CAROTID PLAQUE CHARACTERISTICS AND ITS PREVALENCE IN PATIENTS WITH CORONARY ARTERY DISEASE: AN OBSERVATIONAL STUDY

Background and Aims: To evaluate the prevalence and clinical significance of carotid artery plaque, in patients with coronary artery disease. Material and Methods: A total of 1000 patients with 40-80 years of age with coronary artery disease were enrolled. Carotid ultrasonography was performed in all these patients. Results: Among 100 patients with carotid artery disease, 36 had a carotid plaque. In plaque-positive cases, a majority of patients were in a 50 – 60-year age group. Dyslipidemia was found to be the most common risk factor for carotid plaque. In 36 plaque-positive cases, 20 (56%) were having the plaque at the carotid bulb and 16 (44%) were having the plaque at the common carotid artery. Out of 36 cases, 16 (44%) were hyperechogenic, 8 (22%) were calcified, 6 (17%) were moderate echogenic, 6 (17%) were low echogenic. Conclusion: High-resolution B-mode ultrasonography is a useful non-invasive method to evaluate carotid atherosclerosis. Carotid plaques of the common carotid artery are a surrogate marker of atherosclerosis and associated with cardiovascular events. Routine screening of patients with coronary artery disease may be considered. Keywords: Carotid artery stenosis, coronary artery disease, cardiovascular events, atherosclerosis, carotid ultrasonography.

Carotid Ultrasonography as a Strategy to Optimize the Management of Cardiovascular Risk in Patients with Type 1 Diabetes: A Cohort Study

Background: Although cardiovascular disease (CVD) remains the leading cause of mortality in type 1 diabetes (T1D), the use of cardioprotective drugs is scarce. We aimed to evaluate the impact of carotid ultrasonography (US) on the improvement in cardiovascular risk factors (CVRFs) in T1D.Methods: T1D patients without CVD meeting criteria for lipid treatment according to guidelines (age ≥40 years, nephropathy and/or ≥10 years of diabetes duration with ≥1 additional CVRFs) were included. The carotid-US group (US-G) underwent a standardized US protocol and CVRF assessment; recommendations were made according to subclinical atherosclerosis status. The control group (CG) followed usual clinical practice. Changes in CVRFs, specially statin use and LDL-cholesterol levels, at one year were analysed.Results: A total of 318 patients were included (51.3% female, mean age of 49.1 years and 25.5 years of diabetes duration): 211 in the US-G and 107 in the CG. Participants in the US-G had a higher baseline LDL-cholesterol than controls (114 vs. 102 mg/dL; p<0.001). Lipid-lowering treatment was modified in 38.9% in the US-G and 6.5% in the CG (p<0.001). At 1 year, the US-G was more frequently on statins, had lower LDL-cholesterol and 27% had stopped smoking (p<0.001 for all). Changes were more pronounced in those with plaques (p<0.001). In multivariate analyses adjusted for age, sex and other CVRFs, belonging to the US-G was independently associated with the intensification of lipid-lowering treatment (OR 10.47 [4.06-27.01]).Conclusions: Carotid-US is independently associated with an intensification of lipid-lowering therapy in a high-risk T1D population.

Clinical utility of readily available novel markers of carotid atherosclerotic burden for reclassification and discrimination of very high cardiovascular risk

