Carotid intima-media thickness and plaques in internal carotid artery as surrogate markers of lower limb arterial lesions in Chinese patients with diabetic foot

Peripheral arterial disease (PAD) can impair healing of diabetic foot (DF) in patients with diabetes mellitus. To determine whether carotid intima-media thickness (CIMT) can predict lower limb arterial lesions in patients with DF, this cross-sectional study enrolled patients with DF at West China Hospital (China) between January 2012 and December 2015. Ultrasonography was used to measure CIMT, assess the internal carotid arteries (ICA) for plaques, and evaluate lower limb segmental arteries for stenosis. The optimal CIMT cutoff for detecting lower limb PAD was determined by receiver operating characteristic (ROC) curve analysis. Factors associated with PAD were identified by logistic regression analyses. A total of 167 patients (mean age: 69.7±10.3 years; 102 men) were included. Patients with PAD were older and had higher levels of total cholesterol and low-density lipoprotein than patients without PAD (P<0.05). The area under the ROC curve was 0.747 (P<0.001). At the optimal CIMT cutoff of 0.71 mm, the sensitivity, specificity, positive predictive value, and negative predictive value were 79.65, 61.11, 81.08, and 58.93%, respectively. Compared with those without PAD, more patients with PAD had CIMT ≥0.71 mm (79.65 vs 38.89%; P<0.001) and ICA plaques (66.37vs 11.11%; P<0.001). Multivariate logistic regression revealed that age (odds ratio [OR]: 1.118; 95% confidence interval [95%CI]: 1.056-1.183; P<0.001), ICA plaques (OR: 13.452; 95%CI: 4.450-40.662; P<0.001), and CIMT ≥0.71 mm (OR: 2.802; 95%CI: 1.092-7.188; P=0.032) were associated with PAD.CIMT may be a surrogate marker of PAD in patients with DF.

Assessment of carotid artery wall in patients with OSA syndrome and the effect of CPAP on its thickness

In patients with Obstructive sleep apnea [OSA], the risks of fatal and nonfatal cardiovascular diseases and coronary artery disease are increased and measuring carotid intima-media thickness [CIMT] can assess these complications. Studying the effect of OSA syndrome in the carotid artery wall thickness as an indicator to cardiovascular complications, and the effect of CPAP on these changes. Polysomnography [PSG] was done for 45 patients; 29 patients of them proved to have OSA, and 10 obese subjects with normal PSG were included as a control group. All of them had ultrasonographic assessment of CIMT. 17 patients with OSA used CPAP overnight for 6 months and the CIMT was remeasured. 29 were diagnosed with OSA [12 severe, 9 moderate and 8 mild OSA]. There was a highly significant difference [p < 0.01] in CIMT between patient and control groups, and also between severe and mild OSA patients with non-significant difference [p > 0.05] between severe and moderate OSA. Regarding the different risk factors predispose to atherosclerosis, only factors related to OSA syndrome were correlated with CIMT. There was a highly significant reduction [p < 0.01] in CIMT after six months of CPAP usage. CIMT as a marker of atherosclerosis is significantly increased in patients with OSA and the use of CPAP in those patients is very important not only for improving sleep efficiency but also for reducing cardiovascular complications associated with OSAS