Maximum Plaque Thickness Research Articles

Assessing the Relationship between Atherosclerotic Cardiovascular Disease Risk Score and Carotid Artery Imaging Findings.

To characterize the relationship between computed tomography angiography (CTA) imaging characteristics of carotid artery and the 10-year risk of atherosclerotic cardiovascular disease (ASCVD) score. We retrospectively identified all patients who underwent a cervical CTA at our institution from January 2013 to July 2016, extracted clinical information, and calculated the 10-year ASCVD score using the Pooled Cohort Equations from the 2013 ACC/AHA guidelines. We compared the imaging features of artery atherosclerosis derived from the CTAs between low and high risk. One hundred forty-six patients met our inclusion criteria. Patients with an ASCVD score ≥7.5% (64.4%) had significantly more arterial stenosis than patients with an ASCVD score <7.5% (35.6%, P<.001). Maximal plaque thickness was significantly higher (mean 2.33vs. .42mm, P<.001) and soft plaques (55.3% vs. 13.5%, P<.001) were significantly more frequent in patients with an ASCVD score ≥7.5%. However, among patients with a 10-year ASCVD score ≥7.5%, 33 (35.1%) had no arterial stenosis, 35 (37.2%) had a maximal plaque thickness less than. 9 mm, and 42 (44.7%) had no soft plaque. Furthermore, among the patients with a 10-year ASCVD score <7.5%, 8 (15.4%) had some arterial stenosis, 8 (15.4%) had a maximal plaque thickness more than. 9mm, and 7 (13.5%) had soft plaque. There is some concordance but not a perfect overlap between the 10-year ASCVD risk scores calculated from clinical and blood assessment and carotid artery imaging findings.

Relationship between Angiotensin Converting Enzyme Gene Polymorphism and Carotid Atherosclerotic Plaque: A Study Based on Vessel Wall Magnetic Resonance Imaging

Objective To investigate the relationship between angiotensin converting enzyme(ACE) gene polymorphism and carotid plaque composition,vessel wall morphology,and clinical symptoms based on vessel wall magnetic resonance imaging. Methods Totally 75 hypertensive patients(75 internal carotid artery plaques) with maximum plaque thickness≥1.5 mm,according to the ACE insertion(I) or deletion(D) gene polymorphism,were divided into ACE 2 genotype group(n=37) and ACE ID/DD genotype group(n=38). The influences of plaque composition,vessel wall morphology,clinical symptoms,and use of ACE inhibitor or angiotensin receptor blocker(ACEI/ARB) on vessel wall morphology were analyzed. Results Compared with ACE 2 genotype group,the ACE ID/DD genotype group had significantly higher incidence of ischemic stroke(Χ2=3.921,P=0.048). The plaque composition and vessel wall morphology showed no significant difference between these two groups. Inside ACE ID/DD genotype group,the carotid remodeling index was significantly lower in users of ACEI/ARB than non-users of ACEI/ARB(1.85±0.60 vs. 2.48±0.40;t=3.854,P=0.001).Conclusion In primary hypertension,ACE ID/DD genotype may be associated with carotid atherosclerotic plaque.

Impact of Thyroid Hormone Therapy on Atherosclerosis in the Elderly With Subclinical Hypothyroidism: A Randomized Trial.

Subclinical hypothyroidism (SHypo) has been associated with atherosclerosis, but no conclusive clinical trials assessing the levothyroxine impact on carotid atherosclerosis exist. To assess the impact of treatment of SHypo with levothyroxine on carotid atherosclerosis. Randomized, double-blind, placebo-controlled trial nested within the Thyroid Hormone Replacement for Subclinical Hypothyroidism trial. Participants aged ≥65 years with SHypo [thyroid-stimulating hormone (TSH), 4.60 to 19.99 mIU/L; free thyroxine level within reference range]. Levothyroxine dose-titrated to achieve TSH normalization or placebo, including mock titrations. Carotid intima media thickness (CIMT), maximum plaque thickness measured with ultrasound. One hundred eighty-five participants (mean age 74.1 years, 47% women, 96 randomized to levothyroxine) underwent carotid ultrasound. Overall mean TSH ± SD was 6.35 ± 1.95 mIU/L at baseline and decreased to 3.55 ± 2.14 mIU/L with levothyroxine compared with 5.29 ± 2.21 mIU/L with placebo (P < 0.001). After a median treatment of 18.4 months (interquartile range 12.2 to 30.0 months), mean CIMT was 0.85 ± 0.14 mm under levothyroxine and 0.82 ± 0.13 mm under placebo [between-group difference = 0.02 mm; 95% CI, -0.01 to 0.06; P = 0.30]. The proportion of carotid plaque was similar (n = 135; 70.8% under levothyroxine and 75.3% under placebo; P = 0.46). Maximum carotid plaque thickness was 2.38 ± 0.92 mm under levothyroxine and 2.37 ± 0.91 mm under placebo (between-group difference -0.03; 95% CI, -0.34 to 0.29; P = 0.86). There were no significant interactions between levothyroxine treatment and mean CIMT, according to sex, baseline TSH (categories 4.6 to 6.9, 7.0 to 9.9, and ≥10 mIU/L), or established cardiovascular disease (all P for interaction ≥ 0.14). Normalization of TSH with levothyroxine was associated with no difference in CIMT and carotid atherosclerosis in older persons with SHypo.

