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Atherosclerosis is a chronic disease characterized by the formation of plaque in hemodynamically unstable regions of arteries. The disease involves complicated molecular and cellular processes including inflammation, the immune system, low density lipoprotein, cytokines, and many other components. As such, the degree of disease is difficult to determine, and the clinical outcomes that stem from the disease are hard to predict. Current imaging techniques lack specificity for the plaques likely to cause clinical consequences such as heart attack or stroke. Consequently, a new and molecularly selective contrast agent formulation is necessary for accurate imaging of plaque and to aid in the determination of the correct patient-specific treatment. To that end, a stealth biodegradable particle was designed containing a high payload of contrast agent that is targetable to specific states of plaque development. The core material used in creation of the particle was the FDA-approved poly(lactide-co-glycolide) (PLGA), with carboxylic acid termini. The polymer was used in a modified water-in-oil-in-oil double emulsion method to form particles of sizes ranging from approximately 50 nm to 20 [mu]m, of near‐spherical shape, and with smooth surfaces. The PLGA particles were loaded with up to 30% Gd-DTPA, an FDA-approved contrast agent used with magnetic resonance imaging (MRI). As an adjunct, to enable visualization of individual particles in vitro, particles were alternatively loaded with rhodamine 6G, a fluorescent agent. The PLGA particles were surface functionalized with poly(ethylene glycol) (PEG) with a primary amine end group. The acid group of the PLGA and PEG-linked amine were coupled through an amide bond using carbodiimide chemistry. The presence of PEG on the surface of particles was confirmed using electron microscopy, 1H NMR, and zeta potential. The other end of the PEG chain terminated in a carboxylic acid that was subsequently used for coupling to a monoclonal antibody against the cell surface markers of inflammation and atherosclerosis, vascular cell adhesion molecule‐1 (VCAM‐1) and intercellular adhesion molecule-1 (ICAM-1). Particles with conjugated antibodies successfully attached to, entered, and distributed throughout cells in vitro. / text

Carotid artery wall stiffness has been widely considered as an index of vascular health, and has been associated with occurrence of cardiovascular events, such as stroke. In addition, the blood flow patterns in the carotid artery can yield crucial information on atherosclerosis progression and cerebrovascular impairment. Pulse wave imaging (PWI) is a non-invasive ultrasound imaging technique that tracks the propagation of the arterial pulse wave, providing thus regional arterial wall stiffness mapping. Moreover, towards enabling accurate visualization of blood flow patterns, ultrasound-based vector flow imaging (VFI) modalities have been developed. Building upon PWI and VFI techniques, the overall goal of this dissertation is to develop ultrasound-based methodologies that can provide simultaneous imaging of the carotid artery wall mechanics and blood flow dynamics at high temporal and spatial resolutions. The developed techniques are validated through vessel phantom experiments and simulations. Furthermore, their potential to diagnose pre-clinical stages of carotid artery disease and provide additional insights in risk for stroke assessment, is demonstrated in an atherosclerotic swine study and human subjects in vivo. More specifically: A method is presented that analyzes the pattern of arterial wall motion derived by PWI, in order to detect spatial mechanical inhomogeneity across an imaged artery, and provide piecewise arterial wall stiffness estimates. The proposed technique is validated in a phantom consisting of a soft and a stiff segment, while its feasibility is demonstrated to identify inhomogeneous wall properties in atherosclerotic human carotid arteries, as well as provide atherosclerotic plaque mechanical characterization in vivo. Subsequently, PWI is integrated with VFI techniques in the same ultrasound acquisition sequence, in order to enable simultaneous and co-localized imaging of arterial wall stiffness and blood vector flow velocity. The performance of the technique is investigated through experiments and FSI simulations. Moreover, its feasibility was shown to investigate associations between carotid artery Pulse Wave Velocity and blood flow patterns, in vivo. Based on the previously developed PWI and VFI modalities, a novel ultrasound-based technique is developed that combines high frame rate vector flow imaging with a data clustering approach, in order to enable direct and robust wall shear stress measurements. The performance of the proposed method is evaluated through vessel phantom experiments and simulations, while its feasibility is shown to detect pre-clinical stages of carotid artery disease in a swine model in vivo. In addition, a pilot clinical study is presented involving application of the developed modality in normal and atherosclerotic human carotid arteries in-vivo. Moving forward, the developed imaging modalities are used to implement novel clinical biomarkers based on carotid artery arterial wall mechanics and blood flow dynamics, that can potentially assist in risk for stroke assessment. The patterns of those biomarkers are investigated in the common carotid arteries of subjects with low degree of stenosis and medical history of stroke, against subjects without history of stroke. The same biomarkers are also analyzed with respect to stroke symptomatology in atherosclerotic patients with moderate to high degree of stenosis. Moreover, the developed techniques are used to identify vulnerable plaque components in subjects with fully developed plaques, as compared with CTA scans. Finally, a deep learning-based approach for motion tracking of the arterial wall throughout the cardiac cycle is proposed. A neural network is trained to learn the motion patterns of the carotid artery and potentially improve the quality of PWI. The performance of the technique is assessed in vessel phantom experiments and its feasibility is demonstrated in healthy human carotid arteries in-vivo.

