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. 2022 May 24;79(20):1969-1982.
doi: 10.1016/j.jacc.2022.03.352.

Arterial Ultrasound Testing to Predict Atherosclerotic Cardiovascular Events

Andrew N Nicolaides  1 , Andrie G Panayiotou  2 , Maura Griffin  3 , Theodosis Tyllis  4 , Dawn Bond  3 , Niki Georgiou  5 , Efthyvoulos Kyriacou  6 , Costantinos Avraamides  7 , Richard M Martin  8
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Free article

Arterial Ultrasound Testing to Predict Atherosclerotic Cardiovascular Events

Andrew N Nicolaides et al. J Am Coll Cardiol. .
Free article

Abstract

Background: Studies have indicated that the presence and size of subclinical atherosclerotic plaques improve the prediction of atherosclerotic cardiovascular events (ASCVE) over and above that provided by conventional risk factors alone. However, the relative contribution of different ultrasonographic measurements and sites of measurements on the 10-year ASCVD risk is largely unknown.

Objectives: Our aims were to determine the relative performance of carotid intima-media thickness, plaque thickness, and plaque area in 10-year ASCVD prediction when added to conventional risk factors as well as whether the vascular territory of these measurements, carotid or common femoral bifurcation, and the number of bifurcations with plaque (NBP) influence prediction.

Methods: We enrolled 985 adults (mean age: 58.1 ± 10.2 years) free of atherosclerotic cardiovascular disease. Conventional risk factors were recorded, and both carotid and common femoral bifurcations were scanned with ultrasonography. The primary endpoint was a composite of first-time fatal or nonfatal ASCVE.

Results: Over a mean ± SD follow-up of 13.2 ± 3.7 years, ASCVE occurred in 154 (15.6%) participants. By adding different plaque measurements to conventional risk factors in a Cox model, net reclassification improvement was 10.4% with maximum intima-media thickness, 9.5% with carotid plaque thickness, and 14.2% with carotid plaque area. It increased to 16.1%, 16.6%, and 16.6% (P < 0.0001) by adding measurements from 4 bifurcations: NBP, total plaque thickness, and total plaque area, respectively.

Conclusions: NBP, total plaque thickness, or total plaque area from both the carotid and common femoral bifurcations provides a better prediction of future ASCVE than measurements from a single site. The results need to be validated in an independent cohort.

Keywords: carotid plaque; common femoral plaque; subclinical atherosclerosis; total plaque area; total plaque thickness; ultrasound.

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Conflict of interest statement

Funding Support and Author Disclosures This work was supported in part by a grant (41/50ΠE-2002) from the Cyprus Research Promotion Foundation, Nicosia, Cyprus; a grant from the Ministry of Health, Government of Cyprus, Nicosia, Cyprus; and a grant from the AG Leventis Foundation, London, United Kingdom. Dr Martin is a National Institute for Health and Care Research (NIHR) Senior Investigator. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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