Cardiovascular magnetic resonance parameters of atherosclerotic plaque burden improve discrimination of prior major adverse cardiovascular events - PubMed (original) (raw)

doi: 10.1186/1532-429X-11-10.

Paul Muntner, Samuel S Gidding, Silvia H Aguiar, Hamza El Aidi, Karen B Weinshelbaum, Hiroaki Taniguchi, Rob van der Geest, Johan H C Reiber, Sameer Bansilal, Michael Farkouh, Valentin Fuster, John E Postley, Mark Woodward, Zahi A Fayad

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Cardiovascular magnetic resonance parameters of atherosclerotic plaque burden improve discrimination of prior major adverse cardiovascular events

Venkatesh Mani et al. J Cardiovasc Magn Reson. 2009.

Abstract

Aims: Patients with prior major cardiovascular or cerebrovascular events (MACE) are more likely to have future recurrent events independent of traditional cardiovascular disease risk factors. The purpose of this study was to determine if patients with traditional risk factors and prior MACE had increased cardiovascular magnetic resonance (CMR) plaque burden measures compared to patients with risk factors but no prior events.

Methods and results: Black blood carotid and thoracic aorta images were obtained from 195 patients using a rapid extended coverage turbo spin echo sequence. CMR measures of plaque burden were obtained by tracing lumen and outer vessel wall contours. Patients with prior MACE had significantly higher MR plaque burden (wall thickness, wall area and normalized wall index) in carotids and thoracic aorta compared to those without prior MACE (Wall thickness carotids: 1.03 +/- 0.03 vs. 0.93+/- 0.03, p = 0.001; SD wall thickness carotids: 0.137 +/- 0.0008 vs. 0.102 +/- 0.0004, p < 0.001; wall thickness aorta: 1.63 +/- 0.10 vs. 1.50 +/- 0.04, p = 0.009; SD wall thickness aorta: 0.186 +/- 0.035 vs. 0.139 +/- 0.012, p = 0.009 respectively). Plaque burden (wall thickness) and plaque eccentricity (standard deviation of wall thickness) of carotid arteries were associated with prior MACE after adjustment for age, sex, and traditional risk factors. Area under ROC curve (AUC) for discriminating prior MACE improved by adding plaque eccentricity to models incorporating age, sex, and traditional CVD risk factors as model inputs (AUC = 0.79, p = 0.05).

Conclusion: A greater plaque burden and plaque eccentricity is prevalent among patients with prior MACE.

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Figures

Figure 1

Figure 1

MR imaging parameters measured for carotids and thoracic aorta. The red line indicates the measure of the lumen diameter; the teal line represents the vessel diameter, the green line represents the wall thickness. The area enclosed by the blue contour represents the lumen area and the area enclosed by the orange contour represents the total vessel area. The difference between the total vessel area and the lumen area provides the wall area. The normalized wall index is determined by the ratio of the wall area to the total vessel area. The top right panel shows the contours on a sample carotid image.

Figure 2

Figure 2

Sample MR Images showing individuals with varying SD wall thickness of carotid arteries. (Panel A shows an individual with high SD of wall thickness, Panel B shows medium SD of wall thickness and Panel C shows low SD of wall thickness).* indicates lumen. Arrow indicates plaque.

Figure 3

Figure 3

Receiver operating characteristic curves for predicting cardiovascular disease using various models.

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