Current Issue
September 2023
Vol 16, Issue 9
Vol 16, Issue 9
Author
- Rudd, James H F2
- Aboulhosn, Jamil A1
- Akçakaya, Mehmet1
- Al-Shahi Salman, Rustam1
- Alexopoulos, Dimitrios1
- Ammirati, Enrico1
- Antoniadou, Fani1
- Barampoutis, Nikolaos1
- Baron, Jean-Claude1
- Benetos, Georgios1
- Blaha, Michael J1
- Bloom, Jordan P1
- Bounas, Pavlos1
- Boyer, Louis1
- Buck, Andreas K1
- Bueno, Nora1
- Cameron, Duke E1
- Camici, Paolo G1
- Camilleri, Lionel1
- Cao, Yongjun1
- Cassagnes, Lucie1
- Chalard, Aurélie1
- Chang, John1
- Chao, Tze-Fan1
- Chen, Ko-Hsuan A1
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Impact of Metabolic Activity of Vertebra and Amygdala on Stroke Recurrence: A Prospective Cohort Study
- Jeong-Min Kim,
- Reeree Lee,
- Yongsung Kim,
- Hae-Bong Jeong,
- Eun Seong Lee,
- Hye Ryoun Kim,
- Kwang-Yeol Park and
- Ju Won Seok
AbstractPDF/EPUBAbstract
Background:Elevated metabolic activity of amygdala is known to be related to atherosclerotic cardiovascular event by increasing inflammatory cell production from bone marrow. We tried to identify the factors of metabolic activity in the amygdala, vertebrae, liver, spleen, and internal carotid artery related to the future vascular events after stroke.Methods:A total of 110 patients with acute stroke were included (72±10 years of age, 39% women) and underwent whole-body 18F-fluorodeoxyglucose (FDG) positron emission tomography between August 1, 2015 and February 28, 2020. We compared the FDG uptake in the amygdala, vertebrae, liver, spleen, and internal carotid artery between patients with and without recurrent vascular event. Cox proportional hazards model was used to identify factors related to recurrent stroke and vascular event.Results:During the median follow-up period of 18 months, 22 patients experienced vascular events, including 15 stroke recurrence. Patients with recurred vascular event had a significantly higher FDG uptake in the amygdala and vertebrae than those without. The Cox proportional hazard model including diabetes, renal function, and carotid stenosis showed that a higher FDG uptake in the amygdala was independently associated with total vascular events (hazard ratio, 3.11 [95% CI, 1.11–8.70]) and higher FDG uptake in the vertebrae with stroke recurrence (hazard ratio, 4.94 [95% CI, 1.29–18.9]).Conclusions:The increased metabolic activities of the vertebrae and amygdala are related to future vascular event among stroke survivors.Graphical Abstract -
Remnant Cholesterol and Common Carotid Artery Intima-Media Thickness in Patients With Ischemic Stroke
- Sifan Qian,
- Shoujiang You,
- Yaming Sun,
- Qiuyi Wu,
- Xianhui Wang,
- Weiting Tang,
- Xiaofeng Dong,
- Chun-feng Liu,
- Tan Xu,
- Yongjun Cao and
- Chongke Zhong
AbstractPDF/EPUBAbstract
Background:Remnant cholesterol makes great contribution to residual risk of cardiovascular disease, but population-based evidence on the relationship between remnant cholesterol and atherosclerosis is rare. Common carotid artery intima-media thickness (cIMT) is an imaging marker of subclinical atherosclerosis. We aimed to explore the association between remnant cholesterol levels and cIMT in patients with ischemic stroke.Methods:One thousand four hundred ninety-six ischemic stroke patients with baseline serum lipids and carotid artery imaging data were included in this analysis. Fasting remnant cholesterol was calculated as total cholesterol minus HDL (high-density lipoprotein) cholesterol minus LDL (low-density lipoprotein) cholesterol. Abnormal cIMT was defined as mean cIMT and maximum cIMT value ≥1 mm. Logistic regression and restricted cubic spline models were used to assess the relationships between remnant cholesterol levels and abnormal cIMT.Results:The multivariable-adjusted odds ratios (95% CIs) for the highest versus lowest quartile of remnant cholesterol were 2.06 (1.46–2.91) for abnormal mean cIMT and 1.70 (1.23–2.35) for abnormal maximum cIMT. There were linear associations between remnant cholesterol levels and both abnormal mean cIMT (P for linearity, <0.001) and abnormal maximum cIMT (P for linearity, 0.003). Moreover, the remnant cholesterol–cIMT association remained significant in the subsample of patients with optimal LDL cholesterol levels (n=179).Conclusions:Elevated fasting remnant cholesterol levels were positively associated with mean cIMT and maximum cIMT in patients with ischemic stroke, even in patients with optimal LDL cholesterol levels. Future prospective studies are needed to verify our findings and to assess the effect of remnant cholesterol–lowering interventions in patients with ischemic stroke. -
