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Background: Rheumatoid arthritis (RA) is a chronic inflammatory disorder involving the joints along with various other extra-articular manifestations. Mortality due to coronary artery disease is higher in patients with RA when compared to the general population. Hence, this study is undertaken to assess the predictors of sub-clinical atherosclerosis in patients with RA, so that early prompt management can prevent cardiovascular complications. Methods: A case–control study with 42 patients of RA and 42 healthy age- and sex-matched controls was undertaken. Relevant investigations were done. Disease Activity Score (DAS)-28 was calculated. Carotid artery doppler was performed on both sides to examine the common carotid artery. Results: The mean carotid intima–media thickness (CIMT) (mm) was significantly higher in RA patients compared to controls on the right side (0.57 ± 0.11 Vs 0.40 ± 0.03; P < 0.001) as well as left side (0.56 ± 0.11 Vs 0.39 ± 0.06; P < 0.001). Only age (P = 0.006) and DAS-28 (P = 0.002) showed a positive correlation with CIMT. Conclusions: CIMT can be used as a marker for the detection of subclinical atherosclerosis and the risk of atherosclerosis increases with the increasing age and increasing disease severity.

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disorder involving the joints along with various other extra-articular manifestations. Mortality due to coronary artery disease is higher in patients with RA when compared to the general population. Hence, this study is undertaken to assess the predictors of sub-clinical atherosclerosis in patients with RA, so that early prompt management can prevent cardiovascular complications. Methods: A case-control study with 42 patients of RA and 42 healthy age- and sex-matched controls was undertaken. Relevant investigations were done. Disease Activity Score (DAS)-28 was calculated. Carotid artery doppler was performed on both sides to examine the common carotid artery. Results: The mean carotid intima-media thickness (CIMT) (mm) was significantly higher in RA patients compared to controls on the right side (0.57 ± 0.11 Vs 0.40 ± 0.03; P < 0.001) as well as left side (0.56 ± 0.11 Vs 0.39 ± 0.06; P < 0.001). Only age (P = 0.006) and DAS-28 (P = 0.002) showed a positive correlation with CIMT. Conclusions: CIMT can be used as a marker for the detection of subclinical atherosclerosis and the risk of atherosclerosis increases with the increasing age and increasing disease severity. [ABSTRACT FROM AUTHOR]

Abstract Background An increase in cardiac index (CI) during an end-expiratory occlusion test (EEOt) predicts fluid responsiveness in ventilated patients. However, if CI monitoring is unavailable or the echocardiographic window is difficult, using the carotid Doppler (CD) could be a feasible alternative to track CI changes. This study investigates whether changes in CD peak velocity (CDPV) and corrected flow time (cFT) during an EEOt were correlated with CI changes and if CDPV and cFT changes predicted fluid responsiveness in patients with septic shock. Methods Prospective, single-center study in adults with hemodynamic instability. The CDPV and cFT on carotid artery Doppler and hemodynamic variables from the pulse contour analysis EV1000™ were recorded at baseline, during a 20-s EEOt, and after fluid challenge (500 mL). We defined responders as those who increased CI ≥ 15% after a fluid challenge. Results We performed 44 measurements in 18 mechanically ventilated patients with septic shock and without arrhythmias. The fluid responsiveness rate was 43.2%. The changes in CDPV were significantly correlated with changes in CI during EEOt (r = 0.51 [0.26–0.71]). A significant, albeit lower correlation, was found for cFT (r = 0.35 [0.1–0.58]). An increase in CI ≥ 5.35% during EEOt predicted fluid responsiveness with 78.9% sensitivity and 91.7% specificity, with an area under the ROC curve (AUROC) of 0.85. An increase in CDPV ≥ 10.5% during an EEOt predicted fluid responsiveness with 96.2% specificity and 53.0% sensitivity with an AUROC of 0.74. Sixty-one percent of CDPV measurements (from − 13.5 to 9.5 cm/s) fell within the gray zone. The cFT changes during EEOt did not accurately predict fluid responsiveness. Conclusions In septic shock patients without arrhythmias, an increase in CDPV greater than 10.5% during a 20-s EEOt predicted fluid responsiveness with > 95% specificity. Carotid Doppler combined with EEOt may help optimize preload when invasive hemodynamic monitoring is unavailable. However, the 61% gray zone is a major limitation (retrospectively registered on Clinicaltrials.gov NCT04470856 on July 14, 2020).

