Effect of contrast enhancement on measurement of carotid artery intimal medial thickness

Macioch, James E.; Katsamakis, C.Dean; Robin, Jason; Liebson, Philip R.; Meyer, Peter; Geohas, Chris; Raichlen, Joel S.; Davidson, Michael; Feinstein, Steven B.

doi:10.1191/1358863x04vm522oa

Cited by 43 publications

(14 citation statements)

References 27 publications

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“…The positive association we show between the difference in near and far wall IMT and CHD events in our statistical model suggests this possibility. A study looking at the difference between near and far wall noted no difference between near and far wall IMT before ultrasound contrast administration but a significant difference after ultrasound contrast 27 . The significance of this finding is not clear.…”

Section: Discussionmentioning

confidence: 99%

Associations of Coronary Heart Disease with Common Carotid Artery Near and Far Wall Intima-Media Thickness: The Multi-Ethnic Study of Atherosclerosis

Polak

Szklo

O’Leary

2015

Journal of the American Society of Echocardiography

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Background Intima-media thickness (IMT) measured on ultrasound images of the common carotid artery (CCA) is associated with cardiovascular risk factors and events. Based on the physics of ultrasound, CCA far wall IMT measurements are favored over near wall measurements but this theoretical advantage is not well studied. Methods We studied 6606 members of the Multi-Ethnic Study of Atherosclerosis (MESA), a longitudinal cohort study (mean age 62.1 years; 52.7% female) who had near wall and far wall CCA IMT measurements. Multivariable linear regression models were used to estimate model goodness-of-fit of Framingham risk factors (FRF) with near wall IMT, far wall IMT, and combined mean IMT. Multivariable Cox proportional hazards models were used to estimate hazard ratios for incident coronary heart disease (CHD) events for each IMT variable. Change in Harrell’s C-statistic was used to compare the incremental value of each IMT variable when added to FRF. Results Mean IMT had the strongest association with risk factors (R2 = 0.31), followed by the near wall (R2 = 0.26) and far wall IMT (R2 = 0.22). Far wall IMT improved the prediction of coronary artery disease events over the FRF (change in C-statistic of 0.012; 95% confidence intervals: 0.006, 0.017; p < 0.001) as did mean IMT (p = 0.004) but near wall IMT did not. Conclusions Far wall CCA IMT showed the strongest association with incident CHD whereas mean IMT had the strongest associations with risk factors. This difference might affect the selection of appropriate IMT variables in different studies.

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Section: Discussionmentioning

confidence: 99%

Associations of Coronary Heart Disease with Common Carotid Artery Near and Far Wall Intima-Media Thickness: The Multi-Ethnic Study of Atherosclerosis

Polak

Szklo

O’Leary

2015

Journal of the American Society of Echocardiography

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“…The CECU imaging protocol was performed using an ultrasound contrast agent, Optison™ (perflutren protein type-A microspheres; GE Health Care, Milwaukee, WI, USA) per our standard protocol. 10 Optison is an FDA-approved ultrasound contrast agent that is used for enhancement of the cardiac chambers during echocardiography. In 2000, The American Society of Echocardiography published a guideline manuscript on the use of ultrasound contrast agents.…”

Section: Patient Enrollment and Ultrasound Examination Methodsmentioning

confidence: 99%

Contrast-enhanced ultrasound imaging of atherosclerotic carotid plaque neovascularization: a new surrogate marker of atherosclerosis?

et al. 2007

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An atherosclerotic plaque requires a nutrient blood supply, which is predominantly derived from arterial vasa vasorum. A variety of factors (environmental and genetic) contribute to the initiation and growth of atherosclerosis within vessel walls. Chemotactic factors, such as tissue ischemic and hypoxic factors, stimulate the release of vascular endothelial growth factor (VEGF) proteins, resulting in vessel wall angiogenesis. These developments often precede the formation of the luminal plaque. In this report, we describe the use of contrast-enhanced carotid ultrasound (CECU) imaging for the detection and quantification of intra-plaque neovascularization. The efficacy of CECU was measured against the neovascular density observed within the tissue specimens obtained at the time of carotid endarterectomy surgery. The objective of this study was to provide a histologic correlation between CECU and carotid artery atherosclerotic plaque neovascularization. Fifteen patients with significant atherosclerotic carotid artery disease received a CECU examination prior to undergoing a carotid endarterectomy (CEA). Two patients received bilateral endarterectomies, resulting in a total of 17 cases. At the time of surgery, carotid plaque samples were surgically removed and stained with specific vascular markers (CD31, CD34, von Willebrand factor, and hemosiderin) designed to identify the presence and degree of neovascularization. The intra-plaque neovascularization recorded on preoperative CECU was correlated with the degree of neovascularization noted in the tissue specimens. The CECU neovascularization was correlated to CD31-stained tissue specimens. This correlation value was 0.68 using Spearman's rank method. When CECU results were correlated with the other histologic markers (CD34, von Willebrand factor, and hemosiderin), a correlation of 0.50 was obtained. In conclusion, contrast-enhanced carotid ultrasound correlated to the presence and degree of intra-plaque neovascularization as determined from histology specimens.

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“…However, accurate measurements, particularly of the near wall, require a high level of technical expertise. Consequently, some authors suggest the administration of contrast media during the examination period (Macioch et al 2004; Martin and Lekaris 2004). …”

Section: Clinical Assessment Of Endothelial Functionmentioning

confidence: 99%

Noninvasive assessment of preclinical atherosclerosis

Lane

Smith²,

Davies³

2006

Vascular Health and Risk Management

100

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Initially considered as a semipermeable barrier separating lumen from vessel wall, the endothelium is now recognised as a complex endocrine organ responsible for a variety of physiological processes vital for vascular homeostasis. These include the regulation of vascular tone, luminal diameter, and blood flow; hemostasis and thrombolysis; platelet and leucocyte vessel-wall interactions; the regulation of vascular permeability; and tissue growth and remodelling. The endothelium modulates arterial stiffness, which precedes overt atherosclerosis and is an independent predictor of cardiovascular events. Unsurprisingly, dysfunction of the endothelium may be considered as an early and potentially reversible step in the process of atherogenesis and numerous methods have been developed to assess endothelial status and large artery stiffness. Methodology includes flow-mediated dilatation of the brachial artery, assessment of coronary flow reserve, carotid intimamedia thickness, pulse wave analysis, pulse wave velocity, and plethysmography. This review outlines the various modalities, indications, and limitations of available methods to assess arterial dysfunction and vascular risk.

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Effect of contrast enhancement on measurement of carotid artery intimal medial thickness

Cited by 43 publications

References 27 publications

Associations of Coronary Heart Disease with Common Carotid Artery Near and Far Wall Intima-Media Thickness: The Multi-Ethnic Study of Atherosclerosis

Associations of Coronary Heart Disease with Common Carotid Artery Near and Far Wall Intima-Media Thickness: The Multi-Ethnic Study of Atherosclerosis

Contrast-enhanced ultrasound imaging of atherosclerotic carotid plaque neovascularization: a new surrogate marker of atherosclerosis?

Noninvasive assessment of preclinical atherosclerosis

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