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Nyman, E., Vanoli, D., Näslund, U. & Grönlund, C. (2020). Inter-sonographer reproducibility of carotid ultrasound plaque detection using Mannheim consensus in subclinical atherosclerosis. Clinical Physiology and Functional Imaging, 40(1), 46-51
Open this publication in new window or tab >>Inter-sonographer reproducibility of carotid ultrasound plaque detection using Mannheim consensus in subclinical atherosclerosis
2020 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 40, no 1, p. 46-51Article in journal (Refereed) Published
Abstract [en]

Aims: To determine the inter-sonographer reproducibility of carotid ultrasound plaque detection using Mannheim consensus in a subclinical population and evaluate associations related to the reproducibility.

Methods and results: Bilateral ultrasound screening for carotid plaques defined by Mannheim consensus was performed on 106 subclinical participants. Two different sonographers scanned the same participant, and reproducibility of plaque detection was measured by Cohens kappa. Associations with reproducibility were evaluated by comparing wall, and plaque characteristics between subjects with plaques identified in one and both scans. In general, the inter-sonographer reproducibility of plaque detection was substantial with a kappa value of 0 center dot 70 (95% CI 0 center dot 60-0 center dot 80). Plaques detected in only one scan had significantly lower plaque area and plaque thickness (6 center dot 82 mm(2) and 1 center dot 45 mm) as compared to plaques detected in both scans (11 center dot 65 mm(2) and 1 center dot 96 mm, P<0 center dot 001).

Conclusion: Minor carotid plaques contribute to decreased reproducibility as compared to large plaques when screening for subclinical atherosclerosis using Mannheim consensus. Using an alternative plaque definition based on plaque thickness >1.5 mm and plaque area >10 mm(2) could increase the reproducibility of plaque detection in subclinical atherosclerosis.

Place, publisher, year, edition, pages
John Wiley & Sons, 2020
Keywords
carotid, inter-sonographer, plaque, reproducibility, subclinical, ultrasound
National Category
Physiology
Identifiers
urn:nbn:se:umu:diva-165443 (URN)10.1111/cpf.12602 (DOI)000493037200001 ()31605665 (PubMedID)
Available from: 2019-11-27 Created: 2019-11-27 Last updated: 2020-01-10Bibliographically approved
Näslund, U., Ng, N., Lundgren, A., Fhärm, E., Grönlund, C., Johansson, H., . . . Norberg, M. (2019). Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial. The Lancet, 393(10167), 133-142
Open this publication in new window or tab >>Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA): a pragmatic, open-label, randomised controlled trial
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2019 (English)In: The Lancet, ISSN 0140-6736, E-ISSN 1474-547X, Vol. 393, no 10167, p. 133-142Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Primary prevention of cardiovascular disease often fails because of poor adherence among practitioners and individuals to prevention guidelines. We aimed to investigate whether ultrasound-based pictorial information about subclinical carotid atherosclerosis, targeting both primary care physicians and individuals, improves prevention.

METHODS: Visualization of asymptomatic atherosclerotic disease for optimum cardiovascular prevention (VIPVIZA) is a pragmatic, open-label, randomised controlled trial that was integrated within the Västerbotten Intervention Programme, an ongoing population-based cardiovascular disease prevention programme in northern Sweden. Individuals aged 40, 50, or 60 years with one or more conventional risk factors were eligible to participate. Participants underwent clinical examination, blood sampling, and ultrasound assessment of carotid intima media wall thickness and plaque formation. Participants were randomly assigned 1:1 with a computer-generated randomisation list to an intervention group (pictorial representation of carotid ultrasound plus a nurse phone call to confirm understanding) or a control group (not informed). The primary outcomes, Framingham risk score (FRS) and European systematic coronary risk evaluation (SCORE), were assessed after 1 year among participants who were followed up. This study is registered with ClinicalTrials.gov, number NCT01849575.

