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Genkel V, Dolgushin I, Savochkina A, Nikushkina K, Baturina I, Minasova A, Sumerkina V, Pykhova L, Kupriyanov S, Kuznetsova A, Shaposhnik I. Innate and Adaptive Immunity-Related Markers as Predictors of the Short-Term Progression of Subclinical Atherosclerosis in Middle-Aged Patients. Int J Mol Sci 2023; 24:12205. [PMID: 37569579 PMCID: PMC10419170 DOI: 10.3390/ijms241512205] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 07/26/2023] [Accepted: 07/29/2023] [Indexed: 08/13/2023] Open
Abstract
Assessment of inflammation is a promising approach to monitoring the progression of asymptomatic atherosclerosis. The aim of the present study was to investigate the predictive value of innate and adaptive immunity-related markers, in relation to the short-term progression of subclinical atherosclerosis. The study included 183 patients aged 40-64 years who underwent duplex scanning of the carotid and lower limb arteries at two visits with an interval of 12-24 months between examinations. Phenotyping of circulating lymphocytes and monocytes subpopulations were performed through flow cytometry. An increase in the number of circulating TLR4-positive intermediate monocytes (>447.0-467.0 cells/μL) was an independent predictor of the short-term progression of lower limb artery atherosclerosis (p < 0.0001) and polyvascular atherosclerosis (p = 0.003). The assessment of TLR4-positive monocytes significantly improved the prognostic model for the progression of lower limb arterial atherosclerosis (C-index 0.728 (0.642-0.815) versus 0.637 (0.539-0.735); p = 0.038). An increase in the number of circulating TLR4-positive intermediate monocytes was an independent predictor of the short-term progression of lower limb artery and polyvascular atherosclerosis. Their inclusion into models containing conventional risk factors significantly improved their prognostic effectiveness regarding lower limb artery atherosclerosis progression.
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Affiliation(s)
- Vadim Genkel
- Federal State Budgetary Educational Institution of Higher Education “South-Ural State Medical University” of the Ministry of Healthcare of the Russian Federation, 454092 Chelyabinsk, Russia; (I.D.); (A.S.); (K.N.); (I.B.); (A.M.); (V.S.); (L.P.); (S.K.); (A.K.); (I.S.)
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Bonacina F, Di Costanzo A, Genkel V, Kong XY, Kroon J, Stimjanin E, Tsiantoulas D, Grootaert MO. The heterogeneous cellular landscape of atherosclerosis: Implications for future research and therapies. A collaborative review from the EAS young fellows. Atherosclerosis 2023; 372:48-56. [PMID: 37030081 DOI: 10.1016/j.atherosclerosis.2023.03.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/10/2023]
Abstract
Single cell technologies, lineage tracing mouse models and advanced imaging techniques unequivocally improved the resolution of the cellular landscape of atherosclerosis. Although the discovery of the heterogeneous nature of the cellular plaque architecture has undoubtedly improved our understanding of the specific cellular states in atherosclerosis progression, it also adds more complexity to current and future research and will change how we approach future drug development. In this review, we will discuss how the revolution of new single cell technologies allowed us to map the cellular networks in the plaque, but we will also address current (technological) limitations that confine us to identify the cellular drivers of the disease and to pinpoint a specific cell state, cell subset or cell surface antigen as new candidate drug target for atherosclerosis.
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Affiliation(s)
- Fabrizia Bonacina
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Alessia Di Costanzo
- Department of Translational and Precision Medicine, Sapienza University of Rome, Rome, Italy
| | - Vadim Genkel
- Department of Internal Medicine, South-Ural State Medical University, Chelyabinsk, Russia
| | - Xiang Yi Kong
- Research Institute of Internal Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jeffrey Kroon
- Amsterdam UMC Location University of Amsterdam, Department of Experimental Vascular Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands; Amsterdam Cardiovascular Sciences, Atherosclerosis & Ischemic Syndromes, Amsterdam, Netherlands; Laboratory of Angiogenesis and Vascular Metabolism, VIB-KU Leuven Center for Cancer Biology, VIB, Belgium; Laboratory of Angiogenesis and Vascular Metabolism, Department of Oncology, KU Leuven and Leuven Cancer Institute (LKI), Belgium
| | - Ena Stimjanin
- Department of Internal Medicine, Cantonal Hospital Zenical, Zenica, Bosnia and Herzegovina
| | | | - Mandy Oj Grootaert
- Center for Molecular and Vascular Biology, Department of Cardiovascular Sciences, KU Leuven, Leuven, Belgium.
