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Zhang YL, Peng GL, Leng WL, Lian Y, Cheng LQ, Li X, Wang YL, Zhou L, Long M. Association between serum retinol-binding protein and lower limb atherosclerosis risk in type 2 diabetes mellitus. World J Diabetes 2025; 16:98590. [PMID: 40093277 PMCID: PMC11885983 DOI: 10.4239/wjd.v16.i3.98590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2024] [Revised: 11/13/2024] [Accepted: 12/30/2024] [Indexed: 01/21/2025] Open
Abstract
BACKGROUND Serum retinol-binding protein (RBP) is the primary transport protein of circulating vitamin A. RBP has a crucial role in maintaining nutrient metabolism and physiologic homeostasis. Several studies have indicated that serum RBP participates in the progression of diabetes and diabetes-related complications. However, the impact of serum RBP on lower limb atherosclerosis has not been determined in individuals with type 2 diabetes mellitus (T2DM). AIM To determine the association between serum RBP and lower limb atherosclerosis in individuals with T2DM. METHODS This retrospective study enrolled 4428 eligible T2DM patients and divided the patients into non-lower limb atherosclerosis (n = 1913) and lower limb atherosclerosis groups (n = 2515) based on lower limb arterial ultrasonography results. At hospital admission, baseline serum RBP levels were assessed, and all subjects were categorized into three groups (Q1-Q3) based on RBP tertiles. Logistic regression, restricted cubic spline regression, subgroup analysis, and machine learning were used to assess the association between RBP levels and lower limb atherosclerosis risk. RESULTS Among 4428 individuals with T2DM, 2515 (56.80%) had lower limb atherosclerosis. Logistic analysis showed that lower limb atherosclerosis risk increased by 1% for every 1 unit rise in serum RBP level (odds ratio = 1.01, 95% confidence interval: 1.00-1.02, P = 0.004). Patients in the highest tertile group (Q3) had a higher lower limb atherosclerosis risk compared to the lowest tertile group (Q1) (odds ratio = 1.36, 95% confidence interval: 1.12-1.67, P = 0.002). The lower limb atherosclerosis risk gradually increased with an increase in RBP tertile (P for trend = 0.005). Restricted cubic spline analysis indicated a linear correlation between serum RBP levels and lower limb atherosclerosis risk (non-linear P < 0.05). Machine learning demonstrated the significance and diagnostic value of serum RBP in predicting lower limb atherosclerosis risk. CONCLUSION Elevated serum RBP levels correlate with an increased lower limb atherosclerosis risk in individuals with T2DM.
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Affiliation(s)
- Yu-Ling Zhang
- Department of Endocrinology, Southwest Hospital, Army Medical University (The Third Military Medical University), Chongqing 400038, China
- Department of Endocrinology, Southwest Hospital Jiangbei Area (The 958th Hospital of Chinese People’s Liberation Army), Chongqing 400000, China
| | - Gui-Liang Peng
- Department of Endocrinology, Southwest Hospital, Army Medical University (The Third Military Medical University), Chongqing 400038, China
| | - Wei-Ling Leng
- Department of Endocrinology, Southwest Hospital, Army Medical University (The Third Military Medical University), Chongqing 400038, China
| | - Yu Lian
- Department of Endocrinology, Southwest Hospital Jiangbei Area (The 958th Hospital of Chinese People’s Liberation Army), Chongqing 400000, China
| | - Li-Qing Cheng
- Department of Endocrinology, Southwest Hospital, Army Medical University (The Third Military Medical University), Chongqing 400038, China
- Department of Endocrinology, Southwest Hospital Jiangbei Area (The 958th Hospital of Chinese People’s Liberation Army), Chongqing 400000, China
| | - Xing Li
- Department of Endocrinology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing 210093, Jiangsu Province, China
- Department of Endocrinology, Jinling Hospital, Nanjing Medical University, Nanjing 210093, Jiangsu Province, China
- Department of Endocrinology, Jinling Hospital, School of Medicine, Southeast University, Nanjing 210093, Jiangsu Province, China
| | - Yu-Lin Wang
- Department of Endocrinology, Southwest Hospital, Army Medical University (The Third Military Medical University), Chongqing 400038, China
| | - Ling Zhou
- Department of Endocrinology, Southwest Hospital, Army Medical University (The Third Military Medical University), Chongqing 400038, China
| | - Min Long
- Department of Endocrinology, Southwest Hospital, Army Medical University (The Third Military Medical University), Chongqing 400038, China
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Suslov AV, Kirichenko TV, Omelchenko AV, Chumachenko PV, Ivanova A, Zharikov Y, Markina YV, Markin AM, Postnov AY. Aortic Aneurysm with and without Dissection and Concomitant Atherosclerosis-Differences in a Retrospective Study. J Cardiovasc Dev Dis 2024; 11:311. [PMID: 39452282 PMCID: PMC11508889 DOI: 10.3390/jcdd11100311] [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: 08/28/2024] [Revised: 10/01/2024] [Accepted: 10/04/2024] [Indexed: 10/26/2024] Open
Abstract
BACKGROUND Thoracic aortic aneurysm is a latent disease with a high risk of death. Today, as data are accumulating, an estimation of the differences in thoracic aneurysm in men and women of different age groups is required. The present study evaluated the type of atherosclerotic aortic lesions in males and females at different ages regarding the presence or absence of aortic dissection. METHODS A retrospective analysis of clinical and morphological data of 43 patients with thoracic aortic aneurysm was carried out. Patients were divided into groups based on the presence or absence of thoracic aneurysm dissection. RESULTS Our results of a comparative analysis of the age of study participants showed that patients with aneurysm dissection were younger than patients without dissection. In the subgroup of patients with aortic dissection, the mean age was 50.6 years old, and in patients without aortic dissection, the mean age was 55.0 years old. When conducting a frequency analysis using Fisher's exact test, it was found that in men and women aneurysm dissection was not associated with atherosclerotic lesions of the aorta. CONCLUSIONS In women and men, aneurysm dissection was not associated with stage of atherosclerotic lesions of the aorta regardless of age; no statistically significant differences were found between the groups with and without aneurysm dissection (p > 0.05). Dissection of the thoracic aneurysm developed in the absence of severe atherosclerosis of the thoracic aorta. Only 18.6% men and women possessed atherosclerotic plaques of types IV and V.
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Affiliation(s)
- Andrey V. Suslov
- Petrovsky National Research Center of Surgery, Moscow 119991, Russia; (T.V.K.); (A.I.); (Y.V.M.); (A.M.M.); (A.Y.P.)
- Chazov National Medical Research Center of Cardiology, Moscow 121552, Russia;
- Department of Topographic Anatomy and Operative Surgery n.a. acad. Yu.M. Lopukhin, Pirogov Russian National Research Medical University, Moscow 117997, Russia
| | - Tatiana V. Kirichenko
- Petrovsky National Research Center of Surgery, Moscow 119991, Russia; (T.V.K.); (A.I.); (Y.V.M.); (A.M.M.); (A.Y.P.)
- Chazov National Medical Research Center of Cardiology, Moscow 121552, Russia;
| | | | - Petr V. Chumachenko
- Chazov National Medical Research Center of Cardiology, Moscow 121552, Russia;
| | - Alexandra Ivanova
- Petrovsky National Research Center of Surgery, Moscow 119991, Russia; (T.V.K.); (A.I.); (Y.V.M.); (A.M.M.); (A.Y.P.)
| | - Yury Zharikov
- Department of Human Anatomy and Histology, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow 125009, Russia;
| | - Yuliya V. Markina
- Petrovsky National Research Center of Surgery, Moscow 119991, Russia; (T.V.K.); (A.I.); (Y.V.M.); (A.M.M.); (A.Y.P.)
| | - Alexander M. Markin
- Petrovsky National Research Center of Surgery, Moscow 119991, Russia; (T.V.K.); (A.I.); (Y.V.M.); (A.M.M.); (A.Y.P.)
| | - Anton Yu. Postnov
- Petrovsky National Research Center of Surgery, Moscow 119991, Russia; (T.V.K.); (A.I.); (Y.V.M.); (A.M.M.); (A.Y.P.)
- Chazov National Medical Research Center of Cardiology, Moscow 121552, Russia;
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Greco F, Bertagna G, Quercioli L, Pucci A, Rocchiccioli S, Ferrari M, Recchia FA, McDonnell LA. Lipids associated with atherosclerotic plaque instability revealed by mass spectrometry imaging of human carotid arteries. Atherosclerosis 2024; 397:118555. [PMID: 39159550 DOI: 10.1016/j.atherosclerosis.2024.118555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 06/22/2024] [Accepted: 08/06/2024] [Indexed: 08/21/2024]
Abstract
BACKGROUND AND AIMS Lipids constitute one of the main components of atherosclerosis lesions and are the mediators of many mechanisms involved in plaque progression and stability. Here we tested the hypothesis that lipids known to be involved in plaque development exhibited associations with plaque vulnerability. We used spatial lipidomics to overcome plaque heterogeneity and to compare lipids from specific regions of symptomatic and asymptomatic human carotid atherosclerotic plaques. METHODS Carotid atherosclerotic plaques were collected from symptomatic and asymptomatic patients. Plaque lipids were analyzed with the spatial lipidomics technique matrix-assisted laser desorption/ionization mass spectrometry imaging, and histology and immunofluorescence were used to segment the plaques into histomolecularly distinct regions. RESULTS Macrophage-rich regions from symptomatic lesions were found to be enriched in phosphatidylcholines (synthesized to counteract excess free cholesterol), while the same region from asymptomatic plaques were enriched in polyunsaturated cholesteryl esters and triglycerides, characteristic of functional lipid droplets. Vascular smooth muscle cells (VSMCs) of the fibrous cap of asymptomatic plaques were enriched in lysophosphatidylcholines and cholesteryl esters, know to promote VSMC proliferation and migration, crucial for the buildup of the fibrous cap stabilizing the plaque. CONCLUSIONS The investigation of the region-specific lipid composition of symptomatic and asymptomatic human atherosclerotic plaques revealed specific lipid markers of plaque outcome, which could be linked to known biological characteristics of stable plaques.
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Affiliation(s)
- Francesco Greco
- Centro Health and BioMedLab, Scuola Superiore Sant'Anna, Pisa, Italy; Fondazione Pisana per la Scienza ONLUS, San Giuliano Terme (PI), Italy; Fondazione Toscana Gabriele Monasterio, Pisa, Italy
| | - Giulia Bertagna
- Azienda Ospedaliero Universitaria Pisana, Department of Vascular Surgery, Pisa, Italy
| | - Laura Quercioli
- Azienda Ospedaliero Universitaria Pisana, Department of Vascular Surgery, Pisa, Italy
| | - Angela Pucci
- Department of Histopathology, University Hospital, Pisa, Italy
| | | | - Mauro Ferrari
- Azienda Ospedaliero Universitaria Pisana, Department of Vascular Surgery, Pisa, Italy
| | - Fabio A Recchia
- Institute of Clinical Physiology, National Research Council, Pisa, Italy; Aging & Cardiovascular Discovery Center, Lewis Katz School of Medicine, Philadelphia, USA; Scuola Superiore Sant'Anna, Pisa, Italy
| | - Liam A McDonnell
- Fondazione Pisana per la Scienza ONLUS, San Giuliano Terme (PI), Italy.
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Mazzolai L, Teixido-Tura G, Lanzi S, Boc V, Bossone E, Brodmann M, Bura-Rivière A, De Backer J, Deglise S, Della Corte A, Heiss C, Kałużna-Oleksy M, Kurpas D, McEniery CM, Mirault T, Pasquet AA, Pitcher A, Schaubroeck HAI, Schlager O, Sirnes PA, Sprynger MG, Stabile E, Steinbach F, Thielmann M, van Kimmenade RRJ, Venermo M, Rodriguez-Palomares JF. 2024 ESC Guidelines for the management of peripheral arterial and aortic diseases. Eur Heart J 2024; 45:3538-3700. [PMID: 39210722 DOI: 10.1093/eurheartj/ehae179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Khamtuikrua C, Chaikittisilpa N, Suksompong S, Slisatkorn W, Raykateeraroj N. Prevalence of ascending aortic atheromatous plaques and risk factors in Thai cardiac surgery patients: A prospective cohort study. Heliyon 2024; 10:e36607. [PMID: 39262997 PMCID: PMC11388658 DOI: 10.1016/j.heliyon.2024.e36607] [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: 02/18/2024] [Revised: 07/30/2024] [Accepted: 08/19/2024] [Indexed: 09/13/2024] Open
Abstract
Cerebral embolism, a serious complication in cardiac surgery, is significantly impacted by atheromatous plaques in the ascending aorta and aortic arch. However, data on the prevalence of these plaques in Asian populations are sparse. This study aimed to evaluate the prevalence of atheromatous plaques in the ascending aorta among Thai cardiac surgery patients, thereby facilitating risk stratification and improving preoperative management. We conducted intraoperative epiaortic ultrasound examinations on 239 cardiac surgery patients. Clinically significant atheromatous plaques were defined as those exceeding 3.0 mm in thickness. The collected demographic and clinical data included sex, age, body weight, height, American Society of Anesthesiologists physical status classification, smoking status, alcohol consumption, and comorbidities. Atheromatous plaques were found in 33.5 % of the ascending aortas and 41.4 % of the aortic arches. The primary risk factors were advanced age (over 80 years; relative risk (RR) 1.444, 95 % confidence interval (CI) 1.113-1.874, P = 0.006) and carotid stenosis (RR 1.247, 95 % CI 1.04-1.495, P = 0.017). The prevalence of atheromatous plaques in Thai cardiac surgery patients was significant, with older age and carotid stenosis being major risk factors. Preoperative aortic imaging, such as computed tomography angiography or epiaortic ultrasound, should be applied to cardiac surgery candidates. In resource-limited settings, prioritizing patients of advanced age or those with carotid stenosis for imaging is advised.
