Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk: From the American Society of Echocardiography

Johri, Amer M.; Nambi, Vijay; Naqvi, Tasneem Z.; Feinstein, Steven B.; Kim, Esther S.H.; Park, Margaret M.; Becher, Harald; Sillesen, Henrik

doi:10.1016/j.echo.2020.04.021

Cited by 207 publications

(199 citation statements)

References 102 publications

(115 reference statements)

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“…Selection for eradicating interventions is conventionally determined by measuring luminal stenosis that results from in situ atheromatous plaques [7][8][9]. Apart from the degree of stenosis, plaque morphology has emerged in recent years as an important contributory factor in stroke risk [3]. During onset of thrombembolic events in arteresclerosis, vulnerable plaques play an important role [10].…”

Section: Discussionmentioning

confidence: 99%

“…Compared with calcium-containing "hard plaques", plaques with a high lipid content are associated with an increased risk of ipsilateral cerebral ischemia [1,2]. Most of the trials emphasizing the relationship between plaque echo structure and stroke risk are based on high-resolution ultrasound (US) using a visual method of classi ication [3,4]. To date, the plaques of carotid arteries are divided into friable, ibroatheromatous and atheromatous forms [5].…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Evidence of woven bone formation in carotid artery plaques

Mirzaie¹,

Guliyev²,

Schultz³

et al. 2021

J Cardiol Cardiovasc Med

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Objective: Plaque morphology plays an important prognostic role in the occurrence of cerebrovascular events. Echolucent and heterogeneous plaques, in particular, carry an increased risk of subsequent stroke. Depending on the quality of the plaque echogenicity based on B-mode ultrasound examination, carotid plaques divide into a soft lipid-rich plaque and a hard plaque with calcification. The aim of this study was to investigate structural changes in the basement membrane of different carotid artery plaque types. Patients and methods: Biopsies were taken from 10 male patients (average age; 75 + 1 years) and 7 females (68 + 3 years). The study population included patients suffering from a filiform stenosis of the carotid artery, 8 patients with acute cerebrovascular events and 9 with asymptomatic stenosis. Scanning electron and polarised light microscopic investigations were carried out on explanted plaques to determine the morphology of calcified areas in vascular lesions. Results: By means of scanning electron microscopy, multiple foci of local calcification were identified. The endothelial layer was partially desquamated from the basement membrane and showed island-like formations. Polarised light microscopy allows us to distinguish between soft plaques with transparent structure and hard plaques with woven bone formation. Conclusion: The major finding of our study is the presence of woven bone tissue in hard plaques of carotid arteries, which may result from pathological strains or mechanical overloading of the collagen fibers. These data suggest a certain parallel with sclerosis of human aortic valves due to their similar morphological characteristics.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Evidence of woven bone formation in carotid artery plaques

Mirzaie¹,

Guliyev²,

Schultz³

et al. 2021

J Cardiol Cardiovasc Med

View full text Add to dashboard Cite

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“…Therefore, the scope of this review is restricted to the use of carotid ultrasound for CVD risk assessment in RA patients. The automated cIMT and carotid PA are considered surrogate markers of coronary artery disease and widely used for CVD/stroke risk assessment [31][32][33][34].…”

Section: Carotid Ultrasound Atherosclerosis Imaging For Cvd Risk Assementioning

confidence: 99%

“…Ultrasound imaging, specifically in carotid arteries, is a comparatively low-cost, non-invasive, radiation-free, and easy-to-use imaging modality that is widely adopted in preventive cardiovascular and clinical vascular practices [29,30]. The image-based phenotypes of carotid ultrasound, such as carotid intima-media thickness (cIMT) and carotid plaque, are considered surrogate markers of coronary artery disease and have been used for preventive CVD risk assessments in several studies [31][32][33][34]. These image-based phenotypes indicate the morphological variations in the atherosclerotic plaque and are associated with the inflammatory markers of RA [35][36][37][38].…”

Section: Introductionmentioning

confidence: 99%

Cardiovascular risk assessment in patients with rheumatoid arthritis using carotid ultrasound B-mode imaging

