title: Carotid artery plaque morphology and composition in relation to incident cardiovascular events: the Multi-Ethnic Study of Atherosclerosis (MESA).
abstract: OBJECTIVE
  To determine if carotid plaque morphology and composition with magnetic resonance (MR) imaging can be used to identify asymptomatic subjects at risk for cardiovascular events.
  
  
  METHODS
  Institutional review boards at each site approved the study, and all sites were Health Insurance Portability and Accountability Act (HIPAA) compliant. A total of 946 participants in the Multi-Ethnic Study of Atherosclerosis (MESA) were evaluated with MR imaging and ultrasonography (US). MR imaging was used to define carotid plaque composition and remodeling index (wall area divided by the sum of wall area and lumen area), while US was used to assess carotid wall thickness. Incident cardiovascular events, including myocardial infarction, resuscitated cardiac arrest, angina, stroke, and death, were ascertained for an average of 5.5 years. Multivariable Cox proportional hazards models, C statistics, and net reclassification improvement (NRI) for event prediction were determined.
  
  
  RESULTS
  Cardiovascular events occurred in 59 (6%) of participants. Carotid IMT as well as MR imaging remodeling index, lipid core, and calcium in the internal carotid artery were significant predictors of events in univariate analysis (P < .001 for all). For traditional risk factors, the C statistic for event prediction was 0.696. For MR imaging remodeling index and lipid core, the C statistic was 0.734 and the NRI was 7.4% and 15.8% for participants with and those without cardiovascular events, respectively (P = .02). The NRI for US IMT in addition to traditional risk factors was not significant.
  
  
  CONCLUSIONS
  The identification of vulnerable plaque characteristics with MR imaging aids in cardiovascular disease prediction and improves the reclassification of baseline cardiovascular risk.
authors.affiliation: From the Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada (A.E.H.Z.); Departments of Radiology (B.A.W., J.A.C.L.) and Medicine (J.A.C.L.), Johns Hopkins University, Baltimore, Md; Collaborative Health Studies Coordinating Center, University of Washington, Seattle, Wash (R.L.M.); Department of Radiology, University of California-Los Angeles School of Medicine, Los Angeles, Calif (A.S.G.); Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minn (A.R.F.); Department of Radiology, Tufts Medical Center, Boston, Mass (J.F.P.); and Department of Radiology and Imaging Sciences, National Institutes of Health Clinical Center, 10 Center Dr, Bldg 10/1C355, Bethesda, MD 20892 (D.A.B.).
authors.forename: Anna E H
authors.initials: AE
authors.lastname: Zavodni
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Wasserman
authors.forename: Robyn L
authors.initials: RL
authors.lastname: McClelland
authors.forename: Antoinette S
authors.initials: AS
authors.lastname: Gomes
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.forename: Joseph F
authors.initials: JF
authors.lastname: Polak
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059168:Carotid Intima-Media Thickness; D016893:Carotid Stenosis / Q000453:epidemiology* / Q000208:ethnology*; D003287:Contrast Media; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000208:ethnology*; D005260:Female; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000453:epidemiology* / Q000208:ethnology*; D011237:Predictive Value of Tests; D012307:Risk Factors
chemical_list: D003287:Contrast Media