The role of carotid plaque echogenicity in baroreflex sensitivity

ObjectiveThe baroreflex sensitivity is impaired in patients with carotid atherosclerosis. The purpose of our study was to assess the impact of carotid plaque echogenicity on the baroreflex function in patients with significant carotid atherosclerosis, who have not undergone carotid surgery.MethodSpontaneous baroreflex sensitivity (sBRS) was estimated in 45 patients with at least a severe carotid stenosis (70%-99%). sBRS calculation was performed noninvasively, with the spontaneous sequence method, based on indirectly estimated central blood pressures from radial recordings. This method failed in three patients due to poor-quality recordings, and eventually 42 patients were evaluated. After carotid duplex examination, carotid plaque echogenicity was graded from 1 to 4 according to Gray-Weale classification and the patients were divided into two groups: the echolucent group (grades 1 and 2) and the echogenic group (grades 3 and 4).ResultsSixteen patients (38%) and 26 patients (62%) were included in the echolucent and echogenic group, respectively. Diabetes mellitus was observed more frequently among echolucent plaques (χ2 = 8.0; P < .004), while those plaques were also more commonly symptomatic compared with echogenic atheromas (χ2 = 8.5; P < .003). Systolic arterial pressure, diastolic arterial pressure, and heart rate were similar in the two groups. Nevertheless, the mean value of baroreflex sensitivity was found to be significantly lower in the echogenic group (2.96 ms/mm Hg) compared with the echolucent one (5.0 ms/mm Hg), (F [1, 42] = 10.1; P < .003).ConclusionsThese findings suggest that echogenic plaques are associated with reduced baroreflex function compared with echolucent ones. Further investigation is warranted to define whether such an sBRS impairment could be responsible for cardiovascular morbidity associated with echogenic plaques

Case Report Myasthenia Gravis and Stroke in the Setting of Giant Cell Arteritis

This case report concerns the diagnosis of two independent chronic diseases in a patient hospitalized for stroke, myasthenia gravis (MG) and giant cell arteritis (GCA). MG has been found to be associated with several diseases, but there are very few cases documenting its coexistence with GCA. We report the case of a 79-year-old woman initially hospitalized for stroke. Patient&apos;s concurrent symptoms of blepharoptosis, dysphagia, and proximal muscle weakness were strongly suggestive of myasthenia gravis. The persistent low-grade fever and elevated inflammatory markers in combination with the visual deterioration that developed also raised the suspicion of GCA. Histological examination confirmed GCA, while muscle acetylcholine receptor antibodies were also present. Even though in medicine one strives to interpret a patient&apos;s symptoms with one diagnosis, when one entity cannot fully interpret the clinical and laboratory findings, clinicians must consider the possibility of a second coexisting illness