Global Left Atrial Longitudinal Strain Using 3-Beat Method Improves Risk Prediction of Stroke Over Conventional Echocardiography in Atrial Fibrillation
- Jo-Nan Liao,
- Tze-Fan Chao,
- Jen-Yuan Kuo,
- Kuo-Tzu Sung,
- Jui-Peng Tsai,
- Chi-In Lo,
- Yau-Huei Lai,
- Cheng-Huang Su,
- Chung-Lieh Hung and
- Hung-I Yeh
AbstractPDF/EPUBAbstract
Background:Atrial fibrillation (AF) is associated with a risk of ischemic stroke, and functional myocardial imaging has offered novel insights on its pathophysiology and prognosis, but its use in AF-related stroke remains limited. We aimed to evaluate the feasibility of left atrial (LA) deformations and its prognostic values of ischemic stroke in a large-scale AF population.Methods:Peak atrial longitudinal strain (LA strain), left ventricular strain (global longitudinal strain), LA strain rate (LA SR) at reservoir (LA longitudinal systolic strain rate), and early diastolic conduit (LA longitudinal early diastolic strain rate) phases were analyzed using 2-dimensional speckle tracking echocardiography. Consecutive 3-beat averaged values of strain and SR were used. The clinical end point was ischemic stroke.Results:Among 1457 AF participants, the mean LA strain, LA longitudinal systolic strain rate, and LA longitudinal early diastolic strain rate values were 12.9±4.8%, 0.80±0.28 s−1, and −1.17±0.46 s−1, respectively. There were strong positive linear relationships of 3-beat average with index-beat analysis (R=0.94, 0.94, and 0.94 for LA strain, LA longitudinal systolic strain rate, and LA longitudinal early diastolic strain rate, respectively; all P<0.001). Multivariate Cox regression models incorporating conventional echocardiography parameters demonstrated LA strain and SRs to be independent prognosticators of ischemic stroke during a median follow-up of 37.6 months. Utilization of LA strain further provided incremental value over CHA2DS2-VASc scoring (C statistics, 0.78–0.81; P=0.006) for ischemic stroke. Overall, the prognostic performances of LA deformations were attenuated after adding global longitudinal strains in models.Conclusions:LA deformations by the 3-beat method are feasible and reproducible during AF. LA strain provided additional prognostic implication over clinical information and conventional echocardiographic measures for ischemic stroke in the AF population but not incremental to global longitudinal strains. -
Association of White Matter Hyperintensities and Cardiovascular Disease: The Importance of Microcirculatory Disease
AbstractPDF/EPUBAbstract
Cardiac and cerebrovascular diseases are currently the leading causes of mortality and disability worldwide. Both the heart and brain display similar vascular anatomy, with large conduit arteries running on the surface of the organ providing tissue perfusion through an intricate network of penetrating small vessels. Both organs rely on fine tuning of local blood flow to match metabolic demand. Blood flow regulation requires adequate functioning of the microcirculation in both organs, with loss of microvascular function, termed small vessel disease (SVD) underlying different potential clinical manifestations. SVD in the heart, known as coronary microvascular dysfunction, can cause chronic or acute myocardial ischemia and may lead to development of heart failure. In the brain, cerebral SVD can cause an acute stroke syndrome known as lacunar stroke or more subtle pathological alterations of the brain parenchyma, which may eventually lead to neurological deficits or cognitive decline in the long term. Coronary microcirculation cannot be visualized in vivo in humans, and functional information can be deduced by measuring the coronary flow reserve. The diagnosis of cerebral SVD is largely based on brain magnetic resonance imaging, with white matter hyperintensities, microbleeds, and brain atrophy reflecting key structural changes. There is evidence that such structural changes reflect underlying cerebral SVD. Here, we review interactions between SVD and cardiovascular risk factors, and we discuss the evidence linking cerebral SVD with large vessel atheroma, atrial fibrillation, heart failure, and heart valve disease. -
Long-Term Embolic Outcomes After Detection of Left Ventricular Thrombus by Late Gadolinium Enhancement Cardiovascular Magnetic Resonance Imaging: A Matched Cohort Study
- Pratik S. Velangi,
- Christopher Choo,
- Ko-Hsuan A. Chen,
- Felipe Kazmirczak,
- Prabhjot S. Nijjar,
- Afshin Farzaneh-Far,
- Osama Okasha,
- Mehmet Akçakaya,
- Jonathan W. Weinsaft and
- Chetan Shenoy
AbstractPDF/EPUBAbstract
