Increased ostial pulmonary vein diameter in congestive heart failure:a multi-slice computed tomography angiography evaluation

Background and Objectives The relationship between left atrial(LA)size and congestive heart failure(CHF)is well recognized;however,there is little information on the association of pulmonary vein(PV)diameter and CHF.The purpose of this study was to investigate the changes of PV and LA sizes in CHF patients by multislice computed tomography(MSCT)angiography using a new 64-slice scanner.Methods and Results We assessed diameters of PVs ostium and LA by 64-slice MSCT with three-dimensional reconstruction in 25 CHF patients and in 26 age-and sex-matched non-CHF controls.Compared with controls,CHF patients showed significant greater diameters of left superior pulmonary vein(LSPV)and right inferior pulmonary vein(RIPV)in both anteriorposterior(AP)and superior-inferior(SI)directions(P<0.01),significant dilation of right superior pulmonary vein(RSPV)in AP direction(P<0.05),as well as significant increase of LA transverse,AP,and SI diameters(P<0.01).Conclusion Significant dilation of PVs with simultaneous LA enlargement was demonstrated in CHF patients.This anatomic and geometric changes may participate in the perpetuation of AF.

Differences in left and right carotid plaque vulnerability in patients with bilateral carotid plaques:a CARE-II study

Background and purpose Atherosclerosis is a very complex process influenced by various systemic and local factors.Therefore,in patients with bilateral carotid plaques(BCPs),there may be differences in carotid plaque vulnerability between the sides.We aimed to investigate the differences in BCP characteristics in patients with BCPs using magnetic resonance vessel wall imaging(MR-VWI).Methods Participants with BCPs were selected for subanalysis from a multicentre study of Chinese Atherosclerosis Risk Evaluation II.We measured carotid plaque burden,identified each plaque component and measured their volume or area bilaterally on MR-VWI.Paired comparisons of the burden and components of BCPs were performed.Results In all,540 patients with BCPs were eligible for analysis.Compared with the right carotid artery(CA),larger mean lumen area(p<0.001),larger mean wall area(p=0.025),larger mean total vessel area(p<0.001)and smaller normalised wall index(p=0.006)were found in the left CA.Regarding plaque components,only the prevalence of lipid-rich necrotic core(LRNC)in the left CA was higher(p=0.026).For patients with a vulnerable plaque component coexisting on both sides,only the intraplaque haemorrhage(IPH)volume(p=0.011)was significantly greater in the left CA than in the right CA.Conclusions There were asymmetries in plaque growth and evolution between BCPs.The left carotid plaques were more likely to have larger plaque burden,higher prevalence of LRNC and greater IPH volume,which may contribute to the lateralisation of ischaemic stroke in the cerebral hemispheres.

Association between coexisting intracranial artery and extracranial carotid artery atherosclerotic diseases and ipsilateral cerebral infarction: a Chinese Atherosclerosis Risk Evaluation (CARE- II) study

Background To evaluate the association between coexisting intracranial and extracranial carotid artery atherosclerotic diseases and ipsilateral acute cerebral infarct(ACI)in symptomatic patients by using magnetic resonance(MR)vessel wall imaging.Methods Symptomatic patients were recruited from a cross-sectional,multicentre study of Chinese Atherosclerosis Risk Evaluation(CARE-II).All patients underwent MR imaging for extracranial carotid arterial wall,intracranial artery and brain.Coexisting intracranial stenosis≥50%and extracranial carotid artery mean wall thickness(MWT)≥1 mm and plaque compositions at the same side were evaluated and the ipsilateral ACI was identified.The association between coexisting atherosclerotic diseases and ACI was evaluated using logistic regression.Results 351 patients were recruited.Patients with ipsilateral ACI had significantly greater prevalence of coexisting intracranial stenosis≥50%and carotid MWT≥1 mm(20.5%vs 4.9%,p<0.001),calcification(15.1%vs 4.4%,p=0.001)and lipid-rich necrotic core(LRNC)(19.2%vs 7.8%,p=0.002)compared with those without.Coexisting intracranial artery stenosis≥50%and carotid MWT≥1 mm(OR 5.043,95%CI 2.378 to 10.694;p<0.001),calcification(OR 3.864,95%CI 1.723 to 8.664;p=0.001)and LRNC(OR 2.803,95%CI 1.455 to 5.401;p=0.002)were significantly associated with ipsilateral ACI.After adjusting for confounding factors,the aforementioned associations remained statistically significant(intracranial stenosis≥50%coexisting with carotid MWT≥1 mm:OR 4.313,95%CI 1.937 to 9.601,p<0.001;calcification:OR 3.606,95%CI 1.513 to 8.593,p=0.004;LRNC:OR 2.358,95%CI 1.166 to 4.769,p=0.017).Conclusions Coexistence of intracranial artery severe stenosis and extracranial carotid artery large burden and intraplaque components of calcification and LRNC are independently associated with ipsilateral ACI.Trial registration number https://www.clinicaltrials.gov/.Unique identifier:NCT02017756.

