The impact of carotid plaque presence and morphology on mortality outcome in cardiological patients

BACKGROUND: Carotid plaque severity and morphology can affect cardiovascular prognosis. We evaluate both the importance of echographically assessed carotid artery plaque geometry and morphology as predictors of death in hospitalised cardiological patients. METHODS: 541 hospitalised patients admitted in a cardiological division (age = 66 ± 11 years, 411 men), have been studied through ultrasound Duplex carotid scan and successively followed-up for a median of 34 months. Echo evaluation assessed plaque severity and morphology (presence of heterogeneity and profile). RESULTS: 361 patients showed carotid stenosis (67% with <50% stenosis, 18% with 50–69% stenosis, 9% with >70% stenosis, 4% with near occlusion and 2% with total occlusion). During the follow-up period, there were 83 all-cause deaths (15% of the total population). Using Cox's proportional hazard model, age (RR 1.06, 95% CI 1.03–1.09, p = 0.000), ejection fraction > 50% (RR = 0.62, 95% CI 0.4–0.96, p = 0.03), treatment with statins (RR = 0.52, 95% CI 0.29–0.95, p = 0.34) and the presence of a heterogeneous plaque (RR 1.6; 95% CI, 1.2 to 2.14, p = 0.002) were independent predictors of death. Kaplan – Meier survival estimates have shown the best outcome in patients without plaque, intermediate in patients with homogeneous plaques and the worst outcome in patients with heterogeneous plaques (90% vs 79% vs 73%, p = 0.0001). CONCLUSION: In hospitalised cardiological patients, carotid plaque presence and morphology assessed by ultrasound are independent predictors of death

Common origin of both right and left coronary arteries from the right sinus of Valsalva

Anomalous origin of the left main coronary artery (LMCA) from the right sinus of Valsalva (RSOV) represents in about 2 per 10,000 patients undergoing diagnostic cardiac catheterization. This rare anomaly correlates with sudden cardiac death after exercise and angina. We describe the case of a middle-aged woman, suffering from typical angina pectoris, with an anomalous common origin of all coronary arteries from the RSOV. We also provide the variations of the anomaly and discuss briefly on pathophysiology and treatment. © 2007 Elsevier Ireland Ltd. All rights reserved

Anomalous common origin of all coronary arteries with a common ostium from the left sinus of Valsalva

We describe the very rare case of a middle-aged man, who was found at the catheterization laboratory to have a common origin of both left and right coronary arteries from a single ostium from the left sinus of Valsalva. © 2008 Published by Elsevier Ireland Ltd

Perforation of a saphenous vein graft during percutaneous angioplasty: Demonstration by means of intravascular ultrasound and consequent treatment with a polytetrafluoroethylene-covered stent

We present a case of a perforation of the saphenous vein graft during percutaneous angioplasty and its subsequent implantation with a polytetrafluoroethylene-covered stent. Angiographic as well as intravascular images of the site of perforation are provided. © 2008 Elsevier Ireland Ltd. All rights reserved

Conjugated estrogen administration improves common carotid artery elastic properties in normotensive postmenopausal women

Background: Various vascular effects of estrogens have been proposed to explain further the beneficial effect of replacement therapy in cardiovascular events. Hypothesis: The study was undertaken to assess the effect of conjugated estrogen on the elastic properties of the large arteries in normotensive, healthy, postmenopausal women. Methods: Toward this end, we investigated the acute effect of conjugated estrogen on the elastic properties of the common carotid artery (CCA) in 20 normotensive, healthy, postmenopausal women (age 54 +/- 3 years) at baseline and 20 min after the intravenous administration of 1.25 mg conjugated estrogens. The CCA distensibility was derived by a combination of surface ultrasonographic data and simultaneous blood pressure measurements at the brachial artery. The carotid pulsatility index, a measure of brain impedance, was determined electronically by tracing the CCA Doppler waveform. Results: At baseline, CCA distensibility had a negative correlation with both patients’ age and time since menopause (r = -0.57 and r = - 0.48, p &lt; 0.05 for both cases). After estrogen administration, estradiol and estrone plasma levels were restored to the range of usual premenopausal values. Estrogen induced a significant increase in CCA distensibility by 0.92 +/- 0.005 dyne(-1) . cm(2) . 10(-6) (from 2.03 to 2.95 dyne(-1) . cm(2) . 10(-6)) and a significant reduction in CCA pulsatility index by 0.24 +/- 0.06, (from 2.17 to 1.93) (p &lt; 0.001 for both cases). The improvement in CCA distensibility had a negative cot-relation with both patients’ age and time since menopause (r = -0.46 and r = -0.44, respectively, p &lt; 0.05 for both cases). Conclusions: Acute conjugated estrogen administration induced an improvement in CCA elasticity and a reduction in brain impedance in non-notensive, postmenopausal women. As the age of women and the time since menopause increased, the improvement in carotid distensibility decreased in such selected subjects