Diagnostic potential of TSH to HDL cholesterol ratio in vulnerable carotid plaque identification

Abstract

Objective: This study aimed to investigate the predictive value of the thyroid-stimulating hormone to high-density lipoprotein cholesterol ratio (THR) in identifying specific vulnerable carotid artery plaques.

Methods: In this retrospective analysis, we included 76 patients with carotid plaques who met the criteria for admission to Zhejiang Hospital from July 2019 to June 2021. High-resolution magnetic resonance imaging (HRMRI) and the MRI-PlaqueView vascular plaque imaging diagnostic system were utilized to analyze carotid artery images for the identification of specific plaque components, including the lipid core (LC), fibrous cap (FC), and intraplaque hemorrhage (IPH), and recording of the area percentage of LC and IPH, as well as the thickness of FC. Patients were categorized into stable plaque and vulnerable plaque groups based on diagnostic criteria for vulnerable plaques derived from imaging. Plaques were categorized based on meeting one of the following consensus criteria for vulnerability: lipid core area over 40% of total plaque area, fibrous cap thickness less than 65 um, or the presence of intraplaque hemorrhage. Plaques meeting the above criteria were designated as the LC-associated vulnerable plaque group, the IPH-associated group, and the FC-associated group. Multivariate logistic regression was employed to analyze the factors influencing carotid vulnerable plaques and specific vulnerable plaque components. Receiver operating characteristic (ROC) curves were used to assess the predictive value of serological indices for vulnerable carotid plaques.

Results: We found that THR (OR = 1.976; 95% CI = 1.094-3.570; p = 0.024) and TSH (OR = 1.939, 95% CI = 1.122-3.350, p = 0.018) contributed to the formation of vulnerable carotid plaques. THR exhibited an area under the curve (AUC) of 0.704 (95% CI = 0.588-0.803) (p = 0.003), and the AUC for TSH was 0.681 (95% CI = 0.564-0.783) (p = 0.008). THR was identified as an independent predictor of LC-associated vulnerable plaques (OR = 2.117, 95% CI = 1.064-4.212, p = 0.033), yielding an AUC of 0.815. THR also demonstrated diagnostic efficacy for LC-associated vulnerable plaques.

Conclusion: This study substantiated that THR and TSH have predictive value for identifying vulnerable carotid plaques, with THR proving to be a more effective diagnostic indicator than TSH. THR also exhibited predictive value and specificity in the context of LC-associated vulnerable plaques. These findings suggest that THR may be a promising clinical indicator, outperforming TSH in detecting specific vulnerable carotid plaques.

Keywords: carotid vulnerable plaque; component characteristics; high-resolution magnetic resonance imaging; thyroid-stimulating hormone; thyroid-stimulating hormone to high-density lipoprotein cholesterol ratio.

Figure 1

Carotid MRI semi-automatic segmentation of plaque composition. (A–D) The MRI-PlqueView vascular plaque imaging Diagnostic System was used to delineate the plaque component regions on T1-weighted imaging (T1WI), T2-weighted imaging (T2WI) and time-of-flight (TOF) sequences. Different colors indicated different plaque components. Yellow represents lipids, white represents calcification, green represents fibrous caps, dark red represents intraplastic hemorrhage, positive red represents lumen, and blue represents wall. (E,F) The MRI-PlaqueView vascular plaque imaging Diagnostic System was used to automatically recompose the cross section and 3D blood vessel images.

Figure 2

ROC of THR and TSH in diagnosing vulnerable plaques. Using vulnerable plaques as reference criteria, the AUC values of THR and TSH for predicting vulnerable plaques were 0.704 and 0.681, respectively (p < 0.05). ROC, receiver operating characteristic; THR, thyroid-stimulating hormone and high-density lipoprotein cholesterol ratio; TSH, thyrotropin; AUC, area under the curve.

Figure 3

ROC for THR diagnosis of LC-associated vulnerable plaques. With LC area >40% as the reference standard for vulnerable plaques, the AUC value of THR for predicting LC-associated vulnerable plaques were 0.815 (p < 0.001). ROC, receiver operating characteristic; THR, thyroid-stimulating hormone and high-density lipoprotein cholesterol ratio; LC, lipid core; AUC, area under the curve.