Background:Late gadolinium enhancement (LGE) cardiovascular magnetic resonance (CMR) imaging is more sensitive than echocardiography for the detection of intracardiac thrombus because of its unique ability to identify thrombus based on tissue characteristics related to avascularity. The long-term prognostic significance of left ventricular (LV) thrombus detected by LGE CMR is unknown.Methods:We performed a matched cohort study of consecutive adult patients with LV thrombus detected by LGE CMR who were matched on the date of CMR, age, and LV ejection fraction to up to 3 patients without LV thrombus. We investigated the long-term incidence of a composite of embolic events: stroke, transient ischemic attack, or extracranial systemic arterial embolism. We also compared outcomes among patients with LV thrombus detected by LGE CMR stratified by whether the LV thrombus was also detected by echocardiography or not.Results:Of 157 LV thrombus patients, 155 were matched to 400 non-LV thrombus patients. During a median follow-up of 3.3 years, the cumulative incidence of embolism was significantly higher in LV thrombus patients compared with the matched non-LV thrombus patients (P<0.001), with annualized rates of 3.7% and 0.8% for LV thrombus and matched non-LV thrombus patients, respectively. LV thrombus was the only independent predictor of the composite embolic end point (hazard ratio, 3.99 [95% CI, 1.54–10.35]; P=0.004). The cumulative incidence of embolism was not different in patients with LV thrombus that was also detected by echocardiography versus patients with LV thrombus not detected by echocardiography (P=0.25).Conclusions:Despite contemporary antithrombotic treatment, LV thrombus detected by LGE CMR is associated with a 4-fold higher long-term incidence of embolism compared with matched non-LV thrombus patients. LV thrombus detected by LGE CMR but not by echocardiography is associated with a similar risk of embolism as that detected by both LGE CMR and echocardiography. -
Increase in Carotid Temperature Heterogeneity Is Associated With Cardiovascular and Cerebrovascular Events: Long-Term Results of a Multicenter Trial
- Konstantinos Toutouzas,
- Georgios Benetos,
- Georgios Oikonomou,
- Nikolaos Barampoutis,
- Iosif Koutagiar,
- Spyros Galanakos,
- Maria Karmpalioti,
- Maria Drakopoulou,
- Konstantinos Stathogiannis,
- Pavlos Bounas,
- Vasiliki Gata,
- Fani Antoniadou,
- Periklis Davlouros,
- Dimitrios Alexopoulos,
- Georgios Hahalis,
- Elias Siores,
- Petros P. Sfikakis and
- Dimitris Tousoulis
PDF/EPUBAbstract
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Presence, Characteristics, and Prognostic Associations of Carotid Plaque Among People Living With HIV
- Sumbal A. Janjua,
- Pedro V. Staziaki,
- Balint Szilveszter,
- Richard A.P. Takx,
- Thomas Mayrhofer,
- Orla Hennessy,
- Hamed A. Emami,
- Jakob Park,
- Alexander Ivanov,
- Travis R. Hallett,
- Michael T. Lu,
- Javier M. Romero,
- Steven K. Grinspoon,
- Udo Hoffmann,
- Markella V. Zanni and
- Tomas G. Neilan
AbstractPDF/EPUBAbstract
Background—Data from broad populations have established associations between incidental carotid plaque and vascular events. Among people living with HIV (PLWHIV), the risk of vascular events is increased; however, whether incidental carotid plaque is increased and there is an association between incidental carotid plaque, plaque characteristics, and vascular events among PLWHIV is unclear.Methods and Results—Data from the multi-institutional Research Patient Data Registry were used. Presence and characteristics (high-risk plaque, including spotty calcification and low attenuation) of carotid plaque by computerized tomography among PLWHIV without known vascular disease were described. Data were compared with uninfected controls similar in age, sex, and cardiovascular risk factors, including diabetes mellitus, hyperlipidemia, and cigarette smoking to cases. Primary outcome was an atherosclerotic cardiovascular disease event, and secondary outcome was ischemic stroke. Cohort consisted of 209 PLWHIV (45±10 years, 72% male) and 168 controls. Using computerized tomography, PLWHIV without vascular disease had higher rates of any carotid plaque (34% versus 25%; P=0.04), noncalcified (18% versus 5%; P<0.001) and high-risk plaque (25% versus 16%; P=0.03). Over a follow-up of 3 years, 19 atherosclerotic cardiovascular disease events (9 strokes) occurred. Carotid plaque was independently associated with a 3-fold increase in atherosclerotic cardiovascular disease events among PLWHIV (hazard ratio, 2.91; confidence interval, 1.10–7.7, P=0.03) and a 4-fold increased risk of stroke (hazard ratio, 4.43; confidence interval, 1.17–16.70; P=0.02); high-risk plaque was associated with a 3-fold increased risk of atherosclerotic cardiovascular disease events and a 4-fold increased risk of stroke.Conclusions—There is an increase in incidental carotid plaque, noncalcified plaque, and high-risk plaque among PLWHIV, and the presence and characteristics of carotid plaque are associated with subsequent vascular events. -