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Affiliation(s)
- Chaowanan Khamtuikrua
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nophanan Chaikittisilpa
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Sirilak Suksompong
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Worawong Slisatkorn
- Division of Cardio-Thoracic Vascular Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Nattaya Raykateeraroj
- Department of Anesthesiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Ogino H, Iida O, Akutsu K, Chiba Y, Hayashi H, Ishibashi-Ueda H, Kaji S, Kato M, Komori K, Matsuda H, Minatoya K, Morisaki H, Ohki T, Saiki Y, Shigematsu K, Shiiya N, Shimizu H, Azuma N, Higami H, Ichihashi S, Iwahashi T, Kamiya K, Katsumata T, Kawaharada N, Kinoshita Y, Matsumoto T, Miyamoto S, Morisaki T, Morota T, Nanto K, Nishibe T, Okada K, Orihashi K, Tazaki J, Toma M, Tsukube T, Uchida K, Ueda T, Usui A, Yamanaka K, Yamauchi H, Yoshioka K, Kimura T, Miyata T, Okita Y, Ono M, Ueda Y. JCS/JSCVS/JATS/JSVS 2020 Guideline on Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection. Circ J 2023; 87:1410-1621. [PMID: 37661428 DOI: 10.1253/circj.cj-22-0794] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/05/2023]
Affiliation(s)
- Hitoshi Ogino
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Osamu Iida
- Cardiovascular Center, Kansai Rosai Hospital
| | - Koichi Akutsu
- Cardiovascular Medicine, Nippon Medical School Hospital
| | - Yoshiro Chiba
- Department of Cardiology, Mito Saiseikai General Hospital
| | | | | | - Shuichiro Kaji
- Department of Cardiovascular Medicine, Kansai Electric Power Hospital
| | - Masaaki Kato
- Department of Cardiovascular Surgery, Morinomiya Hospital
| | - Kimihiro Komori
- Division of Vascular and Endovascular Surgery, Department of Surgery, Nagoya University Graduate School of Medicine
| | - Hitoshi Matsuda
- Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center
| | - Kenji Minatoya
- Department of Cardiovascular Surgery, Graduate School of Medicine, Kyoto University
| | | | - Takao Ohki
- Division of Vascular Surgery, Department of Surgery, The Jikei University School of Medicine
| | - Yoshikatsu Saiki
- Division of Cardiovascular Surgery, Graduate School of Medicine, Tohoku University
| | - Kunihiro Shigematsu
- Department of Vascular Surgery, International University of Health and Welfare Mita Hospital
| | - Norihiko Shiiya
- First Department of Surgery, Hamamatsu University School of Medicine
| | | | - Nobuyoshi Azuma
- Department of Vascular Surgery, Asahikawa Medical University
| | - Hirooki Higami
- Department of Cardiology, Japanese Red Cross Otsu Hospital
| | | | - Toru Iwahashi
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kentaro Kamiya
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Takahiro Katsumata
- Department of Thoracic and Cardiovascular Surgery, Osaka Medical College
| | - Nobuyoshi Kawaharada
- Department of Cardiovascular Surgery, Sapporo Medical University School of Medicine
| | | | - Takuya Matsumoto
- Department of Vascular Surgery, International University of Health and Welfare
| | | | - Takayuki Morisaki
- Department of General Medicine, IMSUT Hospital, the Institute of Medical Science, the University of Tokyo
| | - Tetsuro Morota
- Department of Cardiovascular Surgery, Nippon Medical School Hospital
| | | | - Toshiya Nishibe
- Department of Cardiovascular Surgery, Tokyo Medical University
| | - Kenji Okada
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | | | - Junichi Tazaki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | - Masanao Toma
- Department of Cardiology, Hyogo Prefectural Amagasaki General Medical Center
| | - Takuro Tsukube
- Department of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital
| | - Keiji Uchida
- Cardiovascular Center, Yokohama City University Medical Center
| | - Tatsuo Ueda
- Department of Radiology, Nippon Medical School
| | - Akihiko Usui
- Department of Cardiac Surgery, Nagoya University Graduate School of Medicine
| | - Kazuo Yamanaka
- Cardiovascular Center, Nara Prefecture General Medical Center
| | - Haruo Yamauchi
- Department of Cardiac Surgery, The University of Tokyo Hospital
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
| | | | - Yutaka Okita
- Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine
| | - Minoru Ono
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Nana P, Jama K, Kölbel T, Spanos K, Panuccio G, Jakimowicz T, Rohlffs F. Sex-Comparative Outcomes of the T-Branch Device for the Treatment of Complex Aortic Aneurysms. J Clin Med 2023; 12:5811. [PMID: 37762752 PMCID: PMC10531663 DOI: 10.3390/jcm12185811] [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: 07/30/2023] [Revised: 09/01/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
INTRODUCTION Females are at increased risk of mortality compared to males after complex endovascular aortic repair. This study aims to examine sex-related peri-operative and follow-up outcomes in patients managed with the t-Branch device. METHODS A two-center retrospective analysis of patients managed with the off-the-shelf t-Branch device (Cook Medical Inc., Bjaeverskov, Denmark) between 1 January 2014 and 30 September 2020 was performed. Primary outcomes were sex-comparative 30-day mortality, major adverse events (MAEs) and spinal cord ischemia (SCI). RESULTS A total of 542 patients were included; 28.0% were females. Urgent repair and type I-III thoracoabdominal aneurysms were more common among females (52.6% vs. 34%, p = 0.01, and 57.1% vs. 35.8%, p = 0.004). Technical success was similar (97.4% vs. 96.9%, p = 0.755), as well as early mortality (16.2% in females vs. 10.8% in males; p = 0.084). SCI rates were similar between groups (13.6% vs. 9.2% p = 0.183). MAEs were more common in females; 33.7% vs. 21.4% (p = 0.022). Multivariate analysis did not identify sex as an independent predictor of adverse events. The 12-month survival rate was 75.7% (SE 0.045) for females and 84.1% (SE 0.026) for males (log rank, p = 0.10). CONCLUSIONS Sex was not detected as an independent factor of mortality, MAEs and SCI within patients managed with the t-Branch device. Feasibility was high in both groups. No significant difference was shown in survival during the 12-month follow-up.
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Affiliation(s)
- Petroula Nana
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center, University Medical Center Eppendorf, 20251 Hamburg, Germany; (T.K.); (K.S.); (G.P.); (F.R.)
| | - Katarzyna Jama
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, 02-006 Warsaw, Poland; (K.J.); (T.J.)
| | - Tilo Kölbel
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center, University Medical Center Eppendorf, 20251 Hamburg, Germany; (T.K.); (K.S.); (G.P.); (F.R.)
| | - Konstantinos Spanos
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center, University Medical Center Eppendorf, 20251 Hamburg, Germany; (T.K.); (K.S.); (G.P.); (F.R.)
- Vascular Surgery Department, University Hospital of Larissa, Faculty of Medicine, University of Thessaly, 41110 Larissa, Greece
| | - Giuseppe Panuccio
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center, University Medical Center Eppendorf, 20251 Hamburg, Germany; (T.K.); (K.S.); (G.P.); (F.R.)
| | - Tomasz Jakimowicz
- Department of General, Vascular and Transplant Surgery, Medical University of Warsaw, 02-006 Warsaw, Poland; (K.J.); (T.J.)
| | - Fiona Rohlffs
- German Aortic Center, Department of Vascular Medicine, University Heart and Vascular Center, University Medical Center Eppendorf, 20251 Hamburg, Germany; (T.K.); (K.S.); (G.P.); (F.R.)
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Hu Y, Cai Z, He B. Smooth Muscle Heterogeneity and Plasticity in Health and Aortic Aneurysmal Disease. Int J Mol Sci 2023; 24:11701. [PMID: 37511460 PMCID: PMC10380637 DOI: 10.3390/ijms241411701] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 07/16/2023] [Accepted: 07/18/2023] [Indexed: 07/30/2023] Open
Abstract
Vascular smooth muscle cells (VSMCs) are the predominant cell type in the medial layer of the aorta, which plays a critical role in the maintenance of aortic wall integrity. VSMCs have been suggested to have contractile and synthetic phenotypes and undergo phenotypic switching to contribute to the deteriorating aortic wall structure. Recently, the unprecedented heterogeneity and diversity of VSMCs and their complex relationship to aortic aneurysms (AAs) have been revealed by high-resolution research methods, such as lineage tracing and single-cell RNA sequencing. The aortic wall consists of VSMCs from different embryonic origins that respond unevenly to genetic defects that directly or indirectly regulate VSMC contractile phenotype. This difference predisposes to hereditary AAs in the aortic root and ascending aorta. Several VSMC phenotypes with different functions, for example, secreting VSMCs, proliferative VSMCs, mesenchymal stem cell-like VSMCs, immune-related VSMCs, proinflammatory VSMCs, senescent VSMCs, and stressed VSMCs are identified in non-hereditary AAs. The transformation of VSMCs into different phenotypes is an adaptive response to deleterious stimuli but can also trigger pathological remodeling that exacerbates the pathogenesis and development of AAs. This review is intended to contribute to the understanding of VSMC diversity in health and aneurysmal diseases. Papers that give an update on VSMC phenotype diversity in health and aneurysmal disease are summarized and recent insights on the role of VSMCs in AAs are discussed.
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Affiliation(s)
- Yunwen Hu
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Zhaohua Cai
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Ben He
- Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
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9
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Qazi S, Gona PN, Oyama-Manabe N, Salton CJ, O'Donnell CJ, Manning WJ, Chuang ML. Prevalence and distribution of aortic plaque by sex and age group among community-dwelling adults. Clin Imaging 2023; 94:79-84. [PMID: 36495849 DOI: 10.1016/j.clinimag.2022.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 10/04/2022] [Accepted: 11/28/2022] [Indexed: 12/05/2022]
Abstract
RATIONALE AND OBJECTIVES Atherosclerosis of the aorta is associated with increased risk of cardiovascular mortality and vascular events. We aim to describe the prevalence and distribution of non-calcified atherosclerotic plaque in the descending aorta as quantified by noncontrast cardiovascular magnetic resonance (CMR) in a community-dwelling cohort of adults. MATERIALS AND METHODS We used CMR to quantify noncalcified aortic plaque in 1726 participants (aged 65 ± 9 years, 46.7% men) from the Cohort Study Offspring cohort. ECG-gated, fat-suppressed, T2-weighted, black blood turbo spin echo sequence was used to acquire 36 transverse slices covering the descending aorta from just below the arch to the aortoiliac bifurcation. Plaque was defined as discrete luminal protrusions ≥1 mm; these were manually traced, then summed to determine total descending aortic plaque (DAP) and segmental thoracic and abdominal aortic plaque (TAP, AAP). Participants were stratified by sex and age group (<55, 55-64, 65-74, ≥75y). A healthy referent group (without clinical cardiovascular disease, smoking, diabetes, impaired renal function; (N = 768, 43.8% men) was used to determine upper 90th percentile cutpoints for DAP and AAP which were then applied to the overall study cohort. RESULTS Prevalence of DAP was similar between men (47.3%) and women (48.9%), p = 0.50, as was AAP prevalence (men: 44.5%, women: 46.7%, p = 0.16); TAP was less prevalent in both sexes (men: 8.9%, women: 7.1%, p = 0.15). Both prevalence and burden of DAP, AAP and TAP increased with advancing age. CONCLUSION Noncalcified plaque prevalence, visualized on CMR, in community-dwelling adults is similar between the sexes, and both prevalence and burden of aortic plaque increase with greater age.
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Affiliation(s)
- Saadia Qazi
- The National Heart, Lung and Blood Institute's (NHLBI) Framingham Heart Study, Framingham, MA, United States of America; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - Philimon N Gona
- The National Heart, Lung and Blood Institute's (NHLBI) Framingham Heart Study, Framingham, MA, United States of America; Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts, Boston, MA, United States of America
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Carol J Salton
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Christopher J O'Donnell
- The National Heart, Lung and Blood Institute's (NHLBI) Framingham Heart Study, Framingham, MA, United States of America; Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America
| | - Warren J Manning
- Harvard Medical School, Boston, MA, United States of America; Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, United States of America; Department of Radiology Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Michael L Chuang
- Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
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10
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Kamman AV, van Bakel PAJ, Yang B, Williams DM, Kim KM, Khaja MS, Moll FL, van Herwaarden JA, Trimarchi S, Eagle KA, Eliason JL, Patel HJ. Stroke Following Thoracic Endovascular Aortic Repair: Determinants, Short and Long Term Impact. Semin Thorac Cardiovasc Surg 2023; 35:19-30. [PMID: 35091051 DOI: 10.1053/j.semtcvs.2021.08.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 08/18/2021] [Indexed: 11/11/2022]
Abstract
We performed a contemporary assessment of clinical and radiographic factors of stroke after thoracic endovascular aortic repair (TEVAR). Patients undergoing TEVAR from 2006 to 2017 were identified. We assessed clinical and radiographic data, including preoperative head and neck computed tomography, Doppler ultrasonography, and intraoperative angiography. Our primary outcome was stroke after TEVAR. Four hundred seventy-nine patients underwent TEVAR, mean age 68.1 ± 19.5 years, 52.6% male. Indications for TEVAR included aneurysms (n = 238, 49.7%) or dissections (n = 152, 31.7%). Ishimaru landing zones were Zone 2 (n = 225, 47.0%), Zone 3 (n = 151, 31.5%), or Zone 4 (n = 103, 21.5%). Stroke occurred in 3.8% (n = 18) of patients, with 1.9% (8) major events (modified Rankin Scale >3). Pathophysiology was predominantly embolic (n = 14), and occurred in posterior (n = 6), anterior (n = 6), or combined circulation (n = 4), and in the left hemisphere (n = 10) or bilateral (n = 6). Univariate analysis suggested use of lumbar drain (33.3% versus 57.2%, P = 0.04), inability to revascularize the left subclavian artery (16.7% vs 5.2%, P = 0.04) and number of implanted components (2.5 ± 1.2 vs 2.0 ± 0.97, P = 0.03) were associated with stroke. Multivariable analysis identified number of implanted components (OR 1.7, 95%CI 1.17-2.67 P = 0.00) and inability to revascularize the left subclavian artery as independent predictors of stroke. Stroke was associated with a higher perioperative mortality (27.8% vs 3.9%, P < 0.01). Stroke after TEVAR is primarily embolic in nature and related to both anatomic and procedural factors. This may have important implications for device development in the era of endovascular arch repair.
