Carotid ultrasonography in the evaluation of subclinical arteriosclerosis in patients with risk factors for atherosclerosis

CILJ ISTRAŽIVANJA: Glavni cilj istraživanja bio je ispitati specifičnosti pojedinih strukturnih i funkcionalnih ultrazvučnih (UZV) pokazatelja supkliničke arterioskleroze u ovisnosti o najznačajnijim čimbenicima rizika za aterosklerozu, dobi i spolu. Dodatni cilj bio je ispitati eventualnu povezanost UZV markera supkliničke arterioskleroze s ljestvicama procjene kardiovaskularnog (CV) rizika i njihov mogući utjecaj na klasifikaciju pojedinaca u rizične kategorije. ISPITANICI I METODE: U istraživanje, koje je dizajnirano kao presječno, bilo je uključeno 245 CV zdravih ispitanika (125 žena) raspona životne dobi između 32 i 59 godina, srednje dobi 49,5 godina. Odvojeno po spolu formirane su grupe ispitanika prema kriteriju prisutnosti jednog od triju CV rizičnih čimbenika (arterijska hipertenzija, dijabetes melitus tip 2, pušenje cigareta), te dvije kontrolne skupine ispitanika bez rizičnih čimbenika. Između formiranih skupina ispitanika nije bilo značajne dobne razlike. Na temelju UZV pregleda karotidnih arterija u B-prikazu detektirani su strukturni pokazatelji, a istovremenim mjerenjem krvnog tlaka i pulsatilnih oscilacija lumena izračunati su indeksi elastičnosti i krutosti arterijske stijenke. REZULTATI: Debljina stijenke (CIMT), vaskularna masa, površina poprečnog presjeka stijenke i omjer debljina stijenke/lumen karotidnih arterija pokazuju najveću alteraciju u dijabetičnim skupinama, odnosno prema kontrolnim skupinama statistički su značajno promijenjeni u dijabetičnim i hipertenzivnim skupinama (p 0,05), dok su kod muškaraca pušača DC i B značajno različiti od rezultata kontrolne skupine (p 0. 05), while in male smokers DC and B are significantly different than in the control group (p < 0.05). There is a positive correlation between age and the results of ultrasound tests in the subjects of both sexes (Pearson correlation coefficient from 0.472 to 0.608, p < 0.001). A significant diference has been found when comparing women and men of the same age in 125 terms of pronounced arteriosclerosis change, wich is higher in men (p <0.001). Introducing CIMT as the additional criteria in assessing CV risk by Framingham Risk Score led to reclassification of approximately 70% of women to a higher, and about 10% in a lower risk category. The use of carotid atherosclerotic plaque as an additional criteria led to reclassification of approximately 80% of men from medium-risk category to the high risk category. CONCLUSION: Carotid ultrasonography enables early detection of structural and functional alterations of the arterial wall material that match subclinical arteriosclerosis

Functional Carotid Ultrasound Markers of Subclinical Atherosclerosis in Men With Cardiovascular Risk Factors

Aim: The aim of this study was to compare the most commonly used ultrasound parameters of elasticity and stiffness of the arterial wall in the detection of carotid subclinical atherosclerosis (SA) in vascular healthy men with one of the most prominent cardiovascular risk factors (CVRF). Methods: Total of 120 vascular healthy men between 33 and 59 years of age ( (SD)=49.7(6.93)) were allocated into hypertension, diabetes, smokers and control group of respondents without CVRF. Ultrasound examination of carotid arteries was used to measure intima-media thickness and maximal and minimal lumen diameter. Along with the blood pressure of all respondents, the following markers of elasticity/stiffness of arterial wall were calculated: distensibility coefficient (DC), compliance coefficient (CC), Young\u27s elasticity modulus (YEM) and β stiffness index (β). Results: DC, CC and β indicated significantly lower elasticity and higher stiffness of arterial wall in hypertension and diabetic groups of respondents without CVRF (multiple comparison, p<0.001). There were significant changes in functional characteristics of carotid arteries present between respondents-smokers and the control group detected by DC and β (multiple comparison, p<0,05). There were 94 respondents (78%) with subclinical carotid atherosclerosis criteria. ROC analysis indicated that DC, β and CC (AUC 0.811, 0.810, 0.799) are good markers for SA. Conclusions: In conclusion, it is possible to use an ultrasound in detection of changes of elasticity/stiffness in arterial wall caused by the major CVRF in vascular healthy men. DC and β seem to be the best indicators of the presence/absence of subclinical carotid atherosclerosis

