Achilles Tendon Ultrasonography for Diagnosis of Familial Hypercholesterolemia Among Japanese Subjects

Michikura, Masahito; Ogura, Mariko; Yamamoto, Masahiro; Sekimoto, Masahiko; Fuke, Chizuru; Hori, Mika; Arai, Koji Y.; Kihara, Shinji; Hosoda, Kiminori; Yanagi, Koji; Harada‐Shiba, Mariko

doi:10.1253/circj.cj-17-0041

Cited by 41 publications

(35 citation statements)

References 20 publications

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“…As the Achilles tendon is a common site of lipid deposition, its thickness can provide an early indicator of xanthoma formation [ 7 ]. Although ultrasonography has been used for the measurement of ATT [ 11 – 15 ], the methodology has not been standardized [ 8 ]. As there is no neighboring tissue to serve as a reliable reference, the subjective nature of ultrasonography for the evaluation of diffuse changes in tendon echogenicity is an additional limitation [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

Association of Achilles tendon thickness and LDL-cholesterol levels in patients with hypercholesterolemia

Wang

Zhang

et al. 2018

Lipids Health Dis

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BackgroundAchilles tendons are the most common sites of tendon xanthomas that are commonly caused by disturbance of lipid metabolism. Achilles tendon thickening is the early characteristic of Achilles tendon xanthomas. The relationship between Achilles tendon thickness (ATT) and LDL-C levels, and risk factors of ATT in patients with hypercholesterolemia, have thus far been poorly documented.MethodsA total of 205 individuals, aged 18-75 years, were enrolled from March 2014 to March 2015. According to the LDL-C levels and the “Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults”, all subjects were divided into 3 groups: normal group (LDL-C < 3.37 mmol/L, n = 51); borderline LDL-C group (3.37 mmol/L ≤ LDL-C ≤ 4.12 mmol/L, n = 50); and hypercholesterolemia group (LDL ≥ 4.14 mmol/L, n = 104). ATT was measured using a standardized digital radiography method and the results were compared among the 3 groups. The correlation between ATT and serum LDL-C levels was analyzed by Pearson’s correlation, and the risk factors of ATT were determined by the logistic regression model.ResultsATT in borderline LDL-C group was 8.24 ± 1.73 mm, markedly higher than 6.05 ± 0.28 mm of normal group (P < 0.05). ATT in hypercholesterolemia group was 9.42 ± 3.63 mm which was significantly higher than that of normal group (P < 0.005) and that of borderline LDL-C group (P < 0.05). There was a positive correlation between the serum LDL-C levels and ATT (r = 0.346, P < 0.001). The serum LDL-C level was a risk factor (OR = 1.871, 95% CI: 1.067-3.280) while the levels of HDL-C (OR = 0.099, 95% CI: 0.017-0.573) and Apo AI (OR = 0.035, 95% CI: 0.003-0.412) were protective factors of ATT.ConclusionsATT might serve as a valuable auxiliary diagnostic index for hypercholesterolemia and used for the assessment and management of cardiovascular disease.

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Section: Discussionmentioning

confidence: 99%

Association of Achilles tendon thickness and LDL-cholesterol levels in patients with hypercholesterolemia

Wang

Zhang

et al. 2018

Lipids Health Dis

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“…As it is the largest tendon in the body, the Achilles tendon is the most commonly identified location of xanthomas. Radiography is always used to evaluate the thickness of tendons [13,14]. When the maximum dimensions are greater than 9 mm, hypertrophy of the Achilles tendon is diagnosed [15].…”

Section: Discussionmentioning

confidence: 99%

Grayscale ultrasonic and shear wave elastographic characteristics of the Achilles’ tendon in patients with familial hypercholesterolemia: A pilot study

