Comparison of carotid intima-media thickness and coronary artery calcium score for estimating subclinical atherosclerosis in patients with fatty liver disease.

INTRODUCTION: Fatty liver disease (FLD) is correlated with cardiovascular disease. Carotid intima-media thickness (CIMT) and coronary artery calcium score (CACS) can noninvasively identify subclinical atherosclerosis and predict risk for cardiovascular events. This study evaluated CIMT and CACS measurements to detect subclinical atherosclerosis in patients with and without FLD. METHODS: Patients who underwent carotid and abdominal ultrasounds as well as cardiac computed tomography (CT) scans were evaluated retrospectively. The differences between the mean CIMT value and CACS measurements in patients with FLD and those with normal livers were estimated. RESULTS: Among 819 patients (average age of 53.3 ± 11.2 years), 330 had FLD. The CIMT was greater in patients with FLD compared to the controls (0.79 ± 0.17 vs 0.76 ± 0.17 mm, p = 0.012), and carotid plaques were more commonly seen in patients with FLD. The incidence of a composite of larger CIMT ( ≥ 75th percentile) plus plaque presence was higher in FLD patients (43.3 vs 36.0%, p = 0.041). Particularly among young patients (≤ 50), the CIMT was larger in patients with FLD than in the controls. FLD increased the risk of a composite of large CIMT plus plaque presence in young patients (odds ratio 1.92, 95% confidence interval 1.05-3.49, p = 0.034). However, patients with FLD had no greater incidence of CACS of over 100 than the controls. CONCLUSION: CIMT was a better marker of underlying subclinical atherosclerotic risk among patients with FLD than CACS. FLD particularly, increases the risk of subclinical atherosclerosis in patients younger than 50 years of age. These patients should undergo screening CIMT to detect atherosclerosis and modify risk factors.

Right ventricular strain as predictor of pulmonary complications in patients with femur fracture.

BACKGROUND: Following femur fracture, medullary fat enters the systemic circulation and altered pulmonary haemodynamics may contribute to pulmonary complications. This study evaluated the association between right ventricular (RV) function and pulmonary complications in patients with femur fracture. METHODS: Patients with a femur fracture who had undergone pre-operative echocardiography that included RV peak global longitudinal strain (RV GLS) were evaluated retrospectively between March 2015 and February 2016. Pulmonary complications were defined as the development of pneumonia or pulmonary thromboembolism during the first postoperative month. RESULTS: Among 78 patients, pulmonary complications developed in eight (10.3%). The RV GLS value of all patients was lower than the normal range. In addition, the RV GLS value of patients with pulmonary complications was significantly lower than that of patients without pulmonary complications. Multivariate regression analyses found that worse RV GLS values independently predicted pulmonary complications [odds ratio (OR) 2.09, 95% confidence interval (CI) 1.047-4.151, p = 0.037]. Receiver operating characteristic curve analysis found that a RV GLS value of -14.85% was the best cut-off value to predict pulmonary complications; sensitivity: 75.0%; specificity: 62.9%. Moreover, patients with RV GLS values > -14.85% had significantly lower pulmonary complication-free survival. CONCLUSIONS: In patients with femur fracture, RV GLS values could help predict pulmonary complications. Therefore, patients with RV GLS values > -14.85 should be monitored closely before and after surgery for femur fracture.

Gender-based differences in the relationship between fatty liver disease and atherosclerosis.

BACKGROUND: Carotid intima-media thickness (CIMT) is a surrogate of subclinical atherosclerosis. Fatty liver disease is also linked to increased risk of cardiovascular events. The aim of this study was to evaluate the association between fatty liver disease and CIMT according to gender. METHODS: Patients who had undergone carotid and abdominal ultrasound between June 2011 and December 2013 were retrospectively evaluated. The differences between the CIMT values measured in the common carotid artery and the prevalence of carotid plaque in patients with fatty liver disease and those with normal livers were investigated. RESULTS: Out of a total of 1 121 patients, the men had more fatty liver disease than the women. The mean CIMT of the men was significantly higher than that of the women, and the men had more plaque than the women. The women with fatty liver disease had a significantly higher mean CIMT value and more plaque than the women with normal livers. The differences between the men with fatty liver and those with normal livers in mean CIMT values and in the prevalence of plaque were not significant. In the women, multivariate analysis showed that fatty liver disease was independently associated with subclinical atherosclerosis [adjusted hazards ratio (HR) 1.65, 95% confidence interval (CI) 1.007-2.697, p = 0.047]. CONCLUSIONS: The men had more fatty liver disease, carotid plaque and higher CIMT values than the women. Fatty liver disease was a useful predictor of atherosclerosis, especially for the female study patients.

Subintimal angioplasty of an aortoiliac occlusion: re-entry site created using a transseptal needle under intravascular ultrasound guidance.

PURPOSE: To report the use of a transseptal needle to cross the intimal flap in subintimal angioplasty of a flush aortoiliac occlusion via a retrograde approach. CASE REPORT: A 53-year-old man with claudication of the right lower limb and an angiographically documented right aortoiliac occlusion was treated with subintimal angioplasty via an ipsilateral retrograde approach. After puncture of the right common femoral artery, a 0.035-inch hydrophilic guidewire was advanced via the subintimal space toward the aortic true lumen, but the wire could not re-enter the true lumen. A transseptal needle was used to puncture the intimal flap under intravascular ultrasound (IVUS) guidance. Angioplasty/stenting was performed successfully, and the patient's symptoms were relieved. Computed tomography at 15 months revealed patent stents. CONCLUSION: The use of a transseptal needle to cross the intimal flap in total aortoiliac occlusions is technically feasible under IVUS guidance and enables successful angioplasty.