Key result
A higher peak-systolic velocity to end-diastolic velocity ratio was significantly associated with an increased risk of relevant ischemic stroke (HR 1.502) in patients with asymptomatic carotid stenosis.
Why the study?
The feasibility of the Framingham stroke risk score and ASCVD risk scores for asymptomatic carotid stenosis needed evaluation, alongside developing models combining ultrasonographic parameters with conventional risk scores.
Does the addition of ultrasonographic parameters to conventional cardiovascular risk scores improve the prediction of ischemic stroke and composite outcomes in patients with asymptomatic carotid stenosis?
Cohort (n=150)
No
Does the addition of ultrasonographic parameters to conventional cardiovascular risk scores improve the prediction of ischemic stroke and composite outcomes in patients with asymptomatic carotid stenosis?
Hazard Ratio: 1.502 (95% CI 1.036–1.968)
p-value: p=0.034
The addition of ultrasonographic parameters to conventional cardiovascular risk scores significantly improves the prediction of ischemic stroke and composite vascular outcomes in patients with asymptomatic carotid stenosis.
Should not yet change management in asymptomatic carotid stenosis; hypothesis-generating for velocity ratio in risk stratification.
We evaluated the feasibility of the Framingham stroke risk score (FSRS) and atherosclerotic cardiovascular disease (ASCVD) risk scores for asymptomatic carotid stenosis (ACS). In addition, we developed novel risk prediction models for ischemic stroke and composite outcomes by combining ultrasonographic parameters and conventional cardiovascular risk scores. We retrospectively enrolled 612 patients with ACS greater than 50% over 7 years and evaluated them using transcranial Doppler and carotid duplex ultrasonography. In total, 150 patients were included in the analysis. During the mean 5-year follow-up, 6 ischemic strokes and 25 composite events were detected. Among all ultrasonographic parameters, only a higher peak-systolic velocity/end-diastolic velocity ratio was detected and significantly associated with an increased risk of relevant ischemic stroke (hazard ratio: 1.502, 95% confidence interval: 1.036-1.968). The C-statistics of the FSRS and ASCVD risk scores were 0.646 and 0.649, respectively, for relevant ischemic stroke, and 0.612 and 0.649, respectively, for composite outcomes. C-statistics of the FSRS and ASCVD risk scores combined with ultrasonographic parameters increased to 0.937 and 0.941, respectively, for ischemic stroke, and 0.856 and 0.886, respectively, for composite outcomes. The study suggests that inclusion of ultrasonographic parameters in conventional cardiovascular scores helps identify the risk of further vascular events in ACS patients.
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Kang et al. (2022) conducted a cohort in Asymptomatic carotid stenosis (n=150). Higher peak-systolic velocity/end-diastolic velocity (PSV/EDV) ratio vs. Lower PSV/EDV ratio was evaluated on Relevant ischemic stroke (HR 1.502, 95% CI 1.036-1.968, p=0.034). A higher peak-systolic velocity to end-diastolic velocity ratio was significantly associated with an increased risk of relevant ischemic stroke (HR 1.502) in patients with asymptomatic carotid stenosis.
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