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Genkel V, Kuznetsova A, Lebedev E, Salashenko A, Savochkina A, Nikushkina K, Pykhova L, Sumerkina V, Shaposhnik I. Carotid total plaque area as an independent predictor of short-term subclinical polyvascular atherosclerosis progression and major adverse cardiac and cerebrovascular events. Ther Adv Cardiovasc Dis 2023; 17:17539447231194861. [PMID: 37655749 PMCID: PMC10475231 DOI: 10.1177/17539447231194861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/28/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND The use of ultrasound-based methods for imaging of subclinical atherosclerosis, including measurement of carotid plaque burden (cPB), is a promising direction for further improvement of major adverse cardiac and cerebrovascular events (MACCE) prediction. OBJECTIVES The aim of the study was to research the prognostic values' significance of cPB indicators with regard to the short-term progression of polyvascular subclinical atherosclerosis and the long-term onset of MACCE. DESIGN Single-center prospective cohort study. METHODS The study included patients 40-64 years of age. All patients underwent duplex scanning (DS) of the carotid and lower limb arteries. The following cPB indicators were determined: carotid plaque score (cPS), maximum carotid plaque thickness (cPTmax), and carotid total plaque area (cTPA). The combined endpoint included the following components: cardiovascular death; nonfatal myocardial infarction; nonfatal stroke or transient ischemic attack (TIA); revascularization of the coronary and/or peripheral arteries. RESULTS The study included 387 patients, among whom 142 (36.7%) patients underwent repeated DS after 12-24 months. The median follow-up time was 20.0 (13.0; 36.5) months. MACCE were recorded in 33 (8.52%) of patients. cTPA and cPTmax, but not cPS, were independently associated with the progression of subclinical polyvascular atherosclerosis over a period of 13.9 months of follow-up. cTPA, but not cPTmax and cPS, was independently associated with the development of MACCE over a period of 20.0 months of follow-up. Only a cTPA > 42.0 mm2 proved to be an independent predictor of both the progression of subclinical polyvascular atherosclerosis and MACCE. CONCLUSION In patients from 40 to 64 years of age with various cardiovascular risks, among the indicators of the cPB, only an increase in cTPA > 42.0 mm2 was shown to be independently associated with an increase in the relative risk (RR) of progression of subclinical polyvascular atherosclerosis by 2.38 (1.08-5.25) times, as well as with the development of MACCE by 3.10 (1.54-6.26) times.
