One, two and three-dimensional ultrasound measurements of carotid atherosclerosis before and after cardiac rehabilitation: preliminary results of a randomized controlled trial
Abstract:BackgroundIt is still not known how patients who are post-transient ischemic attack (TIA) or post-stroke might benefit from prospectively planned comprehensive cardiac rehabilitation (CCR). In this pilot evaluation of a larger ongoing randomized-controlled-trial, we evaluated ultrasound (US) measurements of carotid atherosclerosis in subjects following TIA or mild non-disabling stroke and their relationship with risk factors before and after 6-months of CCR.MethodsCarotid ultrasound (US) measurements of one-di… Show more
“…Ultrasound imaging is a cost-effective measurement tool for measuring the area and volume of carotid plaques [27]. Recent advances in technology allow for accurate tissue characterization of elements present in atherosclerotic plaques.…”
Section: Stages Of Plaque and Ultrasound Vascular Tissue Characteristicsmentioning
Cardiovascular diseases (including stroke and heart attack) are identified as the leading cause of death in today's world. However, very little is understood about the arterial mechanics of plaque buildup, arterial fibrous cap rupture, and the role of abnormalities of the vasa vasorum. Recently, ultrasonic echogenicity characteristics and morphological characterization of carotid plaque types have been shown to have clinical utility in classification of stroke risks. Furthermore, this characterization supports aggressive and intensive medical therapy as well as procedures, including endarterectomy and stenting. This is the first state-of-the-art review to provide a comprehensive understanding of the field of ultrasonic vascular morphology tissue characterization. This paper presents fundamental and advanced ultrasonic tissue characterization and feature extraction methods for analyzing plaque. Additionally, the paper shows how the risk stratification is achieved using machine learning paradigms. More advanced methods need to be developed which can segment the carotid artery walls into multiple regions such as the bulb region and areas both proximal and distal to the bulb. Furthermore, multimodality imaging is needed for validation of such advanced methods for stroke and cardiovascular risk stratification.
“…Ultrasound imaging is a cost-effective measurement tool for measuring the area and volume of carotid plaques [27]. Recent advances in technology allow for accurate tissue characterization of elements present in atherosclerotic plaques.…”
Section: Stages Of Plaque and Ultrasound Vascular Tissue Characteristicsmentioning
Cardiovascular diseases (including stroke and heart attack) are identified as the leading cause of death in today's world. However, very little is understood about the arterial mechanics of plaque buildup, arterial fibrous cap rupture, and the role of abnormalities of the vasa vasorum. Recently, ultrasonic echogenicity characteristics and morphological characterization of carotid plaque types have been shown to have clinical utility in classification of stroke risks. Furthermore, this characterization supports aggressive and intensive medical therapy as well as procedures, including endarterectomy and stenting. This is the first state-of-the-art review to provide a comprehensive understanding of the field of ultrasonic vascular morphology tissue characterization. This paper presents fundamental and advanced ultrasonic tissue characterization and feature extraction methods for analyzing plaque. Additionally, the paper shows how the risk stratification is achieved using machine learning paradigms. More advanced methods need to be developed which can segment the carotid artery walls into multiple regions such as the bulb region and areas both proximal and distal to the bulb. Furthermore, multimodality imaging is needed for validation of such advanced methods for stroke and cardiovascular risk stratification.
“…Others use 3D imaging of atherosclerotic plaque [28,29], but the clinical use is limited by costs, calcified plaque, vendor dependence (Philips iU22 ultrasound system), limited field of view (imaging length of 3.8 cm with the potential to miss significant amounts of plaque) and need for specialised centres to quantify the total plaque volume [28]. Further, the correlation coefficients for 2D-TPA and 3D plaque imaging are good, whereas the correlation coefficients for carotid intima-media thickness and 3D plaque imaging in carotid arteries are very poor [30].…”
Section: The Validity Of Carotid Ultrasound Imaging For Cardiovascular Risk Predictionmentioning
OBJECTIVE: About 50% of acute coronary syndromes occur in patients classified as being at low coronary risk. We aimed to assess the potential preventive benefit of carotid plaque imaging with ultrasound. METHODS: We assessed the prevalence of "old" arteries (vascular age ≥70 years; VA70) in 3248 healthy subjects aged 40-65 years from the Swiss region of Olten and the German region of Koblenz. We compared sensitivity, specificity and discriminatory performance of SCORE, PROCAM and AGLA coronary risk calculators to detect VA70 for various decision thresholds and performed reclassification and cost-efficiency analysis.RESULTS: VA70 was found in one out of eight subjects. Sensitivity for VA70 was 6% at the 10% AGLA threshold in women and 30% in men in the Olten area, which was confirmed for the Koblenz area with PROCAM (sensitivity 8% in women, 56% in men). Results were similar for SCORE. The discriminatory performance ranged between 0.69 and 0.82. Reclassification from low risk to a higher risk category occurred in 17-35% of patients. Analysis showed that carotid imaging for CHF 100 per person was highly cost efficient.CONCLUSIONS: In subjects aged 40-65 years, the prevalence of old arteries is one out of eight and the detection rate of AGLA and SCORE is lower in women (6% for PROCAM) than for men (30%) at the 10% threshold. Carotid imaging may be used to reclassify subjects from low to intermediate or high cardiovascular risk. Our method is highly cost efficient at a price of CHF 100 per examination.
“…The change in plaque volume over time has been used to evaluate the effectiveness of plaque-reducing therapies such as atorvastin and statins. 10,11 Figure 2 shows the effect of giving statins on plaque volume. 12 Figure 2Reduction in plaque volume after a course of statins; redrawn from data in Krasinski A, et al.…”
This article describes four technologies relevant to vascular ultrasound which are available commercially in 2015, and traces their origin back through the research literature. The technologies are 3D ultrasound and its use in plaque volume estimation (first described in 1994), colour vector Doppler for flow visualisation (1994), wall motion for estimation of arterial stiffness (1968), and shear wave elastography imaging of the arterial wall (2010). Overall these technologies have contributed to the understanding of vascular disease but have had little impact on clinical practice. The basic toolkit for vascular ultrasound has for the last 25 years been real-time B-mode, colour flow and spectral Doppler. What has changed over this time is improvement in image quality. Looking ahead it is noted that 2D array transducers and high frame rate imaging continue to spread through the commercial vascular ultrasound sector and both have the potential to impact on clinical practice.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
