AI-ECG age predicts carotid atherosclerotic plaque volume and progression.

Is Carotid Intima-Media Thickness a Reliable Clinical Predictor?

Background: Atherosclerosis is a systemic multifocal disease with a preference for the branching points of the arteries. In this study, we quantitatively measured carotid and femoral plaque volume in subjects with cardiovascular risk factors (CVRF) and/or established atherosclerotic disease using a 3D ultrasound technique. Methods: In this prospective, single-centre study, we included 404 patients (median age 64; 56.9% men) with at least one CVRF or established cardiovascular disease. Plaque volume was measured using 3D ultrasound equipped with an automated software. Results: We found a strong correlation of plaque volume with CVRF and the number of vascular beds involved. The strongest associations with total and femoral plaque volume were noted for smoking, hypertension, age, as well as for the presence of peripheral arterial occlusive disease (p < 0.05). Carotid plaque volume was best predicted by hyperlipidaemia, hypertension, age, as well as the presence of cerebrovascular disease and coronary artery disease (p < 0.05). Conclusion: We conclude that smoking appears to be associated with total and femoral plaque volume, whereas hyperlipidaemia seems to be associated with carotid plaque volume. Measurement of 3D plaque volume is a practical and reproducible technique with the potential to become an additional screening tool in cardiovascular risk stratification.

We investigated the utility of three manual planimetric methods to quantify carotid plaque volume. A single observer measured 15 individual plaques from 15 three-dimensional (3D) ultrasound (3D US) images of patients ten times each using three different planimetric approaches. Individual plaque volumes were measured (range: 32.6-597.1 mm3) using a standard planimetric approach (M1) whereby a plaque end was identified and sequential contours were measured. The same plaques were measured using a second approach (M2), whereby plaque ends were first identified and the 3D US image of the plaque was then subdivided into equal intervals. A third method (M3) was used to measure total plaque burden (range: 165.1-1080.0 mm3) in a region (+/- 1.5 cm) relative to the carotid bifurcation. M1 systematically underestimated individual plaque volume compared to M2 (V2 = V1 + 14.0 mm3, r = 0.99, p = 0.006) due to a difference in the mean plaque length measured. Coefficients of variance (CV) for M1 and M2 decrease with increasing plaque volume, with M2 results less than M1. Root mean square difference between experimental and theoretical CV for M2 was 3.2%. The standard deviation in the identification of the transverse location of the carotid bifurcation was 0.56 mm. CVs for plaque burden measured using M3 ranged from 1.2% to 7.6% and were less than CVs determined for individual plaque volumes of the same volume. The utility of M3 was demonstrated by measuring carotid plaque burden and volume change over a period of 3 months in three patients. In conclusion, M2 was determined to be a more superior measurement technique than M1 to measure individual plaque volume. Furthermore, we demonstrated the utility of M3 to quantify regional plaque burden and to quantify change in plaque volume.

BackgroundHigh body mass index (BMI) is a risk factor for type 2 diabetes and cardiovascular disease. However, its relationships with indices of carotid stiffness and plaque volume are unclear. We investigated associations of long-term measurements of BMI with indices of carotid stiffness and atherosclerosis among non-demented diabetes patients from the Israel Diabetes and Cognitive Decline (IDCD) study.MethodsCarotid ultrasound indices [carotid intima media thickness (cIMT), distensibility, elastography and plaque volume] were assessed in N = 471 participants. Mean BMI across all MHS diabetes registry measurements and trajectories of BMI were calculated. BMI was categorized into three trajectory groups representing: a relatively stable normal weight (n = 185, 44%), overweight trajectory (n = 188, 44.8%) and a trajectory of obesity (n = 47, 11.2%). Linear and logistic regressions estimated associations of carotid indices with mean BMI and BMI trajectories.ResultsCompared to the normal weight trajectory, an obesity trajectory was associated with carotid distensibility (β = − 3.078, p = 0.037), cIMT (β = 0.095, p = 0.004), and carotid elastography (β = 0.181, p = 0.004) but not with plaque volume (β = 0.066, p = 0.858). Compared with the normal weight trajectory, an obesity trajectory was associated with increased odds for impaired carotid distensibility (OR = 2.790, p = 0.033), impaired cIMT (OR = 5.277, p = 0.001) and large carotid plaque volume (OR = 8.456, p = 0.013) but not with carotid elastography (OR = 1.956, p = 0.140). Mean BMI was linearly associated with Distensibility (β = − 0.275, p = 0.005) and cIMT (β = 0.005, p = 0.026).ConclusionsLong-term measurements of adiposity are associated with indices of carotid stiffness and plaque volume among older type 2 diabetes adults.