Jamthikar

Gupta

Puvvula³

et al. 2020

Rheumatol Int

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Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease that affects synovial joints and has various extraarticular manifestations, including atherosclerotic cardiovascular disease (CVD). Patients with RA experience a higher risk of CVD, leading to increased morbidity and mortality. Inflammation is a common phenomenon in RA and CVD. The pathophysiological association between these diseases is still not clear, and, thus, the risk assessment and detection of CVD in such patients is of clinical importance. Recently, artificial intelligence (AI) has gained prominence in advancing healthcare and, therefore, may further help to investigate the RA-CVD association. There are three aims of this review: (1) to summarize the three pathophysiological pathways that link RA to CVD; (2) to identify several traditional and carotid ultrasound image-based CVD risk calculators useful for RA patients, and (3) to understand the role of artificial intelligence in CVD risk assessment in RA patients. Our search strategy involves extensively searches in PubMed and Web of Science databases using search terms associated with CVD risk assessment in RA patients. A total of 120 peer-reviewed articles were screened for this review. We conclude that (a) two of the three pathways directly affect the atherosclerotic process, leading to heart injury, (b) carotid ultrasound image-based calculators have shown superior performance compared with conventional calculators, and (c) AI-based technologies in CVD risk assessment in RA patients are aggressively being adapted for routine practice of RA patients.

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“…7 Carotid ultrasound is a non-invasive and effective imaging for modality of assessing subclinical atherosclerosis. 8 However, current statements recommended against screening for asymptomatic carotid artery stenosis in general population in view to offer carotid surgery, they failed to address asymptomatic carotid atherosclerosis as a marker of cardiovascular adverse outcomes. 9,10 Early detection of the underlying atherosclerosis before symptoms manifestation could improve risk strati cation and provide a great opportunity to reduce future cardiovascular risks, in light of many effective nonpharmacologic and pharmacologic interventions.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of Subclinical Carotid Atherosclerosis and Associated Risk Factors in Individuals Without Cardiovascular Risk Factors: Insights from General Population

Tian

Zhang

et al. 2021

Preprint

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Objective: Individuals without conventional cardiovascular risks (CVRFs) still have the risk of adverse outcomes, and subclinical carotid atherosclerosis is a known predictor of cardiovascular events. We aimed to assess the prevalence and associated risk factors of subclinical carotid atherosclerosis in CVRF-free population. Methods: The cross-sectional study was conducted in rural northeast China in 2017-2018. CVRFs freedom was defined as untreated blood pressure < 140/90 mmHg, fasting plasma glucose < 7.0 mmol/L, untreated total cholesterol < 6.22 mmol/L, low-density lipoprotein cholesterol < 4.14 mmol/L, high-density lipoprotein cholesterol (HDL-C) ≥ 1.04 mmol/L, and no current smoking. This subgroup population included 1449 individuals, and ultrasound was used to detect carotid atherosclerosis. Results: The mean carotid intima-media thickness is 0.74 ± 0.14 mm. The prevalence of carotid plaque is 23.4% (95%CI: 21.2%-25.6%) among CVRFs-free population, significantly higher in men than in women (37.1% vs 20.0%, p<0.001), and rises steeply with advancing age. 1.31% have moderate-to-severe carotid stenosis. Advancing age, man, glycosylated hemoglobin (OR, 1.90; 95% CI, 1.20-1.32), HDL-C level (OR, 2.31; 95% CI, 1.75-3.04), and pulse pressure (OR, 1.03; 95% CI, 1.01-1.05) are potentially related to presence of carotid atherosclerosis. Adjusted-dose-response association shows a linear relationship between HDL-C and prevalence of carotid atherosclerosis. Conclusions: The prevalence of subclinical carotid atherosclerosis in CVRF-free population was relatively high, indicating poorly defined factors might contribute to the early atherogenesis. Moreover, we observed a paradoxical response between subclinical carotid atherosclerosis and HDL-C levels, suggesting that treatment targeting to increase HDL-C levels might not reduce future cardiovascular risks.

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Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk: From the American Society of Echocardiography

Cited by 207 publications

References 102 publications

Evidence of woven bone formation in carotid artery plaques

Evidence of woven bone formation in carotid artery plaques

Cardiovascular risk assessment in patients with rheumatoid arthritis using carotid ultrasound B-mode imaging

Prevalence of Subclinical Carotid Atherosclerosis and Associated Risk Factors in Individuals Without Cardiovascular Risk Factors: Insights from General Population

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