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Affiliation(s)
- Arnoud V Kamman
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Italy; Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Pieter A J van Bakel
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Bo Yang
- Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - David M Williams
- Department of Radiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Karen M Kim
- Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Minhaj S Khaja
- Department of Radiology, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Frans L Moll
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Joost A van Herwaarden
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Santi Trimarchi
- Thoracic Aortic Research Center, Policlinico San Donato IRCCS, San Donato Milanese, Italy
| | - Kim A Eagle
- Department of Medicine, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Jonathan L Eliason
- Department of Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan
| | - Himanshu J Patel
- Department of Cardiac Surgery, Frankel Cardiovascular Center, University of Michigan, Ann Arbor, Michigan.
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11
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Neisius U, Gona PN, Oyama-Manabe N, Chuang ML, O’Donnell CJ, Manning WJ, Tsao CW. Relation of MRI Aortic Wall Area and Plaque to Incident Cardiovascular Events: The Framingham Heart Study. Radiology 2022; 304:542-550. [PMID: 35638924 PMCID: PMC9434818 DOI: 10.1148/radiol.210830] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 03/17/2022] [Accepted: 04/13/2022] [Indexed: 01/21/2023]
Abstract
Background Arterial arteriosclerosis and atherosclerosis reflect vascular disease, the subclinical detection of which allows opportunity for cardiovascular disease (CVD) prevention. Larger cohort studies simultaneously quantifying anatomic thoracic and abdominal aortic pathologic abnormalities are lacking in the literature. Purpose To investigate the association of aortic wall area (AWA) and atherosclerotic plaque presence and burden as measured on MRI scans with incident CVD in a community sample. Materials and Methods In this prospective cohort study, participants in the Framingham Heart Study Offspring Cohort without prevalent CVD underwent 1.5-T MRI (between 2002-2005) of the descending thoracic and abdominal aorta with electrocardiogram-gated axial T2-weighted black-blood acquisitions. The wall thickness of the thoracic aorta was measured at the pulmonary bifurcation level and used to calculate the AWA as the difference between cross-sectional vessel area and lumen area. For primary or secondary analyses, multivariable Cox proportional hazards regression models were used to examine the association of aortic MRI measures with risk of first-incident CVD events or stroke and coronary heart disease, respectively. Results In 1513 study participants (mean age, 64 years ± 9 [SD]; 842 women [56%]), 223 CVD events occurred during follow-up (median, 13.1 years), of which 97 were major events (myocardial infarction, ischemic stroke, or CVD death). In multivariable analysis, thoracic AWA and prevalent thoracic plaque were associated with incident CVD (hazard ratio [HR], 1.20 per SD unit [95% CI: 1.05, 1.37] [P = .006] and HR, 1.63 [95% CI: 1.12, 2.35] [P = .01], respectively). AWA and prevalent thoracic plaque were associated with increased hazards: 1.32 (95% CI: 1.07, 1.62; P = .01) and 2.20 (95% CI: 1.28, 3.79; P = .005), for stroke and coronary heart disease, respectively. Conclusion In middle-aged community-dwelling adults, thoracic aortic wall area (AWA), plaque prevalence, and plaque volumes measured with MRI were independently associated with incident cardiovascular disease, with AWA associated in particular with stroke, and plaque associated with coronary heart disease. Clinical trial registration no. NCT00041418 © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Peshock in this issue.
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Affiliation(s)
- Ulf Neisius
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | - Philimon N. Gona
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | | | - Michael L. Chuang
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | - Christopher J. O’Donnell
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | - Warren J. Manning
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
| | - Connie W. Tsao
- From the Department of Medicine, Cardiovascular Division (U.N., N.O.M., M.L.C., W.J.M., C.W.T.), Cardiovascular Imaging Core Laboratory (M.L.C.), and Department of Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215; Cardiology Section, Department of Medicine, VA Boston Healthcare System, Harvard Medical School, Boston, Mass (U.N., C.J.O.); Department of Exercise and Health Sciences, College of Nursing and Health Sciences, University of Massachusetts–Boston, Boston, Mass (P.N.G.); and the Framingham Heart Study, Framingham, Mass (C.J.O., C.W.T.)
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12
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Lüscher TF, Davies A, Beer JH, Valgimigli M, Nienaber CA, Camm JA, Baumgartner I, Diener HC, Konstantinides SV. Towards personalized antithrombotic management with drugs and devices across the cardiovascular spectrum. Eur Heart J 2022; 43:940-958. [PMID: 34624084 DOI: 10.1093/eurheartj/ehab642] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 05/06/2021] [Accepted: 09/01/2021] [Indexed: 01/10/2023] Open
Abstract
Intravascular thrombus formation and embolization are among the most frequent events leading to a number of cardiovascular conditions with high morbidity and mortality. The underlying causes are stasis of the circulating blood, genetic and acquired coagulation disorders, and reduced antithrombotic or prothrombotic properties of the vascular wall (Virchow's triad). In the venous system, intravascular thrombi can cause venous thrombosis and pulmonary and even peripheral embolism including ischaemic stroke [through a patent foramen ovale (PFO)]. Thrombi in the left atrium and its appendage or ventricle form in the context of atrial fibrillation and infarction, respectively. Furthermore, thrombi can form on native or prosthetic aortic valves, within the aorta (in particular at sites of ulcers, aortic dissection, and abdominal aneurysms), and in cerebral and peripheral arteries causing stroke and critical limb ischaemia, respectively. Finally, thrombotic occlusion may occur in arteries supplying vital organs such the heart, brain, kidney, and extremities. Thrombus formation and embolization can be managed with anticoagulants and devices depending on where they form and embolize and on patient characteristics. Vitamin K antagonists are preferred in patients with mechanical valves, while novel oral anticoagulants are first choice in most other cardiovascular conditions, in particular venous thromboembolism and atrial fibrillation. As anticoagulants are associated with a risk of bleeding, devices such as occluders of a PFO or the left atrial appendage are preferred in patients with an increased bleeding risk. Platelet inhibitors such as aspirin and/or P2Y12 antagonists are preferred in the secondary prevention of coronary artery disease, stroke, and peripheral artery disease either alone or in combination depending on the clinical condition. A differential and personalized use of anticoagulants, platelet inhibitors, and devices is recommended and reviewed in this article.
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Affiliation(s)
- Thomas F Lüscher
- Royal Brompton & Harefield Hospitals, Heart Division, Guy Scadding Building, Dovehouse Street, Imperial College, London SW3 6LY, UK.,Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Allan Davies
- Royal Brompton & Harefield Hospitals, Heart Division, Guy Scadding Building, Dovehouse Street, Imperial College, London SW3 6LY, UK
| | - Juerg H Beer
- Center for Molecular Cardiology, University of Zurich, Zurich, Switzerland
| | - Marco Valgimigli
- CardioCentro, Lugano, Switzerland.,University of Bern, Bern, Switzerland
| | - Christoph A Nienaber
- Royal Brompton & Harefield Hospitals, Heart Division, Guy Scadding Building, Dovehouse Street, Imperial College, London SW3 6LY, UK
| | - John A Camm
- St. Georges University and Imperial College, London, UK
| | | | - Hans-Christoph Diener
- Institute for Medical Informatics, Biometry and Epidemiology, Medical Faculty of the University Duisburg-Essen, Duisburg-Essen, Germany
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13
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Mammoto A, Matus K, Mammoto T. Extracellular Matrix in Aging Aorta. Front Cell Dev Biol 2022; 10:822561. [PMID: 35265616 PMCID: PMC8898904 DOI: 10.3389/fcell.2022.822561] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/07/2022] [Indexed: 12/11/2022] Open
Abstract
The aging population is booming all over the world and arterial aging causes various age-associated pathologies such as cardiovascular diseases (CVDs). The aorta is the largest elastic artery, and transforms pulsatile flow generated by the left ventricle into steady flow to maintain circulation in distal tissues and organs. Age-associated structural and functional changes in the aortic wall such as dilation, tortuousness, stiffening and losing elasticity hamper stable peripheral circulation, lead to tissue and organ dysfunctions in aged people. The extracellular matrix (ECM) is a three-dimensional network of macromolecules produced by resident cells. The composition and organization of key ECM components determine the structure-function relationships of the aorta and therefore maintaining their homeostasis is critical for a healthy performance. Age-associated remodeling of the ECM structural components, including fragmentation of elastic fibers and excessive deposition and crosslinking of collagens, is a hallmark of aging and leads to functional stiffening of the aorta. In this mini review, we discuss age-associated alterations of the ECM in the aortic wall and shed light on how understanding the mechanisms of aortic aging can lead to the development of efficient strategy for aortic pathologies and CVDs.
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Affiliation(s)
- Akiko Mammoto
- Department of Pediatrics, Milwaukee, WI, United States
- Department of Cell Biology, Neurobiology and Anatomy, Milwaukee, WI, United States
- *Correspondence: Akiko Mammoto, ; Tadanori Mammoto,
| | - Kienna Matus
- Department of Pediatrics, Milwaukee, WI, United States
| | - Tadanori Mammoto
- Department of Pediatrics, Milwaukee, WI, United States
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, WI, United States
- *Correspondence: Akiko Mammoto, ; Tadanori Mammoto,
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14
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Usefulness of rapid MR angiography using two-point Dixon for evaluating carotid and aortic plaques. Neuroradiology 2021; 64:693-702. [PMID: 34559244 DOI: 10.1007/s00234-021-02812-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 08/30/2021] [Indexed: 12/15/2022]
Abstract
PURPOSE Recently, various magnetic resonance imaging (MRI) modalities have been developed to easily detect carotid and aortic plaques, but these techniques are time-consuming and vulnerable to motion artifacts. We investigated the utility of a gradient echo MRI technique known as liver acquisition with volume acceleration flexible (LAVA-Flex) to detect carotid and aortic atherosclerotic plaques. METHODS Ten patients who underwent carotid endarterectomy (CEA) were assessed regarding the correspondence between LAVA-Flex findings and the histopathology of excised carotid plaques. In addition, 47 patients with cryptogenic ischemic stroke underwent LAVA-Flex and transesophageal echocardiography (TEE) for detection of embolic sources in the thoracic aorta. We analyzed the relationship between the thickness of the aortic plaque measured by TEE and the presence of high-intensity lesions on LAVA-Flex. RESULTS Nine of 10 patients (90.0%) who underwent CEA showed a high-intensity carotid lesion on LAVA-Flex, which corresponded pathologically to plaques containing large lipid cores and hemorrhage. Twenty-four (51.1%) of 47 cryptogenic stroke patients showed a high-intensity lesion in the thoracic aorta on LAVA-Flex; of these, 21 (87.5%) also demonstrated a large plaque (thickness ≥4 mm) on TEE. Twenty-two (95.7%) of 23 patients without a high-intensity lesion on LAVA-Flex demonstrated no large plaque on TEE. LAVA-Flex had a sensitivity of 95.5% and a specificity of 88.0% in patients with large plaques. CONCLUSION This study showed that LAVA-Flex successfully detected carotid and aortic plaques. This imaging technique may be useful to rapidly diagnose and evaluate carotid and aortic plaques, which are critical risk factors for aortogenic stroke.
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15
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Feng Y, Bai X, Zhang X, Wang T, Lu X, Yang K, Ling F, Ma Y, Jiao L. Risk factors for new ischemic cerebral lesions after carotid artery stenting: A systematic review and meta-analysis. Ann Vasc Surg 2021; 77:296-305. [PMID: 34437972 DOI: 10.1016/j.avsg.2021.05.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2020] [Revised: 04/13/2021] [Accepted: 05/11/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND New ischemic cerebral lesions (NICL) are commonly occur after carotid artery stenting (CAS) with an incidence rate ranging from 18-58% and are detected by diffusion-weighted imaging-magnetic resonance imaging (DWI-MRI). Numerous studies have reported that NICL could increase the risk of future cerebrovascular events and cognitive impairment. This systematic review and meta-analysis aimed to identify risk factors for NICL after CAS. METHODS Relevant literature reporting risk factors for NICL after CAS were searched. Randomized controlled trials, case-control studies, or cohort studies were included in accordance with the pre-specified eligibility criteria. The risk of bias was assessed using the Cochrane Collaboration criteria and the quality of evidence was assessed with the corresponding scale. Data were analyzed using the RevMan V. 5.3 analysis software. RESULTS The final analyses included a total of 21 studies and 1907 participants, including 764 NICL-positives and 1143 NICL-negatives. Determinants for NICL-positivity were age (mean deviation (MD): 2.60; 95% confidence interval (CI): [1.53-3.68]), symptomatic carotid lesions (odds ratio (OR): 1.77; 95% CI: [1.39-2.25]) and smoking (OR: 0.74; 95% CI: [0.58-0.94]). For symptomatic patients, risk factors for NICL-positive included diabetes mellitus (OR: 1.76; 95% CI: [1.09-2.82]), but smoking (OR: 0.54; 95% CI: [0.31-0.93]) was a protective factor. Risk factors for centers with high NICL incidence were age (MD: 2.05; 95% CI: [0.93-3.17]) and symptomatic carotid lesions (OR: 1.77; 95% CI: [1.29-2.45]). CONCLUSIONS Older age and symptomatic carotid lesions are associated with an increased risk of post-CAS NICL whereas smoking is associated with a decreased risk. Risk factors for NICL in symptomatic patients is diabetes mellitus, while those for patients at centers with high incidence are age and symptomatic carotid lesions. Systematic review registration: CRD42019121129.