A aterosclerose é uma doença progressiva crônica. Embora segmentar, é generalizada e acomete as artérias carótidas, propiciando maior risco de acidente vascular cerebral. Utilizamos dois métodos diagnósticos, nesta avaliação, que foram a ultra-sonografia modo B em escala de cinza associada também a fluxo Doppler colorido, e a ressonância magnética (RM) com seqüências ponderadas em T1 e T2, ambas pelas técnicas \"black-blood\" (BB) e \"fat sat black-blood\" (FSBB), e angiografia por ressonância magnética \"time-of-flight\'\' tridimensional (3D TOF), com e sem a administração do contraste paramagnético. Objetivou-se a identificação de ateromas carotídeos em pacientes coronariopatas, comprovados por cateterismo cardíaco com indicação de terapia cirúrgica. Realizou-se a estimativa do grau de estenose das artérias carótidas internas, através de ultra-sonografia com fluxo Doppler colorido (UDC) e angiografia por ressonância magnética (ARM), comparando-se os métodos. Também foram feitas comparações entre a ecogenicidade das placas visualizadas através de ultra-sonografia (USG), com a intensidade de sinal adquirida pelos exames de ressonância magnética (RM). Foi realizada avaliação de qualidade de imagens e confiabilidade inter-observadores, nos exames de ressonância magnética. Houve alta incidência de aterosclerose carotídea, nos pacientes em estudo. Do total de 100 segmentos carotídeos analisados por ultra-sonografia, com fluxo Doppler colorido para estimativa do grau de estenose, 81% apresentaram algum tipo de estenose, sendo o grau leve (grau II) predominante, evidenciado em 59% dos casos. Avaliamos a associação entre o grau de estenose visualizado através de UDC e ARM, com e sem contraste, e houve reprodutibilidade marginal entre os métodos. Observaram-se alterações de intensidade de sinal das paredes vasculares nos exames de RM, nas seqüências ponderadas em T1-BB, T1-FSBB, T2-BB e T2-FSBB, entre 71% e 72%. O aumento da intensidade de sinal foi predominante. Nas 72 placas com ecogenicidade tipo 4, houve aumento da intensidade de sinal em 13,9% em 3D TOF, 59,7% em T1-BB, 65,3% em T1-FSBB, 62,5% em T2-BB e 66,7% em T2-FSBB. Nas placas com ecogenicidade tipo 2, houve aumento da intensidade de sinal em 42,9% em 3D TOF, 71,4% em T1-BB e T1-FSBB, 85,7% em T2-BB e 71,4% em T2-FSBB. Nas placas com ecogenicidade tipo 1, houve aumento da intensidade de sinal em 50,0%, nas seqüências ponderadas em 3D TOF, T1 e T2. Em 19 segmentos carotídeos, a USG foi considerada normal. Quando os mesmos segmentos foram avaliados através de RM, observou-se aumento da intensidade de sinal em 21,1% em 3D TOF, 47,4% em T1-BB, 57,9% em T1-FSBB, 52,6% em T2-BB e T2-FSBB. Não houve correlação entre os tipos de ecogenicidade das placas visualizadas através de USG, com as alterações de intensidade de sinal pela RM. A avaliação da qualidade de imagens dos exames de RM, com cortes no plano axial nas seqüências ponderadas em T1 e T2 (BB e FSBB), foi considerada ótima e, em 3D TOF, muito boa. A qualidade de imagem dos exames de ARM, com e sem contraste, foi considerada excelente. Notou-se ótima reprodutibilidade inter-observadores, com valores de índice Kappa acima de 0,71 / Atherosclerosis is a chronic progressive disease. Although being segmental, atherosclerosis is systemic and attacks carotid arteries, propitiating a greater risk of cerebral vascular accident. In this assessment, we have applied two diagnostic imaging methods such as gray-scale B-mode ultrasound (US) in association with color flow Doppler (CFD-US) and T1 and T2-weighted magnetic resonance imaging (MRI) sequences, using black-blood (T1-BB and T2-BB) and black-blood with fat saturation (T1-FSBB and T2-FSBB) techniques, and magnetic resonance angiography (MRA) with and without paramagnetic contrast agent (three-dimensional time-of-flight, 3D TOF). Our objective was the identification of carotid atheromas in patients with coronary artery disease - as confirmed by cardiac catheterism, and referred to cardiac surgery. The degree of stenosis of the internal carotid arteries was estimated by CFD-US and by MRA, and the results from both methods were compared. The echogenicity of carotid