Intraplaque hemorrhage (IPH) is one of the main features of the carotid plaque instability's and predictor of ischemic stroke. Benefits (on the basis on benefit/risk ratio) of the carotid endarterectomy remain unclear for stroke asymptomatic patients; thus, more and more patients with important stenosis (i.e. over 60%) detected are not operated. However, these patients need adapted therapeutic treatments to limit plaque instability and this should include physical activity (PA). Indeed, PA has been showed to decrease numerous inflammatory markers involved in atherosclerosis. It has also recently been reported on stroke asymptomatic patients that the prevalence of carotid IPH was decreased in those with higher level of PA. Magnetic Resonance Imaging (MRI) of the IPH has been shown to be the better non-invasive imaging technique to assess carotid plaque instability and in particular IPH. Here, the aim of this study is to assess the effect of an individualized home-based 6 months physical activity intervention on carotid IPH and other biomarkers of vulnerability for asymptomatic patients. This study has been designed as a monocentric, longitudinal and interventional study. This study will involve one centre: Hopital Louis Pradel (HCL, Lyon). After inclusion tests, patients will be randomly included in the control group, or in the PA group. Patients of the PA group will have connected bracelets to measure daily count of steps. Twice a month, daily goals will be revaluated to increase or maintain the steps per day. The final goal is to reach 6 000 steps per day or increase by 30% the initial count of steps per day. Same tests will be done after 6 months of intervention for comparison.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Enrollment
56
Subjects will have to reach a daily goal in number of steps, based on the initial evaluation, during 6 months . They will wear connected wrists, and will be contacted twice a month by phone call by an adapted physical activity to revaluate these goals.
An MRI will be performed for each patient at the end of the study to identify IPH and other features of histological vulnerability (lipid core, fibrous cap integrity and calcifications).
Blood will be collected, to analyse monocyte phenotype by flow cytometry, blood rheology by ektacytometry, coagulation by rotational thromboelastometry (ROTEM). Plasma will be extracted from blood to assess inflammation, oxidative stress and antioxidant markers.
sedentary, physical activity, nutrition and quality of life questionnaire will be performed fo each patient.
The 6-minute walk test is a simple, individualized test that measures how fast a patient walks on a flat, hard surface for 6 minutes.
Hôpital Louis Pradel
Bron, France
decreased intensity of IPH levels measured by MRI
Image quality will be assessed from 1 to 5 (grade 1, low Signal-to-Noise Ratio (SNR) limits use, arterial wall and vessel margins are unidentifiable; grade 2, marginal SNR, arterial wall is visible, but the substructure, lumen, and outer boundaries are indistinct; grade 3, marginal SNR, wall structures are identifiable, but lumen and outer boundaries are partially obscured; grade 4, high SNR with minimal artifacts, vessel wall, lumen, and adventitial margins are well defined; and grade 5, high SNR without artifacts, wall architecture depicted in detail, lumen and adventitial boundary are clearly defined) . If the quality of the image is sufficient (≥ 3), IPH levels will be semi-quantified on a scale from 0 to 3 (0: No IPH, 1: light IPH, 2 moderate IPH, strong IPH). Images will be assessed blindly and independently by clinical experts of carotid plaque imaging.
Time frame: Day 0
decreased intensity of IPH levels measured by MRI
Image quality will be assessed from 1 to 5 (grade 1, low Signal-to-Noise Ratio (SNR) limits use, arterial wall and vessel margins are unidentifiable; grade 2, marginal SNR, arterial wall is visible, but the substructure, lumen, and outer boundaries are indistinct; grade 3, marginal SNR, wall structures are identifiable, but lumen and outer boundaries are partially obscured; grade 4, high SNR with minimal artifacts, vessel wall, lumen, and adventitial margins are well defined; and grade 5, high SNR without artifacts, wall architecture depicted in detail, lumen and adventitial boundary are clearly defined) . If the quality of the image is sufficient (≥ 3), IPH levels will be semi-quantified on a scale from 0 to 3 (0: No IPH, 1: light IPH, 2 moderate IPH, strong IPH). Images will be assessed blindly and independently by clinical experts of carotid plaque imaging.
