Comparison of intima-media thickness and ophthalmic artery resistance index for assessing subclinical atherosclerosis in HIV-1-infected patients

Abstract

BackgroundHuman immunodeficiency virus (HIV) infection and antiretroviral treatment are associated with metabolic and cardiovascular complications that potentially increase the risk of atherosclerosis and cardiovascular disease in this population. Measurement of arterial wall thickness has been used as a surrogate of extent, severity and progression of atherosclerosis. A cross-sectional cohort study was performed to compare the validity of two non-invasive arterial measures: carotid intima-media thickness (IMT), a parameter of atherosclerosis, and ophthalmic artery resistance index (OARI), an index of occlusive carotid artery disease.MethodsA total of 95 patients receiving highly active antiretroviral therapy (HAART) for more than 12 months were consecutively enrolled. IMT and OARI were measured by 7.5 MHz linear probe.ResultsThere was a significant linear increase in IMT and OARI values as the grade of cardiovascular risk (0.70 and 0.69 for very low risk, 0.86 and 0.72 for low risk and 0.98 and 0.74 for medium/high risk, p < 0.001). A IMT > 0.83 and an OARI > 0.72 were the most discriminatory values for predicting a cardiovascular risk ≥ 10% (sensibility 89.6% and 75.8%; sensitivity 70.5% and 68.4%; p < 0.001).ConclusionsOur data indicate that OARI may have a potential as a new precocious marker of subclinical atherosclerosis in HIV-1-infected patients.

Increased ophthalmic artery resistance index is associated with cognitive impairment in HIV-infected patients

“…Interestingly, the value of OARI (>0.72) that we related to neurocognitive impairment was the same as that used previously as the most discriminatory cut off associated to a high cardiovascular risk. 17 Our data about a significant relationship between OARI and psychomotor speed, attention and executive functions performance are supported by the findings of another study in HIV-uninfected individuals in which it was suggested that vascular damage in the subcortical area might disrupt higher order cognitive functions and that chronic hypoperfusion might influence the brain's ability to process information efficiently. 16 Based on to these observations it was shown that vascular disease can impair the frontal subcortical area and executive functions but not increase memory deficits, which are characteristic of early degenerative dementia.…”

“…17 Moreover, it was shown that OARI could be a clinically significant indicator of medium/ high cardiovascular risk in HIV infected patients, revealing vascular resistance resulting from atherosclerotic functional changes. 17 OARI could have significant advantages with respect to cIMT assessment, namely, the absence of ultrasound obstacles and the vertical angle, which differs from the parallel-signaling of the carotid artery. 11 Finally, other factors associated with cognitive performance were identified in our population.…”

“…OARI was considered abnormal if the mean value of three separate measurements on left or right side was >0.72, according to previously published data demonstrating that this cut-off was the most discriminating value for predicting a medium/high (>10%) 10-year cardiovascular risk. 17 …”

“…13 Recent data show that increased carotid intima-media thickness (cIMT), a subclinical marker of atherosclerosis, predicts cognitive decline in memory and executive function 14,15 in agreement with the hypothesis that subjects with cognitive impairment can exhibit pathological arterial wall changes. 16 It is also known that OARI provides additional hemodynamic information for the assessment of cardiovascular disease severity in HIV-1-infected patients 8,17 with potential advantages over cIMT measurement. 13 The purpose of this study was to investigate the potential relationship between subclinical cerebrovascular disease assessed by OARI measurement and the development of mild neurocognitive disorders in a cohort of HIV-1-infected patients.…”

Retrobulbar blood flow and carotid intima–media thickness alteration may relate to subclinic atherosclerosis in patients with chronic inflammatory diseases

“…Grima et al found that high OARI values were related to medium/high CV risk and thicker CIMT in HIV-1 infected patients. 35 On the other hand, Hu et al in their study demonstrated that the flow velocities (systolic peak velocity and end-diastolic velocity) and pulsatility indices (resistivity index) in the ophthalmic and central retinal arteries decreased as the degree of carotid stenosis increased. 33 In the present study, the results were correlated with results of Grima's study.…”