Abstract
Background
Detailed multimodality assessment of subclinical atherosclerosis in asymptomatic subjects
referred for risk stratification has not been performed. We analyzed the detection
of early atherosclerosis using 3 imaging modalities: coronary artery calcium (CAC)
scoring, carotid ultrasound (US), and coronary computed tomography angiography (CCTA).
Methods
Asymptomatic subjects free of known vascular disease scheduled to undergo a carotid
US for risk stratification were invited to undergo CCTA/CAC. Subjects taking lipid-lowering
medication were excluded. All images were assessed by experienced core laboratory
personnel. Carotid intima media thickness ≥ 75th percentile for age and sex, CAC >
0, and detection of either carotid or coronary artery plaque were indicators of atherosclerosis.
Results
Fifty patients were included with a median age of 53 years. Atherosclerosis was observed
in 28%, 78%, and 90% of subjects using CAC, CCTA, and carotid US, respectively. All
subjects showed atherosclerosis on at least 1 modality. In 36 patients with a CAC
score = 0, 69% and 86% had atherosclerosis on CCTA and carotid US, respectively.
Conclusions
In this detailed analysis, all subjects identified to warrant further risk stratification
had subclinical atherosclerosis on at least 1 imaging modality. Concordance between
modalities was highly variable, dependent on the specific definition of atherosclerosis
used. Carotid US and CCTA detection of plaque were significantly more sensitive than
CAC > 0 in this middle-aged population. Considering the prevalence of subclinical
disease on carotid US and CCTA, the threshold at which to treat warrants further research.
Résumé
Introduction
L’évaluation détaillée de l’imagerie multimodale de l’athérosclérose subclinique chez
les sujets asymptomatiques orientés pour la stratification du risque n’a pas été réalisée.
Nous avons analysé la détection de l’athérosclérose précoce en utilisant 3 modalités
d’imagerie : le score calcique des artères coronaires (CAC), l’échographie (EG) carotidienne
et la coronarographie par tomodensitométrie (Coro-TDM).
Méthodes
Les sujets asymptomatiques sans maladie vasculaire connue inscrits pour subir une
EG carotidienne en vue de la stratification du risque ont été invités à subir la Coro-TDM/CAC.
Les sujets prenant un hypolipidémiant ont été exclus. Toutes les images ont été évaluées
par le personnel expérimenté du laboratoire central. L’épaisseur de l’intima-média
de la carotide ≥ 75e percentile de l’âge et du sexe, le CAC > 0 et la détection de plaque carotidienne
ou de plaque de l’artère coronaire ont été des indicateurs d’athérosclérose.
Résultats
Cinquante (50) patients dont l’âge moyen était de 53 ans ont été inclus. L’athérosclérose
a été observée chez 28 %, 78 % et 90 % des sujets à l’aide de la CAC, la Coro-TDM
et l’EG carotidienne, respectivement. Tous les sujets ont montré de l’athérosclérose
dans au moins 1 modalité. Chez 36 patients ayant un score de CAC = 0,69 % et 86 %
ont montré de l’athérosclérose à la Coro-TDM et l’EG carotidienne, respectivement.
Conclusions
Dans cette analyse détaillée, tous les sujets identifiés pour justifier une stratification
du risque plus poussée ont montré de l’athérosclérose subclinique dans au moins 1
modalité d’imagerie. La concordance entre les modalités a été très variable, dépendamment
de la définition de l’athérosclérose utilisée. La détection de la plaque à l’EG carotidienne
et à la Coro-TDM a été significativement plus sensible qu’à la CAC > 0 chez cette
population d’âge moyen. Si l’on considère la prévalence de la maladie subclinique
à l’EG carotidienne et à la Coro-TDM, le seuil auquel traiter justifie d’autres recherches.
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Article Info
Publication History
Published online: October 28, 2013
Accepted:
October 1,
2013
Received:
July 8,
2013
Footnotes
See page 1694 for disclosure information.
Identification
Copyright
© 2013 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