Objective: To assess the carotid artery disease spectrum in patients with coronary artery stenosis who underwent Carotid Doppler studies. Study Design: Analytical Cross-sectional study. Place and Duration of Study: Radiology department, AFIC/NIHD, Rawalpindi Pakistan from Jan 2018 to Jul 2019. Methodology: Doppler ultrasound study of both carotid arteries was done in consecutive patients. All participants regardless of age and gender underwent carotid doppler assessment for the site of carotid plaque and percentage of stenosis. Data was grouped into two categories based upon Carotid Doppler outcomes such as; insignificant findings and significant findings. Insignificant findings comprised of no plaque or insignificant plaque with intima-media thickness (≤1.1mm), peak systolic velocity (1.1mm, peak systolic velocity (>125cm/s), end-diastolic velocity (>40cm/s) and >50% carotid stenosis were represented as significant Doppler outcomes. Pearson Chi-square test was applied by using SPSS-26:00. Results: Total n=654 patients were included. Normal carotid doppler outcome was seen in 290(43.4%) patients, while 350(53.5%) had insignificant findings and 20(3.1%) had significant findings. The commonest lesion found was the atherosclerotic plaque and most frequently present in the left carotid system 392(60.0%) while most common site of plaque presence was at carotid bifurcation 218(33.3%). Significant association of plaque site and plaque type with carotid doppler outcomes was found (p

Background: An increase in cardiac index (CI) during an end-expiratory occlusion test (EEOt) predicts fluid responsiveness in ventilated patients. However, if CI monitoring is unavailable or the echocardiographic window is difficult, using the carotid Doppler (CD) could be a feasible alternative to track CI changes. This study investigates whether changes in CD peak velocity (CDPV) and corrected flow time (cFT) during an EEOt were correlated with CI changes and if CDPV and cFT changes predicted fluid responsiveness in patients with septic shock. Methods: Prospective, single-center study in adults with hemodynamic instability. The CDPV and cFT on carotid artery Doppler and hemodynamic variables from the pulse contour analysis EV1000™ were recorded at baseline, during a 20-s EEOt, and after fluid challenge (500 mL). We defined responders as those who increased CI ≥ 15% after a fluid challenge. Results: We performed 44 measurements in 18 mechanically ventilated patients with septic shock and without arrhythmias. The fluid responsiveness rate was 43.2%. The changes in CDPV were significantly correlated with changes in CI during EEOt (r = 0.51 [0.26–0.71]). A significant, albeit lower correlation, was found for cFT (r = 0.35 [0.1–0.58]). An increase in CI ≥ 5.35% during EEOt predicted fluid responsiveness with 78.9% sensitivity and 91.7% specificity, with an area under the ROC curve (AUROC) of 0.85. An increase in CDPV ≥ 10.5% during an EEOt predicted fluid responsiveness with 96.2% specificity and 53.0% sensitivity with an AUROC of 0.74. Sixty-one percent of CDPV measurements (from − 13.5 to 9.5 cm/s) fell within the gray zone. The cFT changes during EEOt did not accurately predict fluid responsiveness. Conclusions: In septic shock patients without arrhythmias, an increase in CDPV greater than 10.5% during a 20-s EEOt predicted fluid responsiveness with > 95% specificity. Carotid Doppler combined with EEOt may help optimize preload when invasive hemodynamic monitoring is unavailable. However, the 61% gray zone is a major limitation (retrospectively registered on Clinicaltrials.gov NCT04470856 on July 14, 2020). [ABSTRACT FROM AUTHOR]

Introduction There is no noninvasive method that can reliably and accurately identify fluid responsiveness. As such, in patients with undifferentiated shock, treatment often involves empiric fluid administration, in the hope that volume expansion will increase preload, which will then serve to increase cardiac output. However, for patients on the flat portion of the Starling curve, aggressive fluid administration results in no appreciable increase in cardiac output and may be detrimental to hemodynamically unstable patients. Objective The aim of this study was to compare the sensitivity and specificity of cardiac output measurement using bedside ultrasound on carotid artery and Transthoracic Echocardiogram(TTE) while assessing volume responsiveness in cardiogenic shock patients. Patients and methods In this prospective observational study, 40 cardiogenic shock patients were enrolled. Carotid artery Doppler ultrasound was performed where carotid blood flow (CBF) was calculated and TTE where cardiac output was calculated before and after passive leg-raising test to assess volume responsiveness. Results CBF measurements in comparison with cardiac output for assessment of fluid responsiveness had a sensitivity of 83.33% and specificity of 100%. Conclusion Carotid Doppler ultrasound and calculation of CBF is a reliable predictor to fluid responsiveness in patients with cardiogenic shock where transthoracic echocardiography is the gold standard in dynamic monitoring of the change in stroke volume after a maneuver that increases venous return (preload). [ABSTRACT FROM AUTHOR]