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Affiliation(s)
- Vadim Genkel
- Federal State Budgetary Educational Institution of Higher Education 'South-Ural State Medical University' of the Ministry of Healthcare of the Russian Federation, Vorovskogo street 64, Chelyabinsk 454092, Russia
| | - Alla Kuznetsova
- Federal State Budgetary Educational Institution of Higher Education 'South-Ural State Medical University' of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Evgeniy Lebedev
- Federal State Budgetary Educational Institution of Higher Education 'South-Ural State Medical University' of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
- State Autonomous Health Care Institution Order of the Red Banner of Labor 'City Clinical Hospital No. 1 of Chelyabinsk', Chelyabinsk, Russia
| | - Alexey Salashenko
- Federal State Budgetary Educational Institution of Higher Education 'South-Ural State Medical University' of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Albina Savochkina
- Federal State Budgetary Educational Institution of Higher Education 'South-Ural State Medical University' of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Karina Nikushkina
- Federal State Budgetary Educational Institution of Higher Education 'South-Ural State Medical University' of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Lubov Pykhova
- Federal State Budgetary Educational Institution of Higher Education 'South-Ural State Medical University' of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Veronika Sumerkina
- Federal State Budgetary Educational Institution of Higher Education 'South-Ural State Medical University' of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Igor Shaposhnik
- Federal State Budgetary Educational Institution of Higher Education 'South-Ural State Medical University' of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
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Genkel V, Kuznetsova A, Lebedev E, Salashenko A, Pykhova L, Sumerkina V, Shaposhnik I. Achilles tendon thickness normalized to body surface area as a marker of asymptomatic peripheral arterial disease. Vascular 2022:17085381221140621. [PMID: 36395485 DOI: 10.1177/17085381221140621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
OBJECTIVES The normalisation of Achilles tendon thickness (ATT) to anthropometric parameters may increase the diagnostic efficiency of the assessment of ATT. The aim of this study was to compare the diagnostic value of AT dimensions depending on their normalization to body surface area (BSA) in patients with asymptomatic peripheral arterial disease (PAD). METHODS All patients underwent duplex scanning of the carotid arteries and the lower limb arteries. Asymptomatic PAD was defined as the presence of ≥50% stenosis in the carotid and/or lower limb arteries. ATT was measured using a longitudinal scan, width (ATW) and cross-sectional area (AT CSA), which was determined during a cross-sectional scan. RESULTS The study included 369 patients, among whom asymptomatic PAD was detected in 18 (4.88%) patients. Only the ATT demonstrated diagnostic value for asymptomatic PAD. After normalizing the size of the AT to the BSA, the diagnostic performance of ATT, ATW and AT CSA became statistically significant. Among the studied parameters, only an increase in ATT/BSA >0.29 cm/m2 was associated with a significant increase in the odds ratio (OR) of asymptomatic PAD by 4.11 times (95% CI 1.08-15.7; p = .038) after adjustments. CONCLUSION An increase in ATT/BSA >0.29 cm/m2 predicted the presence of asymptomatic PAD with a sensitivity of 61.1% and a specificity of 77.9%. ATT/BSA values of less than 0.29 cm/m2 made it possible to exclude asymptomatic PAD with a probability of 97.5%. An increase in ATT/BSA >0.29 cm/m2 was associated with a 4.11-fold increase in the OR of asymptomatic PAD (95% CI 1.08-15.7).
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Affiliation(s)
- Vadim Genkel
- 111233South-Ural State Medical University, Chelyabinsk, Russia
| | - Alla Kuznetsova
- 111233South-Ural State Medical University, Chelyabinsk, Russia
| | - Evgeniy Lebedev
- 111233South-Ural State Medical University, Chelyabinsk, Russia
| | | | - Lubov Pykhova
- 111233South-Ural State Medical University, Chelyabinsk, Russia
| | | | - Igor Shaposhnik
- 111233South-Ural State Medical University, Chelyabinsk, Russia
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Genkel V, Dolgushin I, Baturina I, Savochkina A, Nikushkina K, Minasova A, Pykhova L, Sumerkina V, Kuznetsova A, Shaposhnik I. Circulating Ageing Neutrophils as a Marker of Asymptomatic Polyvascular Atherosclerosis in Statin-Naïve Patients without Established Cardiovascular Disease. Int J Mol Sci 2022; 23:ijms231710195. [PMID: 36077592 PMCID: PMC9456564 DOI: 10.3390/ijms231710195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2022] [Revised: 09/02/2022] [Accepted: 09/03/2022] [Indexed: 11/16/2022] Open
Abstract
Background: Current data on the possible involvement of aging neutrophils in atherogenesis are limited. This study aimed to research the diagnostic value of aging neutrophils in their relation to subclinical atherosclerosis in statin-naïve patients without established atherosclerotic cardiovascular diseases (ASCVD). Methods: The study was carried out on 151 statin-naïve patients aged 40–64 years old without ASCVD. All patients underwent duplex scanning of the carotid arteries, lower limb arteries and abdominal aorta. Phenotyping and differentiation of neutrophil subpopulations were performed through flow cytometry (Navios 6/2, Beckman Coulter, USA). Results: The number of CD62LloCXCR4hi-neutrophils is known to be significantly higher in patients with subclinical atherosclerosis compared with patients without atherosclerosis (p = 0.006). An increase in the number of CD62LloCXCR4hi-neutrophils above cut-off values makes it possible to predict atherosclerosis in at least one vascular bed with sensitivity of 35.4–50.5% and specificity of 80.0–92.1%, in two vascular beds with sensitivity of 44.7–84.4% and specificity of 80.8–33.3%. Conclusion: In statin-naïve patients 40–64 years old without established ASCVD with subclinical atherosclerosis, there is an increase in circulating CD62LloCXCR4hi-neutrophils. It was also concluded that the increase in the number of circulating CD62LloCXCR4hi-neutrophils demonstrated moderate diagnostic efficiency (AUC 0.617–0.656) in relation to the detection of subclinical atherosclerosis, including polyvascular atherosclerosis.