The Role of Total Antioxidant Status in Cerebral Vasoreactivity of Chronic Obstructive Pulmonary Disease Patients

Introduction: Chronic obstructive pulmonary disease (COPD) is associated with an oxidant-antioxidant imbalance. COPD patients have impaired cerebral vasoreactivity (CVR). Impaired CVR could be correlated with total antioxidant status (TAS) in plasma. Aim: To determine the role of systemic TAS in CVR of COPD patients. Material and Methods: In this cross-sectional observational study, we included 120 participants (the mean age of 67±7.9, 87 males), 90 COPD patients categorized according to the severity of airway obstruction in mild, moderate, severe/very severe and 30 age- and sex-matched controls. We analyzed baseline mean flow velocities (MFV) of the middle cerebral artery (MCA) and the basilar artery (BA), the mean breath-holding index (BHIm) of those arteries (BHImMCA and BHImBA) by transcranial Doppler ultrasound and TAS in plasma. The level of significance was set to α=0.05. Results: A significant negative correlation between TAS and BHImBA (Rho=−0.445, P=0.01) was found only in the mild COPD group. In COPD groups, baseline MFV BA is in a significant positive correlation with BHImMCA and BHImBA (Rho=0.336, P=0.001 and Rho=0.647, P<0.001). According to the severity of airway obstruction in COPD groups, a significant positive correlation between baseline MFV BA and BHImBA was found: in mild (Rho=0.731, P<0.001), moderate (Rho=0.574, P=0.001) and severe/very severe (Rho=0.398, P=0.03). Conclusion: Systemic TAS was not correlated with CVR in all COPD groups. However, perfusion in the BA of COPD groups was in a significant positive correlation with the anterior and posterior CVR. The analysis of perfusion in the basal cerebral arteries should be part of a future study of CVR in COPD patients. (Hlavati M, Tomić S, Buljan K, Butković-Soldo S. The Role of Total Antioxidant Status in Cerebral Vasoreactivity of Chronic Obstructive Pulmonary Disease Patients. SEEMEDJ 2020; 4(2); 48-61

Relationship between Age and Thickness of Carotid Arteries in a Population without Risk Factors for Atherosclerosis

The intima-media thickness (IMT) of carotid arteries is a marker of subclinical atherosclerosis associated with risk factors for atherosclerosis and a predictor of vascular disease. The aim of the research was to determine the correlation of IMT and age, and above normal IMT values in healthy adults in Slavonia (eastern Croatia). The study included 275 subjects of both sexes, aged between 20 and 79, who had no clinical manifestations of vascular disease or presence of major risk factors for atherosclerosis (hypertension, hypercholesterolemia, diabetes mellitus, cigarette smoking). Ultrasonic measurement of IMT in the B-mode was performed on far walls of the carotid arteries on both sides at three locations (common and internal carotid artery, carotid bifurcation). At all three sites of measurement a high correlation between the IMT values and age was found in both sexes, including the maximum for IMT of carotid bifurcation (men r=0.92, women 0.91). Upper normal values (75th percentile) IMT of common carotid arteries were determined for the ten-year age groups. It is the same for both men and women in age groups both 20-29 and 30-39 (0.41, 0.46 mm). On the other hand, in age groups 40-49, 50-59, 60-69 and 70-79 upper normal values for men are 0.57, 0.62, 0.77 and 0.96 mm, and for women 0.50, 0.57, 0.71 and 0.81 mm. Our study in healthy adults in Slavonia (eastern Croatia) established a clear connection between carotid IMT and age, which implies a need for taking the age as an essential factor into account when conducting researches that involve the IMT