Background and Objectives: Carotid artery Doppler ultrasound is being explored for its potential as a non-invasive tool for evaluating coronary artery disease (CAD) severity and cardiovascular risk. This study aimed to investigate the association between carotid Doppler parameters and CAD severity, as determined by the Gensini score (GS) and multi-vessel disease presence., Methods: Ninety patients undergoing coronary angiography (CAG) and carotid ultrasound were retrospectively analysed. Carotid Doppler parameters and CAD severity were assessed through bivariate and multivariable analyses., Results: Among the patients studied, 80% were male, with a mean age of 65.24 years (±9.91). Triple vessel disease (68.9%) and dominant vessel disease (73.3%) were prevalent coronary findings, with a mean GS of 139.2 (±76.6). Increased intima-media thickness (IMT) in the common carotid artery (CCA) and internal carotid artery (ICA) showed significant associations (CCA IMT: OR = 0.312, p = 0.037; ICA IMT: OR = 0.354, p = 0.017) with high GS (>125) and multi-vessel disease. Significant carotid stenosis (>50% diameter stenosis) emerged as an independent predictor of CAD severity. Fibrocalcific plaques, detected in 62.2% of cases, correlated significantly with elevated GS. Plaque burden, especially plaques in >3 locations, indicated a higher likelihood of triple vessel disease and a higher GS., Conclusion: Carotid Doppler parameters, particularly IMT and significant stenosis, are robust predictors of CAD severity, including high GS and multi-vessel disease. Integrating carotid artery assessment into clinical protocols can aid in timely interventions and preventive strategies for CAD management., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Ramaiah Ethics Committee issued approval 105/04-2023. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Agarwal et al.)

Objective: To determine and compare the presence and extent of coronary artery disease and its association with ICA Doppler flow parameters in patients undergoing carotid artery stenting and patients who were treated conservatively. Methods: 1st June to 31st December 2016. This cross-sectional study consisted of patients referred from our internal and neurological department, from local general practitioners, and other hospitals for carotid angiogarphy. These patients underwent baseline carotid USG before carotid angiography and coronary angiography in the same session were evaluated retrospectively. Patients with sonographically significant lesion (diameter stenosis of =50%), underwent elective carotid angiography and coronary angiography in a single session were enrolled in the study at Sakarya University Training and Research Hospital from For all analyses, a two-tailed p 0.05 was considered statistically significant. Results: Total of 112 patients were included. Thirty of the stented patients and 21 of the conservatively treated patients had coronary artery disease. Gensini scoring was 22±8 in the stented group and 20±6 in the conservative group, p=0.764). The preprocedural PSV, EDV, ICA/CCA ratio were 196±25, 104±33, 3.9±1.3 in the stented group and 136±65, 42±6, 1.9±0.8 in the conservative group, respectively. When two groups were compared, these parameters were significantly lower in patients treated conservatively (p < 0.001). In addition, the percentage of patients with CAD were similar in both treatment groups (46 % and 44 %, p>0.05). Atherosclerotic risk factors such as age, gender, BMI, hypertension, DM and familial history of CAD, current smoking, LDL and triglyceride levels were not significantly different between the stented and the conservative group. Significant correlation was found between two Doppler parameters (ICA PSV and ICA/CCA PSV ratio) and extension of CAD Gensini scoring). Conclusion: Patients with carotid artery disease have a high incidence of concomitant coronary artery disease, which is not different between the patients treated conservatively and stenting. In addition, the extension of coronary artery disease (not the presence) were associated with these two Doppler parameters. [ABSTRACT FROM AUTHOR]

Objective: To assess the carotid artery disease spectrum in patients with coronary artery stenosis who underwent Carotid Doppler studies. Study Design: Analytical Cross-sectional study. Place and Duration of Study: Radiology department, AFIC/NIHD, Rawalpindi Pakistan from Jan 2018 to Jul 2019. Methodology: Doppler ultrasound study of both carotid arteries was done in consecutive patients. All participants regardless of age and gender underwent carotid doppler assessment for the site of carotid plaque and percentage of stenosis. Data was grouped into two categories based upon Carotid Doppler outcomes such as; insignificant findings and significant findings. Insignificant findings comprised of no plaque or insignificant plaque with intima-media thickness (≤1.1mm), peak systolic velocity (<125cm/s), end-diastolic velocity (<40cm/s) and <50% narrowing of carotid arteries. Findings in which intima-media thickness was >1.1mm, peak systolic velocity (>125cm/s), end-diastolic velocity (>40cm/s) and >50% carotid stenosis were represented as significant Doppler outcomes. Pearson Chi-square test was applied by using SPSS-26:00. Results: Total n=654 patients were included. Normal carotid doppler outcome was seen in 290(43.4%) patients, while 350(53.5%) had insignificant findings and 20(3.1%) had significant findings. The commonest lesion found was the atherosclerotic plaque and most frequently present in the left carotid system 392(60.0%) while most common site of plaque presence was at carotid bifurcation 218(33.3%). Significant association of plaque site and plaque type with carotid doppler outcomes was found (p<0.001). Conclusion: Carotid artery disease is common on routine ultrasonic assessment. Carotid bifurcation was the most common site of plaque while the left internal carotid artery was the commonest site of both critical and significant stenosis. [ABSTRACT FROM AUTHOR]