January 1, 2009Journal of Cardiovascular Magnetic Resonance65 citationsOpen Access

Cardiovascular magnetic resonance parameters of atherosclerotic plaque burden improve discrimination of prior major adverse cardiovascular events

VMVenkatesh Mani PMPaul Muntner SGSamuel S. Gidding

Structured PICO

Do cardiovascular magnetic resonance (CMR) parameters of atherosclerotic plaque burden improve the discrimination of prior major adverse cardiovascular events compared to traditional risk factors alone?

Population

195 patients with traditional cardiovascular disease risk factors, with or without prior major cardiovascular or cerebrovascular events (MACE).

Intervention

Cardiovascular magnetic resonance (CMR) imaging of carotid and thoracic aorta plaque burden (wall thickness, wall area, normalized wall index, plaque eccentricity).

Comparator

Patients with traditional risk factors but no prior MACE (for plaque burden comparison); traditional risk factor models alone (for discrimination model).

Outcome

Difference in CMR plaque burden measures between patients with and without prior MACE, and improvement in Area Under the ROC Curve (AUC) for discriminating prior MACE.surrogate

CMR-derived measures of atherosclerotic plaque burden and eccentricity in the carotid and thoracic aorta improve the discrimination of prior major adverse cardiovascular events beyond traditional risk factors.

Abstract

AIMS: Patients with prior major cardiovascular or cerebrovascular events (MACE) are more likely to have future recurrent events independent of traditional cardiovascular disease risk factors. The purpose of this study was to determine if patients with traditional risk factors and prior MACE had increased cardiovascular magnetic resonance (CMR) plaque burden measures compared to patients with risk factors but no prior events. METHODS AND RESULTS: Black blood carotid and thoracic aorta images were obtained from 195 patients using a rapid extended coverage turbo spin echo sequence. CMR measures of plaque burden were obtained by tracing lumen and outer vessel wall contours. Patients with prior MACE had significantly higher MR plaque burden (wall thickness, wall area and normalized wall index) in carotids and thoracic aorta compared to those without prior MACE (Wall thickness carotids: 1.03 +/- 0.03 vs. 0.93+/- 0.03, p = 0.001; SD wall thickness carotids: 0.137 +/- 0.0008 vs. 0.102 +/- 0.0004, p < 0.001; wall thickness aorta: 1.63 +/- 0.10 vs. 1.50 +/- 0.04, p = 0.009; SD wall thickness aorta: 0.186 +/- 0.035 vs. 0.139 +/- 0.012, p = 0.009 respectively). Plaque burden (wall thickness) and plaque eccentricity (standard deviation of wall thickness) of carotid arteries were associated with prior MACE after adjustment for age, sex, and traditional risk factors. Area under ROC curve (AUC) for discriminating prior MACE improved by adding plaque eccentricity to models incorporating age, sex, and traditional CVD risk factors as model inputs (AUC = 0.79, p = 0.05). CONCLUSION: A greater plaque burden and plaque eccentricity is prevalent among patients with prior MACE.

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