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Kuznetsova A, Selyanina A, Khusainova G, Dolgushina A, Shaposhnik I, Genkel V. In patients with non-alcoholic fatty liver disease, liver stiffness directly correlates with the carotid plaque burden. Atherosclerosis 2022. [DOI: 10.1016/j.atherosclerosis.2022.06.801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Genkel V, Kuznetcova A, Pykhova L, Nikushkina K, Savochkina A, Dolgushin I, Shaposhnik I. Prognostic significance of hypertriglyceridemia in patients at high and very high cardiovascular risk depending on the concentration of high-sensitivity C-reactive protein. Endocr Metab Immune Disord Drug Targets 2022; 22:1403-1409. [PMID: 35490328 DOI: 10.2174/1871530322666220427094330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 10/31/2021] [Accepted: 01/07/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND It has been established that an increase in triglyceride-rich lipoprotein levels is associated with the development of systemic low-grade inflammation. Data on the prognostic role of hypertriglyceridemia (HTG) dependent on the state of low-grade inflammation are limited. OBJECTIVE The study's objective was to evaluate the predictive value of mild-to-moderate HTG (2.3-11.2 mmol/L) regarding the development of cardiovascular events in patients at high and very high cardiovascular risk (CVR), depending on the high-sensitivity C-reactive protein (hsCRP) values. METHODS The study included 185 patients with high and very high CVR. The concentration of hsCRP in blood serum was measured using an enzyme-linked immunosorbent assay kit. The combined endpoint was cardiovascular death, nonfatal myocardial infarction or unstable angina (which required hospitalization), nonfatal stroke, and coronary revascularization. RESULTS HTG was revealed in 17.3% of the patients. An increase in hsCRP ≥2.0 mg/L was observed in 51.9% of the patients. The event-free survival of patients with HTG was not statistically different from that in patients with TG <2.3 mmol/L (RR 1.61; 95% CI 0.86-3.00; p=0.133). In the subgroup of patients with hsCRP <2.0 mg/L, the survival rate of patients with HTG was not significantly different from the survival rate of patients without HTG. In the subgroup of patients with hsCRP ≥2.0 mg/L the presence of HTG was associated with 4.63 times increase in the RR of adverse cardiovascular events (95% CI 1.35-15.8; p=0.015) after adjusting for potential confounders. CONCLUSION In patients with high and very high CVR, an increase in TG ≥2.3 mmol/L was associated with the development of adverse cardiovascular events only in the subgroup of patients with an increase in hsCRP ≥2.0 mg/L. The presence of HTG was associated with 4.63 times increase in RR of adverse cardiovascular events (95% CI 1.35-15.8; p=0.015).