Baroreflex sensitivity in obese and non obese individuals

Obesity is a major public health problem. It represents an independent risk factor for cardiovascular morbidity and mortality. Obesity is characterised by sympathetic nervous system overactivity. Arterial baroreceptors have an important role in the short-term modulation of arterial blood pressure by reflex chronotropic effect on heart and by reflex regulation of sympathetic outflow. Reduction in baroreflex sensitivity has been associated with impaired regulation of blood pressure, electrical instability of the myocardium, and increased risk of cardiovascular disease related mortality. Two of the parameters that influence baroreflex sensitivity are autonomic nervous system balance and arterial distensibility. Previous data demonstrate that baroreflex sensitivity is attenuated whenever sympathetic nervous system activity is enhanced. In addition baroreflex sensitivity seems to be blunted when central arterial compliance is reduced. Thus, baroreflex sensitivity estimation in obesity is of clinical relevance, as a hyporesponsive baroreflex represents a negative prognostic factor in cardiovascular diseases, which are common in obesity. The main research hypothesis of the present cross-sectional study was that baroreflex sensitivity, assessed by measurement of aortic pressure, is blunted in obesity. An additional purpose was to examine the potential role of cardiac autonomic nervouws system activity and of arterial compliance on the difference of baroreflex sensitivity that might be observed between obese and non-obese subjects. This study has shown that baroreflex sensitivity is severely reduced (by almost 50%) in obese, otherwise healthy women. In addition, our findings suggest autonomic nervous system dysfunction - i.e. sympathetic over activity- as the principal underlying alteration to explain baroreflex sensitivity impairment in obesity. Body fatness, age, and the parasympathetic nervous system activity are the main determinants of baroreflex sensitivity. These parameters acount for 72% of baroreflex sensitivity valuew variation. Comprehensive insight of baroreflex behaviour is of clinical relevance, since an attenuated baroreflex represents a negative prognostic factor in cardiovascular diseases, which demonstrate increased prevalence among obese individuals.Η παχυσαρκία χαρακτηρίζεται από διαταραχή στη δραστηριότητα του αυτόνομου νευρικού συστήματος και συγκεκριμένα από αύξηση της δραστηριότητας του συμπαθητικού και μείωση της δραστηριότητας του παρασυμπαθητικού νευρικού συστήματος. Η υπερδραστηριότητα του συμπαθητικού νευρικού συστήματος ενέχεται στην παθογένεια των καρδιαγγειακών επιπλοκών της παχυσαρκίας. Οι αρτηριακοί τασεοϋποδοχείς διαδραματίζουν σημαντικό ρόλο στη βραχυπρόθεσμη ρύθμιση της αρτηριακής πίεσης, ασκώντας αντανακλαστική χρονότροπη και ινότροπη μεταβολή στην καρδιακή λειτουργία. Δύο από τις παραμέτρους που επηρεάζουν την λειτουργία των τασεοϋποδοχέων είναι η δραστηριότητα του αυτονόμου νευρικού συστήματος και η διατασιμότητα των αγγείων. Η μείωση της ευαισθησίας των τασεοϋποδοχέων έχει συσχετισθεί με αυξημένη θνητότητα σε ασθενείς με καρδιαγγειακά νοσήματα. Συνεπώς η εκτίμηση της ευαισθησία των τασεοϋποδοχέων στην παχυσαρκία παρουσιάζει κλινικό ενδιαφέρον δεδομένου ότι οι παχύσαρκοι ασθενείς εμφανίζουν ιδιαίτερα αυξημένη επίπτωση καρδιαγγειακών νοσημάτων. Σκοπός αυτής της μελέτης ήταν: α) Να εκτιμηθεί η ευαισθησία των τασεοϋποδοχέων παχύσαρκων ατόμων και να συγκριθεί με αυτήν υγιών μαρτύρων β) Να γίνει ταυτόχρονη εκτίμηση της δραστηριότητας του καρδιακού αυτονόμου νευρικού συστήματος και της διατασιμότητας των αγγείων στα παχύσαρκα άτομα και στους υγιείς μάρτυρες ώστε να διερευνηθεί το παθοφυσιολογικό υπόστρωμα της λειτουργίας των τασεοϋποδοχέων κατά την παχυσαρκία. Τα σημαντικότερα συμπεράσματα που προέκυψαν ήταν: α) Υπάρχει σημαντική μείωση της ευαισθησίας των τασεοϋποδοχέων κατά την παχυσαρκία. β) Ο δείκτης μάζας σώματος, η ηλικία και το καρδιακό παρασυμπαθητικό νευρικό σύστημα είναι οι κύριοι ρυθμιστές της ευαισθησίας των τασεοϋποδοχέων και ευθύνονται για το 72% της διακύμανσης των τιμών της. γ) Η μείωση της ευαισθησίας των τασεοϋποδοχέων στην παχυσαρκία οφείλεται στη δυσλειτουργία του αυτόνομου νευρικού συστήματος και όχι στη μείωση της διατασιμότητας των αγγείων

Baroreflex sensitivity in obesity: Relationship with cardiac autonomic nervous system activity

Objective: The aim of this study was to test the hypothesis that baroreflex sensitivity (BRS), assessed by indirect measurement of aortic pressure, is blunted in obesity. Additionally, the potential effect of cardiac autonomic nervous system (ANS) activity, aortic compliance, and metabolic parameters on BRS of obese subjects was investigated. Research Methods and Procedures: A group of 30 women with BMI &gt; 30 kg/m(2) and a group of 30 controls with BMI &lt; 25 kg/m(2) were examined. BRS was estimated by the sequence technique, cardiac ANS activity by short-term spectral analysis of heart rate variability (HRV), and aortic compliance by the method of applanation tonometry. Results: BRS was lower in obese women (9.18 +/- 3.77 vs. 19.63 +/- 9.16 ms/mm Hg, p &lt; 0.001). The median values (interquartile range) of the power of both the high-frequency and low-frequency components of the HRV were higher in the lean than in the obese participants [1079.2 (202.7 to 1716.9) vs. 224.1 (72.7 to 539.6) msec(2), P = 0.001 and 4118 (199.3 to 798.0) vs. 235.8 (99.4 to 424.5) msec(2), p = 0.01 respectively]. Low-to-high-frequency ratio values were higher in the obese subjects [0.82 (0.47 to 2.1) vs. 0.57 (0.28 to 0.89), p = 0.02]. Aortic augmentation values were not significantly different between lean and obese subjects. Multivariate analysis demonstrated a significant and independent association between BRS and age (p = 0.003), BMI (p &lt; 0.001), and high-frequency power of HRV (p &lt; 0.001). These variables explained 72% of the variation of BRS values. Discussion: BRS is severely reduced in obese subjects. BMI, age, and the parasympathetic nervous system activity are the main determinants of BRS. Baroreflex behavior is of clinical relevance because an attenuated BRS represents a negative prognostic factor in cardiovascular diseases, which are common in obesity

