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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 | Journal Scan
Study Questions:
What is the prevalence of subclinical atherosclerotic cardiovascular disease (ASCVD) in a developed health care system, and what is the value of direct imaging, compared with standard ASCVD risk factor algorithms, to initiate preventative medical treatment?
Methods:
Data from two asymptomatic cohorts from India with unknown ASCVD risk factors were compared to two 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 nonexperts. A simplified metric of atherosclerotic disease burden (FUster-Narula or FUN Score) was developed from 3-D imaging data by summing intima-media volume 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 one of the four 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 two 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:
The authors concluded that B-mode ultrasound examination of bilateral iliofemoral arteries provided an incremental yield in identifying subclinical atherosclerotic disease compared to carotid evaluation alone.
Perspective:
This study reports that rapid screening for subclinical atherosclerosis is feasible with automated ultrasound examination of carotid and iliofemoral arteries. Furthermore, the study results suggest that ultrasound examination, when compared with ATP III and ATP IV guidelines, allowed improved identification of individuals who could be targeted for prophylactic medical intervention, and may benefit from such intervention for the prevention of ASCVD-related events.
Keywords: Arteriosclerosis, Atherosclerosis, Blood Pressure, Imaging, Three-Dimensional, Lipids, Risk Factors, Algorithms
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