Clinical Factors Associated With High-Risk Carotid Plaque Features as Assessed by Magnetic Resonance Imaging in Patients With Established Vascular Disease (from the AIM-HIGH Study)

Zhao, Xue Qiao; Hatsukami, Thomas S.; Hippe, Daniel S.; Sun, Jie; Balu, Niranjan; Isquith, Daniel; Crouse, John R.; Anderson, Todd J.; Huston, John; Polissar, Nayak L.; O’Brien, Kevin D.; Yuan, Chun

doi:10.1016/j.amjcard.2014.08.001

Cited by 38 publications

(33 citation statements)

References 27 publications

(24 reference statements)

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“…Mean age was 61.2±8.6 years and 82% were males. Detailed clinical characteristics of the MRI cohort and their association with carotid plaque characteristics have been reported in a previous publication (22). …”

Section: Resultsmentioning

confidence: 99%

“…metal implants, claustrophobia, glomerular infiltration rate < 60 ml/min/1.73 m 2 ) and were willing to participate. Of 447 available AIM-HIGH subjects at 21 clinical sites, 232 met inclusion criteria of the MRI sub-study and underwent MRI at 10 imaging sites (22). Institutional review board approval was obtained at all participating sites.…”

Section: Methodsmentioning

confidence: 99%

“…To comprehensively characterize carotid plaques, a multicontrast protocol was standardized and implemented on both GE and Philips platforms, including 3D time-of-flight, T1, T2, proton-density, and magnetization-prepared rapid acquisition gradient-echo (MPRAGE). Detailed parameters and reproducibility of the MRI protocol have been previously reported (22,23). Each sequence acquired a contiguous stack of cross-sectional images centered on the common carotid bifurcation (acquired in-plane resolution: 0.625 × 0.625 mm 2 ; slice thickness: 2 mm).…”

Section: Methodsmentioning

confidence: 99%

“…Inter-scan reproducibility of plaque measurements derived from multicontrast MRI review using CASCADE has been previously reported, with intraclass correlation coefficient ranging from 0.87 to 0.99 for all morphological and compositional measurements (23,25). Furthermore, the previously proposed definitions of high-risk plaques that include heterogeneous plaque types were also studied (7,22,26): the American Heart Association (AHA) Type VI lesions include plaques with surface disruption (i.e. cap rupture, ulceration, and calcified nodule), IPH, or mural thrombus; the Carotid Atherosclerosis Score Type 4 lesions (CAS-4) include American Heart Association Type VI lesions as well as those with maximum % LRNC area (LRNC area / wall area) >40%.…”

Section: Methodsmentioning

confidence: 99%

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Carotid Plaque Lipid Content and Fibrous Cap Status Predict Systemic CV Outcomes

Sun

Zhao

Balu

et al. 2017

JACC: Cardiovascular Imaging

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Objectives We sought to investigate whether and what carotid plaque characteristics predict systemic cardiovascular outcomes in patients with clinically established atherosclerotic disease. Background Advancements in atherosclerosis imaging have allowed assessment of various plaque characteristics, some of which are more directly linked to the pathogenesis of acute cardiovascular events compared to plaque burden. Methods As part of an event-driven clinical trial (AIM-HIGH), subjects with clinically established atherosclerotic disease underwent multicontrast carotid MRI to detect plaque tissue composition and high-risk features. Prospective associations between MRI measurements and the AIM-HIGH primary endpoint (fatal and non-fatal myocardial infarction, ischemic stroke, hospitalization for acute coronary syndrome, and symptom-driven revascularization) were analyzed using Cox proportional hazard models. Results Of 232 subjects recruited, 214 (92.2%) with diagnostic image quality constituted the study population (mean age: 61±9 years; males: 82%; statin use: 94%). During a median follow-up of 35.1 months, 18 (8.4%) subjects reached the AIM-HIGH endpoint. High lipid content (hazard ratio per one-standard-deviation increase in % lipid core volume: 1.57, p=0.002) and thin/ruptured fibrous cap (hazard ratio: 4.31, p=0.003) in carotid plaques were strongly associated with the AIM-HIGH endpoint. Intraplaque hemorrhage had a low prevalence (8%) and was marginally associated with the AIM-HIGH endpoint (hazard ratio: 3.00, p=0.053). High calcification content (hazard ratio per one-standard-deviation increase in % calcification volume: 0.66, p=0.20), plaque burden metrics, and clinical risk factors were not significantly associated with the AIM-HIGH endpoint. The associations between carotid plaque characteristics and the AIM-HIGH endpoint changed little after adjusting for clinical risk factors, plaque burden, or AIM-HIGH randomized treatment assignment. Conclusions Among patients with clinically established atherosclerotic disease, carotid plaque lipid content and fibrous cap status were strongly associated with systemic cardiovascular outcomes. Markers of carotid plaque vulnerability may serve as novel surrogate markers for systemic atherothrombotic risk.