Chinese Atherosclerosis Risk Evaluation(CARE II)study:a novel cross-sectional,multicentre study of the prevalence of high-risk atherosclerotic carotid plaque in Chinese patients with ischaemic cerebrovascular events-design and rationale

Background:Carotid atherosclerotic plaque is identified as one of the main sources of ischaemic stroke.However,the prevalence of carotid high-risk atherosclerotic plaque in Chinese patients with ischaemic cerebrovascular events has been inconsistently reported and needs to be investigated in a large population.Objectives:The primary objective of CARE II study was to determine the prevalence and characteristics of high-risk features of atherosclerotic plaques in the carotid arteries in Chinese patients with recent ischaemic stroke or transient ischaemia attack(TIA).The relationship between carotid plaque features and cerebral infarcts,the differences of carotid plaque patterns among different regions of China and the gender specific characteristics of carotid plaque will be also determined.Study design:The CARE II study will enrol 1000 patients with recent ischaemic stroke or TIA and carotid plaque from 13 hospitals and medical centres across China.In this cross-sectional,non-randomised,observational,multicentre study,all patients will undergo carotid artery MRI of bilateral carotid arteries and routine brain MRI with standardised protocols.The MRI will be interpreted at core reading centres to evaluate the characteristics of morphology and compositions of carotid plaque.Conclusions:This is a cross-sectional,multicentre study to investigate the prevalence and characteristics of high-risk atherosclerotic carotid plaque in Chinese patients with stroke and TIA by using high-resolution MRI of vessel wall.This trial is sufficiently powered to demonstrate the prevalence of carotid high-risk plaque and to explore regional differences in Chinese patients who suffered stroke.

Differences in atheroma between Caucasian and Asian subjects with anterior stroke:A vessel wall MRI study

Background and purpose While extracranial carotid artery stenosis is more common among Caucasians and intracranial artery stenosis is more common among Asians,the differences in atherosclerotic plaque characteristics have not yet been extensively examined.We sought to investigate plaque location and characteristics within extracranial carotid and intracranial arteries in symptomatic Caucasians and Chinese using vessel wall MRI.Methods Subjects with recent anterior circulation ischaemic stroke were recruited and imaged at two sites in the USA and China using similar protocols.Both extracranial carotid and intracranial arteries were reviewed to determine plaque location and characteristics.Results The prevalence of extracranial carotid plaque in Caucasians and Chinese was 73.1%and 49.1%,respectively(p=0.055).Prevalence of intracranial plaque was 38.5%and 69.1%in Caucasians and Chinese,respectively(p=0.02).Furthermore,42% of Caucasians and 16%of Chinese had high-risk plaque(HRP)features(intraplaque haemorrhage,luminal surface disruption)in the extracranial carotid artery(p=0.03).The prevalence of HRP features in intracranial arteries was not significantly different between the two cohorts(4%vs 11%;p=0.42).Conclusions Differences in the location and characteristics of cerebrovascular atherosclerosis were identified by vessel wall MRI in US Caucasian and Chinese subjects with recent anterior circulation ischaemic stroke.Extracranial carotid plaques with HRP features were more common in Caucasians.Intracranial plaques were more common in Chinese subjects,but no significant difference between the two cohorts in intracranial HRP prevalence was found.Larger studies using vessel wall imaging to investigate racial differences in cerebrovascular disease may inform underlying mechanisms of HRP development and may ultimately help guide appropriate therapy.