Background Among high cardiovascular (CV) risk patients, there is emerging need to recognize those who will benefit from new treatments targeting residual risk. Readily available modalities providing reclassification value would be clinically useful in this setting. Preliminary data suggest that carotid ultrasonography using plaque burden but not intima-media thickness (IMT) is associated with very high risk. Objectives We aimed to assess the reclassification ability of two markers of carotid atherosclerosis in high-risk patients, reflecting total atherosclerotic burden and the most severe lesion and to compare them with the routinely used carotid indices IMT and number of carotid plaques. Methods In an ongoing registry of patients who visited a cardiovascular protection clinic for cardiovascular risk assessment, we enrolled 735 consecutively recruited patients (mean age 63.1 years, 68.8% male) classified as high or very-high CV risk according to 2019 European Society of Cardiology /European Atherosclerosis Society Guidelines. Sum of carotid wall thickness (sumWT) and maximal wall thickness (maxWT) using high-resolution ultrasonography at baseline were used to assess the total burden and the most severe carotid lesion, respectively. These markers integrate maximum plaque height or maximum IMT if no plaque is present. All patients were followed for a median of 41 months and the primary end-point consisted of CV mortality, acute myocardial infarction or coronary revascularization. Results After adjustment for traditional CV risk factors, maxWT and sumWT were associated with the primary end-point (hazard ratio [HR]=1.73 (95% confidence interval [CI]:1.39 to 2.17) and 1.19 (95% CI 1.10 to 1.30) respectively). Both markers were superior in terms of reclassification and discrimination to identify very high risk over validated CV risk scores including the Heartscore and the SMART score (net reclassification index [NRI]=0.624, p&lt;0.0001, integrated discrimination index [IDI]=0.060, p&lt;0.0001 and difference in the area under the curve (δAUC) = 0.136, p&lt;0.001 for maxWT and NRI=0.497, p&lt;0.0001, IDI=0.046, p&lt;0.0001 and δAUC = 0.128, p&lt;0.001 for sumWT), IMT (NRI=0.502, p&lt;0.0001, IDI= 0.058, p=0.02 for maxWT and NRI=0.559, p&lt;0.0001, IDI=0.051, p=0.016 for sumWT) and the number of carotid plaques (NRI=0.614, p&lt;0.0001, IDI=0.038, p=0.001 for maxWT and NRI=0.292, p=0.019, IDI=0.022, p=0.009 for sumWT). Conclusions The use of two novel cumulative markers of atherosclerotic burden improves risk stratification and discriminates high from very high CV risk. Given that carotid ultrasonography is a readily available modality, its clinical application for risk refinement of high-risk patients to facilitate treatment decisions merits further investigation. FUNDunding Acknowledgement Type of funding sources: None.

Internal Jugular Vein Velocity and Spontaneous Echo Contrast Correlate with Alzheimer’s Disease and Cognitive Function

Background: Many issues persist in the today’s Alzheimer’s disease (AD) screening and the breakthrough method is desired. Objective: We aim to validate the association between venous reflux and AD, and to develop a new method for AD screening. Methods: We examined spontaneous echo contrast, area, diameter, retrograde velocity, and anterograde velocity of the bilateral cervical internal jugular vein (IJV) using carotid ultrasonography. Results: A total of 112 patients participated in this study, with 26 diagnosed as AD. The proportion of both or either IJV spontaneous echo contrast (+) occupied 25 of total 26 AD patients, which showed 96.2%of sensitivity and 98.5%negative predictive value. The IJV velocities also showed significant correlation with AD diagnosis, although the IJV area or diameter did not. Conclusion: Our results indicate that the validation of the spontaneous echo contrast or velocities of the IJV are convenient AD diagnosis screening methods and that the venous reflux disturbance correlates with AD development.

The Predictive Value of Carotid Ultrasonography With Cardiovascular Risk Factors—A “SPIDER” Promoting Atherosclerosis