Orthogonal B-Mode Evaluation of Common Carotid Artery Plaques Reveals the Absence of Outward Remodeling

To properly assess morphologic and dynamic parameters of arteries and plaques, we propose the concept of orthogonal distance measurements, that is, measurements made perpendicular to the local lumen axis rather than along the ultrasound beam (vertical direction for a linear array). The aim of this study was to compare orthogonal and vertical artery and lumen diameters at the site of a plaque in the common carotid artery (CCA). Moreover, we investigated the interrelationship of orthogonal diameters and plaque size and the association of artery parameters with plaque echogenicity. In 29 patients, we acquired a longitudinal B-mode ultrasound recording of plaques at the posterior CCA wall. After semi-automatic segmentation of end-diastolic frames, diameters were extracted orthogonally along the lumen axis. To establish inter-observer variability of diameters obtained at the location of maximal plaque thickness, a second observer repeated the analysis (subset N = 21). Orthogonal adventitia–adventitia and lumen diameters could be determined with good precision (coefficient of variation: 1%–5%. However, the precision of the change in lumen diameter from diastole to systole (distension) at the site of the plaque was poor (21%–50%). The orthogonal lumen diameter was significantly smaller than the vertical lumen diameter (p < 0.001). Surprisingly, the plaques did not cause outward remodeling, that is, a local increase in adventitia–adventitia distance at the site of the plaque. The intra- and inter-observer precision of diastolic–systolic plaque compression was poor and of the same order as the standard deviation of plaque compression. The orthogonal relative lumen distension was significantly lower for echogenic plaques, indicating a higher stiffness, than for echolucent plaques (p < 0.01). In conclusion, we illustrated the feasibility of extracting orthogonal CCA and plaque dimensions, albeit that the proposed approach is inadequate to quantify plaque compression.

Abstract TP127: Morphology of Acute Symptomatic Intracranial Atherosclerotic Plaques

Introduction: Intracranial atherosclerotic disease (ICAD) is an important subtype of ischemic stroke worldwide. Understanding the morphologic features of acutely symptomatic plaques may help identify vulnerable lesions and guide treatment. Methods: We prospectively recruited 170 patients (median age = 60.5 years) with acute ischemic stroke attributed to ICAD (≥60% stenosis) confirmed by 3-dimensional rotational angiography (3DRA) from May 2007 to Feb 2017. We evaluated the morphology of the index atherosclerotic plaques in 3DRA. We categorized plaques with irregular or ulcerated surface as complicated plaques. We compared the morphological features of smooth and complicated plaques. Results: The median interval between symptom onset and 3DRA exam was 22 days. The median severity of luminal stenosis was 75%. The median maximum plaque thickness was 1.3mm and lesion length was 8.8mm. The plaque surface was smooth, irregular, or ulcerated in 50 (29.4%), 90 (52.9%), and 27 (15.9%) cases, respectively. The point of maximum stenosis was located in the distal end of the lesions in 88 (51.8%) cases. A majority (85.3%) of the plaques were eccentric. The median angulation between the upstream plaque shoulder and an imagined “normal” vessel wall (assuming there were no plaque) was 33.4°. Overall, complicated plaques led to more severe luminal stenosis (medians 77.0 vs 73.0%; p=0.032); the lesions were longer (medians 10.0 vs 6.9 mm; p&lt;0.001), and the upstream shoulders were steeper (median angles 34.3 vs 28.0°; p=0.048) than smooth plaques. Conclusions: We identified the morphologic pattern of symptomatic high-grade intracranial atherosclerotic plaques during the acute phase that are significantly different between smooth and complicated plaques. The current findings warrant a comparison with silent ICAD lesions for validation.

