P3716Increased two-year cerebrovascular event rate in patients with bilateral high carotid tempratures

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
G Benetos ◽  
K Toutouzas ◽  
G Oikonomou ◽  
I Koutagiar ◽  
M Karmpalioti ◽  
...  
Keyword(s):  
Carotid Plaque ◽  
Cerebrovascular Event ◽  
Stroke Rate ◽  
Kaplan Meier ◽  
Cerebrovascular Events ◽  
Rigorous Research ◽  
Plaque Inflammation ◽  
Artery Disease ◽  
Documented Coronary Artery Disease

Abstract Introduction The association of carotid plaque inflammation with cerebrovascular events is a matter of rigorous research. Microwave Radiometry (MWR) allows in vivo noninvasive measurement of the internal temperatures of tissues, reflecting inflammation. Purpose To investigate whether increased carotid temperatures in patients with documented coronary artery disease (CAD) are associated with cerebrovascular events. Methods Consecutive patients with significant CAD from three tertiary centers were included in the study. Maximum carotid plaque thickness was assessed in all carotids by ultrasound. ΔT by MWR was assigned as the temperature difference (maximal minus minimum) along the carotid artery. ΔT ≥0.90°C was assigned as high ΔT. All patients were followed-up clinically for two years and all strokes were adjudicated by an independent committee. Transient ischemic attacks were excluded. Results In total 300 patients were included in the study. High ΔT temperatures bilaterally were measured in 47 patients (15.7%). Three patients (1.0%) suffered a stroke, including one fatal. Stoke rate was 4.3% in the group with bilateral high ΔT and 0.4% in non-high ΔT group (p=0.02). In Kaplan-Meier plot patients with bilateral high ΔT showed higher stroke rate (log-rank p=0.004, figure) Conclusions Bilateral high carotid temperatures are associated with increased two-year stroke rate. The potential value of the present finding in risk stratification of intermediate carotid stenosis mandates further investigation.

scholarly journals Incidence and determinants of cerebrovascular events in outpatients with stable coronary artery disease

2018 ◽  
Vol 3 (3) ◽  
pp. 272-280 ◽  
Author(s):  
Charlotte Cordonnier ◽  
Gilles Lemesle ◽  
Barbara Casolla ◽  
Matthieu Bic ◽  
François Caparros ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Ischaemic Stroke ◽  
Intracranial Haemorrhage ◽  
Stable Coronary Artery Disease ◽  
Myocardial Infarctions ◽  
Cerebrovascular Event ◽  
Cerebrovascular Events ◽  
St Elevation ◽  
Artery Disease

Introduction There are limited data on cerebrovascular events in patients with stable coronary artery disease. To study the risk of cerebrovascular event, the relative proportion of ischaemic stroke and intracranial haemorrhage, and their prognostic factors in stable coronary artery disease are investigated. Patients and methods The CORONOR registry prospectively recruited, between February 2010 and April 2011, 4184 unselected stable coronary artery disease outpatients. All events occurring during a five-year follow-up were adjudicated. Results Ninety-six patients had an ischaemic stroke and 34 had an intracranial haemorrhage, reaching a cumulative incidence after five years of 3.2 (2.7–3.8)%. During the same period, 677 deaths and 170 myocardial infarctions (ST-elevation MI, n = 55; non-ST-elevation MI, n = 115) occurred. In elderly individuals, the number of cerebrovascular events was higher than that of myocardial infarctions and largely exceeded that of ST-elevation myocardial infarctions. Predictors of ischaemic stroke were: previous history of stroke (subhazard ratio (SHR)=3.16(1.95–5.14)), absence of statin therapy at inclusion (SHR = 2.45(1.47–4.10), increasing age (SHR = 1.45(1.16–1.82) per 10-year increase) and diabetes mellitus (SHR = 1.65(1.10–2.49)). Predictors of intracranial haemorrhage were: combination of vitamin K antagonists with an antiplatelet agent at inclusion (SHR = 5.41(2.49–11.75), single antiplatelet therapy as reference), and increasing age (SHR = 1.47(1.12–1.93) per 10-year increase). Discussion In stable coronary artery disease patients, the brain deserves attention. In patients at high risk of ischaemic stroke, secondary prevention could be intensified. Our results raise awareness of the hazard of the association of antiplatelet drugs with oral anticoagulants in stable coronary artery disease patients. Conclusion While improving the prevention of future vaso-occlusive events should be our ultimate goal in coronary artery disease patients, the net clinical benefit of our treatments should carefully be studied.