Time frame: Month 6
Evaluation of intermediate monocyte phenotype (cluster of differentiation 14 (CD14)++ /cluster of differentiation 16 (CD16)+)
monocytes will be extracted from blood sample, marked with specific antibodies (anti CD14/16) and intermediate phenotypes (in %) will be measured by flow cytometry
Time frame: Day 0
Evaluation of intermediate monocyte phenotype (cluster of differentiation 14 (CD14)++ /cluster of differentiation 16 (CD16)+)
monocytes will be extracted from blood sample, marked with specific antibodies (anti CD14/16) and intermediate phenotypes (in %) will be measured by flow cytometry
Time frame: Month 6
Evaluation of classical monocyte phenotype (cluster of differentiation 14 (CD14)++ /cluster of differentiation 16 (CD16)-)
monocytes will be extracted from blood sample, marked with specific antibodies (anti CD14/16) and classical phenotypes (in %) will be measured by flow cytometry
Time frame: Day 0
Evaluation of classical monocyte phenotype (cluster of differentiation 14 (CD14)++ /cluster of differentiation 16 (CD16)-)
monocytes will be extracted from blood sample, marked with specific antibodies (anti CD14/16) and classical phenotypes (in %) will be measured by flow cytometry
Time frame: Month 6
Evaluation of non-classical monocyte phenotype (cluster of differentiation 14 (CD14)+ /cluster of differentiation 16 (CD16)++)
monocytes will be extracted from blood sample, marked with specific antibodies (anti CD14/16) and non-classical phenotypes (in %) will be measured by flow cytometry
Time frame: Day 0
Evaluation of non-classical monocyte phenotype (cluster of differentiation 14 (CD14)+ /cluster of differentiation 16 (CD16)++)
monocytes will be extracted from blood sample, marked with specific antibodies (anti CD14/16) and non-classical phenotypes (in %) will be measured by flow cytometry
Time frame: Month 6
Assessment of red blood cell aggregation
Red blood cell aggregation (in %)will be measured by ektacytometry
Time frame: Day 0
Assessment of red blood cell aggregation
Red blood cell aggregation (in %) will be measured by ektacytometry
Time frame: Month 6
in vitro clotting formation time
In vitro clotting formation time (in minutes) will be measured on whole blood by rotational thromboelastometry
Time frame: Day 0
in vitro clotting formation time
In vitro clotting formation time (in minutes) will be measured on whole blood by rotational thromboelastometry
Time frame: Month 6
Measurement of in vitro clot lysis index
In vitro clot lysis index (in millimeter) will be measured on whole blood by rotational thromboelastometry
Time frame: Day 0
Measurement of in vitro clot lysis index
In vitro clot lysis index (in millimeter) will be measured on whole blood by rotational thromboelastometry
Time frame: Month 6
Measurement of in vitro clot firmness
In vitro clot firmness (in millimeter) will be measured on whole blood by rotational thromboelastometry
Time frame: Day 0
Measurement of in vitro clot firmness
In vitro clot firmness (in millimeter) will be measured on whole blood by rotational thromboelastometry
Time frame: Month 6
Assessment of plasma lipid oxidation
Plasma protein oxidation (advanced oxidation proteins products) measured by by spectrophotometry (in micromole/liter (µmol/L))
Time frame: Day 0
Assessment of plasma lipid oxidation
Plasma protein oxidation (advanced oxidation proteins products) measured by by spectrophotometry (in micromole/liter (µmol/L))
Time frame: Month 6
Assessment of plasma protein oxidation
Plasma protein oxidation (advanced oxidation proteins products) measured by by spectrophotometry (in micromole/liter (µmol/L))
Time frame: Day 0
Assessment of plasma protein oxidation
Plasma protein oxidation (advanced oxidation proteins products) measured by by spectrophotometry (in micromole/liter (µmol/L))
Time frame: Month 6
Assessment of plasma protein nitration
Plasma protein nitration (nitrotyrosine) measured by the enzyme-linked immunosorbent assay (ELISA) in micromole/liter (µmol/L).
Time frame: Day 0
Assessment of plasma protein nitration
Plasma protein nitration (nitrotyrosine) measured by the enzyme-linked immunosorbent assay (ELISA) in micromole/liter (µmol/L).
Time frame: Month 6
Assessment of plasma inflammatory markers
Plasma inflammatory markers will be measured by multiplex assay in micromole/liter (µmol/L).
Time frame: Day 0
Assessment of plasma inflammatory markers
Plasma inflammatory markers will be measured by multiplex assay in micromole/liter (µmol/L).