Association between fluid-attenuated inversion recovery vascular hyperintensity and outcome varies with different lesion patterns in patients with intravenous thrombolysis

Background and purpose To evaluate relationship between fluid-attenuated inversion recovery vascular hyperintensity(FVH)after intravenous thrombolysis and outcomes in different lesion patterns on diffusion-weighted imaging(DWI).Methods Patients with severe internal carotid or intracranial artery stenosis who received intravenous thrombolysis from March 2012 to April 2019 were analysed.They were divided into four groups by DWI lesion patterns:border-zone infarct(BZ group),multiple lesions infarct(ML group),large territory infarct(LT group),and single cortical or subcortical lesion infarct(SL group).Logistic regression was performed to identify risk factors for outcome(unfavourable outcome,modified Rankin Scale(mRS)≥2;poor outcome,mRS≥3).Results Finally,203 participants(63.3±10.2 years old;BZ group,n=72;ML group,n=64;LT group,n=37;SL group,n=30)from 1190 patient cohorts were analysed.After adjusting for confounding factors,FVH(+)was associated with unfavourable outcome in total group(OR 3.02;95%CI 1.49 to 6.13;p=0.002),BZ group(OR 4.22;95%CI 1.25 to 14.25;p=0.021)and ML group(OR 5.44;95%CI 1.41 to 20.92;p=0.014)patients.FVH(+)was associated with poor outcome in total group(OR 2.25;95%CI 1.01 to 4.97;p=0.046),BZ group(OR 5.52;95%CI 0.98 to 31.07;p=0.053)and ML group(OR 4.09;95%CI 1.04 to 16.16;p=0.045)patients,which was marginal significance.FVH(+)was not associated with unfavourable or poor outcome in LT and SL groups.Conclusion This study suggests that association between FVH and outcome varies with different lesion patterns on DWI.The presence of FVH after intravenous thrombolysis may help to identify patients who require close observations in the hospitalisation in patients with border-zone and multiple lesion infarcts.

Comparison of carotid atherosclerotic plaques between subjects in Northern and Southern China: a Chinese atherosclerosis risk evaluation study

Background and purpose To investigate differences in the characteristics of carotid atherosclerotic plaques of symptomatic subjects in northern and southern China using MRI.Methods Sixty-three subjects in northern China(mean age:59.1±8.6 years,45 men)and 56 subjects in southern China(mean age:60.4±8.6 years,38 men)were included.All subjects underwent carotid artery multicontrast vessel wall MRI.Plaque morphology,calcification,lipid-rich necrotic core,intraplaque haemorrhage,luminal surface disruption and high-risk plaque were measured and identified.All plaque characteristics were compared between subjects in northern and southern China using Mann-Whitney U test or χ^(2) test.results Compared with subjects in southern China,those in northern China had significantly greater areas for lumen(57.7±14.9 mm^(2) vs 50.4±18.3 mm^(2),p=0.009),wall(38.4±13.1 mm^(2) vs 31.9±11.7 mm^(2),p<0.001)and total vessel(96.1±20.2 mm^(2) vs 82.4±22.7 mm^(2),p=0.001)and mean wall thickness(1.25±0.43 mm vs 1.13±0.40 mm,p=0.019).χ^(2) analysis showed that subjects in northern China tended to have a higher prevalence of intraplaque haemorrhage(14.3%vs 5.4%,p=0.106)and high-risk plaque(20.6%vs 10.7%,p=0.140)than those in southern China,although these differences were not statistically significant(all p>0.05).Conclusion Subjects in northern China have significantly larger vessel size and may have a higher prevalence of vulnerable plaques than those in southern China.Our findings provide additional perspective to optimise the management of cerebrovascular disease in individuals in different regions in China.