Background: To quantify the association between effects of interventions on carotid intimamedia thickness (cIMT) progression and their effects on cardiovascular disease (CVD) risk. Methods: We systematically collated data from randomized controlled trials. cIMT was assessed as the mean value at the common-carotid-artery; if unavailable, the maximum value at the common-carotid-artery or other cIMT measures were utilized. The primary outcome was a combined CVD endpoint defined as myocardial infarction, stroke, revascularization procedures, or fatal CVD. We estimated intervention effects on cIMT progression and incident CVD for each trial, before relating the two using a Bayesian meta-regression approach. Results: We analyzed data of 119 randomized controlled trials involving 100,667 patients (mean age 62 years, 42% female). Over an average follow-up of 3.7 years, 12,038 patients developed the combined CVD endpoint. Across all interventions, each 10 μm/year reduction of cIMT progression resulted in a relative risk for CVD of 0.91 (95% credible interval 0.87-0.94), with an additional relative risk for CVD of 0.92 (0.87-0.97) being achieved independent of cIMT progression. Taken together, we estimated that interventions reducing cIMT progression by 10, 20, 30, or 40 μm/year would yield relative risks of 0.84 (0.75-0.93), 0.76 (0.67-0.85), 0.69 (0.59-0.79), or 0.63 (0.52-0.74). Results were similar when grouping trials by type of intervention, time of conduct, time to ultrasound follow-up, availability of individual-participant data, primary vs. secondary prevention trials, type of cIMT measurement, and proportion of female patients. Conclusions: The extent of intervention effects on cIMT progression predicted the degree of CVD risk reduction. This provides a missing link supporting the usefulness of cIMT progression as a surrogate marker for CVD risk in clinical trials.

http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.10101008/-/DC1.

The use of contrast-enhanced ultrasound (CEUS) for vascular imaging indications has increased dramatically during the last decade. Ultrasound contrast agents are gas-filled microbubbles that are injected into the bloodstream and serve as strict intravascular reflectors of ultrasound waves. Numerous studies have addressed the potential clinical use of CEUS in different vascular fields including the carotid arteries, the abdominal aorta, renal arteries and the kidneys. In this review article we discuss the clinical value of contrast agents in vascular ultrasound by enhancing the vascular lumen, and more important, their role as a tool to deliver high resolution, real-time images of microvascular perfusion. Specifically, CEUS imaging of the carotid artery provides a novel, non-invasive method not only to improve the delineation of the vessel wall, but also for the assessment of the vasa vasorum and the ectopic vascularization of the atherosclerotic plaque (intraplaque neovascularization); probably providing a "window" to risk stratify atherosclerotic lesions and individuals by identifying "vulnerable" plaques prone to rupture causing vascular events. CEUS imaging has also emerged as a novel diagnostic tool in various aortic pathologies and particularly for the detection of endoleaks following endovascular treatment of abdominal aortic aneurysms. It is also a valuable tool for the assessment of the tissue perfusion in native and transplanted kidneys providing information on perfusion deficits of the parenchyma. Furthermore, a real-time CEUS method has recently been developed to assess the skeletal muscle microcirculation which could be used to study patients with peripheral arterial occlusive disease or diabetic microangiopathy. In the future, the use of targeted microbubbles could further enhance and expand the diagnostic capabilities of current vascular ultrasound imaging by detecting specific molecular processes that play a role in the pathophysiology of vascular disease.

When stress is experienced in the postprandial period, acute psychological stress significantly increases glucose concentrations in patients with Type 2 diabetes.

Volume supplementation with 24 h sodium chloride 0.9% is superior to sodium bicarbonate for the prevention of CIN. A short-term regimen with sodium bicarbonate is non-inferior to a 7 h regimen. ClinicalTrials.gov Identifier: NCT00130598.