Time frame: Month 6
Assessment of plasma enzymes activity
Plasma antioxidant enzymes activity will be measured by enzymology (in micromole/liter/minute (µmol/L/min))
Time frame: Day 0
Assessment of plasma enzymes activity
Plasma antioxidant enzymes activity will be measured by enzymology (in micromole/liter/minute (µmol/L/min))
Time frame: Month 6
number of steps per day
the daily number of steps (in number of step per day) will be measured using a connected wrist activity tracker
Time frame: during 2 weeks after Day 0
number of steps per day
the daily number of steps (in number of step per day) will be measured using a connected wrist activity tracker
Time frame: during 2 weeks after Month 6
distance of the 6 minutes walking test
The distance at the 6 minutes walking test (in meters) will be evaluated on the 30meters flat round-trip
Time frame: Day 0
distance of the 6 minutes walking test
The distance at the 6 minutes walking test (in meters) will be evaluated on the 30meters flat round-trip
Time frame: Month 6
quadriceps maximal isometric strength
The quadriceps maximal isometric strength (in Newton) will be evaluated in sitting position using dynamometer
Time frame: Day 0
quadriceps maximal isometric strength
The quadriceps maximal isometric strength (in Newton) will be evaluated in sitting position using dynamometer
Time frame: Month 6
Determination of the level of physical activity
the level physical activity will be evaluated by the global physical activity questionnaire (in Metabolic Equivalent of Task/minutes per week (MET/min.week)).
Time frame: Day 0
Determination of the level of physical activity
the level physical activity will be evaluated by the global physical activity questionnaire (in Metabolic Equivalent of Task/minutes per week (MET/min.week)).
Time frame: Month 6
Determination of the sedentary time
Sedentary time will be evaluated by the sedentary behaviour questionnaire evaluating the total daily sitting and lying down time (in minute/day) during awaking time.
Time frame: Day 0
Determination of the sedentary time
Sedentary time will be evaluated by the sedentary behaviour questionnaire evaluating the total daily sitting and lying down time (in minute/day) during awaking time.
Time frame: Month 6
descriptive health state score
Health state score will be assessed using descriptive system of the EQ-5D-5L (five-level version of the EuroQol five-dimensional) questionnaire. Health status is measured in terms of five dimensions (5D); mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The subjects self-rate their level of severity for each dimension using a five-level (EQ-5D-5L) scale (scored from 1 to 5, 1 indicating no problem and 5 indicating extreme problem). The health rate score correspond to the addition of each dimension score and is from 5 to 25. The lower the score, the better the health state.
Time frame: Day 0
descriptive health state score
Health state score will be assessed using descriptive system of the EQ-5D-5L (five-level version of the EuroQol five-dimensional) questionnaire. Health status is measured in terms of five dimensions (5D); mobility, self-care, usual activities, pain/discomfort, and anxiety/depression. The subjects self-rate their level of severity for each dimension using a five-level (EQ-5D-5L) scale (scored from 1 to 5, 1 indicating no problem and 5 indicating extreme problem). The health rate score correspond to the addition of each dimension score and is from 5 to 25. The lower the score, the better the health state.
Time frame: Month 6
self-evaluated overall health status
Overall health status will be assessed using the evaluation part of the EQ-5D-5L (five-level version of the EuroQol five-dimensional) questionnaire. The subject's self- evaluate their overall health status using the visual analogue scale (EQ-VAS). The raw score is from 0 to 100. The higher the score, the better the perceived overall health status
Time frame: Day 0
self-evaluated overall health status
Overall health status will be assessed using the evaluation part of the EQ-5D-5L (five-level version of the EuroQol five-dimensional) questionnaire. The subject's self- evaluate their overall health status using the visual analogue scale (EQ-VAS). The raw score is from 0 to 100. The higher the score, the better the perceived overall health status
Time frame: Month 6
body mass index
Body mass index (in kilogram/metre² (kg/m²)) will be calculated with the measurement of body weight (in kilogram) and height (in meter)
Time frame: Day 0
body mass index
Body mass index (in kilogram/metre² (kg/m²)) will be calculated with the measurement of body weight (in kilogram) and height (in meter)
Time frame: Month 6
number of comorbidities
Number of comorbidities (Diabetes, hypertension, obesity and , poly-atheroma) will be determined
Time frame: Day 0
number of comorbidities
Number of comorbidities (Diabetes, hypertension, obesity and , poly-atheroma) will be determined
Time frame: Month 6
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