Early vascular damage in retinal microcirculation in arterial hypertension: the Czech post-MONICA study

Retinal microcirculation reflects retinal perfusion abnormalities and retinal arterial structural changes at relatively early stages of various cardiovascular diseases. Wall-to-lumen ratio (WLR) may represent the earliest step in hypertension-mediated organ damage.Our objective was to compare functional and structural parameters of retinal microcirculation in a randomly selected urban population sample, in hypertensive and normotensive individuals.

DESIGN AND METHOD

A total of 398 randomly selected individuals from an urban population aged 25-65 years, residing in Pilsen, Czech Republic, were screened for major cardiovascular risk factors. Retinal microcirculation was assessed using scanning laser Doppler flowmetry, with data evaluable in 343 patients. Complete data were available for 342 individuals divided into four groups based on blood pressure and control status of hypertension: normotensive individuals ( n  = 213), treated controlled hypertensive individuals ( n  = 30), treated uncontrolled hypertensive individuals ( n  = 26), and newly detected/untreated hypertensive individuals ( n  = 73).

RESULTS

There was a tendency to higher wall thickness in treated but uncontrolled hypertensive patients (compared to normotensive and treated controlled hypertensive individuals). WLR was significantly increased in treated but uncontrolled hypertensive patients as well as in individuals with newly detected thus untreated hypertension or in patients with known but untreated hypertension. There was no difference in WLR in treated, controlled hypertensive patients compared with normotensive individuals.

CONCLUSION

Our results show that an increased WLR, reflecting early vascular damage, was found in newly detected individuals with hypertension and in untreated hypertensive patients, reflecting early hypertension-mediated vascular damage. Early initiation of hypertension treatment may be warranted.

Lumen diameter is associated with the patency after percutaneous angioplasty of arteriovenous fistulas

AIM

To assess the value of lumen diameter after percutaneous angioplasty (PTA) to predict functional dialysis use (FDU) of arteriovenous fistulas (AVF).

METHODS

We performed a retrospective study of all patients who underwent first PTA because of AVF stenosis between March 2019 and March 2021. The outcome was FDU of AVF at 6 months follow up. Independent factors of FDU were identified using multivariate regression analyses. Receiver operating characteristic (ROC) curve was performed to investigate the predictive ability of lumen diameter for FDU.

RESULTS

A total 68 patients were included into this study and the AVF of 53 cases (77.9%) were good for FDU after 6 months. The AVF age was younger in failure group than that in success group (16.1 ± 9.1 months vs 28.3 ± 20.0 months, p = 0.026). Compared with failure group, the post-PTA minimum luminal diameter (MLD) was bigger in success group (4.5 [4.0-4.5 mm] vs 5.5 mm [4.5-5.5 mm], p < 0.001). Meanwhile, the gain of lumen diameter in success group was also bigger than that in failure group (2.5 mm [2.0-3.0 mm] in failure group vs 3.0 mm [2.75-3.5 mm] in success group, p = 0.012). The residual stenosis was higher in failure group than that in success group (30% [10%-40%] vs 10% [0%-20%], p = 0.003). Logistic regression showed that AVF age and post-PTA MLD were independent predictors of FDU. ROC analysis showed that the gain of lumen diameter, post-PTA MLD and improvement of stenosis were comparable to predict FDU. For post-PTA MLD, the area under ROC curve was 0.804 (95% CI, 0.681-0.927, p < 0.001). The best cutoff is 4.75 mm, with the sensitivity and specificity was 71.7% and 80.0%, respectively.

CONCLUSIONS

AVF age and post-PTA MLD were independently predictors for FDU of AVF after PTA. To get the best performance, a minimum vein diameter of 4.75 mm should be obtained after angioplasty.