plaques as seen by US and the signal intensity of MR images were also compared. Evaluation of image quality and inter-rater reliability of evaluation of MR images were also performed. There was a high incidence of carotid atherosclerosis in the patient population under study. From a total of one hundred (100) carotid artery segments analyzed by CFD-US for stenosis degree estimation, 81% showed some degree of stenosis, with a predominance of mild grade (grade II), which was detected in 59.0% of the cases. We have evaluated the association between the degree of stenosis visualized by CFD-US and by MRA with and without contrast agent and there was a marginal reproducibility between these methods. It was observed changes in artery wall signal intensity of 71% to 72%, in the T1-BB, T1-FSBB, T2-BB and T2-FSBB sequences of the MRI examinations. Increases in signal intensity were predominant. Among 72 plaques with echogenicity type 4, the signal intensity has increased 13.9% in 3D TOF, 59.7% inT1-BB, 65.3% in T1-FSBB, 62.5% in T2-BB and 66.7% in T2-FSBB. Among plaques with echogenicity type 2, the signal intensity has increased 42.9% in 3D TOF, 71.4% in T1-BB and T1-FSBB, 85.7% in T2-BB and 71.4% in T2-FSBB. Plaques with echogenicity type 1, showed signal intensity increase of 50.0% in the 3D TOF, T1 and T2 weighted MRI sequences. In 19 carotid artery segments, CFD-US was considered normal. When the same segments were evaluated by MRI, it was noted an increase of the image signal intensity in 21.1% in 3D TOF, 47.4% in T1-BB, 57.9% in T1-FSBB, 52.6% in T2-BB and T2-FSBB. There was no correlation between the types of plaque echogenicities seen by the CFD-US with the changes of signal intensity seen by MRI. The image quality and interobserver reliability of MR examinations were evaluated. The image quality of the T1 and T2-weighted axial MR images was considered excellent and for 3D TOF images, the quality was considered very good. The quality of the MRA images with and without paramagnetic contrast agent was considered excellent. It was noted an excellent interobserver reproducibility with values of Kappa index greater than 0.71

A aterosclerose é uma doença progressiva crônica. Embora segmentar, é generalizada e acomete as artérias carótidas, propiciando maior risco de acidente vascular cerebral. Utilizamos dois métodos diagnósticos, nesta avaliação, que foram a ultra-sonografia modo B em escala de cinza associada também a fluxo Doppler colorido, e a ressonância magnética (RM) com seqüências ponderadas em T1 e T2, ambas pelas técnicas \"black-blood\" (BB) e \"fat sat black-blood\" (FSBB), e angiografia por ressonância magnética \"time-of-flight\'\' tridimensional (3D TOF), com e sem a administração do contraste paramagnético. Objetivou-se a identificação de ateromas carotídeos em pacientes coronariopatas, comprovados por cateterismo cardíaco com indicação de terapia cirúrgica. Realizou-se a estimativa do grau de estenose das artérias carótidas internas, através de ultra-sonografia com fluxo Doppler colorido (UDC) e angiografia por ressonância magnética (ARM), comparando-se os métodos. Também foram feitas comparações entre a ecogenicidade das placas visualizadas através de ultra-sonografia (USG), com a intensidade de sinal adquirida pelos exames de ressonância magnética (RM). Foi realizada avaliação de qualidade de imagens e confiabilidade inter-observadores, nos exames de ressonância magnética. Houve alta incidência de aterosclerose carotídea, nos pacientes em estudo. Do total de 100 segmentos carotídeos analisados por ultra-sonografia, com fluxo Doppler colorido para estimativa do grau de estenose, 81% apresentaram algum tipo de estenose, sendo o grau leve (grau II) predominante, evidenciado em 59% dos casos. Avaliamos a associação entre o grau de estenose visualizado através de UDC e ARM, com e sem contraste, e houve reprodutibilidade marginal entre os métodos. Observaram-se alterações de intensidade de sinal das paredes vasculares nos exames de RM, nas seqüências ponderadas em T1-BB, T1-FSBB, T2-BB e T2-FSBB, entre 71% e 72%. O aumento da intensidade de sinal foi predominante. Nas 72 placas com ecogenicidade tipo 