Right atrium enlargement is related to increased heart damage and mortality in well-controlled hypertension

Background and aimLeft heart remodeling is a well-known pathophysiological effect of arterial hypertension. Right Heart status is not considered in its evaluation. No data are available on right atrium (RA) and its impact on the outcome in hypertension.We wondering to understand whether RA may play a role as a marker of an increased risk for organ damage in well-controlled hypertensives, to probe the clinical significance and whether it could indicate an increased risk.Methods and resultsWe studied well-controlled hypertensive patients. Heart damage was assessed by echocardiography. Patients were subdivided into those with RA area ≤18 cm² (normal RA - Group 1) (554 pts, 227 M, aged 60.35 ± 10.48 years) and those >18 cm² (Increased RA - Group 2) (101 pts, 71 M, age 61.65 ± 9.46 years). Group 2 had a higher left ventricle mass (LVM) and left atrium volume (LAV) both as absolute value (both p < 0.0001) and indexed for body surface area (LVMi p < 0.013; LAVi p = 0.0013). Group 2 showed an increased vascular stiffness (p < 0.0001) and carotid stenosis percentage (p = 0.011). TAPSE (p < 0.0001) resulted significantly increased. In The RA area was significantly correlated directly to LVM and LAV in both groups, but these correlations persisted in indexed values only in Group 2. Moreover, in this group there was a significant direct correlation between RA area and Tricuspid s'wave at echocardiography TDI analysis. Finally, Group 2 had an increased mortality rate compared to Group 1 (Log-Rank p = 0.0006).ConclusionGroup 2 hypertensive patients showed more alterations in dimensional and volumetric left heart parameters, and an increased mortality.     

The Retardation of Progression,Stabilization, and Regression of Coronary and Carotid Atherosclerosis by Low-Density Lipoprotein Apheresis in Patients with Familial Hypercholesterolemia

Abstract: The long-term effects of low-density lipoprotein (LDL) apheresis (LA) on the progression and regression of atherosclerosis were evaluated by angiographic and pathological findings as well as ultrasonography based studies, and the clinical significance of the treatment was evaluated. We studied 11 patients with familial hypercholesterolemia (FH), 2 with homozygous FH and 9 with severe heterozygous FH who received combined LA and drug therapy for a mean of 7.7 years. During the treatment period, the mean time-averaged level of LDL cholesterol was 181 ± 52 mg/dl. According to the coronary angiographic results, 3 patients showed regression, 6 patients showed progression, and 2 patients showed no change. Cardiac events occurred in 6 patients. We pathologically examined at autopsy the coronary arteries of 1 FH patient who had received long-term LA therapy before death. The results revealed the process of scarring of atheromatous plaque, suggesting pathological regression correlated with the angiographic regression shown in serial angiograms taken during LA treatment. It was further suggested that the formation of an eccentric thick end wall lesion rich in collagen fiber prevented atheromatous plaque from tearing off. However, the annual progression rate of the mean maximal intima-media thickness in the common carotid artery was 0.0002 mm/year in the LA group, which was significantly lower than the mean of 0.251 mm/year seen in the control group (drug therapy only group). In the patients with heterozygous FH (9 patients), the annual progression rate was lowered to 0.0023 mm/year, suggesting regression. The findings of the present study indicate that patients with severe FH refractory to drug treatment may benefit from more aggressive cholesterol lowering treatments such as LA combined with cholesterol lowering drug therapy. The progression of atherosclerosis may be prevented, plaque may be stabilized (regressed), and clinical events may be reduced as seen with patients with non-FH hypercholesterolemia.     

RhoA/ROCK信号通路与原发性高血压患者血压变异性及颈动脉内膜中层厚度的相关性

目的探讨原发性高血压患者血清RhoA激酶(ROCK)水平与血压变异性(BPV)及颈动脉内膜中层厚度(IMT)的关系。方法选取2013年9月至2014年8月山东大学附属济南市中心医院心内科原发性高血压患者73例,根据血清ROCK1水平分为高表达组(n=37)和低表达组(n=36)。选取同期体检血压正常者40例为正常对照组。采用Human Rock1 Elisa kit及酶标仪检测血清ROCK1水平;监测24 h血压,记录24 h、白昼、夜间血压均值以及相应的血压标准差;采用彩色多普勒超声仪测量颈动脉IMT。结果高表达组和低表达组血清ROCK1水平明显高于正常对照组(P<0.01);高表达组24 h收缩压标准差(24h SSD)、日间收缩压标准差(d SSD)、夜间收缩压标准差(n SSD)均明显高于低表达组(P<0.05);高表达组和低表达组颈动脉IMT比正常对照组明显增厚,高表达组颈动脉IMT比低表达组明显增厚(P<0.05);血清ROCK1水平与24h SSD、d SSD、n SSD及颈动脉IMT呈显著正相关性(P<0.05)。结论高血压患者血压变异性增高与RhoA/ROCK1信号通路高表达有关,RhoA/ROCK1信号通路过度激活可导致颈动脉IM T增厚及颈动脉粥样硬化斑块(AS)形成。     