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Affiliation(s)
- Yao Feng
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China
| | - Xuesong Bai
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China
| | - Xiao Zhang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China
| | - Tao Wang
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China
| | - Xia Lu
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China
| | - Kun Yang
- Department of Evidence-Based Medicine, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Feng Ling
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China
| | - Yan Ma
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China
| | - Liqun Jiao
- Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, China; China International Neuroscience Institute (China-INI), Beijing, China; Department of Interventional Neuroradiology, Capital Medical University, Beijing, China.
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16
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Nicot F, Charbonnel C, Jego C, Jourda F, Vinsonneau U, Garçon P, Turlotte G, Rivière JF, Maurin M, Lubret R, Meimoun P, Akret C, Cournot M, Sokic C, Michel L, Lescure M, Kenizou D, Melay M, Fayard M, Chauvat A, Fouché R, Cartigny G, Dijoux N, Martin AC, Tho-Agostini A, Mann H, Magnin D, Goralski M, Pico F, Georges JL, Belle L. Use of ADAM-C and CHA2DS2-VASc scores to predict complex aortic atheroma after brain ischemia: A prospective observational study. Echocardiography 2021; 38:612-622. [PMID: 33764608 DOI: 10.1111/echo.15034] [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: 11/10/2020] [Revised: 02/03/2021] [Accepted: 03/01/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND AIMS Complex aortic atheroma (CAA) is a common cause of acute brain ischemia (BI), including ischemic stroke (IS) and transient ischemic attack (TIA), and is associated with recurrence. The CHA2DS2-VASc score is a useful tool for predicting stroke in patients with atrial fibrillation (AF), and can also predict cardiovascular events in other populations, including non-AF populations. The ADAM-C score is a new risk score for predicting the diagnostic yield of transesophageal echocardiography (TEE) after BI. We aimed to evaluate the ability of CHA2DS2-VASc and ADAM-C scores to predict CAA after BI. METHODS This prospective, multicenter, observational study included 1479 patients aged over 18 years who were hospitalized for BI. CAA was defined as the presence of one or more of the following criteria: thrombus, ulcerated plaque, or plaque thickening ≥ 4 mm. RESULTS CAA was diagnosed in 216 patients (14.6%). CHA2DS2-VASc and ADAM-C scores were significantly higher in the CAA group versus the non-CAA group (P < .0001 for both). The CHA2DS2-VASc and ADAM-C scores appear to be good predictors of CAA (AUC 0.699 [0.635, 0.761] and 0.759 [0.702, 0.814], respectively). The sensitivity, specificity, predictive positive value (PPV), and negative predictive value (NPV) of the scores for detecting CAA were 94%, 22%, 17%, and 96%, respectively, for a CHA2DS2-VASc score < 2, and 90%, 46%, 22%, and 96%, respectively, for an ADAM-C score < 3 CONCLUSIONS: CHA2DS2-VASc and ADAM-C scores are able to predict CAA after BI. CHA2DS2-VASc < 2 and ADAM-C < 3 both have an interesting NPV of 96%.
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Affiliation(s)
- Florence Nicot
- Department of Cardiology, Versailles Hospital, Le Chesnay, France
| | | | - Christophe Jego
- Department of Cardiology, Toulon inter-armée Hospital, Toulon, France
| | | | - Ulric Vinsonneau
- Department of Cardiology, Brest inter-armée Hospital, Brest, France
| | - Philippe Garçon
- Department of Cardiology, Saint Joseph Hospital, Paris, France
| | - Guillaume Turlotte
- Department of Cardiology, La Roche sur Yon Hospital, La Roche sur Yon, France
| | | | - Marion Maurin
- Department of Cardiology, CHU Grenoble-Alpes, Grenoble, France
| | - Rémy Lubret
- Department of Cardiology, Boulogne sur mer Hospital, Boulogne sur mer, France
| | - Patrick Meimoun
- Department of Cardiology, Compiègne Hospital, Compiègne, France
| | - Chrystelle Akret
- Department of Cardiology, Annecy-Genevois Hospital, Annecy, France
| | - Maxime Cournot
- Department of Cardiology, Saint Paul Hospital, Saint Paul, France
| | - Charles Sokic
- Department of Cardiology, Haguenau Hospital, Haguenau, France
| | - Laurent Michel
- Department of Cardiology, Saint Lo Hospital, Saint Lo, France
| | | | - David Kenizou
- Department of Cardiology, Mulhouse Hospital, Mulhouse, France
| | - Marie Melay
- Department of Cardiology, Vichy Hospital, Vichy, France
| | - Maxime Fayard
- Department of Cardiology, Chalon sur Saone Hospital, Chalon sur Saone, France
| | - Anthony Chauvat
- Department of Cardiology, Argenteuil Hospital, Argenteuil, France
| | - Renaud Fouché
- Department of Cardiology, Montbéliard Hospital, Montbéliard, France
| | | | - Nicolas Dijoux
- Department of Cardiology, Saint Pierre Hospital, Saint Pierre, France
| | - Anne Céline Martin
- Department of Cardiology, European Georges Pompidou Hospital, Paris, France
| | | | - Hubert Mann
- Department of Cardiology, Voiron Hospital, Voiron, France
| | | | - Marc Goralski
- Department of Cardiology, Orléans Hospital, Orléans, France
| | - Fernando Pico
- Department of Cardiology, Versailles Hospital, Le Chesnay, France.,Department of Neurology, Université Versailles Saint-Quentin en Yvelines et Paris Saclay, Le Chesnay, France
| | | | - Loïc Belle
- Department of Cardiology, Annecy-Genevois Hospital, Annecy, France
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17
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Necas M, Adams M, Brennan O, Curtis N, Heslop R, Woodrow‐Smith E. The value of evaluating the abdominal aorta in patients <50 years of age presenting for abdominal ultrasound. Australas J Ultrasound Med 2021; 24:27-30. [PMID: 34760608 PMCID: PMC8412018 DOI: 10.1002/ajum.12212] [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: 01/30/2020] [Revised: 04/22/2020] [Accepted: 04/23/2020] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Practitioners of US routinely include a survey of the abdominal aorta during abdominal US in accordance with international guidelines. Such practice is of uncertain value in younger patients. METHODOLOGY This study was a retrospective review of 2000 abdominal US examinations which included visualisation of the aorta in patients <50 years of age. Patient demographics and referral details were recorded, and US images and reports were reviewed for the presence of aortic and periaortic pathology. RESULTS The most common indications for US were abdominal pain (1337, 44%), deranged liver function tests (453, 15%), nausea and/or vomiting (229, 8%), elevated inflammatory markers (146, 5%), pancreatitis (134, 4%) and pyrexia (127, 4%). Fewer than half (977, 49%) of the reports contained a comment regarding the aorta. Aortic pathology was reported in 2 (0.1%) cases. Both were reported as aortic ectasia and both represented a false-positive diagnosis. One male patient had a known abdominal aortic aneurysm with endovascular aortic repair. No new aortic aneurysms were found. All cases of atherosclerotic disease were ignored, and none were reported. Periaortic pathology was encountered on 1 patient, but this was known. No case of new periaortic pathology was detected. CONCLUSION Routine and indiscriminate imaging of the abdominal aorta during abdominal US in patients <50 years of age is not evidence based. No new case of abdominal aortic aneurysm or new para-aortic pathology was detected, all cases of atherosclerosis were ignored, and two false-positive diagnoses of aortic ectasia were made.
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Affiliation(s)
- Martin Necas
- Department of UltrasoundRadiologyWaikato HospitalPembroke StreetHamilton3204New Zealand
| | - Matt Adams
- Department of UltrasoundRadiologyWaikato HospitalPembroke StreetHamilton3204New Zealand
| | - Orlaith Brennan
- Department of UltrasoundRadiologyWaikato HospitalPembroke StreetHamilton3204New Zealand
| | - Nicole Curtis
- Department of UltrasoundRadiologyWaikato HospitalPembroke StreetHamilton3204New Zealand
| | - Rachel Heslop
- Department of UltrasoundRadiologyWaikato HospitalPembroke StreetHamilton3204New Zealand
| | - Emma Woodrow‐Smith
- Department of UltrasoundRadiologyWaikato HospitalPembroke StreetHamilton3204New Zealand
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18
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Juif A, Calame P, Winiszewski H, Turco C, Verdot P, Pili-Floury S, Piton G, Delabrousse E. Atherosclerosis is associated with poorer outcome in non-occlusive mesenteric ischemia. Eur J Radiol 2020; 134:109453. [PMID: 33290974 DOI: 10.1016/j.ejrad.2020.109453] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 11/19/2020] [Accepted: 11/24/2020] [Indexed: 02/08/2023]
Abstract
PURPOSE To evaluate whether abdominal atherosclerosis was associated with poorer outcome in a single-centre cohort of patients suffering from nonocclusive mesenteric ischemia (NOMI). METHODS From January 2009 to December 2019, 121 consecutive patients from the critical care unit who underwent laparotomy for suspected NOMI and with available unenhanced and contrast-enhanced CT were included. Clinical and biological data at the time of the CT scan were retrospectively extracted from medical charts and reviewed by a single radiologist. Unenhanced CT acquisitions were used to calculate calcium scores of the abdominal aorta, celiac trunk, superior mesenteric artery (SMA) and common iliac arteries according to the Agatston method. Univariate and multivariate analysis were performed. RESULTS Among the 121 patients with NOMI and calcium score calculation, only 4 patients had no aortic calcifications (3 %) and 32 had no superior mesenteric artery calcification (26 %). 35 patients (29 %) died within 24 h after the abdominal CT scan. Univariate analysis showed that a total abdominal calcium score greater than 15 000 (last quartile) was significantly associated with death within 24 h (14 (40 %) vs 17 (20 %) patients, p = 0.035). By multivariate analysis, a total abdominal calcium score greater than 15 000 was an independent risk factor for death (HR = 1.94, 95 %CI [1.02-3.73], p = 0.044). Regarding separate calcium scores, only a SMA calcium score greater than 50 was a risk factor for death (HR 2.46, 95 %CI [1.14-3.93], p = 0.019). CONCLUSION Our results show that abdominal atherosclerosis, especially in the SMA, is associated with poorer outcome in NOMI.
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Affiliation(s)
- Arnaud Juif
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Paul Calame
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France.
| | - Hadrien Winiszewski
- Medical Intensive Care Unit, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Celia Turco
- Digestive Surgery Unit, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Pierre Verdot
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Sebastien Pili-Floury
- Surgical Intensive Care Unit, University of Bourgogne Franche-Comté, CHRU Besançon, France
| | - Gael Piton
- Medical Intensive Care Unit, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
| | - Eric Delabrousse
- Department of Radiology, University of Bourgogne Franche-Comté, CHRU Besançon, 25030, Besançon, France
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19
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Stoka KV, Maedeker JA, Bennett L, Bhayani SA, Gardner WS, Procknow JD, Cocciolone AJ, Walji TA, Craft CS, Wagenseil JE. Effects of Increased Arterial Stiffness on Atherosclerotic Plaque Amounts. J Biomech Eng 2019; 140:2672193. [PMID: 29392300 DOI: 10.1115/1.4039175] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Indexed: 12/21/2022]
Abstract
Increased arterial stiffness is associated with atherosclerosis in humans, but there have been limited animal studies investigating the relationship between these factors. We bred elastin wildtype (Eln+/+) and heterozygous (Eln+/-) mice to apolipoprotein E wildtype (Apoe+/+) and knockout (Apoe-/-) mice and fed them normal diet (ND) or Western diet (WD) for 12 weeks. Eln+/- mice have increased arterial stiffness. Apoe-/- mice develop atherosclerosis on ND that is accelerated by WD. It has been reported that Apoe-/- mice have increased arterial stiffness and that the increased stiffness may play a role in atherosclerotic plaque progression. We found that Eln+/+Apoe-/- arterial stiffness is similar to Eln+/+Apoe+/+ mice at physiologic pressures, suggesting that changes in stiffness do not play a role in atherosclerotic plaque progression in Apoe-/- mice. We found that Eln+/-Apoe-/- mice have increased structural arterial stiffness compared to Eln+/+Apoe-/- mice, but they only have increased amounts of ascending aortic plaque on ND, not WD. The results suggest a change in atherosclerosis progression but not end stage disease in Eln+/-Apoe-/- mice due to increased arterial stiffness. Possible contributing factors include increased blood pressure and changes in circulating levels of interleukin-6 (IL6) and transforming growth factor beta 1 (TGF-β1) that are also associated with Eln+/- genotype.