Image-based assessment of uncertainty in quantification of carotid lumen

Measurements of the vessel lumen diameter are often used to determine the degree of atherosclerotic disease in carotid arteries. However, quantification results vary with imaging technique and acquisition settings. We aim at providing a tool that quantifies the lumen diameter on different image datasets and gives an estimate of quantification uncertainties, so that they can be taken into consideration when evaluating and comparing measurements. For the segmentation of the vessel lumen, we present an algorithm using ray-casting techniques and partial volume correction. We furthermore propose a scheme for the analysis and exploration of the lumen diameter. Finally, we present a clinically relevant application scenario, in which we explore agreement between lumen diameter estimations in corresponding computed tomography angiography, contrast-enhanced magnetic resonance angiography, time-of-flight, and subtraction images of carotid vessels with severe carotid atherosclerotic plaques.

Arterial stiffening is a heritable trait associated with arterial dilation but not wall thickening: a longitudinal study in the twins UK cohort

Aims

Vascular ageing is characterized by arterial stiffening, dilation, and arterial wall thickening. We investigated the extent to which these changes are related and their heritability during 5 year follow-up in the Twins UK cohort.

Methods and results

Carotid-femoral pulse wave velocity (PWVcf), carotid diameter, carotid distensibility, and carotid intima-media thickness (IMT) were measured in 762 female twins (mean age 57.9 ± 8.6 years) at two time-points over an average follow-up of 4.9 ± 1.5 years. Magnetic resonance imaging (MRI) was performed in a sub-sample of 38 women to measure aortic pulse wave velocity (PWVaorta), diameter, and wall thickness. Heritability of changes in arterial wall properties was estimated using structural equation modelling. Annual increases in PWVcf, carotid diameter, distensibility, and IMT were 0.139 m/s, 0.028 mm, -0.4 kPa-1, and 0.011 mm per year, respectively. In regression analysis, predictors of progression in PWVcf included age, mean arterial pressure (MAP), and heart rate (HR) at baseline, and progression in MAP, HR, and body mass index (BMI). Predictors of progression in IMT included progression in MAP, BMI, and triglyceride levels. Progression of PWV and distensibility correlated with progression in carotid diameter but not with IMT. Heritability of progression of PWVcf, diameter, and IMT was 55%, 21%, and 8%, respectively. In a sub-sample of women that underwent MRI, aortic wall thickness increased by 0.19 mm/year, but aortic wall thickening was not correlated with an increase in lumen diameter or PWVaorta.

Conclusion

Arterial stiffening, as measured by PWVcf, and dilation are heritable but independent of arterial wall thickening. Genetic and cardiovascular risk factors contribute differently to progression of PWV and IMT.

Computer-Aided Evaluation of Blood Vessel Geometry From Acoustic Images

A method for computer-aided assessment of blood vessel geometries based on shape-fitting algorithms from metric vision was evaluated. Acoustic images of cross sections of the radial artery and cephalic vein were acquired, and medical practitioners used a computer application to measure the wall thickness and nominal diameter of these blood vessels with a caliper method and the shape-fitting method. The methods performed equally well for wall thickness measurements. The shape-fitting method was preferable for measuring the diameter, since it reduced systematic errors by up to 63% in the case of the cephalic vein because of its eccentricity.

Wood Cellular Dendroclimatology: Testing New Proxies in Great Basin Bristlecone Pine

Dendroclimatic proxies can be generated from the analysis of wood cellular structures, allowing for a more complete understanding of the physiological mechanisms that control the climatic response of tree species. Century-long (1870-2013) time series of anatomical parameters were developed for Great Basin bristlecone pine (Pinus longaeva D.K. Bailey) by capturing strongly contrasted microscopic images through a Confocal Laser Scanning Microscope. Environmental information embedded in wood anatomical series was analyzed in comparison with ring-width series using measures of empirical signal strength. Response functions were calculated against monthly climatic variables to evaluate climate sensitivity of cellular features (e.g., lumen area; lumen diameter) for the period 1950-2013. Calibration-verification tests were used to determine the potential to generate long climate reconstructions from these anatomical proxies. A total of eight tree-ring parameters (two ring-width and six chronologies of xylem anatomical parameters) were analyzed. Synchronous variability among samples varied among tree-ring parameters, usually decreasing from ring-width to anatomical features. Cellular parameters linked to plant hydraulic performance (e.g., tracheid lumen area and radial lumen diameter) showed empirical signal strength similar to ring-width series, while noise was predominant in chronologies of lumen tangential width and cell wall thickness. Climatic signals were different between anatomical and ring-width chronologies, revealing a positive and temporally stable correlation of tracheid size (i.e., lumen and cell diameter) with monthly (i.e., March) and seasonal precipitation. In particular, tracheid lumen diameter emerged as a reliable moisture indicator and was then used to reconstruct total March-August precipitation from 1870 to 2013. Wood anatomy holds great potential to refine and expand dendroclimatic records by allowing estimates of plant physiological adaptations to external stressors. Integrating xylem cellular features with ring-width chronologies can widen our understanding of past climatic variability (including annual extreme events) and improve the evaluation of long-term plant response to drought, especially in connection with future warming scenarios.

