Download PDF
CC BY-NC-ND 4.0 · Indian J Radiol Imaging 2024; 34(03): 460-468
DOI: 10.1055/s-0044-1779522
Original Article

Assessment of Carotid Plaque Enhancement on Contrast-Enhanced Ultrasound as a Predictor for Severe Coronary Artery Disease

Vanshika Agarwal 
1   Department of Diagnostic and Intervention Radiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
,
Poonam Sherwani 
1   Department of Diagnostic and Intervention Radiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
,
Udit Chauhan
1   Department of Diagnostic and Intervention Radiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
,
Barun Kumar
2   Department of Cardiology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
› Author Affiliations Funding None.
› Further Information
Also available at
   Permissions and Reprints

Abstract

Background and Aim Contrast-enhanced ultrasound (CEUS) can reliably identify vulnerable plaques. As atherosclerosis is a systemic disease, we evaluated whether contrast enhancement of carotid plaque (CECP) can predict severe coronary artery disease (CAD) by comparing CECP in patients who have had acute coronary syndromes (ACS) recently with asymptomatic individuals.

Settings and Design This case–control study was done at a tertiary care center during 2022.

Materials and Methods Fourteen participants were recruited in each group, after screening in-patients for carotid plaques and inclusion and exclusion criteria. Those who had history of ACS were enrolled as cases, while those who did not were enrolled as controls. All these patients underwent grayscale, Doppler, and CEUS examination for characterization of the carotid plaque. For cases, findings on CEUS were also compared with the severity of CAD on catheter coronary angiography.

Statistical Analysis Diagnostic parameters including sensitivity, specificity, and diagnostic accuracy were calculated and proportions were compared by using Fisher's exact test.

Results Eight out of 28 patients showed CECP. CECP and CAD were positively associated with p-Value of 0.033. Eighty-three percent patients with triple vessel disease and 50% patients with double vessel disease on coronary angiography showed CECP. Sensitivity and specificity of CECP for prediction of CAD were 50 and 92.9%, respectively.

Conclusion CECP on CEUS can predict CAD and is a more reliable indicator of severe CAD than plaque characteristics on grayscale and Doppler imaging; making it useful for screening of patients at risk of having CAD.

Keywords

coronary artery disease - contrast-enhanced ultrasound - intraplaque neovascularization - contrast enhancement of carotid plaque

Availability of Data

The underlying research data of this article is not publicly available for patient privacy. The data are available from the corresponding author on reasonable request.


Ethical Approval

All the patients were explained the study and gave written and informed consent before enrollment. All procedures performed were in accordance with the ethical standards of the Institutional Ethics Committee and with the 1964 Helsinki Declaration and its later amendments. None of the figures submitted reveal the identity of the participants.