Atherosclerosis risk factors in young patients formerly treated for idiopathic nephrotic syndrome

A total of 30 patients (ten female/20 male), 9 years to 22 years old (mean age 17.3 years) and 30 healthy teenage controls (mean age 16.4 years) were included in our study. The patients had steroid-sensitive idiopathic nephrotic syndrome (INS) and had completed steroid therapy 4 years to 15 years ago. Height and weight, body mass index (BMI), body composition, and intima-media thickness (IMT) were determined, as were levels of total cholesterol (TCh), low-density lipoprotein cholesterol (LDL-Ch), high-density lipoprotein cholesterol (HDL-Ch), triacylglycerols (TAGs), homocysteine (HCY), and high-sensitivity C-reactive protein (hsCRP). We did not observe any differences between the study and control groups in IMT (0.47 ± 0.1 vs 0.46 ± 0.1 mm) and body composition (fat tissue and water content). Differences in HDL-Ch and hsCRP levels between groups were not significant. In the study group we found significantly higher TCh levels (187.6 ± 57.2 mg/dl vs 158.8 ± 25.7 mg/dl; P = 0.012), LDL-Ch (115.9 ± 63.7 mg/dl vs 79.4 ± 25.4 mg/dl; P = 0.005), HCY (12.3 ± 7.7 μmol/l vs 7.6 ± 1.6 μmol/dl; P < 0.001), apolipoprotein B (ApoB) (113.6 ± 30.0 mg/dl vs 78.7 ± 13.6 mg/dl; P < 0.001) and ApoA1 (203.5 ± 50.8 mg/dl vs 156.5 ± 12.4 mg/dl; P < 0.001) levels. Multi-factor analysis of the influence of independent factors (number of recurrences, duration of remission, age, gender, and BMI) on the parameters under investigation indicated a positive correlation between IMT and the number of recurrences. Conclusions: 1. Patients treated for idiopathic nephrotic syndrome in the past should undergo regular laboratory tests of atherosclerosis risk factors, including not only cholesterol and its fractions, but also ApoA1, ApoB and HCY. 2. It is necessary to continue systematic check-ups of the intima-media thickness of the carotid arteries among young patients with anamnesis of INS, especially among patients who suffered from numerous relapses of this disease.     

Comparison of Common Carotid Artery Intima-Media Thickness Between Brazilian Euro-Descendants and Afro-Descendants with Atherosclerosis Risk Factors

OBJECTIVE:

To compare common carotid intima-media thickness (IMT) between the two major Brazilian ethnic groups (those of African descent and those of European descent) among individuals with one or more risk factors for atherosclerotic disease.

METHOD:

Two hundred and six patients with one or more risk factors for atherosclerotic disease were evaluated in a cross-sectional study in which their clinical, ethnic and Demographic characteristics were collected. All patients underwent duplex ultrasound examination of their carotid vessels to obtain IMT measurements.

RESULTS:

One hundred and fifty-three patients (74.3%) had a carotid IMT greater than 1.0 mm at one or more point of measurement in at least one common carotid artery. There was a significant correlation between older age and mean carotid wall thickness (R=0.479 / P<0.01). Multivariate analysis identified male sex, arterial hypertension and older age as variables associated with increased IMT (P<0.05 for all variables). When IMT was compared between the two ethnic groups in this study, no significant differences were noted. Euro-descendants and Afro-descendants had similar IMT values, even when the groups were stratified by degree of IMT (normal vs. increased) and presence of stroke and/or transient ischemic attack (yes vs. no).

CONCLUSIONS:

The risk factors associated with increased common carotid artery IMT in Brazilian individuals are similar to those in previously described populations. No differences were observed between the two main Brazilian ethnic groups. Longitudinal studies are required for a better evaluation of the incidence, etiologic factors and evolution of carotid intimomedial thickening in this population.     

Intima-media thickness and age of first depressive episode

Background

Late life depression, including patients with vascular depression, has been associated with higher levels of intima-media thickness (IMT). Although individuals with vascular depression tend to report a later onset of depression, the relationship of IMT and age of first depressive episode is uncertain in younger adults. We therefore investigated the relationship between IMT and age of first depressive episode in a sample of 202 adults (age range 40–81 years) with major depression (MDD).

Methods

Depression status was assessed using the Structured Clinical Interview Schedule and the Hamilton Depression Rating Scale. Patients underwent a physical examination in which a medical history was obtained. IMT was measured from the left and right common carotid arteries. Simple regression analyses were used to investigate the association between IMT and self-reported age of first depressive episode.

Results

IMT was associated with a later onset of first major depressive episode (b = .225, P = .0005) and this association remained significant after controlling for age, Framingham Stroke Risk Profile, smoking pack years, physical activity, high- and low-density lipoprotein, body mass index, triglyceride levels, and history of chronic medical conditions (b = .142, P = .028). Each .10 mm increase in IMT was associated with a 2.6-year later reported occurrence of first major depressive episode (MDE). Similarly, higher levels of IMT were associated with fewer previous MDEs (b = −.149, P = .020) and this effect remained significant in our multivariate model (b = −.140, P = .030). In contrast, IMT was not associated with current depressive severity (b = −.024, P = .720).

