title: Assessment of subclinical atherosclerosis and intraplaque neovascularization using quantitative contrast-enhanced ultrasound in patients with familial hypercholesterolemia.
abstract: OBJECTIVE
  Patients with heterozygous familial hypercholesterolemia (FH) are at severely increased risk of developing atherosclerosis at relatively young age. The aim of this study was to assess the prevalence of subclinical atherosclerosis and intraplaque neovascularization (IPN) in patients with FH, using contrast-enhanced ultrasound (CEUS) of the carotid arteries.
  
  
  METHODS
  The study population consisted of 69 consecutive asymptomatic patients with FH (48% women, mean age 55 ± 8 years). All patients underwent carotid ultrasound to evaluate the presence and severity of carotid atherosclerosis, and CEUS to assess IPN. IPN was assessed in near wall plaques using a semi-quantitative grading scale and semi-automated quantification software.
  
  
  RESULTS
  Carotid plaque was present in 62 patients (90%). A total of 49 patients had plaques that were eligible for the assessment of IPN: 7 patients (14%) had no IPN, 39 (80%) had mild to moderate IPN and 3 (6%) had severe IPN. Semi-automated quantification software showed no statistical significant difference in the amount of IPN between patients > 50 years and patients ≤ 50 years and between patients with a defective low-density lipoprotein receptor (LDLR) mutation and patients with a negative LDLR mutation. Plaques with irregular or ulcerated surface had significantly more IPN than plaques with a smooth surface (p < 0.05).
  
  
  CONCLUSIONS
  Carotid ultrasound demonstrated atherosclerotic plaque in 90% of asymptomatic patients with FH without known atherosclerosis. IPN assessed with CEUS, was present in 86% of these patients. Irregular and ulcerated plaques exhibited significantly more IPN than plaques with a smooth surface.
authors.affiliation: Dept. of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands; Dept. of Biomedical Engineering, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Stijn C H
authors.initials: SC
authors.lastname: van den Oord
authors.forename: Zeynettin
authors.initials: Z
authors.lastname: Akkus
authors.forename: Jeanine E
authors.initials: JE
authors.lastname: Roeters van Lennep
authors.forename: Johan G
authors.initials: JG
authors.lastname: Bosch
authors.forename: Antonius F W
authors.initials: AF
authors.lastname: van der Steen
authors.forename: Eric J G
authors.initials: EJ
authors.lastname: Sijbrands
authors.forename: Arend F L
authors.initials: AF
authors.lastname: Schinkel
mesh_terms: D000328:Adult; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000453:epidemiology; D003287:Contrast Media; D005260:Female; D006801:Humans; D006938:Hyperlipoproteinemia Type II / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000235:genetics; D008297:Male; D008875:Middle Aged; D009389:Neovascularization, Pathologic / Q000000981:diagnostic imaging / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015995:Prevalence; D014463:Ultrasonography
chemical_list: D003287:Contrast Media
keywords: Atherosclerosis; CEUS; CIMT; Carotid ultrasound; Contrast-enhanced ultrasound; FH; Familial hypercholesterolemia; IPN; carotid intima-media thickness; contrast-enhanced ultrasound; familial hypercholesterolemia; intraplaque neovascularization