Insufficient recommendations do not support the clinical use of carotid ultrasonography for further risk stratification in moderate-to-high risk patients with cardiovascular disease (CVD). A literature review was performed to assess six aspects of the research progress and limitations of carotid ultrasonography and carotid atherosclerosis-related risk factors: (1) structures of the carotid intima and media; (2) plaques; (3) inflammation; (4) dynamics of carotid blood flow; (5) early detection and intervention; and (6) risk factors for CVD. Although carotid intima-media thickness and carotid plaques are well-acknowledged independent predictors of CVD risk, normative and cut-off values are difficult to define due to the heterogeneous measurements reported in previous studies. Plaque properties, including location, number, density, and size, become more important risk predictors for cardiovascular disease, but a better approach for clinical use needs to be further established. Three-dimensional ultrasound and contrast-enhanced ultrasound are promising for promoting risk stratification with more details on plaque morphology. Moreover, inflammatory diseases and biomarkers should be evaluated for a full assessment of the inflammatory burden for atherosclerosis. Carotid flow velocity is not only an indicator for stenosis but also a potential risk predictor. Carotid atherosclerosis should be detected and treated early, and additional clinical trials are needed to determine the efficacy of these measures in reducing CVD risk. Cardiovascular risk factors tend to affect carotid plaques, and early treat-to-target therapy might yield clinical benefits. Based on the aforementioned six aspects, we consider that these six important factors act like a “SPIDER” spinning the web of atherosclerosis; a timely comprehensive assessment and intervention may halt the progression to CVD. Carotid ultrasound results should be combined with other atherosclerotic factors, and a comprehensive risk assessment may help to guide cardiovascular prevention decisions.

Relationship of Neutrophil-to-Lymphocyte Ratio with Carotid Plaque Vulnerability and Occurrence of Vulnerable Carotid Plaque in Patients with Acute Ischemic Stroke

Background. Carotid plaque is an undefined risk factor in ischemic stroke and is driven by inflammation. Mounting evidence suggests that neutrophil-to-lymphocyte ratio (NLR) is crucial not only for cerebrovascular events but also in atherosclerosis progression. Here, we aimed to explore the association between the admission NLR and carotid plaque vulnerability as well as the occurrence of vulnerable carotid plaque detected by carotid ultrasonography in patients with acute ischemic stroke (AIS) among Chinese. Methods. We conducted a retrospective study composed of 588 patients with AIS and 309 healthy controls free of carotid plaque in the Department of Neurology in The Second Hospital of Lanzhou University from March 2014 to February 2015. All patients were classified as nonplaque, stable plaque, and vulnerable plaque groups on the basis of carotid ultrasonography results. The baseline information was collected and compared among the four different groups. The correlation between variables and carotid plaque vulnerability was tested by Spearman linear correlation analysis. To identify the independent predictors for vulnerable carotid plaque, univariate and multivariate logistic regression analysis was performed. Results. The comparisons of age, sex proportion, history of hypertension, diabetes, and smoking, the levels of HDL-C, Lp(a), BMI, SBP, DBP, Fib, CRP, leukocyte, and NLR among the four groups showed a statistically significant difference ( P < 0.05 ); in particular, the NLR was significantly higher in the vulnerable plaque group as compared to the control ( P = 0.043 ), nonplaque ( P = 0.022 ), and stable plaque groups ( P = 0.015 ). The Spearman correlation analysis presented a positive correlation between carotid plaque vulnerability and age ( r = 0.302 ; P < 0.001 ), SBP ( r = 0.163 ; P < 0.001 ), and NLR ( r = 0.087 ; P = 0.034 ), while the lymphocyte was negatively related to the carotid plaque vulnerability ( r = − 0.089 ; P = 0.030 ). The multivariate logistic regression analysis adjusted for confounding factors revealed that age (odds ratio [OR], 1.042; 95% confidence interval [CI], 1.025-1.060; P < 0.001 ), male gender (OR, 2.005; 95% CI, 1.394-2.884; P < 0.001 ), diabetes (OR, 1.481; 95% CI, 1.021-2.149; P = 0.039 ), SBP (OR, 1.012; 95% CI, 1.003-1.021; P = 0.010 ), and NLR (OR, 1.098; 95% CI, 1.018-1.184; P = 0.015 ) are independent predictors of vulnerable carotid plaque in patients with AIS. Conclusion. The admission NLR is a novel and meaningful biomarker that can be used in predicting carotid plaque vulnerability and the presence of vulnerable carotid plaque assessed by carotid ultrasonography in patients with AIS among Chinese.