Advertisement

International Urology and Nephrology

, Volume 48, Issue 10, pp 1713–1720 | Cite as

B-flow imaging estimation of carotid and femoral atherosclerotic plaques: vessel walls rheological damage or strong predictor of cardiovascular mortality in chronic dialysis patients

  • Petar AvramovskiEmail author
  • Maja Avramovska
  • Aleksandar Sikole
Nephrology - Original Paper

Abstract

Background

The aim of this study was to investigate the cardiovascular mortality in chronic hemodialysis patients (CHPs) and to discover the importance of carotid and femoral artery plaques as cardiovascular (CV) mortality predictor.

Methods

In this study with 4 years of follow-up period, we studied a cohort of 101 CHPs. Mean age at entry was 58.1 ± 11.9 years, and mean duration of dialysis was 5.8 ± 5.3 years. We performed B-flow imaging of both carotid and femoral arteries to estimate and score the plaque thickness.

Results

The mean carotid and femoral plaque scores (PSs) at entry were 5.02 ± 4.20 and 4.04 ± 3.30 (p = 0.0002). The carotid cutoff point and femoral cutoff point (by ROC curves) were 5.4 and 5.9. The regression coefficients (b) and Exp (b) hazard ratio coefficients of carotid and femoral PS in Cox regression survival analysis in CV outcomes were: b = 0.142, Exp (b) = 1.153, p = 0.0035 versus b = 0.457, Exp (b) = 1.578, p < 0.0001. Relative hazard ratio (HR) risk of exposed group according to CV events was HR 2.812 (CI 1.301–6.081) for carotid PS and HR 2926 (CI 1.424–6.013) for femoral PS.

Conclusion

Carotid and femoral plaques are strong independent predictors of CV mortality in CHPs. The HR risk of femoral artery plaques is more predictable than HR risk of carotid artery plaques.

Keywords

Carotid plaque Femoral plaque Chronic hemodialysis patients Cardiovascular mortality B-flow imaging 

Notes

Acknowledgments

There is no grant support or any acknowledgement. There is no disclose significant financial interests that he or she maintains (or members of their family maintain) with organizations or companies that might be affected by their research.

Compliance with ethical standards

Conflict of interest

Every one of the authors of this manuscript declares that they have not any conflict of interest. No potential conflict of interest relevant to this article was reported.

Ethical approval

All procedures in our studies and all human participants were in accordance with the ethical standards and our regional ethics committee approved the study. All participants give us informed and signed consent before including in the study.

