Paediatric heart transplantation recipients ≥7 years of age receiving donors with pre-existing coronary atherosclerosis showed progressive coronary artery disease

Background: This study aimed to determine the effect of donor-transmitted atherosclerosis on the late aggravation of cardiac allograft vasculopathy in paediatric heart recipients aged ≥7 years. Methods: In total, 48 patients were included and 23 had donor-transmitted atherosclerosis (baseline maximal intimal thickness of >0.5 mm on intravascular ultrasonography). Logistic regression analyses were performed to identify risk factors for donor-transmitted atherosclerosis. Rates of survival free from the late aggravation of cardiac allograft vasculopathy (new or worsening cardiac allograft vasculopathy on following angiograms, starting 1 year after transplantation) in each patient group were estimated using the Kaplan–Meier method and compared using the log-rank test. The effect of the results of intravascular ultrasonography at 1 year after transplantation on the late aggravation of cardiac allograft vasculopathy, correcting for possible covariates including donor-transmitted atherosclerosis, was examined using the Cox proportional hazards model. Results: The mean follow-up duration after transplantation was 5.97 ± 3.58 years. The log-rank test showed that patients with donor-transmitted atherosclerosis had worse survival outcomes than those without (p = 0.008). Per the multivariate model considering the difference of maximal intimal thickness between baseline and 1 year following transplantation (hazard ratio, 22.985; 95% confidence interval, 1.948–271.250; p = 0.013), donor-transmitted atherosclerosis was a significant covariate (hazard ratio, 4.013; 95% confidence interval, 1.047–15.376; p = 0.043). Conclusion: Paediatric heart transplantation recipients with donor-transmitted atherosclerosis aged ≥7 years had worse late cardiac allograft vasculopathy aggravation-free survival outcomes.

Segmental Representation of Intimal Thickness in Ascending Aorta as Early Clinical Marker of Aging

Background: Intimal thickness is the innermost layer of aorta; play a vital role in development of atherosclerotic changes. It may vary in the different parts of the aorta and may increase with age. Methods: 120 aortas of adult human forensic bodies were taken. Histological slides were formed and the thickness of different segments of aorta were measured microscopically. Data were statically analyzed using ANOVA, p test methods. Results and Discussion: There is no significant difference of Intimal thickness in different segments of ascending aorta though it significantly increase with age may be due to accumulation of medial SMCs into intima. Results agree with previous workers. Conclusion: No significant difference between different segments of ascending aorta and it increase with age showing the aging aorta and early sign of atherosclerotic changes. KEY WORDS: Aging, Intimal thickness, Age Groups, Smooth Muscle Cells, Medial thickness.

Evaluation of Carotid Intimal Thickness in Type 2 Diabetic Individuals by Colour Doppler Ultrasonography in a Teaching Hospital in Hyderabad, Telanaga, India

BACKGROUND Diabetes mellitus is a common chronic condition in our country and is an established modifiable risk factor for cardiovascular diseases and ischemic stroke. Carotid Doppler ultrasonography is a popular tool for evaluating atherosclerosis of the carotid artery. Its two-dimensional grayscale can be used for measuring the intima-media thickness, which is a very good biomarker for atherosclerosis and can aid in plaque characterisation. We intend to evaluate carotid intimal thickness by colour Doppler ultrasonography in type 2 diabetic individuals in a teaching hospital. METHODS A prospective study was done among 70 cases of diabetes mellitus in whom ultrasonography (USG) was done in the Department of General Medicine, Maheshwara Medical College, Patancheru, Hyderabad, Telangana. RESULTS In the present study, study participants were in the age group of 20 - 70 years. Majority of the cases was in the 41 - 50 years age group with a slight male predominance and the male to female ratio was 1.8:1. In this study, intimal medial thickness (IMT) change of 0.07 mm was observed. Within the observation period of eight months, the IMT of diabetic patients increased by an average of 0.06 mm. CONCLUSIONS Colour Doppler ultrasonography of carotid is an important imaging modality for early detection of carotid artery stenosis in diabetic patients who are at risk for developing carotid atherosclerosis. It should be a routine practice to screen diabetic patients for carotid atherosclerosis. KEYWORDS Colour Doppler USG, Intima-Media Thickness, Type 2 Diabetes, Atherosclerosis

