ECHO 2013 / The Role of Vascular Imaging in Cardiovascular Risk Assessment
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Plaque Volume or Area
As With cIMT, Plaque is
Associated with Prevalence of CVD
Patients with occlusive carotid disease 7 times more likely to have positive exercise stress test than patients with normal carotid arteries
Presence of carotid plaques associated with angiographic CAD
Multi-vessel CAD associated with higher prevalence of carotid plaque than single-vessel disease
Bruckert E et al. Atherosclerosis 1992
Nowak J et al. Stroke 1998
Skaguchi M et al. Ultrasound Med Biol 2003
Carotid Plaque Associated with Incidence of CV Events in Asymptomatic Subjects
STUDY |
N |
Age |
Years |
Event |
Adjusted HR |
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|
ARIC |
12,375 |
45-64 |
7 |
MI, CHD, |
2.96 (1.54-3.30) |
|
|
|
Death |
|
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|
|
|
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|
|
KIHD |
1,288 |
42-60 |
≤2 |
MI |
4.15 (1.5-11.47) |
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|
|
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|
Yao City |
1,289 |
60-74 |
4.5 |
Stroke |
3.2 (1.4-7.1) |
|
|
|
|
|
|
MDCS |
5,163 |
40-68 |
7 |
MI, CHD, |
1.81 (1.14-2.87) |
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Death |
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Northern |
1,939 |
> 40 |
6.2 |
Stroke |
3.1 (1.1-8.5) |
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Manhattan |
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Rotterdam |
6,389 |
> 55 |
7-10 |
MI |
1.83 (1.27-2.62) |
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Wyman WA, et al. Vasc Med 2006; 11:123
Carotid Ultrasound in
CV Risk Assessment
Limitations of Current CV Risk
Prediction Models
Heavily dependent on age
Family history not incorporated
Focused on short-term (10 year) risk
Patients with extremely high levels of a single risk factor may not be adequately classified
Smoking considered as present or absent only
Proposed Biomarkers for Risk Prediction
Coronary Calcium Score
Brachial Flow Mediated Dilation
Brachial Artery Diameter
Intima Media Thickness
Carotid Plaque Area
Pulse Wave Velocity
Pulse Wave Analysis
High sensitivity CRP
ABI at rest
Genetic Markers
Combinations
Case 1
50 year old female
Hypertension
Current smoker
No DM
No known CAD
TC 212 HDL 57 LDL 126 TG 144
FRS 6%
Would the presence of carotid plaque on ultrasound change our risk assessment?
NOMAS: Measure of Subclinical ATH
Maximum Carotid Plaque Thickness (MCPT)
PLAQUE: Area of focal wall thickening 50% greater than surrounding wall thickness
MCPT = 0 (no plaque)
MCPT <1.9 mm
MCPT ≥ 1.9 mm (Q75)
MAX plaque
Thickness
MCPT in Prospective Cohort (mean follow-up 4 y) Distribution by AGE (N = 2,149)
100% |
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ANY PLAQUE (58%, n=1247) |
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90% |
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83% |
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80% |
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77% |
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69% |
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70% |
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59% |
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60% |
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50% |
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50% |
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40% |
33% |
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ICA Stenosis |
|
30% |
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|
60-80% |
2% |
20% |
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> 80% |
1% |
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Occlusion 0.5% |
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10% |
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0% |
40-60 |
61-65 |
66-70 71-75 |
76-80 |
>81 |
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Years |
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Rundek T et al. 2002