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Affiliation(s)
- Kellie V Stoka
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO 63130
| | - Justine A Maedeker
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO 63130
| | - Lisa Bennett
- Department of Biomedical Engineering, Saint Louis University, St. Louis, MO 63130
| | - Siddharth A Bhayani
- Department of Biomedical Engineering, Saint Louis University, St. Louis, MO 63130
| | - William S Gardner
- Department of Biomedical Engineering, Saint Louis University, St. Louis, MO 63130
| | - Jesse D Procknow
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO 63130
| | - Austin J Cocciolone
- Department of Mechanical Engineering and Materials Science, Washington University, , St. Louis, MO 63130
| | - Tezin A Walji
- Department of Cell Biology and Physiology, Washington University, St. Louis, MO 63130
| | - Clarissa S Craft
- Department of Cell Biology and Physiology, Washington University, St. Louis, MO 63130
| | - Jessica E Wagenseil
- Department of Mechanical Engineering and Materials Science, Washington University, , St. Louis, MO 63130 e-mail:
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Vendrov AE, Sumida A, Canugovi C, Lozhkin A, Hayami T, Madamanchi NR, Runge MS. NOXA1-dependent NADPH oxidase regulates redox signaling and phenotype of vascular smooth muscle cell during atherogenesis. Redox Biol 2018; 21:101063. [PMID: 30576919 PMCID: PMC6302039 DOI: 10.1016/j.redox.2018.11.021] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/16/2018] [Accepted: 11/29/2018] [Indexed: 02/07/2023] Open
Abstract
Increased reactive oxygen species (ROS) production and inflammation are key factors in the pathogenesis of atherosclerosis. We previously reported that NOX activator 1 (NOXA1) is the critical functional homolog of p67phox for NADPH oxidase activation in mouse vascular smooth muscle cells (VSMC). Here we investigated the effects of systemic and SMC-specific deletion of Noxa1 on VSMC phenotype during atherogenesis in mice. Neointimal hyperplasia following endovascular injury was lower in Noxa1-deficient mice versus the wild-type following endovascular injury. Noxa1 deletion in Apoe-/- or Ldlr-/- mice fed a Western diet showed 50% reduction in vascular ROS and 30% reduction in aortic atherosclerotic lesion area and aortic sinus lesion volume (P < 0.01). SMC-specific deletion of Noxa1 in Apoe-/- mice (Noxa1SMC-/-/Apoe-/-) similarly decreased vascular ROS levels and atherosclerotic lesion size. TNFα-induced ROS generation, proliferation and migration were significantly attenuated in Noxa1-deficient versus wild-type VSMC. Immunofluorescence analysis of atherosclerotic lesions showed a significant decrease in cells positive for CD68 and myosin11 (22% versus 9%) and Mac3 and α-actin (17% versus 5%) in the Noxa1SMC-/-/Apoe-/- versus Apoe-/- mice. The expression of transcription factor KLF4, a modulator of VSMC phenotype, and its downstream targets – VCAM1, CCL2, and MMP2 – were significantly reduced in the lesions of Noxa1SMC-/-/Apoe-/- versus Apoe-/- mice as well as in oxidized phospholipids treated Noxa1SMC-/- versus wild-type VSMC. Our data support an important role for NOXA1-dependent NADPH oxidase activity in VSMC plasticity during restenosis and atherosclerosis, augmenting VSMC proliferation and migration and KLF4-mediated transition to macrophage-like cells, plaque inflammation, and expansion.
NOXA1 is a VSMC-specific regulator of NADPH oxidase 1 activity and downstream cell signaling. NOX1 NADPH oxidase-dependent ROS generation is required for VSMC proliferation and migration after endovascular injury. NOXA1-dependent NOX1 activation of KLF4 in atherosclerotic lesions induces SMC phenotypic switch to macrophage-like cells. Atherosclerotic lesion macrophage-like cells promote plaque inflammation, matrix remodeling and increase volume expansion.
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Affiliation(s)
- Aleksandr E Vendrov
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Arihiro Sumida
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Chandrika Canugovi
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Andrey Lozhkin
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Takayuki Hayami
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Nageswara R Madamanchi
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Marschall S Runge
- Frankel Cardiovascular Center, Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
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21
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Roseman DA, Hwang SJ, Oyama-Manabe N, Chuang ML, O'Donnell CJ, Manning WJ, Fox CS. Clinical associations of total kidney volume: the Framingham Heart Study. Nephrol Dial Transplant 2018; 32:1344-1350. [PMID: 27325252 DOI: 10.1093/ndt/gfw237] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 05/18/2016] [Indexed: 01/01/2023] Open
Abstract
Background Total kidney volume (TKV) is an imaging biomarker that may have diagnostic and prognostic utility. The relationships between kidney volume, renal function and cardiovascular disease (CVD) have not been characterized in a large community-dwelling population. This information is needed to advance the clinical application of TKV. Methods We measured TKV in 1852 Framingham Heart Study participants (mean age 64.1 ± 9.2 years, 53% women) using magnetic resonance imaging. A healthy sample was used to define reference values. The associations between TKV, renal function and CVD risk factors were determined using multivariable logistic regression analysis. Results Overall, mean TKV was 278 ± 54 cm3 for women and 365 ± 66 cm3 for men. Risk factors for high TKV (>90% healthy referent size) were body surface area (BSA), diabetes, smoking and albuminuria, while age, female and estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 were protective. Participants with high TKV had higher odds of diabetes [odds ratio (OR) 2.15, P < 0.001] and lower odds of eGFR <60 mL/min/1.73 m2 (OR 0.32, P = 0.007). Risk factors for low TKV (<10% healthy referent size) were age, female and eGFR <60 mL/min/1.73 m2, while BSA and diabetes were protective. Participants with low TKV had higher odds of eGFR <60 mL/min/1.73 m2 (OR 6.12, P < 0.001) and albuminuria (OR 1.56, P = 0.03). Conclusions Low TKV is associated with markers of kidney damage including albuminuria and eGFR <60 mL/min/1.73 m2, while high TKV is associated with diabetes and decreased odds of eGFR <60 mL/min/1.73 m2. Prospective studies are needed to characterize the natural progression and clinical consequences of TKV.
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Affiliation(s)
- Daniel A Roseman
- National Heart, Lung and Blood Institute, Framingham Heart Study, Framingham, MA, USA
| | - Shih-Jen Hwang
- National Heart, Lung and Blood Institute, Framingham Heart Study, Framingham, MA, USA.,Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA
| | - Noriko Oyama-Manabe
- Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Sapporo, Japan
| | - Michael L Chuang
- National Heart, Lung and Blood Institute, Framingham Heart Study, Framingham, MA, USA.,Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Christopher J O'Donnell
- National Heart, Lung and Blood Institute, Framingham Heart Study, Framingham, MA, USA.,Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.,Cardiology Section, Veterans Affairs Boston Healthcare System, Boston, MA, USA
| | - Warren J Manning
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA.,Department of Radiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, USA
| | - Caroline S Fox
- National Heart, Lung and Blood Institute, Framingham Heart Study, Framingham, MA, USA.,Division of Intramural Research, National Heart, Lung, and Blood Institute, Bethesda, MD, USA.,Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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22
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Geraci G, Mulè G, Paladino G, Zammuto MM, Castiglia A, Scaduto E, Zotta F, Geraci C, Granata A, Mansueto P, Cottone S. Relationship between kidney findings and systemic vascular damage in elderly hypertensive patients without overt cardiovascular disease. J Clin Hypertens (Greenwich) 2017; 19:1339-1347. [DOI: 10.1111/jch.13127] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/03/2017] [Accepted: 08/14/2017] [Indexed: 01/24/2023]
Affiliation(s)
- Giulio Geraci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS); Unit of Nephrology and Hypertension; European Society of Hypertension Excellence Center; University of Palermo; Palermo Italy
| | - Giuseppe Mulè
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS); Unit of Nephrology and Hypertension; European Society of Hypertension Excellence Center; University of Palermo; Palermo Italy
| | - Gabriella Paladino
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS); Unit of Geriatrics; University of Palermo; Palermo Italy
| | - Marta Maria Zammuto
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS); Unit of Nephrology and Hypertension; European Society of Hypertension Excellence Center; University of Palermo; Palermo Italy
| | - Antonella Castiglia
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS); Unit of Nephrology and Hypertension; European Society of Hypertension Excellence Center; University of Palermo; Palermo Italy
| | - Emilia Scaduto
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS); Unit of Nephrology and Hypertension; European Society of Hypertension Excellence Center; University of Palermo; Palermo Italy
| | - Federica Zotta
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS); Unit of Nephrology and Hypertension; European Society of Hypertension Excellence Center; University of Palermo; Palermo Italy
| | - Calogero Geraci
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS); Unit of Nephrology and Hypertension; European Society of Hypertension Excellence Center; University of Palermo; Palermo Italy
| | - Antonio Granata
- “San Giovanni di Dio” Hospital; Unit of Nephrology and Dialysis; Agrigento Italy
| | - Pasquale Mansueto
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS); Unit of Geriatrics; University of Palermo; Palermo Italy
| | - Santina Cottone
- Dipartimento Biomedico di Medicina Interna e Specialistica (DIBIMIS); Unit of Nephrology and Hypertension; European Society of Hypertension Excellence Center; University of Palermo; Palermo Italy
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23
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Association of descending thoracic aortic plaque with brain atrophy and white matter hyperintensities: The Framingham Heart Study. Atherosclerosis 2017; 265:305-311. [PMID: 28673480 DOI: 10.1016/j.atherosclerosis.2017.06.919] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Revised: 05/24/2017] [Accepted: 06/21/2017] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND AIMS Aortic atherosclerosis is an aggregate marker of vascular risk factor exposure and has been associated with intracranial atherosclerosis and stroke. We hypothesized that atherosclerosis of the descending aorta (DAo) could be a risk marker for brain aging and injury. METHODS We evaluated 1527 participants (mean age 59.9 years, 53.5% women) in the Framingham Offspring cohort who underwent both aortic and brain MRI. Participants were free of clinical stroke, dementia, or other neurological illness at the time of axial MRI of the thoracic and abdominal DAo and subsequent brain MRI. We related the prevalence and burden of aortic plaque to total cerebral brain volume (TCBV) and white matter hyperintensity volume (WMHV). An additional analysis compared incidence of stroke or TIA in participants with and without DAo plaques. RESULTS Presence of thoracic DAo plaque (8%) was associated with decreased TCBV in sex-pooled analysis (-0.77, SE 0.25, p = 0.002, equivalent to 4.5 years of aging) and with increased WMHV only in men (0.26, SE 0.12, p = 0.032, equivalent to 6.5 years aging). We observed similar associations of DAo plaque burden with TCBV and WMHV. There were 43 strokes and 11 TIAs in prospective follow-up (median 7 years). Presence of DAo plaque was not associated with subsequent stroke or TIA. CONCLUSIONS In this cross-sectional community-based study, we found DAo plaque is associated with accelerated brain aging. These data underscore the potential implications of incidentally identified subclinical aortic atherosclerosis and question whether targeted intervention in these high risk individuals can modulate cognitive decline.
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24
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Yaghi S, Bernstein RA, Passman R, Okin PM, Furie KL. Cryptogenic Stroke: Research and Practice. Circ Res 2017; 120:527-540. [PMID: 28154102 DOI: 10.1161/circresaha.116.308447] [Citation(s) in RCA: 135] [Impact Index Per Article: 16.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 09/23/2016] [Accepted: 10/04/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Cryptogenic stroke accounts for 30% to 40% of ischemic stroke. It is essential to determine the possible culprit because this will improve secondary stroke prevention strategies. METHODS We performed a narrative nonsystematic review of the literature that included randomized trials, exploratory comparative studies, and case series on cryptogenic stroke. RESULTS There are several possible mechanisms implicated in cryptogenic stroke, including occult paroxysmal atrial fibrillation, patent foramen ovale, aortic arch atherosclerosis, atrial cardiopathy, and substenotic atherosclerosis. The heterogeneity of these mechanisms leads to differences in stroke prevention strategies among cryptogenic stroke patients. CONCLUSIONS A thorough diagnostic evaluation is essential to determine the pathogenesis in cryptogenic stroke. This approach, in addition to risk factor management and lifestyle modifications, will lead to improved stroke prevention strategies in patients with cryptogenic stroke. This will allow for targeted clinical trials to improve stroke prevention strategies in this patient population.
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Affiliation(s)
- Shadi Yaghi
- From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.)
| | - Richard A Bernstein
- From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.)
| | - Rod Passman
- From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.)
| | - Peter M Okin
- From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.)
| | - Karen L Furie
- From the Department of Neurology, The Warren Alpert Medical School of Brown University, Providence, RI (S.Y., K.L.F.); Department of Neurology (R.A.B.) and Department of Internal Medicine, Division of Cardiovascular Medicine (R.P.), The Feinberg School of Medicine, Northwestern University, Chicago, IL; and Department of Internal Medicine, Division of Cardiology, Weill Cornell Medicine, New York, NY (P.M.O.).
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Abstract
Aortic diseases are a heterogeneous group of disorders, including atherothrombotic conditions like aortic atheroma, cholesterol embolization syndrome, aortic mural thrombus, thrombus within an aneurysm, and large vessel vasculitis. In this review, we provide a summary of the current evidence regarding atherothrombotic diseases of the aorta, focusing on therapeutic avenues. In patients with previous stroke, aortic arch atheroma is recognized as a strong predictor of recurrent atheroembolism, and antiplatelet therapy alone is still associated with a high (11.1%) residual risk of recurrent stroke. In secondary prevention, the use of dual antiplatelet therapy or moderate intensity anticoagulation with warfarin may lower the risk of recurrent stroke at a cost of increased life-threatening bleeding. Thrombi adherent to the aortic wall are generally associated with underlying atherosclerosis or aneurysmal disease. Primary aortic mural thrombus is a rare condition, sometimes related with systemic prothrombotic or inflammatory diseases. Retrospective studies suggest that anticoagulation is beneficial in patients with mobile mural thrombus. The pathogenesis and consequences of thrombus in an aortic aneurysm, or in an endograft following endovascular aneurysm repair, have been studied, but the role of antiplatelet therapy in those two conditions is still unclear and should be driven by general cardiovascular risk prevention. The benefit of anticoagulation to reduce thrombus load is uncertain. Patients with large vessel vasculitis experience increased cardiovascular events secondary to inflammation-driven atherothrombotic processes. Antiplatelet therapy is recommended as part of the therapy for prevention of cardiovascular disease. Anticoagulation with warfarin has shown limited benefit in few retrospective studies.