Early Diagnosis and Treatment of Coronary Heart Disease in Asymptomatic Subjects With Advanced Vascular Atherosclerosis of the Carotid Artery (Type III and IV b Findings Using Ultrasound) and Risk Factors

BackgroundA study was conducted as to whether the early diagnosis of coronary heart disease in asymptomatic subjects with advanced atherosclerosis of the carotid artery which additionally shows at least one risk factor is successful using ultrasound technology.MethodsWithin the scope of an occupational screening program using subjects from diverse employment sectors, people were given the opportunity to determine their risk of heart attack. During the study the total plaque area (TPA), the maximum plaque thickness in the carotid artery and the PROCAM-Scores of 3,748 healthy men and 2,260 healthy women between the ages of 20 and 64 years were determined. During the subsequent follow-up study 94 subjects sickened. An ultrasound examination of the carotid artery of 79 patients revealed a type III or IV b finding. In a pilot study 33 asymptomatic subjects with a type III or IV b finding in the ultrasound examination were assessed using a computed tomography (CT) coronary angiogram. Additional 10 asymptomatic subjects were examined independently to undergo further cardiac examinations.ResultsIn the final analysis only five patients had entirely smooth coronary arteries, six had coronary sclerosis, eight had a 30% stenosis, one had a 30-50% stenosis and 23 patients had a stenosis ≥ 50%; and in extreme case, a left main coronary artery stenosis with three-vessel disease.ConclusionsAsymptomatic subjects with advanced atherosclerosis of the carotid artery (type III and type IV b findings) had a high risk for coronary heart disease (CHD). Early treatment of the disease improves the patient's prognosis. A screening consisting in the combination of TPA measurement and determining the maximum plaque thickness is recommended.

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

We tested a novel 3-D matrix transducer with respect to inter-scan reproducibility of carotid maximum plaque thickness (MPT) and volume measurements. To improve reproducibility while focusing on the largest plaque/most diseased part of the carotid artery, we introduced a new partial plaque volume (PPV) measure centered on MPT. Total plaque volume (TPV), PPV from a 10-mm segment and MPT were measured using dedicated semi-automated software on 38 plaques from 26 patients. Inter-scan reproducibility was assessed using the t-test, Bland–Altman plots and Pearson's correlation coefficient. There was a mean difference of 0.01 mm in MPT (limits of agreement: −0.45 to 0.42 mm, Pearson's correlation coefficient: 0.96). Both volume measurements exhibited high reproducibility, with PPV being superior (limits of agreement: −35.3 mm3 to 33.5 mm3, Pearson's correlation coefficient: 0.96) to TPV (limits of agreement: −88.2 to 61.5 mm3, Pearson's correlation coefficient: 0.91). The good reproducibility revealed by the present results encourages future studies on establishing plaque quantification as part of cardiovascular risk assessment and for follow-up of disease progression over time.

Carotid plaque thickness and carotid plaque burden predict future cardiovascular events in asymptomatic adult Americans.

Prediction of cardiovascular events improves using imaging, i.e. coronary calcium score and ultrasound assessment of carotid plaque. This study analysed the predictive value of two ultrasound measures of carotid plaque size: carotid plaque thickness and carotid and intima-media thickness (IMT). A total of 6102 asymptomatic persons underwent assessment of conventional risk factors and imaging by carotid ultrasound. Carotid plaque burden (cPB) and maximum carotid plaque thickness (cPTmax) were measured from 'cross-sectional sweep' video acquisition of the carotid artery. IMT was measured from distal common carotid artery images. All participants were followed up for ∼3 years, and major cardiovascular events (MACE) were collected and adjudicated. All data were available for 5808 participants, in whom 216 first MACE events were observed. Increasing both cPB and cPTmax were associated with increasing the risk of future MACE when compared with participants without carotid atherosclerosis. Fully adjusted for risk factors, hazard ratios for cPTmax were 1.96 [95% confidence interval (CI) 0.91-4.25, P = 0.015] for primary MACE and 3.13 (95% CI 1.80-5.51, P < 0.001) for secondary MACE, similar to that of cPB. IMT did not improve risk prediction significantly. Non-categorical net reclassification index (NRI) for cPTmax was 0.178 (95% CI 0.027-0.299, P = 0.032) for primary MACE and 0.173 (95% CI 0.109-0.243, P < 0.001) for secondary MACE, which is almost similar to cPB. IMT assessment did not result in significant NRI. The simpler cPTmax predicted cardiovascular events similarly to the more comprehensive cPB, whereas IMT did not. Awaiting true 3D ultrasound technology cPTmax may be a simple useful measure for prediction of future ASCVD.

