Three-Dimensional and Conventional Carotid Ultrasound for Assessment of Carotid Plaque in a Stroke Patient: A Simple Way to Validate Findings

2017 ◽  
Vol 33 (3) ◽  
pp. 412.e1-412.e3
Author(s):  
Hayrapet Kalashyan ◽  
Maher Saqqur ◽  
Harald Becher ◽  
Cian O'Kelly ◽  
Helen Romanchuk ◽  
...  
Keyword(s):  
Stroke Patient ◽  
Carotid Plaque ◽  
Three Dimensional ◽  
Carotid Ultrasound

Abstract 17791: Yield of Different Approaches for Screening for Cardiovascular Disease in Asymptomatic Diabetics

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Timothy W Churchill ◽  
Carlos H Rassi ◽  
Carlos A Fernandes Tavares ◽  
Mateus G Fahel ◽  
Fabricia P Rassi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Coronary Stenosis ◽  
Carotid Plaque ◽  
Intima Media Thickness ◽  
Carotid Intima Media Thickness ◽  
Coronary Plaque ◽  
Carotid Ultrasound ◽  
Asymptomatic Subjects ◽  
A Prospective Study

Introduction: While diabetes has long been considered a coronary heart disease equivalent, there is increasing evidence to suggest that not all individuals with diabetes have cardiovascular disease, and it is unclear how best to risk stratify this population. We sought to compare the yield of testing for pre-clinical atherosclerosis with various approaches. Methods: A group of 98 asymptomatic subjects with type 2 diabetes mellitus (T2DM) without known coronary artery disease (CAD) were enrolled in a prospective study and underwent carotid ultrasound, exercise treadmill testing (ETT), coronary artery calcium (CAC) scoring, and coronary computed tomography angiography (CTA). CTA was used as the reference standard for CAD. Results: Of 98 subjects (average age 55±6, 64% female, 22 on insulin, mean A1c 7.3%), 43 (44%) had coronary plaque detectable on CTA, and 38 (39%) had CAC score > 0. By CTA, 16 (16%) had coronary stenosis ≥ 50%, including 3 subjects with CAC=0. Subjects with coronary plaque had greater prevalence of carotid plaque (58% vs. 38%, p=0.01) and greater carotid intima media thickness (0.80±0.20 mm vs. 0.70±0.11mm, p=0.02). However, 18 of the 55 subjects (33%) with normal CTA had carotid plaque. Eight subjects had a positive ETT, of whom 5 had ≥ 50% coronary stenosis and 2 had <50% stenosis, but there was no difference in METS achieved between subjects with and without plaque (8.2 vs. 8.7, p=0.19). Test characteristics of different imaging modalities for prediction of coronary plaque are shown in Figure 1. Conclusion: Among asymptomatic subjects with T2DM, a majority (56%) had no CAD by CTA. CAC was the most accurate screening modality for detection of CAD while ETT and carotid ultrasound had a limited sensitivity. Interestingly, 33% of subjects with normal CTA had carotid plaque. Further studies are needed to better characterize stroke risk in such patients and whether there is a role for screening for carotid plaque in diabetics without CAC or with normal CTA.

Effect of cilostazol on carotid plaque volume measured by three‐dimensional ultrasonography in patients with type 2 diabetes: The FANCY study

2020 ◽  
Vol 22 (12) ◽  
pp. 2257-2266
Author(s):  
Dong‐Hwa Lee ◽  
Eun Ju Chun ◽  
Ji Hye Moon ◽  
Han Mi Yun ◽  
Soo Lim
Keyword(s):  
Type 2 Diabetes ◽  
Carotid Plaque ◽  
Three Dimensional ◽  
Plaque Volume

P1467Long-term prognostic value of simultaneous assessment of atherosclerosis and ischemia in patients with suspected angina: implications for routine use of carotid ultrasound during stress echocardiograp

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
S Ahmadvazir ◽  
J Pradhan ◽  
R S Khattar ◽  
R Senior
Keyword(s):  
Stable Angina ◽  
Carotid Plaque ◽  
Cox Regression ◽  
Plaque Burden ◽  
Carotid Ultrasound ◽  
Cardiac Events ◽  
Cox Regression Analysis ◽  
History Of ◽  
Artery Disease

