High-resolution B-mode ultrasonography in evaluation of atherosclerosis in uremia

Kawagishi, Takahiko; Nishizawà, Yoshiki; Konishi, Toshiaki; Kawasaki, Koichi; Emoto, Masanori; Shoji, Tetsuo; Tabata, Tsutomu; Inoue, Takashi; Morii, Hirotoshi

doi:10.1038/ki.1995.356

Cited by 291 publications

(231 citation statements)

References 36 publications

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“…Macrovascular disease involving atherosclerosis and arteriosclerosis develops rapidly in uremic patients (13) and is believed to be responsible for the high incidence of ischemic heart disease, LVH, congestive heart disease, sudden death, and stroke in these patients (14). A significantly greater incidence of plaques has been reported in the common carotid artery of patients with ESRD (15).…”

Section: Atherosclerosis and Arteriosclerosis In Esrdmentioning

confidence: 95%

Cardiovascular Calcifications in Uremic Patients

London

2003

Journal of the American Society of Nephrology

193

137

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Abstract. Cardiovascular disease is the leading cause of mortality among patients with ESRD (chronic kidney disease stage 5). Left ventricular hypertrophy and arterial diseases are the two principal risk factors for cardiovascular mortality in hemodialysis patients. Epidemiologic studies show that damage to large conduit arteries contributes to morbidity and mortality in patients with chronic kidney disease. Atherosclerosis is primarily an intimal disease characterized by the presence of plaques and occlusive lesions. Although atherosclerosis is the most frequent underlying cause of cardiovascular disease in patients with ESRD, it represents only one form of structural response to metabolic and hemodynamic alterations that interfere with the process of aging. Arterial alterations in ESRD include nonocclusive arterial remodeling accompanying the growing hemodynamic burden and humoral abnormalities that are associated with chronic uremia. The consequences of these alterations are different from those attributed to atherosclerotic plaques and are characterized principally by hardening (stiffening) of arteries. Arteriosclerosis, characterized by stiffening of the aorta and large capacitative arteries, is a major determinant of left ventricular pressure overload and of abnormal coronary perfusion. Atherosclerosis and arteriosclerosis are frequently comorbid and characterized by a high degree of both intimal and medial calcifications in patients with ESRD. The extent of calcifications and the degree of arterial stiffening are independent predictors of mortality. Studies in patients with ESRD have shown that attenuation of arterial stiffness can have a favorable effect, associated with regression of left ventricular hypertrophy, on survival. Calciumfree, metal-free phosphate binders such as sevelamer can reduce calcification scores.

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Section: Atherosclerosis and Arteriosclerosis In Esrdmentioning

confidence: 95%

Cardiovascular Calcifications in Uremic Patients

London

2003

Journal of the American Society of Nephrology

193

137

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“…Interstudy differences in populations, distribution of GFR, and medications could account for some of this variation. Cross-sectional analyses (15)(16)(17)(18)(19)(20), moreover, do not measure progression. The finding that IMT is higher at reduced GFR does not necessarily imply that IMT increases faster at lower GFR.…”