Relation between quantitative coronary CTA and myocardial ischemia by adenosine stress myocardial CT perfusion

BackgroundCoronary-computed tomography angiography (CTA) has limited accuracy to predict myocardial ischemia. Besides luminal area stenosis, other coronary plaque morphology and composition parameters may help to assess ischemia. With the integration of coronary CTA and adenosine stress CT myocardial perfusion (CTP), reliable information regarding coronary anatomy and function can be derived in one procedure. This analysis aimed to investigate the association between coronary stenosis severity, plaque composition and morphology and the presence of ischemia measured with adenosine stress myocardial CTP. Methods and Results84 patients (age, 62 ± 10 years; 48% men) who underwent sequential coronary CTA and adenosine stress myocardial CT perfusion were analyzed. Automated quantification was performed in all coronary lesions (quantitative CTA). Downstream myocardial ischemia was assessed by visual analysis of the rest and stress CTP images and defined as a summed difference score of ≥1. One or more coronary plaques were present in 146 coronary arteries of which 31 (21%) were ischemia-related. Of the lesions with a stenosis percentage <50%, 50%-70%, and >70%, respectively, 9% (6/67), 18% (9/51), and 57% (16/28) demonstrated downstream ischemia. Furthermore, mean plaque burden, plaque volume, lesion length, maximal plaque thickness, and dense calcium volume were significantly higher in ischemia-related lesions, but only stenosis severity (%) (OR 1.06; 95% CI 1.02-1.10; P = .006) and lesion length (mm) (OR 1.26; 95% CI 1.02-1.55; P = .029) were independent correlates. ConclusionsIncreasing stenosis percentage by quantitative CTA is positively correlated to myocardial ischemia measured with adenosine stress myocardial CTP. However, stenosis percentage remains a moderate determinant. Lumen area stenosis and lesion length were independently associated with ischemia, adjusted for coronary plaque volume, mean plaque burden, maximal lesion thickness, and dense calcium volume.

Quantitative evaluation of atherosclerotic plaques and intraplaque neovascularization using contrast-enhanced ultrasound after treatment with atorvastatin in rabbits

IntroductionThis study is supposed to investigate the value of contrast-enhanced ultrasound (CEUS) in quantitative evaluation of atherosclerotic plaques and intraplaque neovascularization after treatment with atorvastatin (ATV) in rabbits. Material and methodsForty-five New Zealand white rabbits were enrolled to construct the rabbit model of AS. All rabbits were assigned into the control, AS group and ATV groups (n=15 individually). The AS plaque formation and relative parameters were observed and calculated by CEUS respectively. Total cholesterol (TC), triglyceride (TG), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were measured. Serum levels of matrix metalloproteinase-3 and 9 (MMP-3/9) and high-sensitivity C-reactive protein (hs-CRP) were examined by ELISA. The histological changes plaques, maximal plaque thickness (MPT), plaque area (PA) and corrected plaque area (PA/CVA) were evaluated by HE staining. Immunohistochemistry (IHC) was used to measure the positive protein expressions of VEGF, FVIII-Rag, MMP-3, CD40L and F8. The correlation between CEUS parameters with ELISA and IHC was analyzed by the Spearman correlation analysis. ResultsAt the 8th week, no plaque and new blood vessel were observed in the control group. The ATV group showed more plaques and new blood vessels, and lower IMT, plaque thickness and area than the AS group. The PI and RI were significantly increased in the AS and ATV groups compared to the control group. PI, RI. Plaque EI and its ratio in plaque and arterial lumen of the ATV group were lower than those in the AS group. Compared with the control group, the AS and ATV groups had higher serum levels of TC, TG, LDL, MMP-3, MMP-9 and hs-CRP, and higher AI. However, compared with AS group, serum levels of TC, TG, LDL and AI fell in ATV group. In comparison of the AS group, serum levels of MMP-3, MMP-9 and hs-CRP, MPT, PA and PA/CVA, and the positive expressions of VEGF, FVIII-Rag, MMP-3, CD40L and F8 were significantly reduced in the ATV group. The AS and ATV groups showed a positive correlation of EI in the plaque and its ratio in the plaque and arterial lumen with F8 protein expression, MMP-3 and MMP-9. ConclusionIn conclusion, our results indicated that ATV stabilizes atherosclerotic plaques and reduces intraplaque neovascularization in a rabbit model with AS, which can be characterized using CEUS.

Post-processing reproducibility of the structural characteristics of the common carotid artery in a Flemish population