scholarly journals CAROTID PLAQUE INFLAMMATION IN PATIENTS WITH DIABETES MELLITUS AND CORONARY ARTERY DISEASE

2017 ◽  
Vol 69 (11) ◽  
pp. 75
Author(s):  
Georgios Tzanis ◽  
Maria Bonou ◽  
Georgios Benetos ◽  
Smaragda Biliou ◽  
Stavros Liatis ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Plaque ◽  
Patients With Diabetes ◽  
Plaque Inflammation ◽  
Artery Disease

Carotid Plaque Inflammation Assessed by 18F-FDG PET/CT and Lp-PLA2 Is Higher in Symptomatic Patients

Angiology ◽  
2020 ◽  
pp. 000331972096541
Author(s):  
Alicia Bueno ◽  
Jose Ramon March ◽  
Pilar Garcia ◽  
Cristina Cañibano ◽  
Antonio Ferruelo ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Carotid Plaques ◽  
Fdg Uptake ◽  
Standardized Uptake Values ◽  
Asymptomatic Patients ◽  
Pet Ct ◽  
Significant Difference ◽  
Plaque Inflammation ◽  
Artery Disease

Carotid plaque inflammation assessed by 2-deoxy-2-[18F]fluoro-D-glucose (18F-FDG) positron emission tomography/computed tomography (PET/CT) and lipoprotein-associated phospholipase A2 (Lp-PLA2) levels are higher in symptomatic patients. The aim of this study was to assess correlations between 18F-FDG uptake on PET scan of carotid artery plaques, plasma levels of Lp-PLA2, and cerebrovascular symptoms. The study included 45 consecutive patients (22 symptomatic, 23 asymptomatic) with >70% carotid stenosis. Patients were examined by hybrid PET/CT, and maximum standardized uptake values (SUVmax) were recorded. Blood samples were obtained, and plasma was stored at −80 °C for subsequent Lp-PLA2 analysis. Symptomatic and asymptomatic patients showed no significant difference in classical cardiovascular risk factors. Asymptomatic carotid stenosis patients more frequently had a history of coronary artery disease ( P = .025) and peripheral artery disease ( P = .012). The symptomatic group had higher 18F-FDG uptake in carotid plaques ( P < .001), higher plasma Lp-PLA2 ( P < .01), and higher high-sensitive C-reactive protein ( P = .022). 2-Deoxy-2-[18F]fluoro-D-glucose uptake on PET/CT and plasma Lp-PLA2 show a statistically significant association with the symptomatic status of carotid plaques.

Abstract 11139: Prevalence, Characteristics and Prognostic Associations of Carotid Plaque Among HIV-infected Subjects Free of Known Cerebrovascular Disease

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Sumbal A Janjua ◽  
Pedro V Staziaki ◽  
Richard A Takx ◽  
Hamed Emami ◽  
Jakob Park ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cerebrovascular Disease ◽  
Carotid Plaque ◽  
Cerebrovascular Event ◽  
Clinical Registry ◽  
Persistent Inflammation ◽  
Cerebrovascular Events ◽  
Spotty Calcification ◽  
Ct Analysis ◽  
Cox Proportional Hazard Models