4, houve aumento da intensidade de sinal em 13,9% em 3D TOF, 59,7% em T1-BB, 65,3% em T1-FSBB, 62,5% em T2-BB e 66,7% em T2-FSBB. Nas placas com ecogenicidade tipo 2, houve aumento da intensidade de sinal em 42,9% em 3D TOF, 71,4% em T1-BB e T1-FSBB, 85,7% em T2-BB e 71,4% em T2-FSBB. Nas placas com ecogenicidade tipo 1, houve aumento da intensidade de sinal em 50,0%, nas seqüências ponderadas em 3D TOF, T1 e T2. Em 19 segmentos carotídeos, a USG foi considerada normal. Quando os mesmos segmentos foram avaliados através de RM, observou-se aumento da intensidade de sinal em 21,1% em 3D TOF, 47,4% em T1-BB, 57,9% em T1-FSBB, 52,6% em T2-BB e T2-FSBB. Não houve correlação entre os tipos de ecogenicidade das placas visualizadas através de USG, com as alterações de intensidade de sinal pela RM. A avaliação da qualidade de imagens dos exames de RM, com cortes no plano axial nas seqüências ponderadas em T1 e T2 (BB e FSBB), foi considerada ótima e, em 3D TOF, muito boa. A qualidade de imagem dos exames de ARM, com e sem contraste, foi considerada excelente. Notou-se ótima reprodutibilidade inter-observadores, com valores de índice Kappa acima de 0,71 / Atherosclerosis is a chronic progressive disease. Although being segmental, atherosclerosis is systemic and attacks carotid arteries, propitiating a greater risk of cerebral vascular accident. In this assessment, we have applied two diagnostic imaging methods such as gray-scale B-mode ultrasound (US) in association with color flow Doppler (CFD-US) and T1 and T2-weighted magnetic resonance imaging (MRI) sequences, using black-blood (T1-BB and T2-BB) and black-blood with fat saturation (T1-FSBB and T2-FSBB) techniques, and magnetic resonance angiography (MRA) with and without paramagnetic contrast agent (three-dimensional time-of-flight, 3D TOF). Our objective was the identification of carotid atheromas in patients with coronary artery disease - as confirmed by cardiac catheterism, and referred to cardiac surgery. The degree of stenosis of the internal carotid arteries was estimated by CFD-US and by MRA, and the results from both methods were compared. The echogenicity of carotid plaques as seen by US and the signal intensity of MR images were also compared. Evaluation of image quality and inter-rater reliability of evaluation of MR images were also performed. There was a high incidence of carotid atherosclerosis in the patient population under study. From a total of one hundred (100) carotid artery segments analyzed by CFD-US for stenosis degree estimation, 81% showed some degree of stenosis, with a predominance of mild grade (grade II), which was detected in 59.0% of the cases. We have evaluated the association between the degree of stenosis visualized by CFD-US and by MRA with and without contrast agent and there was a marginal reproducibility between these methods. It was observed changes in artery wall signal intensity of 71% to 72%, in the T1-BB, T1-FSBB, T2-BB and T2-FSBB sequences of the MRI examinations. Increases in signal intensity were predominant. Among 72 plaques with echogenicity type 4, the signal intensity has increased 13.9% in 3D TOF, 59.7% inT1-BB, 65.3% in T1-FSBB, 62.5% in T2-BB and 66.7% in T2-FSBB. Among plaques with echogenicity type 2, the signal intensity has increased 42.9% in 3D TOF, 71.4% in T1-BB and T1-FSBB, 85.7% in T2-BB and 71.4% in T2-FSBB. Plaques with echogenicity type 1, showed signal intensity increase of 50.0% in the 3D TOF, T1 and T2 weighted MRI sequences. In 19 carotid artery segments, CFD-US was considered normal. When the same segments were evaluated by MRI, it was noted an increase of the image signal intensity in 21.1% in 3D TOF, 47.4% in T1-BB, 57.9% in T1-FSBB, 52.6% in T2-BB and T2-FSBB. There was no correlation between the types of plaque echogenicities seen by the CFD-US with the changes of signal intensity seen by MRI. The image quality and interobserver reliability of MR examinations were evaluated. The image quality of the T1 and T2-weighted axial MR images was considered excellent and for 3D TOF images, the quality was considered very good. The quality of the MRA images with and without paramagnetic contrast agent was considered excellent. It was noted an excellent interobserver reproducibility with values of Kappa index greater than 0.71