The role of carotid plaque echogenicity in baroreflex sensitivity

Objective: The baroreflex sensitivity is impaired in patients with carotid atherosclerosis. The purpose of our study was to assess the impact of carotid plaque echogenicity on the baroreflex function in patients with significant carotid atherosclerosis, who have not undergone carotid surgery. Method: Spontaneous baroreflex sensitivity (sBRS) was estimated in 45 patients with at least a severe carotid stenosis (70%-99%). sBRS calculation was performed noninvasively, with the spontaneous sequence method, based on indirectly estimated central blood pressures from radial recordings. This method failed in three patients due to poor-quality recordings, and eventually 42 patients were evaluated. After carotid duplex examination, carotid plaque echogenicity was graded from 1 to 4 according to Gray-Weale classification and the patients were divided into two groups: the echolucent group (grades 1 and 2) and the echogenic group (grades 3 and 4). Results: Sixteen patients (38%) and 26 patients (62%) were included in the echolucent and echogenic group, respectively. Diabetes mellitus was observed more frequently among echolucent plaques (chi(2) = 8.0; P &lt; .004), while those plaques were also more commonly symptomatic compared with echogenic atheromas (chi(2) = 8.5; P &lt; .003). Systolic arterial pressure, diastolic arterial pressure, and heart rate were similar in the two groups. Nevertheless, the mean value of baroreflex sensitivity was found to be significantly lower in the echogenic group (2.96 ms/mm Hg) compared with the echolucent one (5.0 ms/mm Hg), (F[1, 42] = 10.1; P &lt; .003). Conclusions:These findings suggest that echogenic plaques are associated with reduced baroreflex function compared with echolucent ones. Further investigation is warranted to define whether such an sBRS impairment could be responsible for cardiovascular morbidity associated with echogenic plaques. (J Vasc Surg 2011;54:93-99.

Minilaparotomy abdominal aortic aneurysm repair in the era of minimally invasive vascular surgery: preliminary results

Background: This study aimed to evaluate the early post-operative clinical impact of minimal incision aortic surgery (MIAS) for infrarenal abdominal aortic aneurysm (AAA) repair in comparison with the standard open repair. Methods: A case-control study was conducted. Patients of groups A (19 patients) and B (18 patients) were treated with the MIAS technique and the standard open method, respectively. Results: There were significant differences between the two groups in fluid resuscitation during the operation. Post-operatively, there were significant differences between groups A and B in the time until starting liquid diet (2 +/- 0.74 versus 3.55 +/- 0.85 post-operative days (PD), respectively; P &lt; 0.05), the time until starting the solid diet (3.05 +/- 0.77 versus 5.11 +/- 0.75 PD, respectively; P &lt; 0.05), the time of ambulation (2 +/- 0.74 versus 3.4 +/- 0.98 PD, respectively; P &lt; 0.05) and in the hospital length of stay (4 +/- 0.81 versus 9.7 +/- 2.66 days, respectively; P &lt; 0.05). Conclusions: The MIAS technique, for repair of infrarenal aortic aneurysms, is a safe and feasible procedure that combines the early advantages of endovascular repair with the long-term advantages of the traditional open repair

Surgical management of extracranial internal carotid aneurysms by cervical approach

Background: Extracranial internal carotid artery aneurysms (EICAA) are rare vascular problems with a great potential for lethal thromboembolic episodes. Methods: From 1994 to 2004, nine patients with EICAA, seven men and two women, were surgically treated for 10 aneurysms in our department. Aneurysm led to hemispheric symptoms in six cases (two hemispheric strokes and four hemispheric transient ischaemic attacks). The cause was fibrodysplasia in two cases, atherosclerosis in four cases, trauma in two cases and spontaneous dissection in two cases. All aneurysms were treated surgically by the cervical approach using shunting. Extended cervical approach was necessary in four patients with high-lying aneurysms. Nine aneurysms were totally resected and successful revascularization was carried out. Open aneurysmorrhaphy with vein patch angioplasty was carried out in one case of a saccular aneurysm. Results: There were no perioperative deaths or transient ischaemic attacks or strokes. Four patients developed cranial nerve deficits: one had hoarsness, two had partial facial paralysis (patients with extended cervical approach) and one had tongue deviation. These neurological symptoms were observed in large aneurysms (&gt; 4.5 cm) and disappeared within 14 months. No neurological complication was observed in a follow up that ranged from 6 months to 10 years. Conclusions: Surgical repair of EICAA, especially with total resection and arterial reconstruction, is strongly recommended. Extended cervical approach has many technical difficulties but can allow treatment of high-lying aneurysms