Early Markers of Cardiovascular Disease Associated With Clinical Data and Autosomal Ancestry in Patients With Type 1 Diabetes: A Cross-sectional Study in an Admixed Brazilian Population.

BackgroundPatients with type 1 diabetes (T1D) have a higher risk of developing cardiovascular disease (CVD), which is a major cause of death in this population. The objective of this study was to investigate early markers of CVD associated with clinical data and autosomal ancestry in T1D patients from an admixed Brazilian population. MethodsA cross-sectional study was conducted with 99 T1D patients. The early markers of CVD included the ankle-brachial index (ABI), coronary artery calcium score (CACS), and carotid Doppler sonography. Demographic, clinical, and serum data were collected. A panel of autosomal informational insertion/deletion ancestry markers was used to estimate the individual proportions of European, African, and Amerindian ancestry.ResultsThe study sample had a mean age of 27.6 years and 14.4 years of duration of T1D. The prevalence of alterations in early CVD markers was: ABI (< 0,9) 19.6%, CACS (> 0 +) 4.1%, and carotid Doppler 5.0%. There was significant agreement between CACS and carotid Doppler, and these were correlated with traditional risk factors for CVD. There was a predominance of European ancestry (47.3%), followed by African (28%) and Ameridian (24.7%). There were no association between early CVD markers and autosomal ancestry proportions.ConclusionThe ABI was useful in the early identification of CVD in asymptomatic young patients with T1D and with a short duration of disease, and showed agreement with the carotid Doppler. Although CACS and carotid Doppler are non-invasive tests, carotid Doppler is more cost-effective, and both have limitations in screening for CVD in young patients with a short duration of T1D. We did not find a statistically significant relationship between autosomal ancestry proportions and early CVD markers in an admixed Brazilian population.

A Wireless Wearable Doppler Ultrasound Detects Changing Stroke Volume: Proof-of-Principle Comparison with Trans-Esophageal Echocardiography during Coronary Bypass Surgery

Background: A novel, wireless, ultrasound biosensor that adheres to the neck and measures real-time Doppler of the carotid artery may be a useful functional hemodynamic monitor. A unique experimental set-up during elective coronary artery bypass surgery is described as a means to compare the wearable Doppler to trans-esophageal echocardiography (TEE). Methods: A total of two representative patients were studied at baseline and during Trendelenburg position. Carotid Doppler spectra from the wearable ultrasound and TEE were synchronously captured. Areas under the receiver operator curve (AUROC) were performed to assess the accuracy of changing common carotid artery velocity time integral (ccVTI∆) at detecting a clinically significant change in stroke volume (SV∆). Results: Synchronously measuring and comparing Doppler spectra from the wearable ultrasound and TEE is feasible during Trendelenburg positioning. In two representative cardiac surgical patients, the ccVTI∆ accurately detected a clinically significant SV∆ with AUROCs of 0.89, 0.91, and 0.95 when single-beat, 3-consecutive beat and 10-consecutive beat averages were assessed, respectively. Conclusion: In this proof-of-principle research communication, a wearable Doppler ultrasound system is successfully compared to TEE. Preliminary data suggests that the diagnostic accuracy of carotid Doppler ultrasonography at detecting clinically significant SV∆ is enhanced by averaging more cardiac cycles.

Management of significant atherosclerotic carotid artery disease: review of literature

Stroke is the third leading cause of death and disability in the world. Carotid artery stenosis due to atherosclerosis accounts for 20 to 30% of all strokes. The patients can be asymptomatic or present with a transient ischemic attack or stroke. Diagnosis is based primarily on imaging modalities like carotid Doppler, CT (Computed tomography) angiogram, MR (Magnetic resonance) angiogram or DSA (Digital subtraction angiogram). Treatment options include optimal medical therapy, carotid endarterectomy-touted as the gold standard for treating significant carotid stenosis; and carotid artery stenting, whose safety and efficacy have undergone significant improvements due to technological advances in the field. We presented a review of the literature outlining the various aspects of atherosclerotic carotid stenosis and the findings of several randomized controlled trials conducted to settle the debate between endarterectomy and stenting for carotid stenosis.

