Carotid ultrasonography improves residual risk stratification in guidelines-defined high cardiovascular risk patients

Georgios Georgiopoulos; Georgios Mavraganis; Dimitrios Delialis; Stelios Georgiou; Evmorfia Aivalioti; Raphael Patras; Ioannis Petropoulos; Maria-Angeliki Dimopoulou; Lasthenis Angelidakis; Alexandros Sianis; Dimitrios Bampatsias; Anna Dimoula; Eleni Maneta; Marinos Kosmopoulos; Constantine Vardavas; Konstantinos Stellos; Kimon Stamatelopoulos

doi:10.1093/eurjpc/zwac095

Carotid ultrasonography improves residual risk stratification in guidelines-defined high cardiovascular risk patients

Eur J Prev Cardiol. 2022 Oct 18;29(13):1773-1784. doi: 10.1093/eurjpc/zwac095.

Authors

Georgios Georgiopoulos^{1

2}, Georgios Mavraganis¹, Dimitrios Delialis¹, Stelios Georgiou¹, Evmorfia Aivalioti¹, Raphael Patras¹, Ioannis Petropoulos¹, Maria-Angeliki Dimopoulou¹, Lasthenis Angelidakis¹, Alexandros Sianis¹, Dimitrios Bampatsias¹, Anna Dimoula¹, Eleni Maneta¹, Marinos Kosmopoulos³, Constantine Vardavas^{4

5}, Konstantinos Stellos^{6

7

8

9}, Kimon Stamatelopoulos^{1

6}

Affiliations

¹ Department of Clinical Therapeutics, Alexandra Hospital, National and Kapodistrian University of Athens Medical School, 80 Vas. Sofias Str, Athens 11528, Greece.
² Department of Cardiovascular Imaging, School of Biomedical Engineering and Imaging Sciences, Guy's and St Thomas' NHS Foundation Trust, Westminster Bridge Road, SE1 7EH London, UK.
³ Division of Cardiology, Department of Medicine, University of Minnesota School of Medicine, 420 Delaware Street SE, Minneapolis, MN 55455, USA.
⁴ Department of Social Medicine, Faculty of Medicine, University of Crete, University Campus of Voutes, 700 13 Heraklion, Crete.
⁵ Department of Oral Health Policy and Epidemiology, Harvard University, 114 Mt Auburn Street, Cambridge, MA, USA.
⁶ Biosciences Institute, Vascular Biology and Medicine Theme, Faculty of Medical Sciences, Newcastle University, NE1 7RU Newcastle upon Tyne, UK.
⁷ Department of Cardiology, Freeman Hospital, Newcastle Hospitals NHS Foundation Trust, Freeman Rd, High Heaton, NE7 7DN Newcastle Upon Tyne, UK.
⁸ German Center for Cardiovascular Research (DZHK), Heidelberg/Mannheim Partner Site, Mannheim, Germany.
⁹ Department of Cardiovascular Research, European Center for Angioscience, Medical Faculty Mannheim, Heidelberg University, Ludolf-Krehl-Straße 13-17, D-68167 Mannheim, Germany.

PMID: 35580589
DOI: 10.1093/eurjpc/zwac095

Abstract

Aims: The clinical value of carotid atherosclerosis markers for residual risk stratification in high atherosclerotic cardiovascular disease (ASCVD) risk patients is not established. We aimed to derive and validate optimal values of markers of carotid subclinical atherosclerosis improving risk stratification in guidelines-defined high ASCVD risk patients.

Methods and results: We consecutively analysed high or very high ASCVD risk patients from a cardiovascular (CV) prevention registry (n = 751, derivation cohort) and from the Atherosclerosis Risk in Communities (ARIC) study (n = 2,897, validation cohort). Baseline ASCVD risk was defined using the 2021 European Society of Cardiology guidelines (clinical ESCrisk). Intima-media thickness excluding plaque, average maximal (avg.maxWT), maximal wall thickness (maxWT) and number of sites with carotid plaque were assessed. As primary endpoint of the study was defined the composite of cardiac death, acute myocardial infarction and revascularization after a median of 3.4 years in both cohorts and additionally for 16.7 years in the ARIC cohort.

Results: MaxWT > 2.00 mm and avg.maxWT > 1.39 mm provided incremental prognostic value, improved discrimination and correctly reclassified risk over the clinical ESCrisk both in the derivation and the validation cohort (P < 0.05 for net reclassification index, integrated discrimination index and Delta Harrell's C index). MaxWT < 0.9 mm predicted very low probability of CV events (negative predictive value = 97% and 92% in the derivation and validation cohort, respectively). These findings were additionally confirmed for very long-term events in the validation cohort.

Conclusion: Integration of carotid ultrasonography in guidelines-defined risk stratification may identify patients at very high-risk in need for further residual risk reduction or at very low probability for events.

Keywords: Atherosclerosis; Cardiovascular risk; Carotid artery intima-media thickness; Carotid plaque; Prediction of cardiovascular events.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Atherosclerosis* / prevention & control
Cardiovascular Diseases* / diagnostic imaging
Cardiovascular Diseases* / epidemiology
Carotid Artery Diseases* / diagnostic imaging
Carotid Intima-Media Thickness
Heart Disease Risk Factors
Humans
Plaque, Atherosclerotic*
Risk Assessment
Risk Factors
Ultrasonography