FINDINGS: 3532 individuals were enrolled between April 29, 2013, and June 7, 2016, of which 1783 were randomly assigned to the control group and 1749 were assigned to the intervention group. 3175 participants completed the 1-year follow-up. At the 1-year follow-up, FRS and SCORE differed significantly between groups (FRS 1·07 [95% CI 0·11 to 2·03, p=0·0017] and SCORE 0·16 [0·02 to 0·30, p=0·0010]). FRS decreased from baseline to the 1-year follow-up in the intervention group and increased in the control group (-0·58 [95% CI -0·86 to -0·30] vs 0·35 [0·08 to 0·63]). SCORE increased in both groups (0·13 [95% CI 0·09 to 0·18] vs 0·27 [0·23 to 0·30]).

INTERPRETATION: This study provides evidence of the contributory role of pictorial presentation of silent atherosclerosis for prevention of cardiovascular disease. It supports further development of methods to reduce the major problem of low adherence to medication and lifestyle modification.

Place, publisher, year, edition, pages
Elsevier, 2019
National Category
Public Health, Global Health, Social Medicine and Epidemiology Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-154318 (URN)10.1016/S0140-6736(18)32818-6 (DOI)000455437100026 ()30522919 (PubMedID)
Funder
Västerbotten County Council, Dnr ALFVLL-298001Swedish Research Council, Dnr 521-2013-2708Swedish Research Council, 2016-01891Swedish Heart Lung Foundation, Dnr 20150369Swedish Heart Lung Foundation, 20170481
Available from: 2018-12-17 Created: 2018-12-17 Last updated: 2019-02-22Bibliographically approved
Nyman, E., Lindqvist, P., Näslund, U. & Grönlund, C. (2018). Risk marker variability in subclinical carotid plaques based on ultrasound is influenced by cardiac phase, echogenicity and size. Ultrasound in Medicine and Biology, 44(8), 1742-1750
Open this publication in new window or tab >>Risk marker variability in subclinical carotid plaques based on ultrasound is influenced by cardiac phase, echogenicity and size
2018 (English)In: Ultrasound in Medicine and Biology, ISSN 0301-5629, E-ISSN 1879-291X, Vol. 44, no 8, p. 1742-1750Article in journal (Refereed) Published
Abstract [en]

Identification of risk markers based on quantitative ultrasound texture analysis of carotid plaques has the ability to define vulnerable components that correlate with increased cardiovascular risk. However, data describing factors with the potential to influence the measurement variability of risk markers are limited. The aim of this study was to evaluate the influence of electrocardiogram-guided image selection, plaque echogenicity and area on carotid plaque risk markers and their variability in asymptomatic carotid plaques. Plaque risk markers were measured in 57 plaques during three consecutive heartbeats at two cardiac cycle time instants corresponding to the electrocardiogram R-wave (end diastole) and end of T-wave (end systole), resulting in six measurements for each plaque. Risk marker variability was quantified by computing the coefficient of variation (CV) across the three heartbeats. The CV was significantly higher for small plaques (area <15 mm2, 10%) than for large plaques (area >15 mm2, 6%) (p <0.001) in measurements of area, and the CV for measurements of gray-scale median were higher for echolucent plaques (<40, 15%) than for echogenic plaques (>40, 9%) (p <0.001). No significant differences were found between systole and diastole for the mean of any risk marker or the corresponding CV value. However, in a sub-analysis, the echolucent plaques were found to have a higher CV during systole compared with diastole. The variability also caused plaque type reclassification in 16% to 25% of the plaques depending on cutoff value. The results of this study indicate that echolucent and small plaques each contribute to increased risk marker variability. Based on these results, we recommend that measurements in diastole arc preferred to reduce variation, although we found that it may not be possible to characterize small plaques accurately using contemporary applied risk markers. 