IntroductionCommon carotid artery (CCA) intima-media thickness (IMT), lumen diameter, and maximum plaque thickness were assessed on ultrasound images. The objective of the study was to evaluate the intra- and inter-reader reproducibility of the measurements following a standardised protocol. MethodsTwo readers performed the off-line measurements on B-mode ultrasound images of the distal CCA, in a randomly selected subset (n = 60) from a Flemish population cohort (FLEMENGHO). We calculated the coefficient of variation, the interclass correlation coefficient (ICC) and reproducibility according to the Bland–Altman method. ResultsThe intra-reader bias for the measurements of left and right side CCA IMT were −0.003 ± 0.04 mm (p = 0.55) and 0.01 ± 0.04 mm (p = 0.03), respectively. The intra-reader bias of the lumen diameter was −0.04 ± 0.25 mm (p = 0.27) for the left and 0.02 ± 0.22 mm (p = 0.45) for the right side. The measurements for the maximum plaque thickness showed no intra-reader differences with bias 0.07 ± 0.2 mm (p = 0.26) for the left and −0.03 ± 0.2 mm (p = 0.55) for the right side. The inter-reader analysis showed good reproducibility for the left and right side CCA IMT with bias 0.004 ± 0.06 mm (p = 0.57) and −0.008 ± 0.05 mm (p = 0.19), respectively, but the lumen diameter measurements showed inter-reader differences, with bias 0.17 ± 0.27 mm (p < 0.0001) for the left and 0.10 ± 0.21 mm (p = 0.0006) for the right side. The inter-reader bias for the maximum plaque thickness were 0.07 ± 0.2 mm (p = 0.21) and −0.1 ± 0.4 mm (p = 0.26) for the left and right side, respectively. ConclusionThe results demonstrated a reliable reproducibility of carotid wall structural measurements, allowing for an adequate further analysis of the entire population cohort.

Association Between Carotid Atherosclerotic Plaque Calcification and Intraplaque Hemorrhage: A Magnetic Resonance Imaging Study.

Carotid intraplaque hemorrhage (IPH) is associated with cardiovascular events. Calcification, which frequently accompanies IPH, may play a role in IPH occurrence. In this study, we aimed to investigate the associations between calcification characteristics and IPH in carotid plaques. One hundred seventeen patients with cerebrovascular symptoms and carotid plaques detected by ultrasound were recruited and underwent multicontrast magnetic resonance imaging. Advanced carotid plaques with composition measured by magnetic resonance imaging were included in the analysis. Carotid calcifications were divided into the following categories: surface, mixed, and deep calcification. They were also classified into single and multiple calcifications according to quantity. Logistic regression models utilizing generalized estimating equations were performed to evaluate the relationship between calcification and IPH. Of 117 subjects, 85 with 142 plaques were included in the final analysis, whereas 32 were excluded because of lack of plaque compositions. Of the 142 plaques, 40 (28.2%) had IPH. Plaques with IPH showed greater prevalence of calcification than those without (87.5% versus 55.9%; P=0.005). After adjusting for age, low-density lipoprotein, maximum wall thickness, and maximum soft plaque thickness, multiple calcifications (odd ratio, 10.1; 95% confidence interval, 3.3-30.4), surface calcification (odd ratio, 29.4; 95% confidence interval, 4.1-210.8), and mixed calcifications (odd ratio, 27.9; 95% confidence interval, 7.3-107.1) were found to be strongly associated with the presence of IPH (all P<0.05). Surface calcification and multiple calcifications in carotid atherosclerotic plaques are independently associated with the presence of IPH, suggesting that both quantity and location of calcification may play important roles in the occurrence of IPH. These findings may provide novel insights for understanding mechanisms of IPH.

Systemic Atherosclerosis Relate to Brain Arterial Diameters: The Northern Manhattan Study

Background: Phenotypic expressions of arterial disease vary throughout the body and it is not clear to what extent systemic atherosclerosis influences brain arterial remodeling. We aim to test the hypothesis that systemic atherosclerosis is associated with brain arterial diameters. Methods: Stroke-free participants in the Northern Manhattan Study MRI subcohort in whom carotid ultrasound, transthoracic echocardiogram, and brain MRA (n = 482) were performed were included in this analysis. Brain arterial diameters were measured with semi-automated software as continuous and categorical variables. Ultrasound and echocardiography provided the sum of maximum carotid plaque thickness (sMCPT) and aortic plaque thickness. Associations between brain arterial diameters and aortic and carotid plaque thickness were assessed with semi-parametric generalized additive models. Results: Aortic plaque thickness was inversely and linearly associated with brain arterial diameters (B per mm = -0.073 ± 0.034, p = 0.03), while sMCPT was associated nonlinearly in a u-shaped curve with anterior brain arterial diameters (spline regression χ² = 9.19, p = 0.02). Coexisting carotid and aortic atherosclerosis were more prevalent in participants with small luminal diameters (40%) compared with participants with average (30%) or with large (13%) luminal diameters, while carotid atherosclerosis without aortic atherosclerosis was more prevalent among participants with large luminal diameters (31%) compared with those with average (12%) or small luminal diameters (2%, p < 0.001 for both trends). Conclusions: We confirmed the hypothesis that systemic arterial disease is associated with brain arterial diameters. Gaining knowledge about the origin of these phenotypic expressions of atherosclerosis in the human body may lead to a better understanding of the cerebrovascular consequences of the systemic arterial disease.