Carotid ultrasonography in the evaluation of subclinical arteriosclerosis in patients with risk factors for atherosclerosis

CILJ ISTRAŽIVANJA: Glavni cilj istraživanja bio je ispitati specifičnosti pojedinih strukturnih i funkcionalnih ultrazvučnih (UZV) pokazatelja supkliničke arterioskleroze u ovisnosti o najznačajnijim čimbenicima rizika za aterosklerozu, dobi i spolu. Dodatni cilj bio je ispitati eventualnu povezanost UZV markera supkliničke arterioskleroze s ljestvicama procjene kardiovaskularnog (CV) rizika i njihov mogući utjecaj na klasifikaciju pojedinaca u rizične kategorije. ISPITANICI I METODE: U istraživanje, koje je dizajnirano kao presječno, bilo je uključeno 245 CV zdravih ispitanika (125 žena) raspona životne dobi između 32 i 59 godina, srednje dobi 49,5 godina. Odvojeno po spolu formirane su grupe ispitanika prema kriteriju prisutnosti jednog od triju CV rizičnih čimbenika (arterijska hipertenzija, dijabetes melitus tip 2, pušenje cigareta), te dvije kontrolne skupine ispitanika bez rizičnih čimbenika. Između formiranih skupina ispitanika nije bilo značajne dobne razlike. Na temelju UZV pregleda karotidnih arterija u B-prikazu detektirani su strukturni pokazatelji, a istovremenim mjerenjem krvnog tlaka i pulsatilnih oscilacija lumena izračunati su indeksi elastičnosti i krutosti arterijske stijenke. REZULTATI: Debljina stijenke (CIMT), vaskularna masa, površina poprečnog presjeka stijenke i omjer debljina stijenke/lumen karotidnih arterija pokazuju najveću alteraciju u dijabetičnim skupinama, odnosno prema kontrolnim skupinama statistički su značajno promijenjeni u dijabetičnim i hipertenzivnim skupinama (p 0,05), dok su kod muškaraca pušača DC i B značajno različiti od rezultata kontrolne skupine (p 0. 05), while in male smokers DC and B are significantly different than in the control group (p < 0.05). There is a positive correlation between age and the results of ultrasound tests in the subjects of both sexes (Pearson correlation coefficient from 0.472 to 0.608, p < 0.001). A significant diference has been found when comparing women and men of the same age in 125 terms of pronounced arteriosclerosis change, wich is higher in men (p <0.001). Introducing CIMT as the additional criteria in assessing CV risk by Framingham Risk Score led to reclassification of approximately 70% of women to a higher, and about 10% in a lower risk category. The use of carotid atherosclerotic plaque as an additional criteria led to reclassification of approximately 80% of men from medium-risk category to the high risk category. CONCLUSION: Carotid ultrasonography enables early detection of structural and functional alterations of the arterial wall material that match subclinical arteriosclerosis

Bilateral Abducens Nerve Palsy Due to Extensive Cerebral Venous Sinus Thrombosis

Cerebral venous sinus thrombosis (CVST) is a relatively rare condition. We present a case of an acute aseptic thrombosis of the sagittal, transverse and sigmoid sinus in a puerperium patient with protein S deficiency. The specifics of the case include high intracranial pressure (ICP) caused by sinus thrombosis with typical symptomatology and bilateral papilloedema, which also manifested in transient bilateral abducens nerve palsy and, consequently, bilateral horizontal diplopia. The recovery of the cranial nerve function occurred 3 to 4 weeks after it was initially reported. Prompt and adequate anticoagulant therapy contributed to the almost complete recanalization of the dural venous sinus thrombosis and a positive outcome of the disease