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Affiliation(s)
- Vadim Genkel
- Department of Internal Medicine, South-Ural State Medical University, Chelyabinsk, Russia
| | - Alla Kuznetcova
- Department of Hospital Therapy, South-Ural State Medical University, Chelyabinsk, Russia
| | - Lubov Pykhova
- Central Research Laboratory, South-Ural State Medical University, Chelyabinsk, Russia
| | - Karina Nikushkina
- Research Institution of Immunology, South-Ural State Medical University, Chelyabinsk, Russia
| | - Albina Savochkina
- Research Institution of Immunology, South-Ural State Medical University, Chelyabinsk, Russia
| | - Ilya Dolgushin
- Research Institution of Immunology, South-Ural State Medical University, Chelyabinsk, Russia
| | - Igor Shaposhnik
- Department of Internal Medicine, South-Ural State Medical University, Chelyabinsk, Russiac
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Genkel V, Dolgushin I, Baturina I, Savochkina A, Kuznetsova A, Pykhova L, Shaposhnik I. In patients with dyslipidemia without ASCVD, triglyceride levels are directly correlated with the number of circulating immunosuppressive and ageing neutrophils. Atherosclerosis 2021. [DOI: 10.1016/j.atherosclerosis.2021.06.218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Genkel V, Kuznetcova A, Shaposhnik I. Relationship between the abdominal aortic diameter and carotid atherosclerosis in middle-aged patients without established atherosclerotic cardiovascular diseases. INT ANGIOL 2021; 40:131-137. [PMID: 33463974 DOI: 10.23736/s0392-9590.21.04493-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The purpose of our research was to study the relationship between the diameter of abdominal aorta (AA) and subclinical atherosclerosis in patients without established atherosclerotic cardiovascular diseases (ASCD) in the absence of pathological enlargement of AA. METHODS The study included 136 patients (52.9% male, 47.1% female), median age was 51.0 (45.5; 58.0) years. The maximum diameter of AA was measured in the infrarenal region at a level between the place of origin of the lower renal artery and bifurcation in cross section. Measurement of the anteroposterior diameter of AA was carried out from the outer-to-outer edge (OTO). Also, we determined the Aortic Size Index (ASI) with respect to body surface area (BSA), using the values of BSA obtained by five different formulas validated for use in clinical practice. All patients underwent carotid duplex ultrasound scanning with assessment of degree of carotid stenosis (according to ECST criteria). RESULTS An increase in the anteroposterior diameter of AA was directly correlated with maximum stenosis of carotid arteries (r=0.186; P=0.030). According to the results of a logistic regression analysis an increase in the diameter of AA by 1 mm was associated with an increase in the relative risk of carotid stenosis ≥50% by 1.37 times (95% CI: 1.01-1.85; P=0.041) after adjustment. Thus, an increase in diameter of AA of more than 1.75 cm with a sensitivity of 71.4% and a specificity of 73.0% made it possible to predict the presence of stenosis of the carotid arteries ≥50%. An increase in ASI<inf>Boyd</inf> (BSA was calculated using Boyd's formula) of more than 0.84 allowed predicting the presence of stenosis of the carotid arteries ≥50% with a sensitivity of 85.7% and a specificity of 65.6%. CONCLUSIONS In middle-aged patients without established ASCD, the diameter of AA and ASI directly correlated with the degree of carotid stenosis (according to ECST criteria). The diameter of AA and ASI demonstrated good sensitivity and specificity for the presence of asymptomatic carotid stenosis of ≥50%.
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Affiliation(s)
- Vadim Genkel
- Department of Internal Medicine, South-Ural State Medical University, Chelyabinsk, Russia -
| | - Alla Kuznetcova
- Department of Hospital Therapy, South-Ural State Medical University, Chelyabinsk, Russia
| | - Igor Shaposhnik
- Department of Internal Medicine, South-Ural State Medical University, Chelyabinsk, Russia
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Genkel V, Baturina I, Emelyanov I, Shaposhnik I, Dolgushin I. An increase in activated NKT-CD8+ cells is associated with the presence of hypoechoic carotid plaques. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The role of NK-cells and NKT-cells and their subtypes at various stages of the development of atherosclerosis is poorly understood. It was previously shown that CD3+CD56+CD8+ cells can secrete pro-inflammatory cytokines and an increase in their number has been established in patients with active Behçet's Disease and Multiple Sclerosis.