IntroductionMonitoring treatment efficacy and assessing outcome by serial measurements of natriuretic peptides in acute decompensated heart failure (ADHF) patients may help to improve outcome.MethodsThis was a prospective multi-center study of 171 consecutive patients (mean age 80 73-85 years) presenting to the emergency department with ADHF. Measurement of BNP and NT-proBNP was performed at presentation, 24 hours, 48 hours and at discharge. The primary endpoint was one-year all-cause mortality; secondary endpoints were 30-days all-cause mortality and one-year heart failure (HF) readmission.ResultsDuring one-year follow-up, a total of 60 (35%) patients died. BNP and NT-proBNP levels were higher in non-survivors at all time points (all P < 0.001). In survivors, treatment reduced BNP and NT-proBNP levels by more than 50% (P < 0.001), while in non-survivors treatment did not lower BNP and NT-proBNP levels. The area under the ROC curve (AUC) for the prediction of one-year mortality increased during the course of hospitalization for BNP (AUC presentation: 0.67; AUC 24 h: 0.77; AUC 48 h: 0.78; AUC discharge: 0.78) and NT-proBNP (AUC presentation: 0.67; AUC 24 h: 0.73; AUC 48 h: 0.75; AUC discharge: 0.77). In multivariate analysis, BNP at 24 h (1.02 [1.01-1.04], P = 0.003), 48 h (1.04 [1.02-1.06], P < 0.001) and discharge (1.02 [1.01-1.03], P < 0.001) independently predicted one-year mortality, while only pre-discharge NT-proBNP was predictive (1.07 [1.01-1.13], P = 0.016). Comparable results could be obtained for the secondary endpoint 30-days mortality but not for one-year HF readmissions.ConclusionsBNP and NT-proBNP reliably predict one-year mortality in patients with ADHF. Prognostic accuracy of both biomarker increases during the course of hospitalization. In survivors BNP levels decline more rapidly than NT-proBNP levels and thus seem to allow earlier assessment of treatment efficacy. Ability to predict one-year HF readmission was poor for BNP and NT-proBNP.Trial registrationClinicalTrials.gov identifier: NCT00514384.

AimsTo determine the relationship between central venous pressure (CVP) and renal function in patients with acute heart failure (AHF) presenting to the emergency department. Methods and resultsCentral venous pressure was determined non-invasively using compression sonography in 140 patients with AHF at presentation. Worsening renal function (WRF) was defined as an increase in serum creatinine ≥0.3 mg/dL during hospitalization. In the study cohort [age 77 + 12 years, B-type natriuretic peptide 1862 + 1564 pg/mL, left ventricular ejection fraction 40 + 15%, estimated glomerular filtration rate (eGFR) 58 + 28 mL/min, and CVP 13.2 + 6.9 cmH 2 O], 51 patients (36%) developed WRF. No significant association between CVP at presentation or discharge and concomitant eGFR (r ¼ 0.005, P ¼ 0.419 and r ¼ 0.013, P ¼ 0.313, respectively) was observed. However, in patients with systolic blood pressure (SBP) ,110 mmHg and concomitant high CVP (.15 cmH 2 O), eGFR was significantly lower at presentation and discharge (29 + 17 vs. 47 + 19 mL/min/1.73 m 2 , P ¼ 0.039 and 26 + 10 vs. 53 + 26 mL/min/1.73 m 2 , P ¼ 0.013, respectively). Central venous pressure at presentation and at discharge did not differ between patients with or without in-hospital WRF (12.6 + 7.2 vs. 13.5 + 6.7 cmH 2 O, P ¼ 0.503 and 7.4 + 6.5 vs. 7.7 + 5.7 cmH 2 O, P ¼ 0.799, respectively) (receiver-operating characteristic analysis 0.543, P ¼ 0.401 and 0.531, P ¼ 0.625, respectively). However, patients with CVP in the lowest tertile (,10 cmH 2 O) at presentation were more likely to develop WRF within the first 24 h than patients with CVP in the highest tertile (.15 cmH 2 O) (18 vs. 4%, P ¼ 0.046). ConclusionIn AHF, combined low SBP and high CVP predispose to lower eGFR. However, lower CVP may also be associated with short-term WRF. The pathophysiology of WRF and the role of CVP seem to be more complex than previously thought.--

Introduction The identification of patients at highest risk for adverse outcome who are presenting with acute dyspnea to the emergency department remains a challenge. This study investigates the prognostic value of the newly described midregional fragment of the pro-Adrenomedullin molecule (MRproADM) alone and combined to B-type natriuretic peptide (BNP) or N-terminal proBNP (NT-proBNP) in patients with acute dyspnea.