Introduction: The risk of cerebrovascular events is increased among HIV-infected subjects; this risk is independent of conventional cardiovascular (CV) risk factors and may be related to persistent inflammation leading to accelerated carotid atherosclerosis. However, there are no data characterizing the prevalence, characteristics and prognostic associations of carotid plaque among subjects with HIV. Methods: From a clinical registry, we identified all HIV-infected subjects with a CT neck from 2005-2014. Data collection and CT analysis were performed by blinded independent teams and included CV and HIV specific risk factors. CT variables included presence of carotid plaque, plaque composition (calcified/non-calcified/mixed), degree of stenosis [≥ 50%] and high-risk plaque (HRP) features [low attenuation, spotty calcification]. The outcome was a cerebrovascular event (stroke, transient ischemic event) defined by ICD codes and independently adjudicated by a board certified physician. Association between plaque presence, characteristics and HRP with events was tested by Cox proportional hazard models. Results: Of 231 HIV-infected subjects, 32 had prior cerebrovascular disease,15 had poor image quality leaving an n=184 (46±10 yrs, 21% female,12% diabetics, 19% HTN, smoking in 31%, 14% on statins, average LDL of 90±39mg/dl). On CT, 36% had any carotid plaque and 23% had bilateral plaque. Of those with plaque,15% had a stenosis of ≥50% and 70% had any HRP feature. Both plaque and HRP were increased with age, duration of HIV and anti-retroviral therapy. Over a median of 4 yrs,13 (7%) cerebrovascular events occurred. After adjusting for the number of CV risk factors, a carotid plaque [HR: 3.5 (1.1-11) P =0.03, Fig 1A] and any HRP feature [HR: 3.2 (1.0-10) P =0.04, Fig 1B] were associated with incident cerebrovascular events. Conclusions: Among HIV-infected subjects, free of known cerebrovascular disease, carotid plaque and/or HRP predict cerebrovascular events.

scholarly journals Carotid intraplaque neovascularization predicts coronary artery disease and cardiovascular events

2019 ◽  
Vol 20 (11) ◽  
pp. 1239-1247 ◽  
Author(s):  
Laura E Mantella ◽  
Kayla N Colledanchise ◽  
Marie-France Hétu ◽  
Steven B Feinstein ◽  
Joseph Abunassar ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Carotid Plaque ◽  
Significant Coronary Artery Disease ◽  
High Sensitivity ◽  
Coronary Plaque ◽  
Plaque Vulnerability ◽  
Kaplan Meier ◽  
Contrast Enhanced ◽  
Artery Disease

Abstract Aims It is thought that the majority of cardiovascular (CV) events are caused by vulnerable plaque. Such lesions are rupture prone, in part due to neovascularization. It is postulated that plaque vulnerability may be a systemic process and that vulnerable lesions may co-exist at multiple sites in the vascular bed. This study sought to examine whether carotid plaque vulnerability, characterized by contrast-enhanced ultrasound (CEUS)-assessed intraplaque neovascularization (IPN), was associated with significant coronary artery disease (CAD) and future CV events. Methods and results We investigated carotid IPN using carotid CEUS in 459 consecutive stable patients referred for coronary angiography. IPN was graded based on the presence and location of microbubbles within each plaque (0, not visible; 1, peri-adventitial; and 2, plaque core). The grades of each plaque were averaged to obtain an overall score per patient. Coronary plaque severity and complexity was also determined angiographically. Patients were followed for 30 days following their angiogram. This study found that a higher CEUS-assessed carotid IPN score was associated with significant CAD (≥50% stenosis) (1.8 ± 0.4 vs. 0.5 ± 0.6, P < 0.0001) and greater complexity of coronary lesions (1.7 ± 0.5 vs. 1.3 ± 0.8, P < 0.0001). Furthermore, an IPN score ≥1.25 could predict significant CAD with a high sensitivity (92%) and specificity (89%). The Kaplan–Meier analysis demonstrated a significantly higher proportion of participants having CV events with an IPN score ≥1.25 (P = 0.004). Conclusion Carotid plaque neovascularization was found to be predictive of significant and complex CAD and future CV events. CEUS-assessed carotid IPN is a clinically useful tool for CV risk stratification in high-risk cardiac patients.

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