The independent and incremental value of ultrasound carotid plaque length to predict the presence and severity of coronary artery disease: analysis from the carotid plaque length prospective registry

Wen-dong, Tang; Shen, Xia-xian; Li, Hailing; Bai, Yuan; Zhang, Bili; Guo, Zhian; Wu, Hong; Li, Pan; Zhao, Xianxian

doi:10.1093/ehjci/jez304

Cited by 18 publications

(15 citation statements)

References 27 publications

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“…Pathological changes of carotid artery are widely adopted as surrogate for predictive risk factors for cardiovascular disease, [25] although evidence was conflicting. Previous studies demonstrated that intimal medial thickness and plaque prevalence are correlated with increased risk of cardiovascular disease, [26,27] whereas recent study found that carotid plaque length can be a better predictor [28]. In our study, we found carotid stenosis was independently associated with CCS, which can be explained by the hypothesis that carotid stenosis represents long term accumulative exposure of cardiovascular risk factors [29].…”

Section: Discussioncontrasting

confidence: 44%

Early prediction of cerebral-cardiac syndrome after ischemic stroke: the PANSCAN scale

Lian

Shen

et al. 2020

BMC Neurol

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Background: Cerebral-cardiac syndrome, newly developed cardiac damage manifestations subsequent to cerebral injuries, is a common complication of stroke and leads to increased morbidity and mortality. The current study is aimed to develop a risk prediction scale to stratify high-risk population of CCS among ischemic stroke patients. Methods: The study included 410 cases from four tertiary medical centers from June 2018 to April 2019. The risk prediction model was established via logistic regression from the derivation cohort including 250 cases admitted between June 2018 and December 2018. Another 160 cases admitted from January 2019 to April 2019 were included as the validation cohort for external validation. The performance of the model was determined by the area under curve of the receiver operating characteristic curve. A rating scale was developed based on the magnitude of the logistic regression coefficient. Results: The prevalence of CCS was 55.2% in our study. The predictive model derived from the derivation cohort showed good calibration by Hosmer-Lemeshow test (P = 0.492), and showed sensitivity of 0.935, specificity of 0.720, and Youden index of 0.655. The C-statistic for derivation and validation cohort were 0.888 and 0.813, respectively. Our PANSCAN score (0 to 10 points) was then established, which consists of the following independent risk factors: PT(12 s-14 s = 0; otherwise = 1), APTT(30s-45s = 0, otherwise = 1), Neutrophils(50-70% = 0; otherwise = 1), Sex(female = 1), Carotid artery stenosis(normal or mild = 0; moderate to severe = 2), Age(≥65 years = 1), NIHSS score(1 to 4 = 2; ≥5 = 3). Patients scored 3 or more points were stratified as high risk. Conclusion: The risk prediction model showed satisfactory prediction effects. The PANSCAN scale provides convenient reference for preventative treatment and early management for high-risk patients. Trial registration: The study was retrospectively registered in Chinese Trial Registry. The date of registration is April 17, 2019. Trial registration number: ChiCTR1900022587.

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Section: Discussioncontrasting

confidence: 44%

Early prediction of cerebral-cardiac syndrome after ischemic stroke: the PANSCAN scale

Lian

Shen

et al. 2020

BMC Neurol

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“…In our study population, the Gensini score was relatively low. Indeed, as a comparison, in a recent study which prospectively enrolled 2149 consecutive patients who underwent first coronary angiography with a history of any type of chest pain and without dCMP, the patients were classified into three groups according to tertiles of Gensini score: low Gensini acore (<5), intermediate Gensini score (5–33), and high Gensini score (>34) [ 29 ]. Therefore, in spite of low Gensini scores in our study, we identified patients with a high or low CAG and we demonstrated that CAB predicts ischemic CV events and that high-risk patients could benefit from closer follow-up.…”

Section: Discussionmentioning

confidence: 99%

Prognosis of Coronary Atherosclerotic Burden in Non-Ischemic Dilated Cardiomyopathies

