Volume of carotid artery ulceration as a predictor of cardiovascular events.
OBJECTIVE
Previous studies have shown the presence of ulceration in atherosclerotic plaque either by categorizing the plaque as complex (irregular morphology with ulcers) or smooth or by quantifying the number of ulcers observed in a specific region of interest. The aim of this study was to quantify carotid total ulcer volume by 3-dimensional ultrasound to investigate the relationship of total ulcer volume to vascular events (strokes, transient ischemic attack, myocardial infarction, revascularization, or death because of cardiovascular reasons).


METHODS
In total, 349 at-risk subjects provided written informed consent to carotid 3-dimensional ultrasound and were analyzed for ulcerations. Ulcer volume was defined as a distinct discontinuity in an atherosclerotic plaque, with a volume≥1.00 mm3 as measured using manual segmentation. The sum of the volumes of all ulcers seen in both carotids was the total ulcer volume. Participants were monitored for ≤5 years for outcomes, including cardiovascular events and death.


RESULTS
Kaplan-Meier survival analysis showed that subjects with total ulcer volume≥5 mm3 experienced a significantly higher risk of developing stroke, transient ischemic attack, or death (P=0.009) and of developing stroke/transient ischemic attack/death/myocardial infarction/revascularization (P=0.017). Lower ulcer volumes did not predict events nor did ulcer depth.


CONCLUSIONS
Volume of carotid ulceration on 3-dimensional ultrasound predicts cardiovascular events. In addition to improving risk stratification, ulceration is a potential therapeutic target.
From the Department of Pathology and Toxicology, Schulich School of Medicine and Dentistry (M.K.), Department of Psychiatry (V.B.), Imaging Research Group, Robarts Research Institute (G.P., A.F., J.D.S.), and Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute (J.D.S.), Western University, London, Ontario, Canada; and Department of Internal Medicine, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (T.W.).
Mariya
M
Kuk
Thapat
T
Wannarong
Vadim
V
Beletsky
Grace
G
Parraga
Aaron
A
Fenster
J David
JD
Spence
D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000209:etiology; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000209:etiology / Q000401:mortality; D053208:Kaplan-Meier Estimate; D008297:Male; D009203:Myocardial Infarction / Q000209:etiology / Q000401:mortality; D009864:Ontario; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D011237:Predictive Value of Tests; D020521:Stroke / Q000209:etiology / Q000401:mortality; D014463:Ultrasonography
carotid arteries; ischemic attack, transient; stroke; ulcer