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Affiliation(s)
- Francois Caron
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine and Clinical Epidemiology, McMaster University, Hamilton, Ontario, Canada
| | - Sonia S Anand
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Department of Medicine and Clinical Epidemiology, McMaster University, Hamilton, Ontario, Canada
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26
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Chirichella TJ, Dunham CM, Zimmerman MA, Phelan EM, Mandell MS, Conzen KD, Kelley SE, Nydam TL, Bak TE, Kam I, Wachs ME. Donor preoperative oxygen delivery and post-extubation hypoxia impact donation after circulatory death hypoxic cholangiopathy. World J Gastroenterol 2016; 22:3392-3403. [PMID: 27022221 PMCID: PMC4806197 DOI: 10.3748/wjg.v22.i12.3392] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Revised: 10/06/2015] [Accepted: 12/01/2015] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate donation after circulatory death (DCD) orthotopic liver transplant outcomes [hypoxic cholangiopathy (HC) and patient/graft survival] and donor risk-conditions.
METHODS: From 2003-2013, 45 DCD donor transplants were performed. Predonation physiologic data from UNOS DonorNet included preoperative systolic and diastolic blood pressure, heart rate, pH, SpO2, PaO2, FiO2, and hemoglobin. Mean arterial blood pressure was computed from the systolic and diastolic blood pressures. Donor preoperative arterial O2 content was computed as [hemoglobin (gm/dL) × 1.37 (mL O2/gm) × SpO2%) + (0.003 × PaO2)]. The amount of preoperative donor red blood cell transfusions given and vasopressor use during the intensive care unit stay were documented. Donors who were transfused ≥ 1 unit of red-cells or received ≥ 2 vasopressors in the preoperative period were categorized as the red-cell/multi-pressor group. Following withdrawal of life support, donor ischemia time was computed as the number-of-minutes from onset of diastolic blood pressure < 60 mmHg until aortic cross clamping. Donor hypoxemia time was the number-of-minutes from onset of pulse oximetry < 80% until clamping. Donor hypoxia score was (ischemia time + hypoxemia time) ÷ donor preoperative hemoglobin.
RESULTS: The 1, 3, and 5 year graft and patient survival rates were 83%, 77%, 60%; and 92%, 84%, and 72%, respectively. HC occurred in 49% with 16% requiring retransplant. HC occurred in donors with increased age (33.0 ± 10.6 years vs 25.6 ± 8.4 years, P = 0.014), less preoperative multiple vasopressors or red-cell transfusion (9.5% vs 54.6%, P = 0.002), lower preoperative hemoglobin (10.7 ± 2.2 gm/dL vs 12.3 ± 2.1 gm/dL, P = 0.017), lower preoperative arterial oxygen content (14.8 ± 2.8 mL O2/100 mL blood vs 16.8 ± 3.3 mL O2/100 mL blood, P = 0.049), greater hypoxia score >2.0 (69.6% vs 25.0%, P = 0.006), and increased preoperative mean arterial pressure (92.7 ± 16.2 mmHg vs 83.8 ± 18.5 mmHg, P = 0.10). HC was independently associated with age, multi-pressor/red-cell transfusion status, arterial oxygen content, hypoxia score, and mean arterial pressure (r2 = 0.6197). The transplantation rate was greater for the later period with more liberal donor selection [era 2 (7.1/year)], compared to our early experience [era 1 (2.5/year)]. HC occurred in 63.0% during era 2 and in 29.4% during era 1 (P = 0.03). Era 2 donors had longer times for extubation-to-asystole (14.4 ± 4.7 m vs 9.3 ± 4.5 m, P = 0.001), ischemia (13.9 ± 5.9 m vs 9.7 ± 5.6 m, P = 0.03), and hypoxemia (16.0 ± 5.1 m vs 11.1 ± 6.7 m, P = 0.013) and a higher hypoxia score > 2.0 rate (73.1% vs 28.6%, P = 0.006).
CONCLUSION: Easily measured donor indices, including a hypoxia score, provide an objective measure of DCD liver transplantation risk for recipient HC. Donor selection criteria influence HC rates.
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Maedeker JA, Stoka KV, Bhayani SA, Gardner WS, Bennett L, Procknow JD, Staiculescu MC, Walji TA, Craft CS, Wagenseil JE. Hypertension and decreased aortic compliance due to reduced elastin amounts do not increase atherosclerotic plaque accumulation in Ldlr-/- mice. Atherosclerosis 2016; 249:22-9. [PMID: 27062406 DOI: 10.1016/j.atherosclerosis.2016.03.022] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 02/17/2016] [Accepted: 03/16/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND AIMS High blood pressure and reduced aortic compliance are associated with increased atherosclerotic plaque accumulation in humans. Animal studies support these associations, but additional factors, such as fragmented elastic fibers, are present in most previous animal studies. Elastin heterozygous (Eln+/-) mice have high blood pressure and reduced aortic compliance, with no evidence of elastic fiber fragmentation and represent an appropriate model to directly investigate the effects of these factors on atherosclerosis. METHODS AND RESULTS Eln+/- and Eln+/+ mice were crossed with low density lipoprotein receptor knockout (Ldlr-/-) and wild-type (Ldlr+/+) mice and fed normal or Western diet (WD) for 16 weeks. We hypothesized that on WD, Eln+/-Ldlr-/- mice with high blood pressure and reduced aortic compliance would have increased atherosclerotic plaque accumulation compared to Eln+/+Ldlr-/- mice. We measured serum cholesterol and cytokine levels, blood pressure, aortic compliance, and plaque accumulation. Contrary to our hypothesis, we found that on WD, Eln+/-Ldlr-/- mice do not have increased plaque accumulation compared to Eln+/+Ldlr-/- mice. At the aortic root, there are no significant differences in plaque area between Eln+/-Ldlr-/- and Eln+/+Ldlr-/- mice on WD (p = 0.89), while in the ascending aorta, Eln+/-Ldlr-/- mice on WD have 29% less normalized plaque area than Eln+/+Ldlr-/- mice on WD (p = 0.009). CONCLUSION Using an atherogenic mouse model, we conclude that increased blood pressure and reduced aortic compliance are not direct causes of increased aortic plaque accumulation. We propose that additional insults, such as fragmentation of elastic fibers, are necessary to alter plaque accumulation.
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Affiliation(s)
- Justine A Maedeker
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA
| | - Kellie V Stoka
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA
| | - Siddharth A Bhayani
- Department of Biomedical Engineering, Saint Louis University, St. Louis, MO, USA
| | - William S Gardner
- Department of Biomedical Engineering, Saint Louis University, St. Louis, MO, USA
| | - Lisa Bennett
- Department of Biomedical Engineering, Saint Louis University, St. Louis, MO, USA
| | - Jesse D Procknow
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA
| | - Marius C Staiculescu
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA
| | - Tezin A Walji
- Department of Cell Biology and Physiology, Washington University, St. Louis, MO, USA
| | - Clarissa S Craft
- Department of Cell Biology and Physiology, Washington University, St. Louis, MO, USA
| | - Jessica E Wagenseil
- Department of Mechanical Engineering and Materials Science, Washington University, St. Louis, MO, USA.
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Fujita N, Hatakeyama S, Yamamoto H, Tobisawa Y, Yoneyama T, Yoneyama T, Hashimoto Y, Koie T, Nigawara T, Ohyama C. Implication of aortic calcification on persistent hypertension after laparoscopic adrenalectomy in patients with primary aldosteronism. Int J Urol 2016; 23:412-7. [PMID: 26840556 DOI: 10.1111/iju.13060] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 01/04/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify risk factors, including aortic calcification, for persistent hypertension in primary aldosteronism patients undergoing laparoscopic adrenalectomy. METHODS Between October 2000 and October 2015, we carried out 101 consecutive laparoscopic adrenalectomies for unilateral primary aldosteronism. Of these, 95 cases with at least 1 year of postoperative follow up were included. These were divided into two study groups based on whether they had normal blood pressure without antihypertensive medications (resolved group) or still required medications (unresolved group) at 1 year after surgery. Variables included age, sex, body mass index, history of hypertension, dosage of antihypertensive medication score, presence of type 2 diabetes, subclinical Cushing syndrome, preoperative renal function, aldosteronoma resolution score and abdominal calcification index. Univariate and multivariate logistic regression analyses were used to assess independent risk factors for persistent hypertension 1 year after surgery. RESULTS The complete resolution of hypertension without antihypertensive medication 1 year after adrenalectomy was 36 out of 95 (38%). The preoperative antihypertensive medication score, systolic blood pressure and abdominal calcification index were significantly higher, and the aldosteronoma resolution score were significantly lower in the unresolved group than in the resolved group. Using multivariate logistic regression analysis, independent risk factors significantly correlating with persistent hypertension 1 year after surgery were aldosteronoma resolution score and abdominal calcification index. CONCLUSIONS Laparoscopic adrenalectomy for primary aldosteronism is effective in improving blood pressure and reducing the need for antihypertensive medications. Aldosteronoma resolution score and abdominal calcification index represent potential independent risk factors for persistent hypertension 1 year after surgery.
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Affiliation(s)
- Naoki Fujita
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Hayato Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yuki Tobisawa
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Tohru Yoneyama
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takahiro Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Yasuhiro Hashimoto
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takuya Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Takeshi Nigawara
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Chikara Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.,Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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Ayça B, Rakıcı T, Atıcı Y, Avsar M, Yuksel Y, Akın F, Okuyan E, Hakan Dinckal M. Adult degenerative scoliosis associated with increased aortic diameter and plaque burden and composition. Vascular 2015. [PMID: 26223527 DOI: 10.1177/1708538115597371] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE In this study, we aimed to investigate the relationship between adult degenerative scoliosis (ADS) and the aortic plaques and diameters. METHOD We included 219 patients with ADS and 100 control patients without ADS. Diameters of ascending, arch, descending and abdominal aorta and number, localization and types of the aortic plaques, and the Cobb angles of all patients were measured from computed tomography (CT) images. We divided the patients with ADS into three groups according to the Cobb angle, and divided them into four groups according to level of spine deformity. RESULTS The patients with ADS had a larger aorta and more aortic plaques (both, p < 0.001). The patients with ADS had more fibro-fatty and mix plaques (both, p < 0.001). The patients with severe ADS had larger diameters of the ascending and arch of the aorta (p = 0.026 and p = 0.027, respectively). The patients with the main thoracic curve had a larger ascending aorta and the patients with a thoracolumbar curve had more aortic plaques (p = 0.035 and p = 0.029, respectively). In multivariate regression analysis, the ADS was an independent risk factor for both aortic dilatation (>3.6 cm) and aortic plaque build-up (both, p < 0.001). CONCLUSION The ADS may be a risk factor for aortic dilatation and aortic atherosclerosis.
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Affiliation(s)
- Burak Ayça
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Taşkın Rakıcı
- Department of Radiology, Samatya Education and Research Hospital, Istanbul, Turkey
| | - Yunus Atıcı
- Department of Orthopaedics and Traumatology, Metin Sabancı Baltalimanı Bone Disease Education and Research Hospital, Istanbul, Turkey
| | - Murat Avsar
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - Yasin Yuksel
- Department of Cardiology, Samatya Education and Research Hospital, Istanbul, Turkey
| | - Fatih Akın
- School of Medicine, Department of Cardiology, Muğla Sıtkı Kocman University, Muğla, Turkey
| | - Ertugrul Okuyan
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
| | - M Hakan Dinckal
- Department of Cardiology, Bağcılar Education and Research Hospital, Istanbul, Turkey
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Yeon SB, Salton CJ, Gona P, Chuang ML, Blease SJ, Han Y, Tsao CW, Danias PG, Levy D, O’Donnell CJ, Manning WJ. Impact of age, sex, and indexation method on MR left ventricular reference values in the Framingham Heart Study offspring cohort. J Magn Reson Imaging 2015; 41:1038-45. [PMID: 24817313 PMCID: PMC4248013 DOI: 10.1002/jmri.24649] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/17/2014] [Accepted: 04/18/2014] [Indexed: 11/09/2022] Open
Abstract
PURPOSE To determine normative values for left ventricular (LV) volumes, mass, concentricity, and ejection fraction (EF) and investigate associations between sex, age, and body size with LV parameters in community-dwelling adults. MATERIALS AND METHODS In all, 1794 Framingham Heart Study Offspring cohort members underwent LV short-axis oriented, contiguous multislice cine steady-state free precession MR of the left ventricle; from these a healthy referent group (n = 852, 61 ± 9 years, 40% men) free of clinical cardiac disease and hypertension (SBP < 140, DBP < 90 mmHg, never used antihypertensive medication ≥30 years prior to scanning) was identified. Referent participants were stratified by sex and age group (≤55, 56-65, >65 years); LV parameters were indexed to measures of body size. RESULTS Men have greater LV volumes and mass than women both before and after indexation to height, powers of height, and body surface area (P < 0.01 all), but indexation to fat-free mass yielded greater LV volume and mass in women. In both sexes, LV volumes and mass decrease with advancing age, although indexation attenuates this association. LVEF is greater in women than men (68 ± 5% vs. 66 ± 5%, P < 0.01) and increases with age in both sexes (P < 0.05). CONCLUSION Among nonhypertensive adults free of cardiac disease, men have greater LV volumes and mass with sex differences generally persisting after indexation to body size. LV volumes and mass tend to decrease with greater age in both sexes. Female sex and advanced age were both associated with greater LVEF. J. Magn. Reson. Imaging 2015;41:1038-1045. © 2014 Wiley Periodicals, Inc.