Abstract Background The long-term clinical impact of carotid plaque burden (CPB) in patients with new onset suspected stable angina beyond stress echocardiography (SE) with no history of coronary artery disease (CAD) is not known. Methods Consecutive patients referred for SE, underwent simultaneous carotid ultrasonography to assess CPB. Patients were prospectively followed up for major adverse events (MAE). Results Of the 592 patients, 573 (age 59±11, 45% male) had follow-up data. During a mean of 7±1.2 years, 85 patients had first MAE (all-cause mortality and acute myocardial infarction: 67 (hard events) and 18 unplanned revascularisation). On multivariate Cox regression analysis, pre-test probability of CAD, peak wall thickness scoring index and CPB predicted MAE (p<0.0001 for all); however, only CPB retained significance for both hard events and hard cardiac events (p=0.008 and 0.001, respectively). MAE and hard events were least in patients with normal SE and absent carotid plaque (annualised event rate: 1.1% and 1.01%respectively) with significant increase in normal SE with plaque disease (2.4% and 2.05%, p=0.004 and 0.01 respectively). Presence of plaque did not impact on these outcomes in abnormal SE. Conclusions In patients with suspected stable angina, carotid atherosclerosis and myocardial ischemia in combination provided synergistic MAE information long term but atherosclerosis predicted hard events particularly in patients with normal SE but not in ischemic patients. This implies routine use of simultaneous carotid ultrasound following a normal SE for optimum prognostication

scholarly journals Role of adjuvant carotid ultrasound in women undergoing stress echocardiography for the assessment of suspected coronary artery disease

Open Heart ◽  
2020 ◽  
Vol 7 (1) ◽  
pp. e001188
Author(s):  
Sothinathan Gurunathan ◽  
Mayooran Shanmuganathan ◽  
Reinette Hampson ◽  
Rajdeep Khattar ◽  
Roxy Senior
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Predictive Value ◽  
Carotid Plaque ◽  
Stress Echocardiography ◽  
Risk Scores ◽  
Plaque Burden ◽  
Carotid Ultrasound ◽  
Artery Disease

ObjectiveDue to the low prevalence of obstructive coronary artery disease (CAD) in women, stress testing has a relatively low predictive value for this. Additionally, conventional cardiovascular risk scores underestimate risk in women. This study sought to evaluate the role of atherosclerosis assessment using carotid ultrasound (CU) in women attending for stress echocardiography (SE).MethodsThis was a prospective study in which consecutive women with recent-onset suspected angina, who were referred for clinically indicated SE, underwent CU.Results415 women (mean age 61±10 years, 29% diabetes mellitus, mean body mass index 28) attending for SE underwent CU. 47 women (11%) had inducible wall motion abnormalities, and carotid disease (CD) was present in 46% (carotid plaque in 41%, carotid intima-media thickness >75th percentile in 15%). Women with CD were older (65 vs 58 years, p<0.001), and more likely to have diabetes (41% vs 21%, p=0.001), hypertension (67% vs 36%, p<0.01) and a higher pretest probability of CAD (59% vs 41%, p<0.001). 40% of women classified as low Framingham risk were found to have evidence of CD.The positive predictive value of SE for flow-limiting CAD was 51%, but with the presence of carotid plaque, this was 71% (p<0.01). Carotid plaque (p=0.004) and ischaemia (p=0.01) were the only independent predictors of >70% angiographic stenosis. In women with ischaemia on SE and no carotid plaque, the negative predictive value for flow-limiting disease was 88%.During a follow-up of 1058±234 days, there were 15 events (defined as all-cause mortality, non-fatal myocardial infarction, heart failure admissions and late coronary revascularisation). Age (HR 1.07 (1.00–1.15), p=0.04), carotid plaque burden (HR 1.65 (1.36–2.00), p<0.001) and ischaemic burden (HR 1.41 (1.18–1.68), p<0.001) were associated with outcome. There was a stepwise increase in events/year from 0.3% when there were no ischaemia and atherosclerosis, 1.1% when there was atherosclerosis and no ischaemia, 2.2% when there was ischaemia and no atherosclerosis and 10% when there were both ischaemia and atherosclerosis (p<0.001).ConclusionCU significantly improves the accuracy of SE alone for identifying flow-limiting disease on coronary angiography, and improves risk stratification in women attending for SE, as well identifying a subset of women who may benefit from primary preventative measures.

Do Carotid Plaque Ulcers Heal? Potential Detection of Carotid Artery Plaque Healing by Carotid Ultrasound Imaging

2020 ◽  
Author(s):  
Marialaura Simonetto ◽  
Sushrut Dharmadhikari ◽  
Ari Bennett ◽  
Nelly Campo ◽  
Negar Asdaghi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Ultrasound Imaging ◽  
Carotid Plaque ◽  
Carotid Ultrasound ◽  
Carotid Artery Plaque
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