Zhang

Qiang

et al. 2018

European Journal of Radiology

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A B S T R A C TObjective: To investigate the feasibility of grayscale ultrasound and quantitative shear wave elastography (SWE) for assessing the image features and stiffness of the Achilles tendon in patients with familial hypercholesterolemia (FH) compared with healthy controls. Methods: A total of 38 Achilles tendons from healthy control participants and 94 from patients with FH were examined with grayscale ultrasound and SWE. Each Achilles tendon examination was performed on 3 different segments (proximal, middle, and distal). The thickness, grayscale image features and elasticity modulus of each segment was measured on longitudinal views. Results: In Achilles tendons of healthy control participants, the thicknesses of the proximal, middle, and distal segments were (4.46 ± 0.68) mm, (5.41 ± 1.01) mm, and (4.41 ± 0.57) mm, respectively. The grayscale features were diffusely hypoechoic with parallel linear hyperechoic striations. The mean elasticity modulus of the proximal, middle, and distal sites was (418.08 ± 43.13) kPa, (425.78 ± 47.14) kPa, and (407.79 ± 38.74) kPa, respectively. In the FH group, the thicknesses of the proximal, middle, and distal segments were (7.65 ± 3.09) mm, (11.46 ± 4.84) mm, and (8.14 ± 2.90) mm, respectively. The grayscale features were hypoechoic with linear hyperechoic disordered fibre distribution (92/94). Two of 94 Achilles tendons had considerable focal hypoechogenicity. Seventeen of 94 Achilles tendons had calcifications. In the FH group, the mean elasticity modulus of the proximal, middle, and distal segments were (294.86 ± 58.13) kPa, (280.93 ± 63.58) kPa, and (282.41 ± 56.47) kPa, respectively. Statistically significant differences were found between the Achilles tendons of healthy control participants and FH patients in the thicknesses and mean elasticity modulus at the proximal, middle and distal segments of the Achilles tendons (all P < 0.001). Conclusions: Our results suggest that the grayscale features and SWE characteristics of the Achilles tendon provided complementary biomechanical information for quantitative assessment the Achilles tendon in patients with FH.

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“…Achilles tendon thickness had by far the closest association with FH mutation status, but other clinical characteristics, including age, body weight or body mass index, diabetes, triglycerides, and LDL cholesterol were found to be associated with Achilles tendon thickness. As others have also reported that age was independently associated with Achilles tendon thickness, additional clinical characteristics may need to be considered if the thickness is borderline [ 20 ]. Based on this notion, careful attention should be paid when assessing the Achilles tendon thickness among young individuals.…”

Section: Discussionmentioning

confidence: 99%

A reassessment of the Japanese clinical diagnostic criteria of familial hypercholesterolemia in a hospital-based cohort using comprehensive genetic analysis

Tada

Okada

Nomura

et al. 2020

Practical Laboratory Medicine

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Background Clinical diagnostic criteria of familial hypercholesterolemia (FH) in Japan include LDL cholesterol ≥ 180 mg/dL, Achilles tendon thickness ≥ 9.0 mm, and family history. However, few data exist regarding its validation. Design and Methods A series of 680 participants, with a mean LDL cholesterol of 175 mg/dL were enrolled at Kanazawa University Hospital between 2006 and 2018. All had full assessments of, LDL cholesterol, Achilles tendon X-rays, family history records, and genetic analysis of FH-associated genes ( LDLR , APOB , and PCSK9 ). The area under the curve (AUC) of receiver operating characteristic (ROC) curve analysis predicting the presence of FH mutations by each clinical marker were assessed. Results The optimal cutoff values predicting the presence of an FH-associated mutation were 181 mg/dL for LDL cholesterol and ≥7.0 mm for Achilles tendon thickness. AUCs predicting FH mutations were 0.827 for Achilles tendon thickness ≥9.0 mm, 0.889 for LDL cholesterol ≥180 mg/dL, and 0.906 for family history. If Achilles tendon thickness ≥7.0 mm was used as a clinical criterion, then 41 participants (6%) were newly diagnosed with FH and 86 (12%) were newly misclassified as FH. Conclusions Current clinical diagnostic criteria of FH were validated in this cohort. We recommend considering a tentative diagnosis of “potential FH” if the Achilles tendon thickness is ≥ 7.0 mm and <9.0 mm rather than dismissing a diagnosis of FH.

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Achilles Tendon Ultrasonography for Diagnosis of Familial Hypercholesterolemia Among Japanese Subjects

Cited by 41 publications

References 20 publications

Association of Achilles tendon thickness and LDL-cholesterol levels in patients with hypercholesterolemia

Association of Achilles tendon thickness and LDL-cholesterol levels in patients with hypercholesterolemia

Grayscale ultrasonic and shear wave elastographic characteristics of the Achilles’ tendon in patients with familial hypercholesterolemia: A pilot study

A reassessment of the Japanese clinical diagnostic criteria of familial hypercholesterolemia in a hospital-based cohort using comprehensive genetic analysis

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