Purpose
To study the relationship between the number of activated CD3+CD56+CD8+ cells and the echogenicity of plaques in patients with carotid atherosclerosis.
Methods
The study included 40 patients, 21 (52.5%) men and 19 (47.5%) women who underwent carotid ultrasound and immunological studies. The median age was 53.5 (46.7; 57.0) years. All patients underwent duplex ultrasound scanning of the carotid arteries. If an atherosclerotic plaque was detected, its image was saved and exported to Adobe Photoshop CS6® followed by analysis of the gray-scale median (GSM) of the plaque. Hypoechoic was considered a carotid plaque whose GSM values were less than 50. The number of CD3+CD56+CD8+CD11b+ cells was evaluated by flow cytometry using a flow cytometer.
Results
Among the examined patients, carotid plaques were detected in 31 (77.5%) participants. The average values of GSM visualized plaques were 58.0 (46.0; 71.5). Atherosclerotic plaques with GSM <50 were detected in 11 (35.5%) patients.
In patients with hypoechoic carotid plaques, the number of CD3+CD56+CD8+CD11b+ cells was statistically significantly higher – 352 (55.0; 505) cells/uL versus 66.0 (15.5; 138) cells/uL in patients with plaques whose GSM values were more than 50 (p=0.020). Based on the results of correlation analysis it was established inverse relationship between number of CD3+CD56+CD8+CD11b+ cells and GSM of plaques (r=−0.427; p=0.016). According to the results of the ROC-analysis, an increase in the number of activated NKT-CD8+ cells over 46.5 cells/uL was a predictor of the presence of hypoechogenic carotid plaques with a sensitivity of 81.8% and a specificity of 45.0% (see Figure 1).
Conclusion
In patients with hypoechoic carotid plaques, the number of CD3+CD56+CD8+CD11b+ cells was significantly higher in comparison with other patients. An increase in the number of activated NKT-CD8+ cells over 46.5 cells/uL was a predictor of the presence of hypoechoic carotid plaques with sensitivity of 81.8% and specificity of 45.0%
Figure 1
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- V Genkel
- South-Ural State Medical University, Chelyabinsk, Russian Federation
| | - I Baturina
- South-Ural State Medical University, Chelyabinsk, Russian Federation
| | - I Emelyanov
- South-Ural State Medical University, Chelyabinsk, Russian Federation
| | - I Shaposhnik
- South-Ural State Medical University, Chelyabinsk, Russian Federation
| | - I Dolgushin
- South-Ural State Medical University, Chelyabinsk, Russian Federation
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Genkel V, Kuznetsova A, Lebedev E, Sinitskii A, Pykhova L, Shaposhnik I. Achilles Tendon Thickness Is an Independent Predictor of Carotid Atherosclerosis and Is Associated With a Carotid Plaque Burden. Angiology 2020; 71:734-739. [PMID: 32476444 DOI: 10.1177/0003319720928226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The aim of the study was to research the relationship between carotid atherosclerosis markers and ultrasound parameters of Achilles tendons (AT). The study included 150 patients at high and very high cardiovascular risk (CVR). All patients underwent a carotid ultrasound scanning. We evaluated carotid plaque, carotid plaque score (cPS), carotid total plaque area (cTPA), and the percentage of stenosis. All patients underwent AT ultrasound with an assessment of thickness (Achilles tendon thickness [ATT]), width (Achilles tendon width), and cross-sectional area. An increase in the ATT ≥5.07 mm was associated with a 4.55-fold increase in the relative risk of carotid atherosclerosis (sensitivity 68.3% and specificity 62.5%). Direct correlations between the ATT and carotid stenosis (r = 0.277; P = .004), cPS (r = 0.225; P = .035), and cTPA (r = 0.305; P = .004) were determined. An increase in the mean ATT by 1 mm was associated with an increase in cTPA by 8.09 mm2 (95% CI: 2.26-13.9; P = .007) and carotid stenosis by 4.11% (95% CI: 0.64-7.60; P = .021). Thus, in patients with high and very high CVR, an increase in ATT is an independent predictor of carotid atherosclerosis. The ATT directly correlates with the markers of carotid plaque burden.
