High intensity plaque in carotid artery on magnetic resonance imaging predict long term major adverse cardiac and cerebrovascular events

Abstract

Abstract Background Cardiocerebrovascular diseases remain the major cause of death in the world. The presence of carotid plaque is a surrogate marker for systemic atherosclerosis. High intensity plaque (HIP) in carotid artery on magnetic resonance imaging (MRI) was reported to be associated with the ipsilateral ischemic stroke as well as coronary artery disease. However, few studies have examined the impact of carotid HIP on long-term prognosis of cardiocerebrovascular disease. Purpose We investigated whether HIP in carotid artery associated with long term major adverse cardiac and cerebrovascular events (MACCE). Method We retrospectively analyzed 241 patients suspected carotid artery stenosis and underwent MRI at our hospital between January 2002 and December 2004. Plaque imaging was performed with non-contrast T1 imaging, and we defined as HIP if plaque-to-myocardium signal-intensity ratio (PMR) ≥2.0. Patients were divided into the HIP group (n=134) or non-HIP group (n=107). The outcome of this study was first incidence of ischemic cardiac or cerebrovascular events. Cardiovascular events were defined as cardiac death (sudden death, fetal myocardial infarction) and non-fetal myocardial infarction. Cerebrovascular events were defined as cerebral infarction. We compared the cumulative incidents of MACCE between with or without HIP groups using Kaplan-Meier method and log-rank test. Multivariate Cox regression analysis was carried out to assess whether HIP could be independent predicter of MACCE. Results Median age of study patients was 70 (inter quartile range; 65-75) and 215 (88.1%) patients were male, 185 patients (76.6%) had established vascular diseases. The median follow-up periods were 8.6 years (inter quartile range; 4.0-14.2 years). The presence of HIP was associated with MACCE (p<0.001). Multivariate analysis shows that the presence of HIP was an independent predicting factor for MACCE. When we analyzed incidence of each cardiovascular and cerebrovascular event, the presence of HIP was significantly associated with cerebrovascular events (p=0.004) and cardiovascular events(p=0.03), respectively. Conclusion The presence of carotid HIP was associated with long term prognosis for MACCE. Our findings indicate that carotid HIP is a surrogate marker for vulnerable patients with cardiocerebrovascular disease.