Early Diagnosis and Treatment of Coronary Heart Disease in Symptomatic Subjects With Advanced Vascular Atherosclerosis of the Carotid Artery (Type III and IV b Findings Using Ultrasound).

BackgroundA study was conducted as to whether the early diagnosis of coronary heart disease (CHD) in symptomatic patients with advanced atherosclerosis of the carotid artery was more successful using ultrasound technology than exercise electrocardiography (ECG).MethodsWithin the scope of an occupational screening program using subjects from diverse employment sectors, people were given the opportunity to determine their risk of heart attack. During the study, the total plaque area (TPA), the maximum plaque thickness in the carotid artery and the PROCAM scores of 3,513 healthy men and 2,088 healthy women between the ages of 20 and 65 were determined. During the subsequent follow-up study, 36 subjects developed symptoms such as exertional dyspnea, atypical angina pectoris (AP) or typical AP. Four patients displayed no symptoms. The initial cardiac diagnostic testing was conducted on 31 patients using an exercise ECG, four patients were assessed using a coronary angiogram, and five further patients were assessed using a computed tomography (CT) coronary angiogram. An ultrasound examination of the carotid artery of 39 patients revealed a type IV b finding and in one patient, the examination revealed a type III finding.ResultsIn 17 patients, the PROCAM score was < 10%, 13 patients had a score of 10-20% and 10 patients had a score of > 20%. In the final analysis, only two patients had entirely smooth coronary arteries, seven had coronary sclerosis, seven had a 30% stenosis, one had a 30-40% stenosis, one had a 40% stenosis, and 22 patients had a stenosis ≥ 50%, and in extreme cases, a left main coronary artery stenosis with three-vessel disease was shown. The exercise ECG only achieved a true positive result in four patients, and in 21 patients, the result was false negative.ConclusionsSymptomatic patients with advanced atherosclerosis of the carotid artery (type III and type IV b findings) had a high risk for CHD. The diagnosis of CHD is better achieved by using carotid duplex than with an exercise ECG. Early treatment of the disease improves the patient’s prognosis.

Association between high cystatin C levels and carotid atherosclerosis.

AIMTo investigate the association between carotid atherosclerosis and cystatin C (CysC) and to determine the optimal CysC cut-off value.METHODSOne hundred twenty-eight subjects were included in this study. Atherosclerosis was defined as a maximum carotid plaque thickness (MCPT) of greater than 2 mm. A receiver operating characteristic curve analysis was used to determine the diagnostic value of serum CysC for atherosclerosis. The subjects were divided into two groups according to the CysC cut-off value. We screened for diabetes, hypertension, dyslipidemia, smoking status, alcohol consumption, and exercise behavior. The association between atherosclerosis and CysC levels was assessed using multivariate analysis.RESULTSThe subjects were then divided into two groups according to the CysC cut-off value (0.73 mg/L). The median age of the high CysC group was 72 years (85% males), whereas that of the low CysC group was 61 years (63% males). The CysC levels were significantly correlated with Cr and estimated glomerular filtration rate (eGFR) values. Body-mass index, visceral fat area, hypertension, diabetes mellitus, and MCPT were significantly higher in the high CysC group than in the low CysC group. Furthermore, the eGFR was significantly lower in the high CysC group. Regarding lifestyle habits, only the exercise level was lower in the high CysC group than in the low CysC group. Multivariate analysis, adjusted for age and sex, revealed that high CysC levels were significantly associated with an MCPT of ≥ 2 mm (odds ratio: 2.92; 95%CI: 1.13-7.99).CONCLUSIONHigher CysC levels were associated with an MCPT of ≥ 2 mm. The CysC cut-off value of 0.73 mg/L appears to aid in the diagnosis of atherosclerosis.

Pycnogenol® and Centella asiatica to prevent asymptomatic atherosclerosis progression in clinical events.