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Affiliation(s)
- Vadim Genkel
- Department of Internal Medicine, Federal State Budgetary Educational Institution of Higher Education, "South-Ural State Medical University" of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Alla Kuznetsova
- Department of Hospital Therapy, Federal State Budgetary Educational Institution of Higher Education, "South-Ural State Medical University" of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Evgeny Lebedev
- Department of Internal Medicine, Federal State Budgetary Educational Institution of Higher Education, "South-Ural State Medical University" of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Anton Sinitskii
- Central Research Laboratory, Federal State Budgetary Educational Institution of Higher Education, "South-Ural State Medical University" of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Lubov Pykhova
- Central Research Laboratory, Federal State Budgetary Educational Institution of Higher Education, "South-Ural State Medical University" of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
| | - Igor Shaposhnik
- Department of Internal Medicine, Federal State Budgetary Educational Institution of Higher Education, "South-Ural State Medical University" of the Ministry of Healthcare of the Russian Federation, Chelyabinsk, Russia
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Kireev K, Genkel V, Kuznetsova A, Sadykov R. Multivessel spontaneous coronary artery dissection in a patient after mild COVID-19: A case report. SAGE Open Med Case Rep 2020; 8:2050313X20975989. [PMID: 35154771 PMCID: PMC8826099 DOI: 10.1177/2050313x20975989] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 11/03/2020] [Indexed: 12/22/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is characterized by heterogeneity of possible cardiovascular manifestations. Spontaneous coronary artery dissection is a rare cause of acute coronary syndrome, the development of which in patients with COVID-19 has been described and studied insufficiently. A 35-year-old male patient presented to our hospital with an acute coronary syndrome a few weeks after mild COVID-19. According to coronary angiography, a dissection of ramus intermedius was detected. Successful stenting was performed. Subsequently, the patient had relapses of chest pain, which led to two repeated coronary angiographies. The patient had been diagnosed with consecutive dissections of right coronary artery and distal branch of ramus intermedius. Repeated stenting of dissected segments of right coronary artery and ramus intermedius was not performed. Afterward, the patient’s condition remained stable and he was successfully discharged. One of the main pathophysiological mechanisms of cardiovascular complications in COVID-19 is probably the virus-triggered hyperinflammation and massive release of cytokines. A systemic inflammatory response may initiate inflammation of the vascular wall and other target tissues. The results of histological studies confirm the direct infection of endothelial cells 2019-nCoV with the development of diffuse endothelial inflammation (endotheliitis). It is possible that in patients with a genetic predisposition to artery dissection, COVID-19 may be a trigger of spontaneous coronary artery dissection.
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Affiliation(s)
- Konstantin Kireev
- South Ural State Medical University, Chelyabinsk, Russian Federation
- Railway Clinical Hospital on Station Chelyabinsk of JSC Russian Railways, Chelyabinsk, Russian Federation
| | - Vadim Genkel
- South Ural State Medical University, Chelyabinsk, Russian Federation
- Railway Clinical Hospital on Station Chelyabinsk of JSC Russian Railways, Chelyabinsk, Russian Federation
| | - Alla Kuznetsova
- South Ural State Medical University, Chelyabinsk, Russian Federation
- Railway Clinical Hospital on Station Chelyabinsk of JSC Russian Railways, Chelyabinsk, Russian Federation
| | - Rifat Sadykov
- Railway Clinical Hospital on Station Chelyabinsk of JSC Russian Railways, Chelyabinsk, Russian Federation
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Genkel V, Salashenko A, Shaposhnik I. 3040Plaque burden, but not the severity of carotid stenosis, predicts adverse cardiovascular events in patients at high and very high cardiovascular risk. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
According to the current guidelines the visualization of atherosclerotic plaques in the carotid arteries is the only option that carotid ultrasound provides for the assessment of cardiovascular risk (CVR). The direction devoted to the development and implementation of markers based on the quantification of atheroma, is promising.