O número de pacientes com diagnóstico de diabetes aumenta a cada dia. Infarto agudo do miocárdio (IAM) e acidente vascular cerebral (AVC) constituem as principais causas de óbito neste grupo. Ruptura da placa aterosclerótica coronariana é o mecanismo fisiopatológico para (IAM) em 2 a cada 3 casos e as características destas placas mais vulneráveis e propensas a ruptura como:remodelamento positivo do segmento vascular afetado e placa não calcificada com baixa atenuação podem ser avaliadas pela Angiotomografia. Objetivo: Avaliar a frequência de doença arterial coronariana e as principais características de vulnerabilidade dessas placas ateroscleróticas em diabéticos assintomáticos considerando o grau de controle glicêmico através da Angiotomografia Computadorizada Multislice. Desenho do estudo e Métodos: 90 pacientes diabéticos tipo 2 assintomáticos, avaliados,entre junho de 2011 a setembro de 2012, entre 40 e 65 anos de idade, tempo de duração do diabetes inferior a 10 anos, submetidos a avaliação clínica, laboratorial e Angiotomografia Computadorizada de artérias coronárias com 320 colunas de detectores. Resultados: Dos 90 pacientes, 42,2% (n=38) apresentaram doença arterial coronariana a Angiotomo sendo n=11 no grupo A1c < 7% e n=27 no grupo A1c >=7% com diferença estatística (p=0,0006). 14 indivíduos apresentaram doença arterial coronariana significativa (obstrução do lúmen superior a 50%), n=3 no grupo A1c<7% e n=11 no A1c>=7% (p=0,02). O tipo de placa não calcificada predominou no grupo A1c>=7% (p=0,005) e 29% dos diabéticos com doença coronária apresentaram lesões ateroscleróticas classificadas como mais vulneráveis que predominaram no grupo A1c>=7% (p=0,04). Conclusão: O paciente diabético assintomático apresenta além de elevada frequência de doença arterial coronariana possui grande número de placas classificadas como vulneráveis pela Angiotomo e portanto predispostas a ruptura e evento coronariano agudo, principalmente no grupo A1c > =7% / The number of diabetic patients increase every day. Acute myocardial infarction (AMI) and Stroke are the leading causes of death in this group. Coronary atherosclerotic plaque rupture is the pathophysiologic mechanism for (AMI) in 2 every 3 cases and the characteristics of these plaques more vulnerable and prone to rupture as positive remodeling of the vascular segment affected and non-calcified plaque with low attenuation can be evaluated by Angiotomography. Objective: To evaluate the frequency of coronary artery disease and the main characteristics of these vulnerable atherosclerotic plaques in asymptomatic diabetic considering the degree of glycemic control by Multislice Computed Angiotomography. Study Design and Methods: 90 asymptomatic type 2 diabetic patients, evaluated between June 2011 and September 2012, between 40 and 65 years of age, duration of diabetes less than 10 years, underwent clinical, laboratory and Angiotomography Computed coronary arteries with 320 columns of detectors. Results: Of 90 patients, 42.2% (n = 38) had coronary artery disease being the Angiotomo n = 11 in group A1c <7% and n = 27 in group A1c> = 7% with statistical difference (p = 0.0006 ). 14 individuals showed significant coronary artery disease (obstruction of the lumen than 50%), n = 3 in the A1c <7% and n = 11 in A1c> = 7% (p = 0.02). The type of noncalcified plaque predominated in A1c> = 7% (p = 0.005) and 29% of diabetics with coronary disease showed atherosclerotic lesions classified as most vulnerable group that predominated in A1c> = 7% (p = 0.04) . Conclusion: Diabetic patients asymptomatic features besides high frequency of coronary artery disease has a large number of plaques classified as vulnerable by Angiotomo and therefore prone to rupture and acute coronary event, especially in the group A1c> = 7%