Canu

Margerit

Mekhdoul

et al. 2021

JCM

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Background: Atherosclerosis is associated with a worse prognosis in many diseases such as ischemic cardiomyopathy, but its impact in non-ischemic dilated cardiomyopathy (dCMP) is lesser known. Our aim was to study the prognostic impact of coronary atherosclerotic burden (CAB) in patients with dCMP. Methods: Consecutive patients with dCMP and left ventricular (LV) dysfunction diagnosed by concomitant analysis of invasive coronary angiography (ICA) and CMR imaging were identified from registry-database. CAB was measured by Gensini score. The primary composite endpoint was the occurrence of major adverse cardiovascular events (MACE) defined as cardiovascular (CV) mortality, non-fatal MI and unplanned myocardial revascularization. The results of 139 patients constituting the prospective study population (mean age 59.4 ± 14.7 years old, 74% male), average LV ejection fraction was 31.1 ± 11.02%, median Gensini score was 0 (0–3), and mid-wall late gadolinium enhancement (LGE) was the most frequent LGE pattern (42%). Over a median follow-up of 2.8 years, 9% of patients presented MACE. Patients with MACE had significantly higher CAB compared to those who were free of events (0 (0–3) vs. 3.75 (2–15), p < 0.0001). CAB remained the significant predictor of MACE on multivariate logistic analysis (OR: 1.12, CI: 1.01–1.23, p = 0.02). Conclusion: High CAB may be a new prognostic factor in dCMP patients.

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“…However, due to their relatively low occurrences, costliness, and difficulty to quantify, these specific plaque characteristics have not been widely adopted clinically and may be far from ideal markers of MES [ 19 ]. Alternatively, CPL is noninvasive, cost-effective, and easily quantified and may thus be sufficient for predicting MES [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

“…The carotid artery stenosis (CAS) was defined by criteria of ECST (arrange 50% to 99%) (16). Other ultrasonic parameters [ 15 ] that we assessed were as follows: (1) CPL was defined as the maximum length of all ipsilateral carotid artery plaques [ 13 ]; (2) CPT was defined as the maximal thickness of all plaques within ipsilateral carotid arteries; (3) resistance index (RI) was defined by the Mannheim Carotid IMT Consensus, and IMT was assessed at the thickness of segments without plaques and was measured in the far wall of the common carotid artery at approximately 10 mm proximal to the carotid artery bifurcation, as previously described [ 16 ]; (4) plaques of ipsilateral carotid arteries were categorized as either predominantly echolucent, predominantly echogenic, or as mixed echolucent/echogenic; and (5) ulcerative plaques were defined by common criteria in ultrasonography [ 17 ], including plaque surface craters measuring 2 × 2 mm or those with concavity with an echogenic line at the plaque base. Timing of ultrasound examination was not limited, and most of the patients were detected within 3 days after stroke.…”

Section: Methodsmentioning

confidence: 99%

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Plaque Length Predicts the Incidence of Microembolic Signals in Acute Anterior Circulation Stroke

Zhao

et al. 2021

Disease Markers

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Microembolic signals (MES) of the carotid artery are associated with plaque destabilization and reoccurrence of stroke. Previous studies have focused primarily on the degree of carotid artery stenosis and plaque components, and the relationship between plaque length and microembolic sign has received little attention. We aimed to find the association between carotid plaque length (CPL) and the presence of MES. We conducted a retrospective observational cross-sectional study. A total of 84 acute anterior-circulation ischemic stroke/transient ischemic attack (TIA) patients with carotid artery atherosclerosis were classified into an MES-positive (MES+) group and MES-negative (MES−) group. We measured multiple parameters of carotid plaque size (length, thickness) in each patient and evaluated the relationship between different plaque parameters and occurrence of MES. We found that male, carotid artery stenosis (CAS), CPL, carotid plaque thickness (CPT), and intima-media thickness (IMT) of the carotid artery were each significantly different between two groups (all P < 0.05 ). The multivariate analysis showed CPL (odds ratio (OR), 1.109; 95% CI, 1.044–1.177; P = 0.001 ) to be independently associated with the presence of MES. The areas under the ROC curves (AUCs) for CPL for predicting MES were 0.777 (95% CI, 0.640–0.914; P < 0.001 ). The cutoff value of CPL for predicting MES was 16.7 mm, with a sensitivity of 88.2% and a specificity of 77.6%. We found that CPL was a meaningful independent predictor of MES. Therefore, CPL may be useful for risk stratification of long and nonstenotic plaques in anterior circulation stroke.

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The independent and incremental value of ultrasound carotid plaque length to predict the presence and severity of coronary artery disease: analysis from the carotid plaque length prospective registry

Cited by 18 publications

References 27 publications

Early prediction of cerebral-cardiac syndrome after ischemic stroke: the PANSCAN scale

Early prediction of cerebral-cardiac syndrome after ischemic stroke: the PANSCAN scale

Prognosis of Coronary Atherosclerotic Burden in Non-Ischemic Dilated Cardiomyopathies

Plaque Length Predicts the Incidence of Microembolic Signals in Acute Anterior Circulation Stroke

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