Monitoring intra-annual dynamics of wood formation with microcores and dendrometers in Picea abies at two different altitudes

Seasonal analyses of cambial cell production and day-by-day stem radial increment can help to elucidate how climate modulates wood formation in conifers. Intra-annual dynamics of wood formation were determined with microcores and dendrometers and related to climatic signals in Norway spruce (Picea abies (L.) Karst.). The seasonal dynamics of these processes were observed at two sites of different altitude, Savignano (650 m a.s.l.) and Lavazè (1800 m a.s.l.) in the Italian Alps. Seasonal dynamics of cambial activity were found to be site specific, indicating that the phenology of cambial cell production is highly variable and plastic with altitude. There was a site-specific trend in the number of cells in the wall thickening phase, with the maximum cell production in early July (DOY 186) at Savignano and in mid-July (DOY 200) at Lavazè. The formation of mature cells showed similar trends at the two sites, although different numbers of cells and timing of cell differentiation were visible in the model shapes; at the end of ring formation in 2010, the number of cells was four times higher at Savignano (106.5 cells) than at Lavazè (26.5 cells). At low altitudes, microcores and dendrometers described the radial growth patterns comparably, though the dendrometer function underlined the higher upper asymptote of maximum growth in comparison with the cell production function. In contrast, at high altitude, these functions exhibited different trends. The best model was obtained by fitting functions of the Gompertz model to the experimental data. By combining radial growth and cambial activity indices we defined a model system able to synchronize these processes. Processes of adaptation of the pattern of xylogenesis occurred, enabling P. abies to occupy sites with contrasting climatic conditions. The use of daily climatic variables in combination with plant functional traits obtained by sensors and/or destructive sampling could provide a suitable tool to better investigate the effect of disturbances on response strategies in trees and, consequently, contribute to improving our prediction of tree growth and species resilience based on climate scenarios.

Carotid inter-adventitial diameter is more strongly related to plaque score than lumen diameter: An automated tool for stroke analysis

PURPOSE

To compare the strength of correlation between automatically measured carotid lumen diameter (LD) and interadventitial diameter (IAD) with plaque score (PS).

METHODS

Retrospective study on a database of 404 common carotid artery B-mode sonographic images from 202 diabetic patients. LD and IAD were computed automatically using an advanced computerized edge detection method and compared with two distinct manual measurements. PS was computed by adding the maximal thickness in millimeters of plaques in segments taken from the internal carotid artery, bulb, and common carotid artery on both sides.

RESULTS

The coefficient of correlation was 0.19 (p < 0.007) between LD and PS, and 0.25 (p < 0.0006) between IAD and PS. After excluding 10 outliers, coefficient of correlation was 0.25 (p < 0.0001) between LD and PS, and 0.38 (p < 0.0001) between IAD and PS. The precision of merit of automated versus the two manual measurements was 96.6% and 97.2% for LD, and 97.7% and 98.1%, for IAD, respectively.

CONCLUSIONS

Our automated measurement system gave satisfying results in comparison with manual measurements. Carotid IAD was more strongly correlated to PS than carotid LD in this population sample of Japanese diabetic patients.