O número de pacientes com diagnóstico de diabetes aumenta a cada dia. Infarto agudo do miocárdio (IAM) e acidente vascular cerebral (AVC) constituem as principais causas de óbito neste grupo. Ruptura da placa aterosclerótica coronariana é o mecanismo fisiopatológico para (IAM) em 2 a cada 3 casos e as características destas placas mais vulneráveis e propensas a ruptura como:remodelamento positivo do segmento vascular afetado e placa não calcificada com baixa atenuação podem ser avaliadas pela Angiotomografia. Objetivo: Avaliar a frequência de doença arterial coronariana e as principais características de vulnerabilidade dessas placas ateroscleróticas em diabéticos assintomáticos considerando o grau de controle glicêmico através da Angiotomografia Computadorizada Multislice. Desenho do estudo e Métodos: 90 pacientes diabéticos tipo 2 assintomáticos, avaliados,entre junho de 2011 a setembro de 2012, entre 40 e 65 anos de idade, tempo de duração do diabetes inferior a 10 anos, submetidos a avaliação clínica, laboratorial e Angiotomografia Computadorizada de artérias coronárias com 320 colunas de detectores. Resultados: Dos 90 pacientes, 42,2% (n=38) apresentaram doença arterial coronariana a Angiotomo sendo n=11 no grupo A1c < 7% e n=27 no grupo A1c >=7% com diferença estatística (p=0,0006). 14 indivíduos apresentaram doença arterial coronariana significativa (obstrução do lúmen superior a 50%), n=3 no grupo A1c<7% e n=11 no A1c>=7% (p=0,02). O tipo de placa não calcificada predominou no grupo A1c>=7% (p=0,005) e 29% dos diabéticos com doença coronária apresentaram lesões ateroscleróticas classificadas como mais vulneráveis que predominaram no grupo A1c>=7% (p=0,04). Conclusão: O paciente diabético assintomático apresenta além de elevada frequência de doença arterial coronariana possui grande número de placas classificadas como vulneráveis pela Angiotomo e portanto predispostas a ruptura e evento coronariano agudo, principalmente no grupo A1c > =7% / The number of diabetic patients increase every day. Acute myocardial infarction (AMI) and Stroke are the leading causes of death in this group. Coronary atherosclerotic plaque rupture is the pathophysiologic mechanism for (AMI) in 2 every 3 cases and the characteristics of these plaques more vulnerable and prone to rupture as positive remodeling of the vascular segment affected and non-calcified plaque with low attenuation can be evaluated by Angiotomography. Objective: To evaluate the frequency of coronary artery disease and the main characteristics of these vulnerable atherosclerotic plaques in asymptomatic diabetic considering the degree of glycemic control by Multislice Computed Angiotomography. Study Design and Methods: 90 asymptomatic type 2 diabetic patients, evaluated between June 2011 and September 2012, between 40 and 65 years of age, duration of diabetes less than 10 years, underwent clinical, laboratory and Angiotomography Computed coronary arteries with 320 columns of detectors. Results: Of 90 patients, 42.2% (n = 38) had coronary artery disease being the Angiotomo n = 11 in group A1c <7% and n = 27 in group A1c> = 7% with statistical difference (p = 0.0006 ). 14 individuals showed significant coronary artery disease (obstruction of the lumen than 50%), n = 3 in the A1c <7% and n = 11 in A1c> = 7% (p = 0.02). The type of noncalcified plaque predominated in A1c> = 7% (p = 0.005) and 29% of diabetics with coronary disease showed atherosclerotic lesions classified as most vulnerable group that predominated in A1c> = 7% (p = 0.04) . Conclusion: Diabetic patients asymptomatic features besides high frequency of coronary artery disease has a large number of plaques classified as vulnerable by Angiotomo and therefore prone to rupture and acute coronary event, especially in the group A1c> = 7%