Increased Risk of Decompression Sickness When Diving With a Right-to-Left Shunt: Results of a Prospective Single-Blinded Observational Study (The “Carotid Doppler” Study)

Introduction: Divers with a patent Foramen Ovale (PFO) have an increased risk for decompression sickness (DCS) when diving with compressed breathing gas. The relative risk increase, however, is difficult to establish as the PFO status of divers is usually only determined after a DCS occurrence.Methods: This prospective, single-blinded, observational study was designed to collect DCS data from volunteer divers after screening for right-to-left shunt (RLS) using a Carotid Doppler test. Divers were blinded to the result of the test, but all received a standardized briefing on current scientific knowledge of diving physiology and “low-bubble” diving techniques; they were then allowed to dive without restrictions. After a mean interval of 8 years, a questionnaire was sent collecting data on their dives and cases of DCS (if any occurred).Results: Data was collected on 148 divers totaling 66,859 dives. There was no significant difference in diving data between divers with or without RLS. Divers with RLS had a 3.02 times higher incidence of (confirmed) DCS than divers without RLS (p = 0.04). When all cases of (confirmed or possible DCS) were considered, the Relative Risk was 1.42 (p = 0.46). DCS occurred mainly in divers who did not dive according to “low-bubble” diving techniques, in both groups.Conclusion: This prospective study confirms that DCS is more frequent in divers with RLS (such as a PFO), with a Relative Risk of 1.42 (all DCS) to 3.02 (confirmed DCS). It appears this risk is linked to diving behavior, more specifically diving to the limits of the adopted decompression procedures.

Prevalence and correlates of carotid artery stenosis in a cohort of Sri Lankan ischaemic stroke patients

Background Large artery atherosclerotic disease is an important cause of stroke, accounting for 15–46% of ischaemic strokes in population-based studies. Therefore, current guidelines from west recommend urgent carotid imaging in all ischaemic strokes or transient ischaemic attacks and referral for carotid endarterectomy. However, the clinical features and epidemiology of stroke in Asians are different from those in Caucasians and therefore the applicability of these recommendations to Asians is controversial. Data on the prevalence of carotid artery stenosis (CAS) among South Asian stroke patients is limited. Therefore, we sought to determine the prevalence and associated factors of significant CAS in a cohort of Sri Lankan patients with ischaemic stroke. Methods We prospectively studied all ischaemic stroke patients who underwent carotid doppler ultrasonography admitted to the stroke unit of a Sri Lankan tertiary care hospital over 5 years. We defined carotid stenosis as low (< 50%), moderate (50–69%) or severe (70–99%) or total-occlusion (100%) by North American Symptomatic Trial Collaborators (NASCET) criteria. We identified the factors associated with CAS ≥ 50% and ≥ 70% by stepwise multiple logistic regression analysis. Results A total of 550 ischaemic stroke patients (326 (59.3%) male, mean age was 58.9 ± 10.2 years) had carotid doppler ultrasonography. Of them, 528 (96.0%) had low-grade, 12 (2.2%) moderate and 7 (1.3%) severe stenosis and 3 (0.5%) had total occlusion. On multivariate logistic regression, age was associated with CAS ≥ 50% (OR 1.12, p = 0.001) and CAS ≥ 70% (OR 1.14, p = 0.016), but none of the other vascular risk factors studied (sex, hypertension, diabetes mellitus, smoking, past history of TIA, stroke or ischemic heart disease) showed significant associations. Conclusions Carotid stenosis is a minor cause of ischemic stroke in Sri Lankans compared to western populations with only 4.0% having CAS ≥ 50 and 3.5% eligible for carotid endarterectomy. Our findings have implications for the management of acute strokes in Sri Lanka.

Role of Nail Fold Capillaroscopy as A Method of Early Detection of Atherosclerosis in Systemic Lupus Erythematosus Patients

Background The development of atherosclerosis and cardiovascular disease as a consequence Systemic Lupus Erythematosis is a common and dangerous complication in patients with SLE. However, since the prevalence of atherosclerosis and cardiovascular disease is variable and increasing by time, universal screening would imply a large number of unnecessary carotid Doppler. Objective To study the early prediction of atherosclerosis and the cardiovascular risk in SLE patients by Nail fold capillaroscopy and the Intima media thickness of the Carotid artery. Patients and Methods All Patients were subjected to full history taking, full clinical examination, laboratory investigations, carotid Doppler and nail fold capillaroscopy. In this study, we prospectively collected data on 30 consecutive patients referred to Ain Shams University hospitals and The National Research Institute. Results However, nail fold changes was significantly higher in patients with IM thickness changes indicative of atherosclerosis with SLE: it was proved to be highly sensitive and adequately specific in predicting the atherosclerosis in those patients. Conclusion IM thickness and nail fold capillaroscopy could be used as a guiding noninvasive screening tool in patients with SLE to predict the atherosclerosis and CV risk. Nail fold changes is correlated to the atherosclerotic changes happening in SLE patients. These results may lead to a reduction in the number of SLE patients with undiagnosed atherosclerosis and CV risk. Nail fold capillarscopy may also help alleviate the financial and disinfection burdens of radiology units as well as the medical costs associated with atherosclerosis and CV risk. Nail fold capillaroscopy can be used as a screening tool before doing carotid Doppler.