References

  1. 1.
    Foley RN, Parfrey PS, Sarnak MJ (1998) Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 32:112–119CrossRefGoogle Scholar
  2. 2.
    Tyrala K, Amann K (2003) Morphology of the heart and arteries in renal failure. Kidney Int Suppl 84:80–83CrossRefGoogle Scholar
  3. 3.
    Lopez Gomez JM, Jofre R, Cases A (2002) Cardiovascular risk factors in chronic renal disease. Nefrologia 22(Suppl 1):59–67PubMedGoogle Scholar
  4. 4.
    Avramovski P, Janakievska P, Sotiroski K, Sikole A (2013) Accelerated progression of arterial stiffness in dialysis patients compared with the general population. Korean J Intern Med 28(4):464–474CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Van Popele NM, Grobbee DE, Bots ML, Asmar R, Topouchian J, Reneman RS et al (2001) Association between arterial stiffness and atherosclerosis: the Rotterdam Study. Stroke 32(2):454–460CrossRefPubMedGoogle Scholar
  6. 6.
    Dalager S, Falk E, Kristensen IB, Paaske WP (2008) Plaque in superficial femoral arteries indicates generalized atherosclerosis and vulnerability to coronary death: an autopsy study. J Vasc Surg 47(2):296–302CrossRefPubMedGoogle Scholar
  7. 7.
    Spence JD, Eliasziw M, DiCicco M, Hackam DG, Galil R, Lohmann T (2002) Carotid plaque area: a tool for targeting and evaluating vascular preventive therapy. Stroke 33(12):2916–2922CrossRefPubMedGoogle Scholar
  8. 8.
    Kuo F, Gardener H, Dong C, Cabral D, Della-Morte D, Blanton SH et al (2012) Traditional cardiovascular risk factors explain the minority of the variability in carotid plaque. Stroke 43(7):1755–1760CrossRefPubMedPubMedCentralGoogle Scholar
  9. 9.
    Spence JD, Barnett PA, Bulman DE, Hegele RA (1999) An approach to ascertain probands with a non-traditional risk factor for carotid atherosclerosis. Atherosclerosis 144(2):429–443CrossRefPubMedGoogle Scholar
  10. 10.
    Leng GC, Papacosta O, Whincup P, Wannamethee G, Walker M, Ebrahim S et al (2000) Femoral atherosclerosis in an older British population: prevalence and risk factors. Atherosclerosis 152(1):167–174CrossRefPubMedGoogle Scholar
  11. 11.
    Khoury Z, Schwartz R, Gittieb S, Chenzbraun A, Stern S, Keren A (1997) Relation of coronary artery disease to atherosclerotic disease in the aorta, carotid, and femoral arteries evaluated by ultrasound. Am J Cardiol 80(11):1429–1433CrossRefPubMedGoogle Scholar
  12. 12.
    Weskott HP (2000) B-flow: a new method for detecting blood flow. Ultraschall Med 21:59–65CrossRefPubMedGoogle Scholar
  13. 13.
    Tola M, Yurdakul M, Cumhur T (2004) Combined use of color duplex ultrasonography and B-flow imaging for evaluation of patients with carotid artery stenosis. AJNR Am J Neuroradiol 25(10):1856–1860PubMedGoogle Scholar
  14. 14.
    Henri P, Tranquart F (2000) B-flow ultrasonographic imaging of circulating blood. J Radiol 81(4):465–467PubMedGoogle Scholar
  15. 15.
    Hétu M, Armstrong DW, Matangi MF, Stroz MJ, Simpson CS, Ewart P (2014) Carotid plaque height helps address the challenge of diagnosing heart disease in women. Can J Cardiol 30(10):S276–S277CrossRefGoogle Scholar
  16. 16.
    Salonen JT, Salonen R (1991) Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb 11:1245–1249CrossRefPubMedGoogle Scholar
  17. 17.
    Held C, Hjemdahl P, Eriksson SV, Bjorkander I, Forslund L, Rehnqvist N (2001) Prognostic implications of intima-media thickness and plaques in the carotid and femoral arteries in patients with stable angina pectoris. Eur Heart J 22:62–72CrossRefPubMedGoogle Scholar
  18. 18.
    Hollander M, Hak AE, Koudstaal PJ, Bots ML, Grobee DE, Hofman A et al (2003) Comparison between measures of atherosclerosis and risk of stroke. The Rotterdam study. Stroke 34:2367–2373CrossRefPubMedGoogle Scholar
  19. 19.
    Iino R, Yokoyama N, Konno K, Naito K, Isshiki T (2012) Impact of combined assessment of coronary artery calcium score, carotid artery plaque score, and brachial-ankle pulse wave velocity for early coronary revascularization in patients with suspected coronary artery disease. Int Heart J 53(3):154–159CrossRefPubMedGoogle Scholar
  20. 20.
    Antonio B, Emiliana F, Carlo R (2011) Arterial stiffness in chronic kidney disease: the usefulness of a marker of vascular damage. Int J Nephrol 5:73–78Google Scholar