A aterosclerose e suas complicações são a principal causa de morbidade e mortalidade no mundo ocidental. O aumento da espessura da camada médio-intimal da carótida está associado com risco para doenças cardiovasculares, pois representa um marcador de aterosclerose subclínica, podendo ser detectada precocemente em indivíduos assintomáticos. O objetivo desse estudo foi identificar variáveis clínicas e nutricionais associadas com a aterosclerose subclínica em mulheres hipertensas. Estudo transversal envolvendo uma amostra de conveniência composta por 116 mulheres hipertensas entre 40 e 65 anos. Dados clínicos, como pressão arterial (PA) sistólica e diastólica, história de tabagismo, atividade física, uso de medicamentos foram coletados; foi feita a análise do perfil lipídico, glicemia e proteína C reativa (PCR); a avaliação dietética obtida pelo Recordatório de 24 horas e pelo Registro de três dias. A espessura médio-intimal (EMI) de carótidas foi realizada pelo aparelho de ultrassonografia. As pacientes foram divididas em dois grupos, de acordo com os valores da espessura médio-intimal de carótidas: EMI 0,9mm ou EMI > 0,9mm. Houve diferença significativa entre os grupos em relação à idade (50,846,62 vs 53,547,13; p=0,044), PA sistólica (134,5216,54 vs 142,9821,47; p=0,020), pressão de pulso (PP) (49,3611,03 vs 60,15 17,77; p<0,001), HDL (48,988,54 vs 44,057,45; p=0,004) e PCR (2,311,21 vs 3,051,34; p=0,016). Não houve diferença significativa em relação aos parâmetros antropométricos, exceto em relação à reactância (65,199,69 vs 61,447,88; p=0,036), avaliada pela bioimpedância elétrica (BIA). Quanto ao padrão de consumo alimentar, somente o consumo de gordura monoinsaturada foi diferente entre os grupos, sendo o maior consumo no grupo com menor valor de EMI (7,882,09 vs 7,022,06; p=0,031). Não houve diferença em relação à frequência de tabagismo e atividade física. Quando foi feita a análise de correlação da amostra, foi encontrada uma correlação entre a EMI de carótidas e idade (r=0,25; p=0,0067), PAS (r=0,19; p=0,0086); PP (r=0,30; p=0,0009), LDL (r=0,19; p=0,0434), assim como com gordura monoinsaturada (r= -0,25; p=0,0087), PCR (r=0,31; p=0,007) e HDL (r=-0,33; p=0,0004), porém apenas as variáveis HDL, PCRus e pressão de pulso mostraram ser preditoras independentes da EMI de carótida após feita uma análise de regressão linear multivariada. A proteína C reativa, HDL colesterol e pressão de pulso são importantes preditores independentes de aterosclerose subclínica. / Atherosclerosis and its complications are the main cause of morbidity and mortality in the Western world. Increased carotid intima-media thickness is associated with cardiovascular risk,and it represents a marker of subclinical atherosclerosis, which can be detected early in asymptomatic individuals. The aim of this study was to identify clinical and nutritional variables associated with subclinical atherosclerosis in hypertensive women. Cross-sectional study involving a convenience sample composed by 116 hypertensive women aged between 40 and 65. Clinical data such systolic and diastolic blood pressure (BP), smoking history, physical activity, medication use were collected, a lipid profile, blood glucose and C-reactive protein (CRP)analysis was performed, the dietary assessment was obtained by dietary recall 24 hours and three days food record. Carotid intima-media thickness was performed by the high resolution ultrasound. Patients were divided into two groups according to the values of carotid IMT: IMT 0.9 mm or IMT > 0.9 mm. There was significant difference between the groups regarding age (50.846.62 vs 53.547.13; p=0.044), systolic BP(134.5216.54 vs 142.9821.47; p=0.020), pulse pressure (PP) (49.3611.03 vs 60.15 17.77; p<0.001), HDL-cholesterol (49.3611.03 vs 60.1517.77; p<0.001)and CRP(2.311.21 vs 3.051.34; p=0.016). There was no significant difference regarding to anthropometric parameters, except for the reactance (65.199.69 vs 61.447.88; p=0.036), measured by bioelectrical impedance analysis (BIA). Regarding the dietary pattern, only the monounsaturated fat intake was different between the groups 65.199.69 vs 61.447.88; p=0.036),. There was no difference in smoking and physical activity. In the correlation analysis, we have found a correlation between carotid IMT and age (r = 0.25, p = 0.0067), SBP (r= 0.19, p = 0.0086); PP (r = 0.30, p = 0.0009), LDL (r = 0.19, p = 0.0434), and monounsaturated fat (r = -0.25, p = 0.0087), CRP (r = 0.31, p = 0.007) and HDL (r =- 0.33, p = 0.0004), but only HDL-cholesterol, hsCRP and pulse pressure were shown to be independent predictors of carotid IMT after made a multivariate analysis. Conclude that C reactive protein, HDL-cholesterol and pulse pressure are important predictors for subclinical atherosclerosis.