The aim of this study was to evaluate the effect of the nutritional supplements Pycnogenol® and Centella asiatica (CA) on atherosclerosis progression in low-risk, asymptomatic subjects with carotid or femoral stenosing plaques. The study included subjects aged 45-60 with stenosing atherosclerotic plaques (50-60%) in at least one carotid or common femoral bifurcation. Subjects were allocated into 3 groups. In Group 1 (controls), management was based on education, exercise, diet and lifestyle changes. This same management plan was used in the other two groups: Group 2 used Pycnogenol® (100 mg/day), while Group 3 used Pycnogenol® 100 mg/day plus CA (100 mg/day). The follow-up lasted 4 years. Plaque progression was assessed using the ultrasonic arterial score based on arterial wall morphology, considering plaque characteristics and the number of subjects that had cardiovascular events. Oxidative stress was also measured. Of the 413 individuals that were admitted, 391 individuals completed 4 years. Group distribution was comparable. The rate of progression of ultrasound arterial score was significantly lower in the two supplement groups (P<0.05) in comparison with controls suggesting a beneficial effect of Pycnogenol® with a significant difference in favor of the combination (P<0.05). There was a reduction in plaques progression in the supplement groups with the best effects obtained by the combination, considering maximum plaque thickness and length and echogenicity (grey scale median) (P<0.05). Plaques became generally dense (more echogenic) achieving a mixed echogenicity. The occurrence of anginal events was less than 3% in the two supplement groups (in comparison with 6.25% in controls) (P<0.05) with the best results obtained by the combination (P<0.05). The occurrence in myocardial infarctions was significantly lower for the combination (P<0.05). Minor transient ischemic attacks were also less frequent with the supplements with the best results observed with the combination (P<0.05). Events in controls - requiring hospital admission - were globally seen in 16.4% of subjects (minor events) in comparison with 8.9% of subjects using Pycnogenol® and only 3.3% of patients using the combination. At 4 years, oxidative stress in the supplement groups was lower than in controls (P<0.05, with no significant difference between groups 2 and 3). Pycnogenol® and the combination of Pycnogenol® plus CA reduce the progression of arterial plaques and the progression to clinical stages. The reduction in plaques and clinical progression was associated with a reduction in oxidative stress. The results justify a larger study to define the efficacy of the combination of Pycnogenol® plus CA as a prophylaxis in preclinical atherosclerosis.

Vitamin D and Vulnerable Carotid Plaque.

MR imaging-detected carotid intraplaque hemorrhage indicates vulnerable plaque with high stroke risk. Angiotensin II stimulates intraplaque hemorrhage in animal models, and the angiotensin system is highly regulated by vitamin D. Our purpose was to determine whether low vitamin D levels predict carotid intraplaque hemorrhage in humans. In this cross-sectional study, 65 patients with carotid disease underwent carotid MR imaging and blood draw. Systemic clinical confounders and local lumen imaging markers were recorded. To determine the association of low vitamin D levels with MR imaging detected intraplaque hemorrhage, we performed multivariable Poisson regression by using generalized estimating equations to account for up to 2 carotid arteries per patient and backward elimination of confounders. MR imaging detected intraplaque hemorrhage volume was also correlated with vitamin D levels and maximum plaque thickness. Thirty-five patients underwent carotid endarterectomy, and histology-detected intraplaque hemorrhage was correlated with vitamin D levels and total plaque area. Low vitamin D levels (<30 ng/mL, prevalence ratio = 2.05, P = .03) were a significant predictor of MR imaging detected intraplaque hemorrhage, along with plaque thickness (prevalence ratio = 1.40, P < .001). MR imaging detected intraplaque hemorrhage volume linearly correlated with plaque thickness (partial r = 0.45, P < .001) and low vitamin D levels (partial r = 0.26, P = .003). Additionally, histology-detected intraplaque hemorrhage area linearly correlated with plaque area (partial r = 0.46, P < .001) and low vitamin D levels (partial r = 0.22, P = .03). The association of intraplaque hemorrhage volume with low vitamin D levels was also higher with ischemic stroke. Low vitamin D levels and plaque thickness predict carotid intraplaque hemorrhage and outperform lumen markers of vulnerable plaque. This research demonstrates a significant link between low vitamin D levels and carotid intraplaque hemorrhage.

Prediction of Carotid Intraplaque Hemorrhage Using Adventitial Calcification and Plaque Thickness on CTA.

Carotid intraplaque hemorrhage is associated with stroke, plaque thickness, stenosis, ulceration, and adventitial inflammation. Conflicting data exist on whether calcification is a marker of plaque instability, and no data exist on adventitial calcification. Our goal was to determine whether adventitial calcification and soft plaque (a rim sign) help predict carotid intraplaque hemorrhage. This was a retrospective cohort study of 96 patients who underwent carotid MRA and CTA within 1 month, from 2009 to 2016. We excluded occlusions (n = 4) and near occlusions (n = 0), leaving 188 carotid arteries. Intraplaque hemorrhage was detected by using MPRAGE. Calcification, adventitial pattern, stenosis, maximum plaque thickness (total, soft, and hard), ulceration, and intraluminal thrombus on CTA were recorded. Atherosclerosis risk factors and medications were recorded. We used mixed-effects multivariable Poisson regression, accounting for 2 vessels per patient. For the final model, backward elimination was used with a threshold of P < .10. Receiver operating characteristic analysis determined intraplaque hemorrhage by using the area under the curve. Our final model included the rim sign (prevalence ratio = 11.9, P < .001) and maximum soft-plaque thickness (prevalence ratio = 1.2, P = .06). This model had excellent intraplaque hemorrhage prediction (area under the curve = 0.94), outperforming the rim sign, maximum soft-plaque thickness, NASCET stenosis, and ulceration (area under the curve = 0.88, 0.86, 0.77, and 0.63, respectively; P < .001). Addition of the rim sign performed better than each marker alone, including maximum soft-plaque thickness (area under the curve = 0.94 versus 0.86, P < .001), NASCET stenosis (area under the curve = 0.90 versus 0.77, P < .001), and ulceration (area under the curve = 0.90 versus 0.63, P < .001). The CTA rim sign of adventitial calcification with internal soft plaque is highly predictive of carotid intraplaque hemorrhage.