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Affiliation(s)
- Susan B. Yeon
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
| | - Carol J. Salton
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, MA
| | | | | | | | - Yuchi Han
- Department of Medicine (Cardiovascular Division), University of Pennsylvania Medical School, Philadelphia, PA
| | - Connie W. Tsao
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
- The NHLBI’s Framingham Heart Study, Framingham, MA
| | - Peter G. Danias
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, MA
| | - Daniel Levy
- The NHLBI’s Framingham Heart Study, Framingham, MA
| | - Christopher J. O’Donnell
- Harvard Medical School, Boston, MA
- The NHLBI’s Framingham Heart Study, Framingham, MA
- Department of Medicine (Division of Cardiology), Massachusetts General Hospital
| | - Warren J. Manning
- Department of Medicine (Cardiovascular Division), Beth Israel Deaconess Medical Center, Boston, MA
- Harvard Medical School, Boston, MA
- Deparetment of Radiology, Beth Israel Deaconess Medical Center, Boston, MA
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Kirabo A, Harrison DG. Hypertension as a Risk Factor for Atherosclerosis. Atherosclerosis 2015. [DOI: 10.1002/9781118828533.ch6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Characterization of lipid parameters in diabetic and non-diabetic atherosclerotic patients. JOURNAL OF GERIATRIC CARDIOLOGY : JGC 2015; 12:37-43. [PMID: 25678903 PMCID: PMC4308457 DOI: 10.11909/j.issn.1671-5411.2015.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2014] [Revised: 10/20/2014] [Accepted: 10/27/2014] [Indexed: 11/21/2022]
Abstract
Background & Objective The relationship between lipid profile perturbation and diabetes associated complications has long been an area of interest. Dyslipidemia is a potent predictor of cardiovascular morbidity and mortality in diabetic patients. The aim of present study was to investigate relationship between aging and lipid profiles in diabetic and non-diabetic atherosclerotic patients. Methods Five hundred and seventy six individuals (45–75 year age) participated in this study. Among these, 192 were having history of diabetes mellitus and atherosclerosis. Individuals are categorized on the base of health (normal, non-diabetic atherosclerosis, diabetic atherosclerosis) and age (45–55 years, 56–65 years, and 66–75 years). All the participants were subjected to the procedures like a detailed history, biochemical analysis for fasting blood sugar, hemoglobin A1c, total cholesterol (TC), triglycerides (TG), low-density lipoprotein-(LDL), very low-density lipoprotein (VLDL) and high-density lipoprotein (HDL). All these parameters were compared between diabetic and non-diabetic atherosclerotic patients of all three age groups. TC/HDL and LDL/HDL were also calculated. Results Diabetic atherosclerotic individuals (both males and females) had high level of TC, TG, LDL, VLDL and low level of HDL in comparison to non-diabetic atherosclerotic and normal control individuals. Among all three age groups, lipoprotein abnormality was observed to be more frequent in females than males. There was a significant increase in TC/HDL and LDL/HDL ratio in diabetic atherosclerotic subjects compared to age and sex matched non-diabetic atherosclerotic and normal control. Conclusions Degree of dyslipidemia increases with increase in age in both genders. Female are more prone to diabetic dyslipidemia and hence have more risk of developing atherosclerosis with increasing age.
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Imanishi K, Hatakeyama S, Yamamoto H, Okamoto A, Imai A, Yoneyama T, Hashimoto Y, Koie T, Fujita T, Murakami R, Saitoh H, Funyu T, Narumi S, Ohyama C. Post-transplant renal function and cardiovascular events are closely associated with the aortic calcification index in renal transplant recipients. Transplant Proc 2014; 46:484-8. [PMID: 24655995 DOI: 10.1016/j.transproceed.2013.09.039] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 09/20/2013] [Indexed: 12/21/2022]
Abstract
INTRODUCTION The aortic calcification index (ACI) is reported to be closely associated with renal dysfunction and cardiovascular events; however, its implication in renal transplant recipients has not been well examined. In this study, we investigated the relationship between pretransplant ACI, ACI progression, post-transplant renal function, and post-transplant cardiovascular events in renal transplant recipients. PATIENTS AND METHODS The study from June 1996 to Jan 2012 included 61 renal transplant recipients (living donors, 47; cadaveric donors, 14). The median follow-up period was 60 months. ACI was quantitatively measured on abdominal computed tomography. The relationship between age, dialysis period, estimated glomerular filtration rate (eGFR), and pre- and post-transplant ACI was longitudinally evaluated. Risk factors for post-transplant ACI progression were determined by logistic regression analysis. Patient background and the incidence of post-transplant cardiovascular events were also assessed. RESULTS The pretransplant ACI (median 4.2%) significantly correlated with age at transplant, dialysis period, and diabetes mellitus. ACI gradually increased up to 2.8 times at 10 years after transplantation. Post-transplant eGFR significantly correlated with ACI progression in patients with chronic kidney disease of stage ≥ 3. Logistic regression analyses showed that age at transplantation, post-transplant period, cadaveric donors, and post-transplant chronic kidney disease stage 3 were risk factors for post-transplant ACI progression. The pretransplant ACI was higher (median 66%) in 3 patients who experienced post-transplant cardiovascular events. CONCLUSIONS ACI progression closely correlates with age and post-transplant renal function. A high pretransplant ACI is a risk factor for post-transplant cardiovascular events in renal transplant recipients.
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Affiliation(s)
- K Imanishi
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - S Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan.
| | - H Yamamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - A Okamoto
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - A Imai
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Yoneyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Y Hashimoto
- Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Koie
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - T Fujita
- Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - R Murakami
- Department of Cardiology, Respiratory Medicine and Nephrology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - H Saitoh
- Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - T Funyu
- Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - S Narumi
- Department of Transplant Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan
| | - C Ohyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan; Department of Advanced Transplant and Regenerative Medicine, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
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den Ouden ME, Schuurmans MJ, Mueller-Schotte S, Bots ML, van der Schouw Y. Do subclinical vascular abnormalities precede impaired physical ability and ADL disability? Exp Gerontol 2014; 58:1-7. [DOI: 10.1016/j.exger.2014.06.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 05/09/2014] [Accepted: 06/02/2014] [Indexed: 10/25/2022]
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Erbel R, Aboyans V, Boileau C, Bossone E, Bartolomeo RD, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwöger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, Allmen RSV, Vrints CJM. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J 2014; 35:2873-926. [PMID: 25173340 DOI: 10.1093/eurheartj/ehu281] [Citation(s) in RCA: 3066] [Impact Index Per Article: 278.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Abstract
Background Coronary heart disease (CHD) is a major health concern, affecting nearly half the middle-age population and responsible for nearly one-third of all deaths. Clinicians have responsibilities beyond diagnosing CHD, including risk stratification of patients for major adverse cardiac events (MACE), modifying the risks and treating the patient. In this first of a two-part review, identifying risk factors is reviewed, including more potential benefit from autonomic testing. Methods Traditional and non-traditional, and modifiable and non-modifiable risk factors for MACE where compared, including newer risk factors, such as inflammation, carotid intimal thickening, ankle-brachial index, CT calcium scoring, and autonomic function testing, specifically independent measurement of parasympathetic and sympathetic (P&S) activity. Results The Framingham Heart Study, and others, have identified traditional risk factors for the development of CHD. These factors effectively target high-risk patients, but a large number of individuals who will develop CHD and MACE are not identified. Many patients with CHD who appear to be well-managed by traditional therapies still experience MACE. In order to identify these patients, other possible risk factors have been explored. Advanced autonomic dysfunction, and its more severe form, cardiac autonomic neuropathy, have been strongly associated with an elevated risk of cardiac mortality and are diagnosable through P&S testing. Conclusions Independent measures of P&S activity, provides additional information and has the potential to incrementally add to risk assessment. This additional information enables physicians to (1) specifically target more high-risk patients and (2) titrate therapies, with autonomic testing guidance, in order to minimize risk of cardiac mortality and morbidity.
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Chuang ML, Gona P, Oyama-Manabe N, Manders ES, Salton CJ, Hoffmann U, Manning WJ, O'Donnell CJ. Risk factor differences in calcified and noncalcified aortic plaque: the Framingham Heart Study. Arterioscler Thromb Vasc Biol 2014; 34:1580-6. [PMID: 24833796 DOI: 10.1161/atvbaha.114.303600] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The objective of this study was to determine the prevalence and risk factor (RF) correlates of aortic plaque (AP) detected by cardiovascular magnetic resonance (CMR), which mainly shows noncalcified plaques, and by noncontrast computed tomography (CT), which best depicts calcified plaques, in community-dwelling adults. APPROACH AND RESULTS A total of 1016 Framingham Heart Study Offspring cohort members (64 ± 9 years; 474 men) underwent CMR and CT of the aorta. Potential RFs for AP (age; sex; body mass index; blood pressure; low-density lipoprotein and high-density lipoprotein cholesterol; fasting glucose; C-reactive protein; prevalent hypertension, diabetes mellitus, smoking; use of antihypertensive, diabetes mellitus, or lipid-lowering drugs) were compared between participants, with zero versus nonzero AP by CMR and by CT. Candidate RFs attaining P<0.05 for difference with either imaging modality were entered into multivariable logistic regression models adjusting for age, sex, and other RFs. Odds ratios were calculated for modality-specific prevalence of AP. Associations between RFs and continuous measures of AP were assessed using Tobit regression. Prevalence of CMR and CT AP was 49% and 82%, respectively. AP burdens by CMR and CT were correlated, r=0.28, P<0.0001. Increasing age and smoking were associated with prevalent AP by both CMR and CT. Additionally, prevalent AP by CMR was associated with female sex and fasting glucose and prevalent AP by CT with hypertension treatment and adverse lipid profile. CONCLUSIONS AP by CMR and CT are both associated with smoking and increasing age, but other RFs differ between calcified and noncalcified AP. The relative predictive value of AP detected by CMR versus by CT for incident cardiovascular events remains to be determined.
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Affiliation(s)
- Michael L Chuang
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Philimon Gona
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Noriko Oyama-Manabe
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Emily S Manders
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Carol J Salton
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Udo Hoffmann
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Warren J Manning
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.)
| | - Christopher J O'Donnell
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (M.L.C., P.G., E.S.M., C.J.O.); Department of Quantitative Health Sciences, Division of Biostatistics and Health Services Research, University of Massachusetts Medical School, Worcester (P.G.); Departments of Medicine (Cardiovascular Division) (N.O.-M., C.J.S., W.J.M.) and Radiology (W.J.M.), Beth Israel Deaconess Medical Center, Boston, MA; Department of Medicine, Division of Cardiology (C.J.O.) and The Cardiac MR PET CT Program, Department of Radiology (U.H.), Massachusetts General Hospital, Boston; and Harvard Medical School, Boston, MA (U.H., W.J.M., C.J.O.).
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Hong SN, Gona P, Fontes JD, Oyama N, Chan RH, Kenchaiah S, Tsao CW, Yeon SB, Schnabel RB, Keaney JF, O'Donnell CJ, Benjamin EJ, Manning WJ. Atherosclerotic biomarkers and aortic atherosclerosis by cardiovascular magnetic resonance imaging in the Framingham Heart Study. J Am Heart Assoc 2013; 2:e000307. [PMID: 24242683 PMCID: PMC3886740 DOI: 10.1161/jaha.113.000307] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND The relations between subclinical atherosclerosis and inflammatory biomarkers have generated intense interest but their significance remains unclear. We sought to determine the association between a panel of biomarkers and subclinical aortic atherosclerosis in a community-based cohort. METHODS AND RESULTS We evaluated 1547 participants of the Framingham Heart Study Offspring cohort who attended the 7th examination cycle and underwent both cardiovascular magnetic resonance imaging (CMR) and assays for 10 biomarkers associated with atherosclerosis: high-sensitivity C-reactive protein, fibrinogen, intercellular adhesion molecule-1, interleukin-6, interleukin-18, lipoprotein-associated phospholipase-A2 activity and mass, monocyte chemoattractant protein-1, P-selectin, and tumor necrosis factor receptor-2. In logistic regression analysis, we found no significant association between the biomarker panel and the presence of aortic plaque (global P=0.53). Using Tobit regression with aortic plaque as a continuous variable, we noted a modest association between biomarker panel and aortic plaque volume in age- and sex-adjusted analyses (P=0.003). However, this association was attenuated after further adjustment for clinical covariates (P=0.09). CONCLUSIONS In our community-based cohort, we found no significant association between our multibiomarker panel and aortic plaque. Our results underscore the strengths and limitations of the use of biomarkers for the identification of subclinical atherosclerosis and the importance of traditional risk factors.