Response: Carotid Intima-Media Thickness Measurements in Intervention Studies

Tomographic 3D ultrasound (t3DUS) is a promise imaging technique for quantifying carotid plaque through measuring the degree of stenosis and plaque volume. Carotid plaque volume (CPV) could add benefit in predicting the potential risk of stroke. To assess the reproducibility and accuracy of t3DUS for measuring CPV within the internal carotid artery in patients undergoing carotid endarterectomy. t3DUS was used to obtain CPV in vivo from 25 symptomatic patients prior to surgery. Ex vivo CPV from the carotid endarterectomy specimen was then measured using a validated saline displacement method as a reference standard. CPV for each patient was measured twice using both methods (total n = 50 per technique). Intraclass correlation coefficient (ICC) and Bland-Altman plot were used to establish bias and limit of agreement between CPV measurements. There was an excellent agreement between t3DUS and reference test with respect to measuring CPV with an ICC value of 0.98 (95% confidence interval=0.97-0.99, P < 0.001). Bias in measurements was 0.02 ± 0.11 cm3 (95% limit of agreement=-0.19 to 0.25). Intra-observer agreement of t3DUS CPV measurements was excellent with an ICC value of 0.95 (95% confidence interval=0.92-0.97, P < 0.001). Bias in measurements was 0.004 ± 0.07 cm3 (95% limit of agreement=-0.14 to 0.15). t3DUS is a reproducible imaging method and showed excellent agreement with the reference standard with respect to measuring CPV. These findings suggest that t3DUS has the potential to be a valuable non-invasive tool for assessing carotid plaque burden and predicting the risk of stroke.

Carotid Atherosclerotic Plaque Features in Patients with Acute Ischemic Stroke.

Objective To evaluate the clinical value of real-time three-dimensional ultrasonography (RT-3DU)in measuring carotid plaque volume in comparison with that of computed tomographic angiography(CTA).Methods Twenty-five patients were examined with two-dimentional ultrasonography,and thirty-two carotid plaques were found.The carotid plaque volumes were measured using RT-3DU and CTA,respectively.RT-3DU images of the plaques were analyzed with Qlab soft system tO measure the plaque volume semi-automatically,and the CTA images of the plaques volume were measured by multi-slice spiral CT with blood vessel analysis software.Results There were no significant differences between the plaques volumes measured by RT-3DU and CTA [(583.09±215.66)mm~3 vs(602.84±182.45)mm~3,P<0.01],and there was remarkable relationship between the value measured by RT-3DU and that by CTA (r=0.885,P<0.01).Moreover,the difference of plaques volumes between RT-3DU and CTA decreased gradually with the plaque volume increased(r=0.35,P<0.01).Conclusions RT-3DU is accurate in measuring plaque volume with great clinical value. Key words: Ultrasonography; Carotid stenosis; Imaging,three-dimensional

Background/Objectives: Inflammation represents a cornerstone in the development of atherosclerosis and early detection is essential to avoid cardiovascular events. Biomarkers like interleukin-1 beta, interleukin-6, or high sensitivity CRP (hs-CRP) have been investigated intensively in this field. Since they have several limitations, additional biomarkers are needed for cardiovascular risk stratification. The acute phase protein, neutrophil gelatinase-associated lipocalin (NGAL), modulates inflammation and is elevated in cardiovascular disease (CVD). Moreover, it contributes to plaque destabilization. Methods: In this prospective, single-center study, we included 323 asymptomatic patients with at least one cardiovascular risk factor or established CVD. NGAL levels were measured in plasma samples using a commercially available ELISA. Carotid, femoral, and total atherosclerotic plaque volumes (PV) were measured using a 3D ultrasound system (Philips iU22). Patients were separated into a low (n = 243) and high (n = 80) total PV group. Results: NGAL was significantly higher in patients with high total PV versus patients with low total PV. The NGAL amplitude for the prediction of high total PV was significantly higher when compared with hs-CRP. A high predictive value could also be observed for patients without established CVD. Conclusion: NGAL seems to be a promising biomarker for the identification of asymptomatic patients with atherosclerotic disease.

Rivaroxaban Does Not Alter Carotid Plaque Echolucency, Volume, or Neovascularisation.

