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Maximum plaque height in carotid ultrasound predicts cardiovascular disease outcomes: a population-based validation study of the American society of echocardiography’s grade II–III plaque characterization and protocol

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Abstract

The presence of carotid arterial plaque by ultrasound enhances cardiovascular risk stratification beyond traditional risk factors. However, plaque quantification techniques require further outcomes-based investigation. The purpose of this study was to evaluate the utility of a focused carotid ultrasound protocol and novel plaque grading system developed by the American Society of Echocardiography (ASE). A retrospective analysis of 514 outpatients who were referred for coronary angiography between 2011 and 2014 was performed using a province-sponsored health database. All participants prospectively received a focused carotid ultrasound. Maximum plaque height (MPH) of arterial carotid plaque was quantified, using the Grade II–III plaque definition of MPH ≥ 1.5 mm for stratification, according to recent ASE recommendations. Participants were followed for 1.33–5.11 years (average follow-up = 3.60 ± 1.65 years) to identify the occurrence of cardiovascular events. Major events (death, myocardial infarction [MI], stroke, and transient ischemic attack [TIA]) were correlated to MPH. Participants with MPH ≥ 1.5 mm were more likely to experience stable angina, coronary artery bypass grafting, and stress testing at both 1-year and total follow-up. After adjusting for cardiac risk factors, increased MPH was shown to be predictive for TIA (odds ratio [OR] = 1.33, 95% confidence interval (CI) = 1.01–1.75); p = 0.04), whereas the odds of non-ST-elevation MI (OR = 1.55, 95% CI = 0.99–2.43; p = 0.06) approached significance. Using Kaplan–Meier survival analysis, MPH ≥ 1.5 mm demonstrated good separation for the composite outcome of death, MI, stroke, and TIA over total follow-up (p = 0.02). This rapid, office-based quantification of MPH in carotid ultrasound may serve as a stratification tool for predicting major cardiovascular events.

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Acknowledgements

This study was supported by the ICES, which is funded by an annual grant from the Ontario MOHLTC. The opinions, results and conclusions reported in this paper are those of the authors and are independent from the funding sources. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. Parts of this material are based on data and/or information compiled and provided by CIHI. However, the analyses, conclusions, opinions, and statements expressed in the material are those of the author(s), and not necessarily those of CIHI.

Funding

Queen’s University (Department of Medicine Innovation Fund), Canada Foundation for Innovation (CFI IOF#29051), Ontario Research Fund, South Eastern Ontario Academic Medical Organization, and the Heart and Stroke Foundation of Canada (Phase I Career Award to AMJ), Kingston, Canada.

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Authors and Affiliations

  1. Department of Medicine, Division of Cardiology, Queen’s University, CINQ 76 Stuart Street, FAPC 3, Kingston, ON, Canada

    Amer M. Johri, Christopher S. Simpson, Paul Ewart & Marie-France Hétu

  2. Institute for Clinical Evaluative Sciences, Kingston, ON, Canada

    Katherine A. Lajkosz & Christopher S. Simpson

  3. Department of Public Health Sciences, Queen’s University, Kingston, ON, Canada

    Nicholas Grubic & Saadul Islam

  4. Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, ON, Canada

    Amer M. Johri & Terry Y. Li

  5. Stroke Diagnostics and Monitoring Division, AtheroPoint™, Roseville, CA, USA

    Jasjit S. Suri

Authors
  1. Amer M. Johri
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  2. Katherine A. Lajkosz
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  3. Nicholas Grubic
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  4. Saadul Islam
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  5. Terry Y. Li
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  6. Christopher S. Simpson
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  7. Paul Ewart
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  8. Jasjit S. Suri
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  9. Marie-France Hétu
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Amer M. Johri, Katherine A. Lajkosz, Nicholas Grubic, Terry Y. Li, Saadul Islam, Paul Ewart, and Marie-France Hétu. The first draft of the manuscript was written by Amer M. Johri and Marie-France Hétu, and all authors critically revised and commented on previous versions of the manuscript. Christopher S. Simpson and Jasjit S. Suri provided critical revisions to the manuscript. All authors read and approved the final manuscript.

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Correspondence to Amer M. Johri.

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The authors declare no conflicts of interest.

Ethical approval

This study was approved by the Queen’s University Health Sciences and Affiliated Hospitals Research Ethics Board.

Consent to participate

Patients who were 18 years or above and provided informed consent, were enrolled in the study.

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No participants who consented to participate in this study objected to having their data published in a journal article.

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Johri, A.M., Lajkosz, K.A., Grubic, N. et al. Maximum plaque height in carotid ultrasound predicts cardiovascular disease outcomes: a population-based validation study of the American society of echocardiography’s grade II–III plaque characterization and protocol. Int J Cardiovasc Imaging 37, 1601–1610 (2021). https://doi.org/10.1007/s10554-020-02144-5

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  • DOI: https://doi.org/10.1007/s10554-020-02144-5

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