Maria Fernanda Cassou

Intima-media thickness in the origin of right subclavian artery as an early marker of cardiovascular risk

OBJECTIVE: Common carotid artery intima-media thickness (IMT) is considered a factor of cardiovascular risk and an early marker of coronary artery disease. This study aimed to investigate the existence of a correlation between IMT in the carotid arteries and at the origin of the right subclavian artery, as well as to evaluate IMT in the subclavian artery as an earlier marker of cardiovascular risk. METHODS: One hundred and six consecutive patients, 52 males and 54 females, average age 51 years, underwent color Doppler ultrasonography to evaluate carotid and right subclavian arteries. The relationship between carotid IMT and right subclavian IMT was assessed using the Pearsons correlation coefficient analysis and a 95% confidence interval. Reliability of right subclavian artery IMT measurement for the diagnosis of early thickening (considering a > 0.8 mm carotid thickness as reference) was described as to sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Cut-off values for the right subclavian IMT were indicated by the ROC curve, and p values 0.8 mm. The mean IMT value for the carotid artery was 0.87 mm (SD = 0.23) and for the subclavian artery, 1.17 mm (SD = 0.46), with a 0.31 correlation coefficient (95% CI: 0.12; 0.47). The ROC curve analysis indicated a cut-off value of 0.7 mm for the right subclavian artery IMT, using as reference a 0.8 mm cut-off value for the carotid artery (91% sensitivity, 27% specificity, 66% PPV, 65% NPV, and 66% accuracy). CONCLUSION: Our study showed that carotid artery IMT correlates well with right subclavian artery IMT. With a 0.7 mm cut-off value, it is possible to detect IMT in the right subclavian artery earlier than in the carotid arteries. The IMT at the origin of the right subclavian artery can be considered an earlier marker for the assessment of cardiovascular risk.OBJECTIVE Common carotid artery intima-media thickness (IMT) is considered a factor of cardiovascular risk and an early marker of coronary artery disease. This study aimed to investigate the existence of a correlation between IMT in the carotid arteries and at the origin of the right subclavian artery, as well as to evaluate IMT in the subclavian artery as an earlier marker of cardiovascular risk. METHODS One hundred and six consecutive patients, 52 males and 54 females, average age 51 years, underwent color Doppler ultrasonography to evaluate carotid and right subclavian arteries. The relationship between carotid IMT and right subclavian IMT was assessed using the Pearsons correlation coefficient analysis and a 95% confidence interval. Reliability of right subclavian artery IMT measurement for the diagnosis of early thickening (considering a > 0.8 mm carotid thickness as reference) was described as to sensitivity, specificity, positive predictive value, negative predictive value, and accuracy. Cut-off values for the right subclavian IMT were indicated by the ROC curve, and p values < or = 0.05 were considered statistically significant. RESULTS Out of the 41 patients whose carotid arteries were IMT-free, 30 (73%) had right subclavian artery IMT values > 0.8 mm. The mean IMT value for the carotid artery was 0.87 mm (SD = 0.23) and for the subclavian artery, 1.17 mm (SD = 0.46), with a 0.31 correlation coefficient (95% CI: 0.12; 0.47). The ROC curve analysis indicated a cut-off value of 0.7 mm for the right subclavian artery IMT, using as reference a 0.8 mm cut-off value for the carotid artery (91% sensitivity, 27% specificity, 66% PPV, 65% NPV, and 66% accuracy). CONCLUSION Our study showed that carotid artery IMT correlates well with right subclavian artery IMT. With a 0.7 mm cut-off value, it is possible to detect IMT in the right subclavian artery earlier than in the carotid arteries. The IMT at the origin of the right subclavian artery can be considered an earlier marker for the assessment of cardiovascular risk.

Probabilidade de refluxo nas veias safenas de mulheres com diferentes graus de insuficiência venosa crônica

CONTEXTO: A presenca de refluxo nas juncoes safeno-femoral e safeno-poplitea e um dado importante para programacao da cirurgia de varizes. Estudos mostraram que, na maioria dos pacientes com insuficiencia venosa cronica, as juncoes estao competentes, e o refluxo esta presente ao longo do trajeto das veias safenas. OBJETIVOS: Identificar probabilidade de diferentes padroes de refluxo nas veias safenas de mulheres com varios graus de insuficiencia venosa cronica e avaliar se o comprometimento das juncoes das safenas esta associado com gravidade da insuficiencia venosa. METODOS: Um total de 1.184 membros inferiores de 672 mulheres foram estudados pela ultra-sonografia vascular com Doppler colorido e avaliados pela classificacao clinica, etiologica, anatomica e patologica (CEAP). As extremidades foram agrupadas de acordo com a gravidade da insuficiencia venosa em graus leve (CEAP C1-C2), moderado (CEAP C3) e grave (CEAP C4-C6). Para avaliar a classificacao clinica CEAP na predicao do padrao de refluxo, utilizou-se o Teorema de Bayers. Para avaliar associacao entre classificacao clinica CEAP e padroes de refluxo com ou sem comprometimento das juncoes das safenas, utilizou-se o teste qui-quadrado (p < 0,05). RESULTADOS: Das 1.184 extremidades avaliadas, 50,2% apresentavam varizes sem edema (CEAP C2). O padrao de refluxo segmentar foi o mais frequente nas veias safenas magna (35,14%) e parva (8%), independente da gravidade da insuficiencia venosa. As juncoes safeno-femoral e safeno-poplitea foram fontes de refluxo em 12 e 6% das extremidades, respectivamente. Considerando a associacao entre classificacao clinica CEAP e insuficiencia das juncoes das safenas, foi observada diferenca significativa entre presenca de refluxo nas juncoes safeno-femoral (p = 0,0009) e safeno-poplitea (p = 0,0006) na doenca avancada. CONCLUSOES: O refluxo inicia-se predominantemente em segmentos no trajeto das veias safenas. As juncoes das safenas nao sao as principais fontes causadoras do refluxo no sistema venoso superficial. A medida que piora a apresentacao clinica da insuficiencia venosa, aumenta a probabilidade de refluxo nas juncoes das safenas.

Estenose na artéria renal: a necessidade de validação dos critérios diagnósticos no laboratório vascular

OBJECTIVE: To validate the diagnostic criteria of color Doppler ultrasound in the identification of hemodynamically significant stenoses in renal arteries. METHODS: The color Doppler ultrasound was used to prospectively study 137 renal arteries of 69 adult patients suspected of having renovascular arterial hypertension. The results of the color Doppler ultrasound assessment were double-blindly compared to the arteriography. Cut-off values (ROC curve) were defined for systolic velocity, diastolic velocity and renal-aortic ratio, which better identify hemodynamically significant stenoses, at a Doppler angle of 60o. RESULTS: Peak systolic velocity higher than 250 cm/s was the parameter for greater accuracy (87.2%) in the identification of hemodynamically significant stenoses, followed by the renal-aortic ratio greater than 3.2 (85.6%) and peak diastolic velocity higher than 48 cm/s (70.4%). CONCLUSIONS: Parameters recommended in the literature must be validated in every vascular laboratory. For the ultrasound device and population included in this study, the diagnostic criteria for hemodynamically significant stenoses of renal arteries must be readjusted to systolic velocity > 250 cm/s and renal-aortic ratio > 3.2, at a Doppler angle of 60o.