title: Detection of subclinical atherosclerosis in peripheral arterial beds with B-mode ultrasound: a proposal for guiding the decision for medical intervention and an artifact-corrected volumetric scoring index.
abstract: OBJECTIVE
  To assess subclinical atherosclerotic cardiovascular disease (ASCVD) using B-mode ultrasound, with special emphasis on the incremental value of performing imaging in multiple peripheral arteries, and to compare imaging findings with traditional risk factors for medical intervention eligibility.
  
  
  METHODS
  Data from 2 asymptomatic cohorts from India with unknown ASCVD risk factors were compared to 2 cohorts from North America with known ASCVD risk factors. Carotid and iliofemoral arteries of the Indian cohorts were examined with automated ultrasound in a high-pace environment by non-experts. A simplified metric of atherosclerotic disease burden (FUster-Narula or FUN Score) was developed from 3D imaging data by summing intima-media volume (IMV) over 5-cm arterial segments. Effectiveness of ASCVD prevention guidelines to direct therapy was compared to results from direct imaging.
  
  
  RESULTS
  Of the 941 (mean age 44.27 ± 13.76 years, 34% female) enrollees from India, 224 (24%) demonstrated plaques in at least 1 of the 4 arterial sites examined; 107 (11%) had plaques in only the carotids, 70 (7%) in both the carotids and iliofemoral arteries, and 47 (5%) had plaques in only the iliofemoral arteries. Older age and male sex were associated with the presence of plaque, but association with systolic blood pressure was not observed. Data from 2 North American clinics (n = 481, mean age 59.68 ± 11.95 years, 39% female) showed that 203 subjects (42%) had carotid plaque; 82% of whom would not have qualified for lipid-lowering therapy under the Adult Treatment Panel (ATP) III Guidelines. Using the recently published ATP IV Guidelines, 33% of the individuals with carotid plaque would also have failed to qualify for treatment.
  
  
  CONCLUSIONS
  B-mode ultrasound examination of bilateral iliofemoral arteries provided an incremental yield in identifying subclinical atherosclerotic disease compared to carotid evaluation alone. Ultrasound examination allowed improved identification of individuals who could be targeted for prophylactic medical intervention compared to ATP III and ATP IV Guidelines.
authors.affiliation: Bioengineering Department, University of Washington, Seattle, WA, USA. Electronic address: bedi@uw.edu.
authors.forename: Ram
authors.initials: R
authors.lastname: Bedi
authors.affiliation: Mahatma Gandhi Medical College and Hospital, Jaipur, India.
authors.forename: Aslam
authors.initials: A
authors.lastname: Nagra
authors.affiliation: Panasonic Healthcare Corporation of North America, Newark, NJ, USA.
authors.forename: Takenori
authors.initials: T
authors.lastname: Fukumoto
authors.affiliation: Panasonic Healthcare Corporation of North America, Newark, NJ, USA.
authors.forename: Steven
authors.initials: S
authors.lastname: Lynum
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Partho
authors.initials: P
authors.lastname: Sengupta
authors.affiliation: Medcan Clinic, Toronto, Ontario, Canada.
authors.forename: James
authors.initials: J
authors.lastname: Aw
authors.affiliation: Shah Satnamji Specialty Hospital, Sirsa, Haryana, India.
authors.forename: Ivan
authors.initials: I
authors.lastname: Mefford
authors.affiliation: Fort Bend Premier Care, Richmond, TX, USA.
authors.forename: Sadik Raja
authors.initials: SR
authors.lastname: Panwar
authors.affiliation: Mahatma Gandhi Medical College and Hospital, Jaipur, India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Bansal
authors.affiliation: Shah Satnamji Specialty Hospital, Sirsa, Haryana, India.
authors.forename: Puneet
authors.initials: P
authors.lastname: Insaan
authors.affiliation: Shah Satnamji Specialty Hospital, Sirsa, Haryana, India.
authors.forename: Shaanemeet
authors.initials: S
authors.lastname: Singh
authors.affiliation: Rajasthan University of Health Sciences, Jaipur, India.
authors.forename: Rajababoo
authors.initials: R
authors.lastname: Panwar
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Vedanthan
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA.
authors.forename: Valentin
authors.initials: V
authors.lastname: Fuster
authors.affiliation: Icahn School of Medicine at Mount Sinai, New York, NY, USA. Electronic address: narula@mountsinai.org.
authors.forename: Jagat
authors.initials: J
authors.lastname: Narula
mesh_terms: D000328:Adult; D000368:Aged; D016477:Artifacts; D050197:Atherosclerosis / Q000000981:diagnostic imaging* / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D006801:Humans; D007083:Iliac Artery / Q000000981:diagnostic imaging*; D021621:Imaging, Three-Dimensional; D008297:Male; D008875:Middle Aged; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D058226:Plaque, Atherosclerotic; D015995:Prevalence; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging; D017540:Tunica Media / Q000000981:diagnostic imaging; D014463:Ultrasonography