Conclusions

Greater levels of IMT are associated with a later onset of depression and fewer previous depressive episodes among middle-aged and older adults, independent of cardiovascular co-morbidities. These findings provide preliminary evidence that increased vascular burden may be associated with a later onset of depression.     

Boundary detection in carotid ultrasound images using dynamic programming and a directional Haar-like filter

The intima-media thickness (IMT) of the carotid artery, obtained from B-mode ultrasound images, has recently been proposed as one of the most useful indices of atherosclerosis and can also be used to predict major cardiovascular events. Ultrasonic measurements of the IMT are conventionally obtained by time-consuming manual tracing of the interfaces between tissue layers. We propose a computerized method to detect the boundary of the intima-media complex using a directional Haar-like filter that can account for the slope of the boundary in an image. The directional Haar-like filter extracts a directional boundary feature as an image feature in the region of interest, which is used to compute a cost function. A cost function includes not only the directional Haar-like filtering value but also the geometric continuity that is computed for every pixel in the region of interest. The optimal boundary pixels are detected by using a dynamic programming approach that searches for the pixel that minimizes the cost function in each column of the image. We compared the performance of the proposed method with that of manual methods performed by two radiologists. The results showed that our approach produces very similar results to those based on manual tracing, and there was no statistically significant difference between the IMT measurements segmented manually and those analyzed using our method.     

彩色多普勒超声对冠状动脉病变与颈动脉内-中膜厚度的相关性研究

目的通过超声对颈动脉内-中膜厚度（IMT）分析,探讨冠状动脉病变与颈动脉IMT的相关性。方法选择经胸超声检查冠脉正常和冠状动脉病变两组各40例进行颈动脉IMT测量及斑块积分。结果冠状动脉病变组颈动脉IMT（1.39＋0.67）mm和斑块积分（1.69＋0.15）分,均明显高于正常对照组颈动脉IMT（0.83＋0.14）mm和斑块积分（0.28＋0.17）分,两组间有显著性差异（P〈0.01）。结论冠状动脉病变与颈动脉IMT有很好的相关性,可反映冠状动脉病变的程度,通过超声检查颈动脉可预测冠状动脉病变。     

Association of the -757T>C polymorphism in the CRP gene with circulating C-reactive protein levels and carotid atherosclerosis

Introduction

C-reactive protein (CRP) is an inflammatory protein that may play a role in the pathogenesis of atherosclerosis. CRP gene single nucleotide polymorphisms (SNPs) have been shown to be associated with CRP concentration; however, their independent effect on atherosclerosis has not been yet established. We aimed to determine whether the 5′-flanking -757T>C CRP gene polymorphism is associated with CRP concentration and carotid atherosclerosis.

Methods

We genotyped the -757T>C CRP gene SNP and determined the concentration of serum CRP, the intima-media thickness (IMT) of the common carotid artery and the existence of plaque/s in 612 apparently healthy men and women aged 66 ± 10 years.

Results

Carriers of the CRP -757C allele presented with higher IMT and higher CRP concentrations (p = 0.002, p = 0.042, respectively). After adjustment for vascular risk factors, linear regression analysis showed an independent effect of CRP -757C allele on carotid IMT, beyond serum CRP concentrations. This SNP was also associated with carotid plaque occurrence (O.R. 1.74, 95% CI 1.1-2.77, p = 0.002).

Conclusions

The present study provides evidence that a genetic variant of CRP gene is associated with carotid atherosclerosis, independently of traditional vascular risk factors. Further large-scale genomic studies are required, which may identify the genetic vulnerable subjects to develop atherosclerosis.     

脑梗死患者颈动脉粥样硬化斑块和血浆基质金属蛋白酶3的相关性研究

目的研究脑梗死患者颈动脉内膜中层厚度(IMT)及斑块发生率和血浆基质金属蛋白酶3(MMP-3)的血浆水平及二者的相关性。方法用彩色多普勒超声检测80例脑梗死患者和30例健康对照组颈动脉IMT及斑块,脑梗死组根据斑块的性质,分为三组:颈动脉软斑组(n=39)、颈动脉硬斑组(n=24)、无斑块组(n=17),用ELISA法测定血桨MMP-3。结果与对照组相比,脑梗死组比对照组的三酰甘油、总胆固醇、低密度脂蛋白胆固醇的水平偏高,而高密度脂蛋白胆固醇则降低,有显著差异(P<0.05),脑梗死组的颈动脉IMT明显高于对照组,其斑块发生率亦明显高于对照组,有显著差异(P<0.05),MMP-3的血浆水平在脑梗死组明显高于对照组,其中伴有颈动脉软斑及混合斑的脑梗死组明显升高,与颈动脉硬斑、无斑块的脑梗死组和正常对照组比较有显著差异(P<0.05),而无斑块的脑梗死组和正常对照组比较无显著差异(P>0.05)。结论血浆MMP-3水平的提高和颈动脉IMT及斑块的不稳定性及脑梗死的形成有着密切联系。