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Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Carotid Plaque Lipid Content and Fibrous Cap Status Predict Systemic CV Outcomes

Sun

Zhao

Balu

et al. 2017

JACC: Cardiovascular Imaging

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“…In addition, IPH has been found at higher prevalence in males and in higher age groups. 13 With these findings in mind, the goal of this study was to determine a predictive model of IPH using available imaging and clinical markers.…”

Section: Introductionmentioning

confidence: 99%

Optimal Prediction of Carotid Intraplaque Hemorrhage Using Clinical and Lumen Imaging Markers

McLaughlin

Hinckley

Treiman

et al. 2015

AJNR Am J Neuroradiol

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Purpose MRI detects intraplaque hemorrhage (IPH) with high accuracy using the magnetization-prepared rapid acquisition gradient echo (MPRAGE) sequence. Still, MRI is not readily available for all patients, and many receive CTA instead. Our goal was to determine essential clinical and lumen imaging predictors of IPH as indicators of its presence and clues to its pathogenesis. Methods In this retrospective cross sectional study, patients undergoing stroke workup with MRI/MRA underwent carotid IPH imaging. A total of 726 carotid plaques were analyzed, excluding vessels with non-carotid stroke sources (420), occlusions (7), or near-occlusions (3). Potential carotid imaging predictors of IPH included percent diameter and mm stenosis, plaque thickness, ulceration, and intraluminal thrombus. Clinical predictors were recorded and a multivariable logistic regression model was fitted. Backward-elimination was used to determine essential IPH predictors with a threshold two-sided p<.10. Receiver operating characteristic (ROC) analysis was also performed. Results Predictors of carotid IPH included plaque thickness (odds ratio, OR=2.20, p<.001), mm stenosis (OR=0.46, p<.001), ulceration (OR=4.25, p=.020), age (OR=1.11, p=.001) and male sex (OR=3.23, p=.077). The final model discriminatory value was excellent (area under the curve, AUC=0.932). This was significantly higher than models using only plaque thickness (AUC=0.881), mm stenosis (AUC=0.830) or ulceration (AUC=0.715) p<.001. Conclusions Optimal discrimination of carotid IPH requires information on plaque thickness, mm stenosis, ulceration, age and male sex. These factors predict IPH with high discriminatory power, and may provide clues to the pathogenesis of IPH. This model could be used to predict the presence of IPH when MRI is contraindicated.

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Quantitative Magnetic Resonance Imaging Assessment of the Relationships Between Fat Fraction and R2* Inside Carotid Plaques, and Circulating Lipoproteins

Good

Ziegler

Warntjes

et al. 2021

Magnetic Resonance Imaging

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Background: Lipid-rich necrotic core (LRNC) and intraplaque hemorrhage (IPH) are morphological features of high-risk atherosclerotic plaques. However, their relationship to circulating lipoproteins is unclear.Purpose: To study associations between changes in lipoproteins vs. changes in LRNC (represented by fat fraction [FF]) and IPH (represented by R2*). Study Type: Prospective. Subjects: Fifty-two patients with carotid plaques, 33 males (63.5%), mean age 72 (AE5). Field Strength/Sequence: Four-point fast gradient Dixon magnetic resonance imaging (MRI) was used to quantify FF and R2* (to measure IPH) inside plaques and in vessel wall. Turbo-spin echo was used for T 1 weighted sequences to guide manual segmentation. Assessment: Carotid MRI and serum lipid levels were assessed at baseline and at 1-year follow-up. For patients, lipidlowering therapy was customized to reduce low-density lipoprotein (LDL) levels below 1.8 mmol/L. Segmentation was performed with one set of regions of interest for the plaque and one for the vessel wall at the location of the plaque. Thereby MRI data for FF, R2*, and volumes in plaque-and vessel-wall segmentations could be obtained from baseline and followup, as well as changes over the study year. Statistical Tests: Pearson correlation coefficient for correlations. Paired samples t-test for changes over time. Significance at P < 0.05, 95% confidence interval. Results: LDL decreased significantly (2.19-1.88 mmol/L, Z À 2.9), without correlation to changes in plaque composition, nor to the significant reduction in vessel-wall volume (À106.3 mm 3 ). Plaque composition remained unchanged, FF +8.5% (P = 0.366) and R2* +3.5% (P = 0.304). Compared to plaque segmentations, R2* was significantly lower in the vessel-wall segmentations both at baseline (À9.3%) and at follow-up (À9.1%). Data Conclusion:The absence of correlations between changes in lipoproteins and changes in plaque composition indicates more complex relationships between these parameters than previously anticipated. The significant differences in both R2* and volume dynamics comparing plaque segmentations and vessel-wall segmentations suggest differences in their pathobiology of atherosclerosis.

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Clinical Factors Associated With High-Risk Carotid Plaque Features as Assessed by Magnetic Resonance Imaging in Patients With Established Vascular Disease (from the AIM-HIGH Study)

Cited by 38 publications

References 27 publications

Carotid Plaque Lipid Content and Fibrous Cap Status Predict Systemic CV Outcomes

Carotid Plaque Lipid Content and Fibrous Cap Status Predict Systemic CV Outcomes

Optimal Prediction of Carotid Intraplaque Hemorrhage Using Clinical and Lumen Imaging Markers

Quantitative Magnetic Resonance Imaging Assessment of the Relationships Between Fat Fraction and R2* Inside Carotid Plaques, and Circulating Lipoproteins

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