Inter-Scan Reproducibility of Carotid Plaque Volume Measurements by 3-D Ultrasound

IntroductionDevelopment of carotid and femoral atherosclerotic plaques proved to be heritable in previous studies. However, no comprehensive ultrasonographic evaluation of the volume and types of plaque has been performed.MethodsComprehensive carotid and femoral arterial ultrasound examination (Samsung RS85, arterial analysis, 15 MHz probe) was performed in 92 Hungarian twins (54 monozygotic, MZ and 38 dizygotic, DZ twin pairs, mean age 54 ± 13 years). The volume of plaques was automatically measured, and the plaque type was grouped according to echogenicity. Raw heritability was evaluated using the Falconer formula.ResultsNo heritability of the total number of carotid and femoral plaques and total plaque volume was detected. Although the number of carotid plaques themselves has been found to be hereditary (h2 = 0.492), the volume of carotid and femoral plaques as well as the number of femoral plaques were not heritable. More MZ twin pairs were discordant in the presence of soft plaques in the carotid artery as DZ twin pairs, but greater similarity in femoral plaques was not detected between MZ twins, which does not indicate a genetic background. The presence of calcified and mixed echogenic carotid plaques in the MZ twins was more concordant as in DZ twins, indicating inheritance.ConclusionThe total number and volume of carotid and femoral plaques are influenced by the environment. Different plaque types have different backgrounds: while calcified and mixed echogenic carotid plaques are more affected by genetics, soft carotid and femoral plaques are more affected by the environment.

Quantification of carotid plaque volume measurements using 3D ultrasound imaging

Carotid artery total plaque volume (TPV) is a three-dimensional (3D) ultrasound (US) imaging measurement of carotid atherosclerosis, providing a direct non-invasive and regional estimation of atherosclerotic plaque volume - the direct determinant of carotid stenosis and ischemic stroke. While 3DUS measurements of TPV provide the potential to monitor plaque in individual patients and in populations enrolled in clinical trials, until now, such measurements have been performed manually which is laborious, time-consuming and prone to intra-observer and inter-observer variability. To address this critical translational limitation, here we describe the development and application of a semi-automated 3DUS plaque volume measurement. This semi-automated TPV measurement incorporates three user-selected boundaries in two views of the 3DUS volume to generate a geometric approximation of TPV for each plaque measured. We compared semi-automated repeated measurements to manual segmentation of 22 individual plaques ranging in volume from 2mm3 to 151mm3. Mean plaque volume was 43±40mm3 for semi-automated and 48±46mm3 for manual measurements and these were not significantly different (p=0.60). Mean coefficient of variation (CV) was 12.0±5.1% for the semi-automated measurements.

A segmentation framework is proposed to determine the wall thickness, carotid artery plaque volume as morphological markers. MRI features, NMR peaks, oxidative stress markers as MRI-clinical correlates were compared in carotid and coronary plaques. The objective is to distinguish plaque components by their different MR image intensities at different image contrasts using in vivo and ex-vivo images; to segment and quantify plaque components (area and volume) using plaque contour; to compare NMR peaks, MRI features, relaxation times and oxidative stress markers in coronary and carotid endarterectomy samples to implicate plaque as lipid disorder. Fourteen pairs of coronary and ten pairs of carotid arteries after FSE T1 weighted MRI examination from post-surgery donors (aged 42 to 68 years) were analyzed for lipid proton NMR peaks and tissue oxidative stress markers. Ten pairs met the criteria for rigorous analysis. Carotid artery wall thickness and plaque volumes were measured from the MRI images. In vitro NMR peaks and oxidative stress markers were computed in both coronary and carotid artery samples. The carotid artery bifurcation is a site at which MRI can monitor plaque progression reproducibly. Total wall volumes of carotid arteries in vivo and in vitro were moderately correlated (concordance correlation coefficient r/sub c/=0.71). Correlation was measured for atheroma scores (r/sub c/=0.954); and plaque volume scores (r/sub c/=0.942). The observation of comparable NMR lipid peaks and oxidative stress suggested that diagnostic information about atherosclerosis progression in both coronary and carotid arteries may be similar. Carotid artery plaque features were MRI visible and predictive of plaque rupture and stability. Oxidative stress markers were significant in carotid artery tissues and comparable to coronary tissues. Lipid NMR peaks were significant suggestive of lipid accumulation in atherosclerosis of the human carotid arteries as a lipid disorder.