Purpose
The aim of the study was to evaluate the prognostic value of various markers of carotid atherosclerosis (plaque, carotid total plaque area (cTPA) and carotid stenosis) in patients at high and very high CVR.
Methods
The study included patients aged 40–75 years at high and very high CVR. All patients underwent carotid duplex ultrasound. The presence of carotid plaque was assessed according to Mannheim consensus. The percentage of stenosis was measured planimetrically in the B-mode by the diameter in the cross section of the vessel.
cTPA was estimated in the longitudinal position, which allows to achieve the best visualization of plaque, the area of plaque was measured in the manual trace mode. These measurements were performed for each rendered plaque, followed by the calculation of the total value.
The combined endpoint was cardiovascular death, non-fatal myocardial infarction or unstable angina (which required hospitalization), non-fatal stroke, and coronary revascularization.
Results
The study included 100 patients at high and very high risk. The duration of the follow-up period was 24.4 (14.1–34.3) months. The events constituting the combined endpoint occurred in 34 (34%) patients: cardiovascular death was recorded in 7 (7%) patients; non-fatal myocardial infarction or stroke in 3 (3%) patients; unstable angina, which required hospitalization in 24 (24%) patients, while emergency coronary angiography was performed in 8 (8%) patients, coronary artery stenting was performed in 3 (3%) cases.
The presence of carotid plaque in accordance with Cox regression after adjusting for factors such as sex, age, smoking, hypertension, BMI, eGFR, LDL-c and HbA1c, RR of adverse cardiovascular events was 10.5 (95% CI 1.27–86.5; p=0.008; see Figure 1).
The optimal cut-off values of cTPA and carotid stenosis were determined by ROC-analysis.
An increase in cTPA ≥69 mm2 corrected for sex, age, smoking, hypertension, BMI, eGFR, LDL-c, HbA1c, and the presence of carotid plaque was associated with an increase in the RR of adverse cardiovascular events by 5.86 times (95% CI 2.09–16.4; p=0.001; see Figure 1).
Also, there were no statistically significant associations between carotid arteries stenosis and adverse cardiovascular events (RR 1.29; 95% CI 0.61–2.76; p=0.504).
Kaplan–Meier curves for cTPA, stenosis
Conclusion
In patients at high and very high cardiovascular risk among carotid ultrasound parameters the presence of carotid plaque and cTPA, but not the degree of stenosis, had an independent predictive value regarding the development of adverse cardiovascular events.
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Affiliation(s)
- V Genkel
- South-Ural State Medical University, Chelyabinsk, Russian Federation
| | - A Salashenko
- South-Ural State Medical University, Chelyabinsk, Russian Federation
| | - I Shaposhnik
- South-Ural State Medical University, Chelyabinsk, Russian Federation
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Genkel V, Salashenko A, Sumerkina V, Shaposhnik I. Abnormalities Of The Protein C Anticoagulant Pathway As A Possible Marker Of Polyvascular Peripheral Arterial Disease. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Genkel V, Shaposhnik I. Carotid Plaque But Not Femoral Plaque Predicts Cardiovascular Events In Patients At High And Very High Cardiovascular Risk. Atherosclerosis 2019. [DOI: 10.1016/j.atherosclerosis.2019.06.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Genkel V, Shamaeva T, Salashenko A, Sumerkina V, Shaposhnik I. Carotid wall shear rate and arterial stiffness in patients with hypertension and peripheral arterial disease. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Genkel V, Salashenko A, Nikushkina K, Shamaeva T, Shaposhnik I. Low-grade inflammation in patients with coronary artery disease and type 2 diabetes mellitus. Atherosclerosis 2018. [DOI: 10.1016/j.atherosclerosis.2018.06.327] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Genkel V, Salashenko A, Toropova L, Ilinykh E, Sumerkina V, Shaposhnik I. P1415Wall shear rate in patients with hypertension at different stages of atherosclerosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1415] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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