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Risk marker variability in subclinical carotid plaques based on ultrasound is influenced by cardiac phase, echogenicity and size
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology. (Arcum)
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Radiation Physics.
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. Vol. 44, no 8, p. 1742-1750
Keywords [en]
Carotid plaque, Risk markers, Cardiac cycle, Echogenicity, Size, Classification
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:umu:diva-150664DOI: 10.1016/j.ultrasmedbio.2018.03.013ISI: 000436561500018PubMedID: 29735317Scopus ID: 2-s2.0-85046670751OAI: oai:DiVA.org:umu-150664DiVA, id: diva2:1242527
Funder
Swedish Research Council, 2015-04461Available from: 2018-08-28 Created: 2018-08-28 Last updated: 2022-02-14Bibliographically approved
In thesis
1. Ultrasound measurements of subclinical carotid atherosclerosis: methodological and clinical studies
Open this publication in new window or tab >>Ultrasound measurements of subclinical carotid atherosclerosis: methodological and clinical studies
2021 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Mätning av tidig ateroskleros genom ultraljud : metodologiska och kliniska studier
Abstract [en]

Ultrasound measurements of subclinical carotid atherosclerosis have been evaluated as an additional parameter in risk evaluation of cardiovascular diseases (CVD). The overall aim of this thesis was to increase knowledge regarding ultrasound measurements of subclinical carotid atherosclerosis. This included methodological studies of the reproducibility in commonly applied measurements and evaluation of subclinical carotid atherosclerotic progression. All studies within this thesis are based on material from the population based, randomized control trial VIPVIZA. Enrolled from a routine CVD prevention programme, all participants had an additional carotid ultrasound examination including measurements of carotid intima media thickness (cIMT) and carotid plaque detection. The group randomised to the intervention received a pictorial presentation which illustrating their individually measured subclinical atherosclerotic burden. At the 3-year follow-up the same measurements were repeated.

Variability, defined by variation of coefficient (CV) of measurements, of plaque risk markers including echogenicity and plaque area were evaluated throughout the cardiac cycle. Additionally, the inter-observer reproducibility of plaque detection was evaluated, and the intervention effect on the 3-year cIMT and plaque progression was compared between intervention (n: 1575)  and control group (n: 1579). Lastly, association of baseline carotid wall echogenicity and the 3-year progression of cIMT was evaluated. Small and echolucent plaques had higher CV in measurements of area and echogenicity, respectively. Cardiac cycle variations caused reclassification of up to one in four of the analysed plaques. Small carotid plaques contributed to decreased inter-sonographer reproducibility as compared to large plaques. In the 3-year follow-up the intervention group showed decreased progression of cIMT in the left carotid compared to the control group. No difference was found for in plaque related variables. The echogenicity of the carotid wall associated with the progression of cIMT over the 3-year follow-up period, where echolucent carotid wall had a higher rate of progression bilaterally.

Variability of plaque risk markers and the reproducibility of plaque detection should be considered in analysis of subclinical carotid atherosclerosis by ultrasound. Progression of left cIMT was decreased by the intervention, which indicates that increased preventive actions were taken by the intervention group. The echogenicity of the carotid wall may contribute new insights regarding identification of progressive atherosclerotic diseases.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2021. p. 73
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 2152
Keywords
atherosclerosis, ultrasound, carotid artery, carotid intima media thickness, carotid plaque, reproducibility, intervention, echogenicity
National Category
Cardiac and Cardiovascular Systems
Research subject
cardiovascular disease
Identifiers
urn:nbn:se:umu:diva-187756 (URN)978-91-7855-630-4 (ISBN)978-91-7855-629-8 (ISBN)
Public defence
2021-10-15, Bergasalen, Norrlands universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2021-09-24 Created: 2021-09-21 Last updated: 2021-09-21Bibliographically approved

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Nyman, EmmaLindqvist, PerNäslund, UlfGrönlund, Christer

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