Vascularization of the arteriovenous fistula wall and association with maturation outcomes

Background and objectives: The venous vasa vasorum is the mesh of microvessels that provide oxygen and nutrients to the walls of large veins. Whether changes to the vasa vasorum have any effects on human arteriovenous fistula outcomes remains undetermined. In this study, we challenged the hypothesis that inadequate vascularization of the arteriovenous fistula wall is associated with maturation failure. Design, setting, participants, and measurements: This case–control pilot study includes pre-access veins and arteriovenous fistula venous samples (i.e. tissue pairs) from 30 patients undergoing two-stage arteriovenous fistula creation (15 matured and 15 failed to mature). Using anti-CD31 immunohistochemistry, we quantified vasa vasorum density and luminal area (vasa vasorum area) in the intima, media, and adventitia of pre-access veins and fistulas. We evaluated the association of pre-existing and postoperative arteriovenous fistula vascularization with maturation failure and with postoperative morphometry. Results: Vascularization of veins and arteriovenous fistulas was predominantly observed in the outer media and adventitia. Only the size of the microvasculature (vasa vasorum area), but not the number of vessels (vasa vasorum density), increased after arteriovenous fistula creation in the adventitia (median vasa vasorum area 1366 µm2/mm2 (interquartile range 495–2582) in veins versus 3077 µm2/mm2 (1812–5323) in arteriovenous fistulas, p < 0.001), while no changes were observed in the intima and media. Postoperative intimal thickness correlated with lower vascularization of the media ( r 0.53, p = 0.003 for vasa vasorum density and r 0.37, p = 0.045 for vasa vasorum area). However, there were no significant differences in pre-existing, postoperative, or longitudinal change in vascularization between arteriovenous fistulas with distinct maturation outcomes. Conclusion: The lack of change in intimal and medial vascularization after arteriovenous fistula creation argues against higher oxygen demand in the inner walls of the fistula during the vein to arteriovenous fistula transformation. Postoperative intimal hyperplasia in the arteriovenous fistula wall appears to thrive under hypoxic conditions. Vasa vasorum density and area by themselves are not predictive of maturation outcomes.

P3644Plaque progression from normal vessel wall to fibroatheroma: lessons from over 5-year follow-up optical coherence tomography study

Background Progression of atherosclerosis is a non-uniform process characterized by coexistence of normal vessel wall (NVW) and advanced fibroatheroma within the same cross-section (Figure). Plaque progression from NVW to fibroatheroma usually takes years, that has never been investigated in human. Purpose To investigate the incidence and related factors associated with atherosclerotic progression from NVW to fibroatheroma using long-term serial optical coherence tomography (OCT) follow-up data over 5 years. Methods We enrolled 47 vessels in 30 patients who had undergone serial OCT imaging over 5 years (average: 6.8 years). Baseline and follow-up OCT images were matched for longitudinal and circumferential location and OCT cross-sections that had NVW >30 degrees were enrolled. NVW was defined as vessel wall having OCT-detectable three-layer structure with intimal thickening ≤300μm. Cross-sections were diagnosed as +Progression when NVW in the cross-section reduced by >30 degrees during >5-year follow-up. Results In the present study, atherogenic progression from NVW to fibroatheroma was observed only in 37.2% of the enrolled cross-sections. On the other hand, despite an average long-term follow-up period of 6.8 years, the extent of NVW was maintained in 62.8% of cross-sections. The incidence of microchannel in adjacent fibroatheroma within the same cross-section (23.6% vs. 13.1%, p=0.023), eccentric plaque distribution (21.7% vs. 11.4%, p=0.019), and concave shape (6.6% vs. 0%, p=0.001) at baseline was significantly higher in cross-sections with +Progression than those without Progression. Average intimal thickness of NVW (187.2±64.9μm vs. 170.7±68.6μm; p=0.048) at baseline was significantly thicker in cross-sections with +Progression than those without. Multivariate analysis demonstrated that the presence of microchannel, eccentric plaque distribution and thicker average intimal thickness of NVW at baseline were independently associated with plaque progression during the follow-up. Atheroma progression Conclusion The presence of microchannel in adjacent fibroatheroma, eccentric plaque distribution, and thicker intimal thickening of NVW were potentially associated with plaque progression from NVW to fibroatheroma.