POINT-OF-CARE FOCUSED VASCULAR ULTRASOUND (FOVUS) PREDICTS 1-5 YEAR CARDIOVASCULAR DISEASE OUTCOMES

Abstract

Presence of carotid plaque is known to be predictive of cardiovascular disease and events. Focused vascular ultrasound (FOVUS) is a rapid, point of care assessment of carotid plaque in the bulb and internal carotid artery. Plaque height and area can be quickly measured and used to predict coronary disease. We evaluated the utility of FOVUS for predicting future cardiovascular events and cardiac procedures in high risk cardiac patients. In this prospective study, 514 patients who received a FOVUS were followed for cardiovascular related outcomes 1 to 5 years. Medical information was retrieved through the Institute for Clinical Evaluative Sciences (ICES) using OHIP information and other health databases. Major cardiovascular outcomes included death, myocardial infarction (MI), stroke, and transient ischemic attack (TIA). Additional cardiovascular outcomes and procedures were recorded. A maximum plaque height of ≥1.5 mm or a total plaque area (TPA) of ≥25.6 mm2 were used to graph Kaplan–Meier curves to separate event free patients from patients experiencing cardiovascular events. Plaque height (≥1.5 mm) measured by FOVUS was able to stratify combined death/MI/Stroke/TIA (Fig.1A), congestive heart failure, and cardiac procedures. TPA (≥25.6 mm2) was able to stratify the most outcomes, including combined death/MI/Stroke/TIA (Fig.1B), as well as individually death, acute coronary syndrome, myocardial infarction, non-ST-elevation myocardial infarction (non-STEMI), transient ischemic attack, congestive heart failure, and cardiac procedures. Receiver operating characteristic curves specific to each outcome indicated that TPA (< 44.5 mm2, AUC=0.728) and plaque height (< 2.45 mm, AUC=0.704) had high predictability at ruling out non-STEMI. Odd ratios for non-STEMI after adjustment for age and sex, were 1.60 (p=0.02) for increased plaque height and 1.02 (p=0.01) for increased TPA. Rapid quantification of carotid TPA by FOVUS may serve as a stratification tool for predicting major cardiovascular related events. The use of FOVUS may show benefit at the point-of-care in the emergency department or in family physician practice, especially in relation to cardiovascular outcomes.