Section: Discussionmentioning

confidence: 99%

Atheroma Progression in Chronic Kidney Disease

Rigatto¹,

Levin²,

House³

et al. 2009

Clinical Journal of the American Society of Nephrology

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Background and objectives: Cardiovascular events are 10 to 100 times more frequent in chronic kidney disease (CKD). We tested the hypothesis that the rate of atherosclerotic plaque growth is faster in severe versus moderate CKD.Design, setting, participants, & measurements: We performed a prospective cohort study in 318 prevalent CKD patients with initial creatinine clearance (CCr) between 20 and 50 ml/min/1.73 m 2 . Baseline clinical and laboratory data were obtained on all patients. Plaque area was determined every 6 mo using bilateral carotid ultrasonography. Plaque area distribution was normalized using a cube root transformation. Unadjusted and adjusted associations between CCr quintiles and rate of change in the transformed plaque area were assessed using multiple linear regression.Results: The rate of plaque progression appeared lower in patients with the lowest CCr. Median rate of plaque growth was 0.4 mm 2 /yr in the lowest quintile of CCr (< 23 ml/min/1.73 m 2 ) versus 5.0 mm 2 /yr in the highest quintile (> 43 ml/min/1.73 m 2 ). This association remained significant after adjustment for potential confounders. A secondary analysis using quintiles of Modification of Diet in Renal Disease (MDRD) GFR confirmed the absence of increased plaque growth at low GFR, although a reduced rate of growth in the lowest quintile of MDRD GFR was not observed.Conclusion: We did not observe accelerated plaque growth at low levels of renal function. We suggest that mechanisms other than plaque growth are responsible for the observed excess of cardiovascular disease in CKD patients.

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“…Then the right side was used as representative because the coefficient of variation was significantly lower than in the left side (right vs left side: 3.4 vs 4.2%). Using digitized still images of the arteries taken during scanning, IMT was measured in the far wall of the right CCA at sites of the most advanced atherosclerotic lesions, identified as diffuse and continuous projections with the greatest distance between the lumen -intimal interface and the media -adventitial interface but without atherosclerotic plaque, which was defined as localized lesions of thickness $ 2.0 mm (35,36). These interfaces were manually traced and the mean value calculated as the mean of at least three still images obtained from the same section of the CCA.…”

Section: Measurement Of Cca Imtmentioning

confidence: 99%

Change in von Willebrand factor and carotid intima-media thickness in hypothyroid patients with normal thyroid function after levothyroxine replacement therapy

Nagasaki

Inaba

Henmi

et al. 2004

European Journal of Endocrinology

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Objective: This study examined whether levothyroxine (L-T 4 ) replacement might affect serum markers of endothelium injury, including von Willebrand factor (vWF), factor VIII activity and thrombomodulin (TM), during normalization of increased intima-media thickness (IMT) in the common carotid artery (CCA) in hypothyroid patients after L-T 4 replacement therapy. Patients and methods: Thirty-three hypothyroid patients were examined for vWF, factor VIII, TM and CCA IMT before and after 1 year of normalization of thyroid function by L-T 4 replacement. CCA IMT was measured from digitized still images taken during scanning by high-resolution ultrasonography as an indicator of early atherosclerosis. Results: Serum factor VIII and vWF increased significantly during 1 year of normalization of thyroid function (from 122.7^9.4 to 151.3^18.8% (P , 0.05) and from 109.9^9.6 to 135.2^12.4% (P , 0.005) respectively), although these values all fell within the respective normal range. Serum TM, in contrast, did not change appreciably in response to L-T 4 treatment, moving from 2.57^0.15 to 2.74^0.18 ng/ml (P ¼ 0.086). During 1 year of a euthyroid state, all patients showed a significant decrease in CCA IMT (P , 0.0001). Change in serum vWF, but not in factor VIII or TM, showed a positive correlation with that of CCA IMT during L-T 4 replacement therapy. Furthermore, the change in serum vWF was significantly and independently associated with change in CCA IMT (r ¼ 0.490, P ¼ 0.0038).Conclusions: The present study demonstrated that the improvement of CCA IMT during L-T 4 treatment might have the potential to attenuate an elevation of vWF and to attenuate vascular injury by the cardiovascular effects of thyroid hormone in hypothyroid patients. 150 125-131 European Journal of Endocrinology

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High-resolution B-mode ultrasonography in evaluation of atherosclerosis in uremia

Cited by 291 publications

References 36 publications

Cardiovascular Calcifications in Uremic Patients

Cardiovascular Calcifications in Uremic Patients

Atheroma Progression in Chronic Kidney Disease

Change in von Willebrand factor and carotid intima-media thickness in hypothyroid patients with normal thyroid function after levothyroxine replacement therapy

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