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Affiliation(s)
- Susie N Hong
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Exercise Blood Pressure and Heart Rate Reference Values. Heart Lung Circ 2013; 22:661-7. [DOI: 10.1016/j.hlc.2013.02.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 02/21/2013] [Accepted: 02/23/2013] [Indexed: 11/18/2022]
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40
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Egg consumption and coronary atherosclerotic burden. Atherosclerosis 2013; 229:381-4. [DOI: 10.1016/j.atherosclerosis.2013.05.008] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2012] [Revised: 05/05/2013] [Accepted: 05/10/2013] [Indexed: 11/22/2022]
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Gao T, He X, Yu W, Zhang Z, Wang Y. Atherosclerotic plaque pathohistology and classification with high-resolution MRI. Neurol Res 2013; 33:325-30. [DOI: 10.1179/016164110x12767786356318] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Maroules CD, Rosero E, Ayers C, Peshock RM, Khera A. Abdominal aortic atherosclerosis at MR imaging is associated with cardiovascular events: the Dallas heart study. Radiology 2013; 269:84-91. [PMID: 23781118 DOI: 10.1148/radiol.13122707] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To determine the value of two abdominal aortic atherosclerosis measurements at magnetic resonance (MR) imaging for predicting future cardiovascular events. MATERIALS AND METHODS This study was approved by the institutional review board and complied with HIPAA regulations. The study consisted of 2122 participants from the multiethnic, population-based Dallas Heart Study who underwent abdominal aortic MR imaging at 1.5 T. Aortic atherosclerosis was measured by quantifying mean aortic wall thickness (MAWT) and aortic plaque burden. Participants were monitored for cardiovascular death, nonfatal cardiac events, and nonfatal extracardiac vascular events over a mean period of 7.8 years ± 1.5 (standard deviation [SD]). Cox proportional hazards regression was used to assess independent associations of aortic atherosclerosis and cardiovascular events. RESULTS Increasing MAWT was positively associated with male sex (odds ratio, 3.66; P < .0001), current smoking (odds ratio, 2.53; P < .0001), 10-year increase in age (odds ratio, 2.24; P < .0001), and hypertension (odds ratio, 1.66; P = .0001). A total of 143 participants (6.7%) experienced a cardiovascular event. MAWT conferred an increased risk for composite events (hazard ratio, 1.28 per 1 SD; P = .001). Aortic plaque was not associated with increased risk for composite events. Increasing MAWT and aortic plaque burden both conferred an increased risk for nonfatal extracardiac events (hazard ratio of 1.52 per 1 SD [P < .001] and hazard ratio of 1.46 per 1 SD [P = .03], respectively). CONCLUSION MR imaging measures of aortic atherosclerosis are predictive of future adverse cardiovascular events.
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Affiliation(s)
- Christopher D Maroules
- Departments of Radiology, Anesthesiology, Clinical Sciences, and Internal Medicine, Division of Cardiology and the Donald W. Reynolds Cardiovascular Clinical Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8896
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Cecelja M, Frost ML, Spector TD, Chowienczyk P. Abdominal aortic calcification detection using dual-energy X-ray absorptiometry: validation study in healthy women compared to computed tomography. Calcif Tissue Int 2013; 92:495-500. [PMID: 23407824 DOI: 10.1007/s00223-013-9704-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2012] [Accepted: 01/21/2013] [Indexed: 11/29/2022]
Abstract
Abdominal aortic calcification (AAC) is an independent determinant of cardiovascular events. Computed tomography (CT) is currently the gold standard measure of AAC but is limited by high radiation exposure. Lateral dual-energy X-ray absorptiometry (DXA) has the potential to detect AAC at a fraction of the radiation dose. Our objective was to determine the accuracy of lateral-DXA in detecting AAC compared to CT in healthy women. Women from the TwinsUK registry aged 52-80 years (n = 105) underwent noncontrast CT and lateral-DXA imaging of the abdominal aorta at lumbar vertebrae L1-L4. Presence of calcium on CT was scored using the volume method. Lateral-DXA images were scored using the previously validated semiquantitative 24-point score and simplified 8-point score. Calcification was present in 81 % of women as determined by CT and 49 % with lateral-DXA. The mean volume score and the 24- and 8-point scores of AAC were 0.20 ± 0.41 cm(2), 2.39 ± 3.91 arbitrary units, and 1.47 ± 2.13 arbitrary units, respectively. There was moderate agreement between CT and 24-point lateral-DXA (Spearman's rank correlation coefficient r = 0.58, P < 0.0001). The sensitivity of lateral-DXA for detecting AAC was 56 % and specificity was 80 %. Sensitivity and specificity of lateral-DXA improved to 64 and 84 % when analysis was limited to calcium volumes ≥0.008 cm(3) as detected by CT. Lateral-DXA imaging may provide a useful alternative to CT in detecting AAC with minimal radiation exposure, which may be used with concurrent bone mineral density assessment.
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Affiliation(s)
- Marina Cecelja
- King's College London British Heart Foundation Centre, Cardiovascular Division, Department of Clinical Pharmacology, St Thomas' Hospital, Lambeth Palace Road, London, SE1 7EH, UK.
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Abstract
The term geriatric syndrome is used to characterize multifactorial clinical conditions among older people which are not subsumed readily into disease entities, but which nevertheless predispose older people to disability and death. Commonly included are frailty, dementia, delirium, incontinence, falls, and dizziness. Geriatric syndromes are common among older people: in a recent survey, 50% of those aged more than 65 had one or more of these conditions. Better methods for prevention and treatment are needed, but current strategies have lacked a coherent conceptual and diagnostic framework. Prevention and interventions need to be targeted at earlier ages, with geriatrics expertise needed in the definition and operationalization of these complex entities. In this review we consolidate evidence that vascular disorders, including vascular ageing and vascular diseases, are key etiological factors of geriatric syndromes. Identifying this vascular dimension would offer opportunities for more efficient preventive strategies and mandates earlier intervention, especially for women, among whom vascular disease is often expressed more insidiously than among men. This would entail a sensitization of the health care system to the systematic detection of the syndromes, which are currently underdiagnosed. Further disentangling of the mechanisms of vascular ageing may offer therapies for vascular diseases and geriatric syndromes alike.
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Affiliation(s)
- Timo E Strandberg
- Department of Medicine, Geriatric Clinic, University of Helsinki, and Helsinki University Hospital, Finland.
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den Ouden MEM, Schuurmans MJ, Arts IEMA, Grobbee DE, Bots ML, van den Beld AW, Lamberts SWJ, van der Schouw YT. Atherosclerosis and physical functioning in older men, a longitudinal study. J Nutr Health Aging 2013; 17:97-104. [PMID: 23299387 DOI: 10.1007/s12603-012-0424-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Functional decline is a major threat to independency, progressing into functional limitations and eventually leading to disability. Chronic diseases, especially cardiovascular diseases, are important determinants of functional limitations and disability. Vascular damage exits long before it is clinically manifest and can have adverse effects on health, physical and cognitive functioning. The objective was to investigate the association between non-invasive atherosclerosis measures and physical functioning in older men. DESIGN Prospective cohort study. SETTING The study was conducted in the general community. PARTICIPANTS 195 independently living older men. MEASUREMENTS Atherosclerosis was measured by intima media thickness (CIMT) of the common carotid artery using ultrasonography and assessment for presence of atherosclerotic plaques. Physical functioning was measured by isometric handgrip strength and leg extensor strength using a hand held dynamometer, lower extremity function using the physical performance score and ability to perform activities of daily life using the modified Stanford health assessment questionnaire. Linear regression analysis was performed to estimate the associations between CIMT or plaques and physical functioning. RESULTS After adjustment for confounders, higher baseline CIMT was associated with lower isometric handgrip strength at follow up (βCIMT = -7.21, 95% CI[-13.64;-0.77]). No other associations were found between CIMT and physical functioning. In addition, no associations were found for the presence of plaques and physical functioning either at baseline, or at follow-up. CONCLUSION Atherosclerosis, as measured by higher CIMT, is related to a lower isometric handgrip strength at follow-up, but no further associations with physical functioning were found in this longitudinal study among independently living older men.
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Affiliation(s)
- M E M den Ouden
- Julius Center for Health Sciences and Primary Care, STR 6.131, University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands.
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Bochem AE, van Wijk DF, Holleboom AG, Duivenvoorden R, Motazacker MM, Dallinga-Thie GM, de Groot E, Kastelein JJP, Nederveen AJ, Hovingh GK, Stroes ESG. ABCA1 mutation carriers with low high-density lipoprotein cholesterol are characterized by a larger atherosclerotic burden. Eur Heart J 2012; 34:286-91. [PMID: 23136402 DOI: 10.1093/eurheartj/ehs376] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
AIMS Low HDL-C is a potent risk factor for cardiovascular disease (CVD). Yet, mutations in ABCA1, a major determinant of circulating HDL-C levels, were previously not associated with CVD risk in cohort studies. To study the consequences of low plasma levels of high-density lipoprotein cholesterol (HDL-C) due to ATP-binding cassette transporter A1 (ABCA1) dysfunction for atherosclerotic vascular disease in the carotid arteries. METHODS AND RESULTS We performed 3.0 Tesla magnetic resonance imaging (MRI) measurements of the carotid arteries in 36 carriers of high impact functional ABCA1 mutations and 36 normolipidemic controls. Carriers presented with 42% lower HDL-C levels (P < 0.001), a larger mean wall area (18.6 ± 6.0 vs. 15.8 ± 4.3 mm(2); P = 0.02), a larger mean wall thickness (0.82 ± 0.21 vs. 0.70 ± 0.14 mm; P = 0.005), and a higher normalized wall index (0.37 ± 0.06 vs. 0.33 ± 0.04; P = 0.005) compared with controls, retaining significance after adjustment for smoking, alcohol consumption, systolic blood pressure, diabetes, body mass index, history of CVD, LDL-C, and statin use (P = 0.002). CONCLUSION Carriers of loss of function ABCA1 mutations display a larger atherosclerotic burden compared with age and sex-matched controls, implying a higher risk for CVD. Further studies are needed to elucidate the full function of ABCA1 in the protection against atherosclerosis. These data support the development of strategies to up-regulate ABCA1 in patients with established CVD.
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Affiliation(s)
- Andrea E Bochem
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, The Netherlands
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Cheng X, Zhou Y, Jin Y, Li G, Wang H, Song E. Intima-medial thickness homogeneity in the common carotid artery: measurement method and preliminary clinical study. JOURNAL OF CLINICAL ULTRASOUND : JCU 2012; 40:559-565. [PMID: 22965655 DOI: 10.1002/jcu.21987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2012] [Accepted: 08/06/2012] [Indexed: 06/01/2023]
Abstract
BACKGROUND To propose and test in a preliminary clinical study a novel method for calculating intima-medial thickness (IMT) homogeneity (IMTH). METHODS IMT was measured off-line on every horizontal pixel line along the far wall of the common carotid artery, with previously validated software. IMTH was assessed by the SD, coefficient of variation, and interval distribution of obtained IMT values. This method was applied to 129 individuals (age, 40-60 years), including 49 healthy control subjects, 44 subjects at high risk of atherosclerosis, and 36 subjects with known atherosclerosis. Differences with a p value <0.05 were considered statistically significant. RESULTS SD and coefficient of variation were higher in the high-risk than in the control group, as well as in high-risk and control subgroups with maximal IMT = 0.8 mm or mean IMT = 0.55-0.65 mm. There were 85.7, 62.8, and 36% of IMT values in the 0.4- to 0.6-mm range and 0.89, 13.8, and 21.2% of IMT values in the 0.8- to 1.2-mm range in the control, high-risk, and atherosclerosis groups, respectively. CONCLUSIONS IMTH is a promising approach for the assessment of atherosclerosis, in addition to conventional IMT measurement. Further clinical studies are needed to assess its clinical usefulness.
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Affiliation(s)
- Xinyao Cheng
- Cardiovascular Division, Zhongnan Hospital, Wuhan University, Wuhan, PR China
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Three-dimensional imaging of the aortic vessel wall using an elastin-specific magnetic resonance contrast agent. Invest Radiol 2012; 47:438-44. [PMID: 22627945 DOI: 10.1097/rli.0b013e3182588263] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to demonstrate the feasibility of high-resolution 3-dimensional aortic vessel wall imaging using a novel elastin-specific magnetic resonance contrast agent (ESMA) in a large animal model. MATERIALS AND METHODS The thoracic aortic vessel wall of 6 Landrace pigs was imaged using a novel ESMA and a nonspecific control agent. On day 1, imaging was performed before and after the administration of a nonspecific control agent, gadolinium diethylenetriamine pentaacetic acid (Gd-DTPA; Bayer Schering AG, Berlin, Germany). On day 3, identical scans were repeated before and after the administration of a novel ESMA (Lantheus Medical Imaging, North Billerica, Massachusetts). Three-dimensional inversion recovery gradient echo delayed-enhancement imaging and magnetic resonance (MR) angiography of the thoracic aortic vessel wall were performed on a 1.5-T MR scanner (Achieva; Philips Medical Systems, the Netherlands). The signal-to-noise ratio and the contrast-to-noise ratio of arterial wall enhancement, including the time course of enhancement, were assessed for ESMA and Gd-DTPA. After the completion of imaging sessions, histology, electron microscopy, and inductively coupled plasma mass spectroscopy were performed to localize and quantify the gadolinium bound to the arterial vessel wall. RESULTS Administration of ESMA resulted in a strong enhancement of the aortic vessel wall on delayed-enhancement imaging, whereas no significant enhancement could be measured with Gd-DTPA. Ninety to 100 minutes after the administration of ESMA, significantly higher signal-to-noise ratio and contrast-to-noise ratio could be measured compared with the administration of Gd-DTPA (45.7 ± 9.6 vs 13.2 ± 3.5, P < 0.05 and 41.9 ± 9.1 vs 5.2 ± 2.0, P < 0.05). A significant correlation (0.96; P < 0.01) between area measurements derived from ESMA scans and aortic MR angiography scans could be found. Electron microscopy and inductively coupled plasma mass spectroscopy confirmed the colocalization of ESMA with elastic fibers. CONCLUSION We demonstrate the feasibility of aortic vessel wall imaging using a novel ESMA in a large animal model under conditions resembling a clinical setting. Such an approach could be useful for the fast 3-dimensional assessment of the arterial vessel wall in the context of atherosclerosis, aortic aneurysms, and hypertension.
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Ultrasound and radiology surrogate endpoints in pharmacological studies. Atherosclerosis 2012; 224:12-24. [DOI: 10.1016/j.atherosclerosis.2012.03.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2012] [Revised: 03/26/2012] [Accepted: 03/29/2012] [Indexed: 11/17/2022]
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López-Jornet P, Berná-Mestre J, Berná-Serna J, Camacho-Alonso F, Fernandez-Millan S, Reus-Pintado M. Measurement of Atherosclerosis Markers in Patients With Periodontitis: A Case-Control Study. J Periodontol 2012; 83:690-8. [DOI: 10.1902/jop.2011.110412] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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