Multiparametric Imaging of Organ System Interfaces
AbstractPDF/EPUBAbstract
Cardiovascular diseases are a consequence of genetic and environmental risk factors that together generate arterial wall and cardiac pathologies. Blood vessels connect multiple systems throughout the entire body and allow organs to interact via circulating messengers. These same interactions facilitate nervous and metabolic system’s influence on cardiovascular health. Multiparametric imaging offers the opportunity to study these interfacing systems’ distinct processes, to quantify their interactions, and to explore how these contribute to cardiovascular disease. Noninvasive multiparametric imaging techniques are emerging tools that can further our understanding of this complex and dynamic interplay. Positron emission tomography/magnetic resonance imaging and multichannel optical imaging are particularly promising because they can simultaneously sample multiple biomarkers. Preclinical multiparametric diagnostics could help discover clinically relevant biomarker combinations pivotal for understanding cardiovascular disease. Interfacing systems important to cardiovascular disease include the immune, nervous, and hematopoietic systems. These systems connect with classical cardiovascular organs, such as the heart and vasculature, and with the brain. The dynamic interplay between these systems and organs enables processes, such as hemostasis, inflammation, angiogenesis, matrix remodeling, metabolism, and fibrosis. As the opportunities provided by imaging expand, mapping interconnected systems will help us decipher the complexity of cardiovascular disease and monitor novel therapeutic strategies. -
18F-Fluoride and 18F-Fluorodeoxyglucose Positron Emission Tomography After Transient Ischemic Attack or Minor Ischemic Stroke: Case–Control Study
- Alex T. Vesey,
- William S. A. Jenkins,
- Agnese Irkle,,
- Alastair Moss,
- Greg Sng,,
- Rachael O. Forsythe,
- Tim Clark,
- Gemma Roberts,
- Alison Fletcher,
- Christophe Lucatelli,
- James H. F. Rudd,
- Anthony P. Davenport,,
- Nicholas L. Mills,
- Rustam Al-Shahi Salman,
- Martin Dennis,
- William N. Whiteley,
- Edwin J. R. van Beek,
- Marc R. Dweck and
- David E. Newby
AbstractPDF/EPUBAbstract
Background—Combined positron emission tomography (PET) and computed tomography (CT) can assess both anatomy and biology of carotid atherosclerosis. We sought to assess whether 18F-fluoride or 18F-fluorodeoxyglucose can identify culprit and high-risk carotid plaque.Methods and Results—We performed 18F-fluoride and 18F-fluorodeoxyglucose PET/CT in 26 patients after recent transient ischemic attack or minor ischemic stroke: 18 patients with culprit carotid stenosis awaiting carotid endarterectomy and 8 controls without culprit carotid atheroma. We compared standardized uptake values in the clinically adjudicated culprit to the contralateral asymptomatic artery, and assessed the relationship between radiotracer uptake and plaque phenotype or predicted cardiovascular risk (ASSIGN score [Assessing Cardiovascular Risk Using SIGN Guidelines to Assign Preventive Treatment]). We also performed micro PET/CT and histological analysis of excised plaque. On histological and micro PET/CT analysis, 18F-fluoride selectively highlighted microcalcification. Carotid 18F-fluoride uptake was increased in clinically adjudicated culprit plaques compared with asymptomatic contralateral plaques (log10standardized uptake valuemean 0.29±0.10 versus 0.23±0.11, P=0.001) and compared with control patients (log10standardized uptake valuemean 0.29±0.10 versus 0.12±0.11, P=0.001). 18F-Fluoride uptake correlated with high-risk plaque features (remodeling index [r=0.53, P=0.003], plaque burden [r=0.51, P=0.004]), and predicted cardiovascular risk [r=0.65, P=0.002]). Carotid 18F-fluorodeoxyglucose uptake appeared to be increased in 7 of 16 culprit plaques, but no overall differences in uptake were observed in culprit versus contralateral plaques or control patients. However, 18F-fluorodeoxyglucose did correlate with predicted cardiovascular risk (r=0.53, P=0.019), but not with plaque phenotype.Conclusions—18F-Fluoride PET/CT highlights culprit and phenotypically high-risk carotid plaque. This has the potential to improve risk stratification and selection of patients who may benefit from intervention.
