hospital in Brno, Brno, Czech Republic (G.T.)
| | - John T Parissis
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and First Division of Internal Medicine (M.K.), School of Medicine, University of Ioannina, Ioannina, Greece; Second Department of Neurology (K.V., G.T.) and Second Department of Cardiology (J.T.P.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; and International Clinical Research Center, Department of Neurology, St Anne's University Hospital in Brno, Brno, Czech Republic (G.T.)
| | - Athanassios P Kyritsis
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and First Division of Internal Medicine (M.K.), School of Medicine, University of Ioannina, Ioannina, Greece; Second Department of Neurology (K.V., G.T.) and Second Department of Cardiology (J.T.P.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; and International Clinical Research Center, Department of Neurology, St Anne's University Hospital in Brno, Brno, Czech Republic (G.T.)
| | - Georgios Tsivgoulis
- From the Department of Neurology (A.H.K., S.G., A.P.K.) and First Division of Internal Medicine (M.K.), School of Medicine, University of Ioannina, Ioannina, Greece; Second Department of Neurology (K.V., G.T.) and Second Department of Cardiology (J.T.P.), Attikon Hospital, School of Medicine, University of Athens, Athens, Greece; and International Clinical Research Center, Department of Neurology, St Anne's University Hospital in Brno, Brno, Czech Republic (G.T.).
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Ichikawa T, Kawada S, Koizumi J, Endo J, Iino M, Terachi T, Usui Y, Nishibe T, Dardik A, Imai Y. Major Venous Anomalies Are Frequently Associated With Horseshoe Kidneys - Value of Multidetector Computed Tomography -. Circ J 2011; 75:2872-7. [DOI: 10.1253/circj.cj-11-0613] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Tamaki Ichikawa
- Department of Radiology, Tokai University School of Medicine
| | - Shuichi Kawada
- Department of Radiology, Tokai University School of Medicine
| | - Jun Koizumi
- Department of Radiology, Tokai University School of Medicine
| | - Jun Endo
- Department of Radiology, Tokai University School of Medicine
| | - Misako Iino
- Department of Radiology, Tokai University School of Medicine
| | | | - Yukio Usui
- Department of Urology, Tokai University School of Medicine
| | | | - Alan Dardik
- Department of Vascular Surgery, Yale University School of Medicine
| | - Yutaka Imai
- Department of Radiology, Tokai University School of Medicine
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Kuwaki H, Takeuchi M, Kaku K, Haruki N, Yoshitani H, Tamura M, Okazaki M, Abe H, Otsuji Y. Thrombus Attached to the Left Atrial Septal Pouch Assessed on 3-Dimensional Transesophageal Echocardiography. Circ J 2011; 75:2280-1. [DOI: 10.1253/circj.cj-11-0090] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Hiroshi Kuwaki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Masaaki Takeuchi
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Kyoko Kaku
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Nobuhiko Haruki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Hidetoshi Yoshitani
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Masahito Tamura
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Masahiro Okazaki
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Haruhiko Abe
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine
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