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Carotid plaque, Risk markers, Cardiac cycle, Echogenicity, Size, Classification
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:umu:diva-150664 (URN)10.1016/j.ultrasmedbio.2018.03.013 (DOI)000436561500018 ()29735317 (PubMedID)2-s2.0-85046670751 (Scopus ID)
Funder
Swedish Research Council, 2015-04461
Available from: 2018-08-28 Created: 2018-08-28 Last updated: 2019-05-21Bibliographically approved
Nyman, E., Vanoli, D., Grönlund, C., Näslund, U. & Lindqvist, P. (2016). Area measurement of carotid plaque comparing B-MODE, Doppler color and contrast-enhanced ultrasound imaging. Paper presented at Congress of the European-Atherosclerosis-Society (EAS), MAY 29-JUN 01, 2016, Innsbruck, AUSTRIA. Atherosclerosis, 252, E191-E191
Open this publication in new window or tab >>Area measurement of carotid plaque comparing B-MODE, Doppler color and contrast-enhanced ultrasound imaging
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2016 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 252, p. E191-E191Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Objectives: Carotid plaque characteristic analysis are suggested to improve risk stratification. Plaque area and echolucent plaques have shown to correlate with increased risk for cardiovascular diseases. A limitation with B-mode imaging is the uncertainty that the whole plaque area is identified, primarily on echolucent plaques. Contrast-enhanced ultrasound (CEUS) is used to improve carotid imaging including better plaque area measurement. Aim: Evaluate if CEUS could improve accurate plaque area measurement compared with B-mode and Doppler color flow imaging. Methods: The study included 28 participants (50% females, mean age 58 years) with identified asymptomatic carotid plaques. We performed B-mode, Doppler color and CEUS ultrasound imaging whereas the plaque area was manually outdrawn by a single operator. Plaques were also subjectively classified as 1 echogenic, 2 echolucent, or 3 mixed plaques. Results: We did not find a significant difference in plaque area measurements between different ultrasound image modalities having all plaque types included. In the group of echolucent plaques (n= 11) we found a significant different between B-mode and CEUS (p=0.049) and also between B-mode and Doppler color imaging (p=0.039) (Illustrated in Fig 1). Conclusions: Echolucent plaque can be underestimated with B-mode imaging. Use of contrast-enhanced ultrasound should be considered in carotid plaque imaging on echolucent plaques when plaque outline is difficult to identify.

Place, publisher, year, edition, pages
Elsevier, 2016
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-130113 (URN)10.1016/j.atherosclerosis.2016.07.881 (DOI)000388978400649 ()
Conference
Congress of the European-Atherosclerosis-Society (EAS), MAY 29-JUN 01, 2016, Innsbruck, AUSTRIA
Note

Meeting Abstract: EAS16-0052, Vascular Biology: Myocardial Infarction, Stroke, Peripheral Vascular Disease

Available from: 2017-01-13 Created: 2017-01-11 Last updated: 2018-06-09Bibliographically approved
Nyman, E., Grönlund, C., Vanoli, D., Lindqvist, P. & Näslund, U. (2015). Carotid artery plaque assessment within the Västerbotten intervention programme: VIPVIZA. Paper presented at 83rd Congress of the European-Atherosclerosis-Society (EAS), MAR 22-25, 2015, Glasgow, SCOTLAND. Atherosclerosis, 241(1), E159-E159
Open this publication in new window or tab >>Carotid artery plaque assessment within the Västerbotten intervention programme: VIPVIZA
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2015 (English)In: Atherosclerosis, ISSN 0021-9150, E-ISSN 1879-1484, Vol. 241, no 1, p. E159-E159Article in journal, Meeting abstract (Other academic) Published
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:umu:diva-109463 (URN)000360100600527 ()
Conference
83rd Congress of the European-Atherosclerosis-Society (EAS), MAR 22-25, 2015, Glasgow, SCOTLAND
Available from: 2015-10-07 Created: 2015-09-28 Last updated: 2018-06-07Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-4060-4752

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