  21. 21.
    Avramovski P, Janakievska P, Sotirovski K, Zafirovska-Ivanovska B, Sikole A (2014) Aortic pulse wave velocity is a strong predictor of all—cause and cardiovascular mortality in chronic dialysis patients. Ren Fail 36(2):176–186CrossRefPubMedGoogle Scholar
  22. 22.
    Ikeda N, Kogame N, Iijima R, Nakamura M, Sugi K (2012) Carotid artery intima-media thickness and plaque score can predict the SYNTAX score. Eur Heart J 33(1):113–119CrossRefPubMedGoogle Scholar
  23. 23.
    Kanaan N, Goffin E, Maisin D, Struyven J, Jadoul M (2008) CRP measurement: does the assay matter in hemodialy-sis patients? Clin Nephrol 70:503–507CrossRefPubMedGoogle Scholar
  24. 24.
    Owen WF, Lowrie EG (1998) C-reactive protein as an outcome predictor for maintenance hemodialysis patients. Kidney Int 54:627–636CrossRefPubMedGoogle Scholar
  25. 25.
    Dalager S, Falk E, Kristensen IB, Paaske WP (2008) Plaque in superficial femoral arteries indicates generalized atherosclerosis and vulnerability to coronary death: an autopsy study. J Vasc Surg 47(2):296–302CrossRefPubMedGoogle Scholar
  26. 26.
    Belcaro G, Nicolaides AN, Ramaswami G, Cesarone MR, De SM, Incandela L et al (2001) Carotid and femoral ultrasound morphology screening and cardiovascular events in low risk subjects: a 10-year follow-up study (the CAFES-CAVE study [1]). Atherosclerosis 156(2):379–387CrossRefPubMedGoogle Scholar
  27. 27.
    Schmidt C, Fagerberg B, Hulthe J (2005) Non-stenotic echolucent ultrasound-assessed femoral artery plaques are predictive for future cardiovascular events in middle-aged men. Atherosclerosis 181(1):125–130CrossRefPubMedGoogle Scholar
  28. 28.
    Garland JS, Simpson CS, Matangi MF, Parfrey B, Hétu M, Johri AM (2014) Plaque quantification by carotid ultrasound may aid in the selection of chronic kidney disease patients requiring coronary angiography. Can J Cardiol 30:276–277CrossRefGoogle Scholar
  29. 29.
    Amarenco P, Lavallѐe PC, Labreuche J, Ducrocq G, Juliard JM, Feldman L et al (2011) Prevalence of coronary atherosclerosis in patients with cerebral infarction. Stroke 42:22–29CrossRefPubMedGoogle Scholar
  30. 30.
    Siljanovski S, Avramovski P (2009) Carotid artery wall changes as prognostic indicator of coronary artery disease. Maced J Med Sci 2(2):137–140CrossRefGoogle Scholar
  31. 31.
    Ogata T, Yasaka M, Yamagishi M, Seguchi O, Nagatsuka K, Minematsu K (2005) Atherosclerosis found on carotid ultrasonography is associated with atherosclerosis on coronary intravascular ultrasonography. J Ultrasound Med 24:469–474PubMedGoogle Scholar
  32. 32.
    Blacher J, Pannier B, Guerin AP, Marchais SJ, Safar ME, London GM (1998) Carotid arterial stiffness as a predictor of cardiovascular and all-cause mortality in end-stage renal disease. Hypertension 32(3):570–574CrossRefPubMedGoogle Scholar
  33. 33.
    Guerin AP, Blacher J, Pannier B, Marchais SJ, Safar ME, London GM (2001) Impact of aortic stiffness attenuation on survival of patients in end-stage renal failure. Circulation 103(7):987–992CrossRefPubMedGoogle Scholar
  34. 34.
    Blacher J, Guerin AP, Pannier B, Marchais SJ, London GM (2001) Arterial calcification, arterial stiffness, and cardiovascular risk in end-stage renal disease. Hypertension 38(4):938–942CrossRefPubMedGoogle Scholar
  35. 35.
    Pascasio L, Blanco F, Giorgini A, Galli G, Corri G, Panzetta G (1996) Echo color doppler imaging of carotid vessels in hemodialysis patients : evidence of high levels of atherosclerotic lesions. Am J Kidney Dis 28(5):713–720CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media Dordrecht 2016

Authors and Affiliations

  1. 1.Department of Internal MedicineJZU Clinical Hospital “D-r Trifun Panovski”BitolaRepublic of Macedonia
  2. 2.University Clinic of Obstetrics and GynecologyMedical Faculty “Ss. Cyril and Methodius University”SkopjeRepublic of Macedonia
  3. 3.University Clinic of NephrologyMedical Faculty “Ss. Cyril and Methodius University”SkopjeRepublic of Macedonia
  4. 4.High Medical SchoolSt. Clement of Ohrid UniversityBitolaRepublic of Macedonia
  5. 5.Faculty of Veterinary MedicineSt. Clement of Ohrid UniversityBitolaRepublic of Macedonia

Personalised recommendations