Abstract 14184: Patients With Coronary Artery Disease and Bilateral Carotid Inflammation Show Higher One Year Rate of Cardiovascular Events

Background: Inflammation is an essential characteristic of vulnerable atherosclerotic plaque. Although its prognostic value during invasive assessment has been documented, the clinical significance of its routine evaluation is still under dispute. Microwave radiometry (MWR) allows the rapid, in vivo, noninvasive assessment of the internal temperature of carotid arteries, reflecting local inflammation. The aim of the present study was to evaluate the prognostic role of carotid atherosclerotic plaque temperatures in patients with documented coronary artery disease (CAD). Methods: Consecutive patients with significant CAD as documented by coronary angiography were included in the study. All patients underwent evaluation of both carotid arteries by 1) ultrasound and 2) microwave radiometry (MWR). During ultrasound study maximum carotid plaque thickness was assessed in all carotids. Temperature difference (ΔT) by MWR was defined as maximal temperature along the carotid artery minus minimum. ΔT ≥0.90°C was assigned as high ΔT. Major cardiovascular event (MACE) was defined as death, stroke, myocardial infarction or revascularization. All patients were followed-up clinically for one year. Results: In total 192 patients were included in the study. At baseline thirty patients (15.6%) had high ΔT temperatures (≥0.90°C) in both carotid arteries. Max plaque thickness was slightly higher in this group (2.75±1.34 vs 2.27±1.03, p=0.07). MACE was 23.3% in the group with bilateral high ΔT and 4.3% in non-high ΔT group (p&lt;0.001). By multivariate logistic regression analysis, ΔT was an independent predictor for MACE, when adjusted for sex, age contemporary risk factors, number of vessels with significant stenosis and maximum carotid plaque thickness (OR: 6.10, 95% CI 1.56-23.80, p=0.001). In Kaplan-Meier plots patients with bilateral high ΔT showed higher event and mortality rates, compared with patients in non-high ΔT group (log-rank p=0.001 for both comparisons). Conclusion: The presence of bilateral high carotid artery temperatures as assessed by MWR has implications in short term prognosis of patients with CAD. A long term study is warranted to establish the prognostic impact of MWR in this high-risk population.

Abstract 19527: Relation Between Quantitative Coronary Cta and Myocardial Ischemia by Adenosine Stress Ct Myocardial Perfusion

Background: Increasing stenosis severity is related to reduced myocardial blood flow during hyperemia. Stenosis percentage is a moderate predictor for myocardial ischemia. It is known that coronary plaque morphology and composition may improve discrimination. Integration of quantitative coronary CTA (QCT) and adenosine stress CT myocardial perfusion (CTP) provides this information. The aim of this study was to assess the relation between coronary stenosis severity and plaque characteristics by QCT and ischemia diagnosed by CTP. Methods: We evaluated 84 patients who underwent both coronary CTA and adenosine stress CTP. Stenosis percentage and additional plaque characteristics (lesion length, mean plaque burden, plaque volume, remodeling index) were determined. Subsequently, the coronary lesions were related to presence of lesion specific ischemia measured with CTP. Results: Atherosclerosis was present in 146 coronary arteries. 21% (33/146) of the lesions caused downstream ischemia. Stenosis percentage (p&lt;0.001), mean plaque burden (p&lt;0.001), plaque volume (p=0.021), lesion length (p=0.033), maximal plaque thickness (p=0.021), dense calcium volume (p=0.005) were higher in hemodynamically significant lesions. Only 1 (3%) of 37 coronary lesions ≤ 40% stenosis was related to ischemia. Between 41%-60%, 61%-80%, &gt;81%, respectively, 17% (11/61), 34% (11/31) and 59% (10/17) were hemodynamically significant. Conclusion: Increasing stenosis percentage measured by QCT is related to higher prevalence of hemodynamically significant lesions measured with adenosine stress CTP. However, stenosis severity cannot accurately detect ischemic lesions. Coronary plaque volume, mean plaque burden, lesion length, maximal lesion thickness, and dense calcium volume were other characteristics that were related to ischemia, potentially leading to improved discrimination of intermediate to severe stenotic coronary lesions for downstream ischemia.