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Abstract: PO1764

Vascular Function Indices Are Strong Predictors of the Severity and Characteristics of Carotid Atherosclerosis

Session Information

Category: Hypertension and CVD

  • 1401 Hypertension and CVD: Epidemiology, Risk Factors, and Prevention

Authors

  • Shukla, Ashutosh M., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
  • Ly, Lina, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
  • Joyce, Malea, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
  • Orozco, Tatiana, VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
  • Cheung, Alfred K., University of Utah Health, Salt Lake City, Utah, United States
  • Shah, Sudhir V., University of Arkansas for Medical Sciences, Little Rock, Arkansas, United States
  • Segal, Mark S., VA North Florida South Georgia Veterans Health System, Gainesville, Florida, United States
Background

Vascular functional indices strongly predict adverse cardiac outcomes in CKD. However, few have examined the link between vascular function and the severity and characteristics of carotid atherosclerosis in CKD. Management of Cardiovascular disease in cKd(MaCK, NCT03636152) is a randomized controlled study aimed to evaluate the effects of hydroxychloroquine on inflammation, vascular dysfunction and carotid atherosclerosis in Veterans with high-CV risk CKD. Analyzing the baseline parameters of enrollees, we aim to evaluate the predictors of carotid atherosclerosis in CKD patients.

Methods

All randomized participants of MaCK study underwent detailed clinical and laboratory evaluations, including evaluation of inflammation (hsCRP), vascular function (central aortic pressure(CAP), augmentation index(AI) and aortic pulse wave velocity(APWV) by sphygmocore™ XCEL) and detailed evaluation of carotid atherosclerosis 15 mm around bifurcation (total plaque volume (TPV), lipid-rich necrosis, calcification, fibrous cap, and intraplaque hemorrhage by 3T MRI analyzed with Plaquiview™ software).

Results

Initial 17 randomized participants(age 73±4years, all male, 41% with pre-existing CVD and 88% on statins, with eGFR 40±4.7ml/min, microalbumin/creatinine ratio 855±1207mcg/gm, hsCPR 10.6±20.6mg/L total cholesterol 168±40mg/dl, and LDL/HDL ratio 2-1±0.7) with full analyzable MRI were included in the analysis. Significant vascular stiffness was evident at baseline with CAP:98.3±12.6 mm of Hg, Augmentation Index:15.5±7.6 and APWV:9.3±2.4 m/s. Atherosclerotic burden was high, carotid TPV:2207±802mm3 and Normalized Wall Index:71.7±6, with necrotic core, calcification, fibrous cap, and intraplaque hemorrhage volumes of 357.6±289, 556.2±478, 153.8±122 and 49.6±78 mm3 respectively. Univariate analysis showed that detailed baseline clinical and laboratory parameters had no significant correlations with TPV or its individual components whereas, vascular functional indices had strong positive correlations with TPV and individual plaque components(p<0.01), especially the CAP, which had among the strongest correlations with lipid-rich necrotic core (p<0.000).

Conclusion

Non-invasively measured central aortic pressure and aortic pulse wave velocity are strong predictors of carotid atherosclerosis and unstable plaques.

Funding

  • Veterans Affairs Support