A aterosclerose e suas complicações são a principal causa de morbidade e mortalidade no mundo ocidental. O aumento da espessura da camada médio-intimal da carótida está associado com risco para doenças cardiovasculares, pois representa um marcador de aterosclerose subclínica, podendo ser detectada precocemente em indivíduos assintomáticos. O objetivo desse estudo foi identificar variáveis clínicas e nutricionais associadas com a aterosclerose subclínica em mulheres hipertensas. Estudo transversal envolvendo uma amostra de conveniência composta por 116 mulheres hipertensas entre 40 e 65 anos. Dados clínicos, como pressão arterial (PA) sistólica e diastólica, história de tabagismo, atividade física, uso de medicamentos foram coletados; foi feita a análise do perfil lipídico, glicemia e proteína C reativa (PCR); a avaliação dietética obtida pelo Recordatório de 24 horas e pelo Registro de três dias. A espessura médio-intimal (EMI) de carótidas foi realizada pelo aparelho de ultrassonografia. As pacientes foram divididas em dois grupos, de acordo com os valores da espessura médio-intimal de carótidas: EMI 0,9mm ou EMI > 0,9mm. Houve diferença significativa entre os grupos em relação à idade (50,846,62 vs 53,547,13; p=0,044), PA sistólica (134,5216,54 vs 142,9821,47; p=0,020), pressão de pulso (PP) (49,3611,03 vs 60,15 17,77; p<0,001), HDL (48,988,54 vs 44,057,45; p=0,004) e PCR (2,311,21 vs 3,051,34; p=0,016). Não houve diferença significativa em relação aos parâmetros antropométricos, exceto em relação à reactância (65,199,69 vs 61,447,88; p=0,036), avaliada pela bioimpedância elétrica (BIA). Quanto ao padrão de consumo alimentar, somente o consumo de gordura monoinsaturada foi diferente entre os grupos, sendo o maior consumo no grupo com menor valor de EMI (7,882,09 vs 7,022,06; p=0,031). Não houve diferença em relação à frequência de tabagismo e atividade física. Quando foi feita a análise de correlação da amostra, foi encontrada uma correlação entre a EMI de carótidas e idade (r=0,25; p=0,0067), PAS (r=0,19; p=0,0086); PP (r=0,30; p=0,0009), LDL (r=0,19; p=0,0434), assim como com gordura monoinsaturada (r= -0,25; p=0,0087), PCR (r=0,31; p=0,007) e HDL (r=-0,33; p=0,0004), porém apenas as variáveis HDL, PCRus e pressão de pulso mostraram ser preditoras independentes da EMI de carótida após feita uma análise de regressão linear multivariada. A proteína C reativa, HDL colesterol e pressão de pulso são importantes preditores independentes de aterosclerose subclínica. / Atherosclerosis and its complications are the main cause of morbidity and mortality in the Western world. Increased carotid intima-media thickness is associated with cardiovascular risk,and it represents a marker of subclinical atherosclerosis, which can be detected early in asymptomatic individuals. The aim of this study was to identify clinical and nutritional variables associated with subclinical atherosclerosis in hypertensive women. Cross-sectional study involving a convenience sample composed by 116 hypertensive women aged between 40 and 65. Clinical data such systolic and diastolic blood pressure (BP), smoking history, physical activity, medication use were collected, a lipid profile, blood glucose and C-reactive protein (CRP)analysis was performed, the dietary assessment was obtained by dietary recall 24 hours and three days food record. Carotid intima-media thickness was performed by the high resolution ultrasound. Patients were divided into two groups according to the values of carotid IMT: IMT 0.9 mm or IMT > 0.9 mm. There was significant difference between the groups regarding age (50.846.62 vs 53.547.13; p=0.044), systolic BP(134.5216.54 vs 142.9821.47; p=0.020), pulse pressure (PP) (49.3611.03 vs 60.15 17.77; p<0.001), HDL-cholesterol (49.3611.03 vs 60.1517.77; p<0.001)and CRP(2.311.21 vs 3.051.34; p=0.016). There was no significant difference regarding to anthropometric parameters, except for the reactance (65.199.69 vs 61.447.88; p=0.036), measured by bioelectrical impedance analysis (BIA). Regarding the dietary pattern, only the monounsaturated fat intake was different between the groups 65.199.69 vs 61.447.88; p=0.036),. There was no difference in smoking and physical activity. In the correlation analysis, we have found a correlation between carotid IMT and age (r = 0.25, p = 0.0067), SBP (r= 0.19, p = 0.0086); PP (r = 0.30, p = 0.0009), LDL (r = 0.19, p = 0.0434), and monounsaturated fat (r = -0.25, p = 0.0087), CRP (r = 0.31, p = 0.007) and HDL (r =- 0.33, p = 0.0004), but only HDL-cholesterol, hsCRP and pulse pressure were shown to be independent predictors of carotid IMT after made a multivariate analysis. Conclude that C reactive protein, HDL-cholesterol and pulse pressure are important predictors for subclinical atherosclerosis.