Publication History

Article published online:
23 February 2024

© 2024. Indian Radiological Association. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Prabhakaran D, Jeemon P, Sharma M. et al; India State-Level Disease Burden Initiative CVD Collaborators. The changing patterns of cardiovascular diseases and their risk factors in the states of India: the Global Burden of Disease Study 1990-2016. Lancet Glob Health 2018; 6 (12) e1339-e1351
    PubMedSearch in Google Scholar
  • 2 National Family Health Survey -5 Uttarakhand.. Accessed January 14, 2023 at: https://rchiips.org/nfhs/NFHS-5Reports/Uttarakhand.pdf
  • 3 Bisciglia A, Pasceri V, Irini D, Varveri A, Speciale G. Risk factors for ischemic heart disease. Rev Recent Clin Trials 2019; 14 (02) 86-94
    CrossrefPubMedSearch in Google Scholar
  • 4 Steinberg D. Low density lipoprotein oxidation and its pathobiological significance. J Biol Chem 1997; 272 (34) 20963-20966
    CrossrefPubMedSearch in Google Scholar
  • 5 Mathur P, Kulothungan V, Leburu S. et al. National noncommunicable disease monitoring survey (NNMS) in India: estimating risk factor prevalence in adult population. PLoS One 2021; 16 (03) e0246712
    CrossrefPubMedSearch in Google Scholar
  • 6 Kallikazaros I, Tsioufis C, Sideris S, Stefanadis C, Toutouzas P. Carotid artery disease as a marker for the presence of severe coronary artery disease in patients evaluated for chest pain. Stroke 1999; 30 (05) 1002-1007
    CrossrefPubMedSearch in Google Scholar
  • 7 Brinjikji W, Huston III J, Rabinstein AA, Kim GM, Lerman A, Lanzino G. Contemporary carotid imaging: from degree of stenosis to plaque vulnerability. J Neurosurg 2016; 124 (01) 27-42
    CrossrefPubMedSearch in Google Scholar
  • 8 Muller JE, Tofler GH, Stone PH. Circadian variation and triggers of onset of acute cardiovascular disease. Circulation 1989; 79 (04) 733-743
    CrossrefPubMedSearch in Google Scholar
  • 9 Li C, He W, Guo D. et al. Quantification of carotid plaque neovascularization using contrast-enhanced ultrasound with histopathologic validation. Ultrasound Med Biol 2014; 40 (08) 1827-1833
    CrossrefPubMedSearch in Google Scholar
  • 10 Saba L, Saam T, Jäger HR. et al. Imaging biomarkers of vulnerable carotid plaques for stroke risk prediction and their potential clinical implications. Lancet Neurol 2019; 18 (06) 559-572
    CrossrefPubMedSearch in Google Scholar
  • 11 Li Z, Bai Y, Li W. et al. Carotid vulnerable plaques are associated with circulating leukocytes in acute ischemic stroke patients: an clinical study based on contrast-enhanced ultrasound. Sci Rep 2018; 8 (01) 8849
    CrossrefPubMedSearch in Google Scholar
  • 12 Zhou Y, Xing Y, Li Y. et al. An assessment of the vulnerability of carotid plaques: a comparative study between intraplaque neovascularization and plaque echogenicity. BMC Med Imaging 2013; 13 (01) 13
    CrossrefPubMedSearch in Google Scholar
  • 13 Staub D, Partovi S, Schinkel AFL. et al. Correlation of carotid artery atherosclerotic lesion echogenicity and severity at standard US with intraplaque neovascularization detected at contrast-enhanced US. Radiology 2011; 258 (02) 618-626
    CrossrefPubMedSearch in Google Scholar
  • 14 Bokor D. Diagnostic efficacy of SonoVue. Am J Cardiol 2000; 86 (4A): 19G-24G
    CrossrefPubMedSearch in Google Scholar
  • 15 Bom MJ, van der Heijden DJ, Kedhi E. et al. Early detection and treatment of the vulnerable coronary plaque: can we prevent acute coronary syndromes?. Circ Cardiovasc Imaging 2017; 10 (05) 1-20
    CrossrefPubMedSearch in Google Scholar
  • 16 Choi SW, Kim H, Kim IC. et al. Implication of ultrasound contrast-enhancement of carotid plaques in prevalence of acute coronary syndrome and occurrence of cardiovascular outcomes. J Clin Ultrasound 2018; 46 (07) 461-466
    CrossrefPubMedSearch in Google Scholar
  • 17 Hu C, Feng Y, Huang P, Jin J. Adverse reactions after the use of SonoVue contrast agent: characteristics and nursing care experience. Medicine (Baltimore) 2019; 98 (44) e17745
    CrossrefPubMedSearch in Google Scholar
  • 18 Gray-Weale AC, Graham JC, Burnett JR, Byrne K, Lusby RJ. Carotid artery atheroma: comparison of preoperative B-mode ultrasound appearance with carotid endarterectomy specimen pathology. J Cardiovasc Surg (Torino) 1988; 29 (06) 676-681
    PubMedSearch in Google Scholar
  • 19 Tahmasebpour HR, Buckley AR, Cooperberg PL, Fix CH. Sonographic examination of the carotid arteries. Radiographics 2005; 25 (06) 1561-1575
    CrossrefPubMedSearch in Google Scholar
  • 20 Ford TJ, Corcoran D, Berry C. Stable coronary syndromes: pathophysiology, diagnostic advances and therapeutic need. Heart 2018; 104 (04) 284-292
    PubMedSearch in Google Scholar
  • 21 Redgrave JNE, Lovett JK, Rothwell PM. Histological features of symptomatic carotid plaques in relation to age and smoking: the oxford plaque study. Stroke 2010; 41 (10) 2288-2294
    CrossrefPubMedSearch in Google Scholar
  • 22 Parma L, Baganha F, Quax PHA, de Vries MR. Plaque angiogenesis and intraplaque hemorrhage in atherosclerosis. Eur J Pharmacol 2017; 816 (816) 107-115
    CrossrefPubMedSearch in Google Scholar
  • 23 Sigala F, Oikonomou E, Antonopoulos AS, Galyfos G, Tousoulis D. Coronary versus carotid artery plaques. Similarities and differences regarding biomarkers morphology and prognosis. Curr Opin Pharmacol 2018; 39: 9-18
    CrossrefPubMedSearch in Google Scholar
  • 24 Dunmore BJ, McCarthy MJ, Naylor AR, Brindle NPJ. Carotid plaque instability and ischemic symptoms are linked to immaturity of microvessels within plaques. J Vasc Surg 2007; 45 (01) 155-159
    CrossrefPubMedSearch in Google Scholar
  • 25 Fabiani I, Palombo C, Caramella D, Nilsson J, De Caterina R. Imaging of the vulnerable carotid plaque: Role of imaging techniques and a research agenda. Neurology 2020; 94 (21) 922-932
    CrossrefPubMedSearch in Google Scholar
  • 26 Mantella LE, Colledanchise KN, Hétu MF, Feinstein SB, Abunassar J, Johri AM. Carotid intraplaque neovascularization predicts coronary artery disease and cardiovascular events. Eur Heart J Cardiovasc Imaging 2019; 20 (11) 1239-1247
    CrossrefPubMedSearch in Google Scholar
  • 27 Qin C, Zhang L, Wang X, Duan Y, Ye Z, Xie M. Evaluation of carotid plaque neovascularization in patients with coronary heart disease on contrast-enhanced ultrasonography. J Ultrasound Med 2018; 37 (04) 823-831
    CrossrefPubMedSearch in Google Scholar
  • 28 Zhu Y, Deng YB, Liu YN. et al. Use of carotid plaque neovascularization at contrast-enhanced US to predict coronary events in patients with coronary artery disease. Radiology 2013; 268 (01) 54-60
    CrossrefPubMedSearch in Google Scholar
  • 29 Yan H, Wu X, He Y, Staub D, Wen X, Luo Y. Carotid intraplaque neovascularization on contrast-enhanced ultrasound correlates with cardiovascular events and poor prognosis: a systematic review and meta-analysis. Ultrasound Med Biol 2021; 47 (02) 167-176
    CrossrefPubMedSearch in Google Scholar
  • 30 Cui L, Xing Y, Wang L. et al. Carotid intraplaque neovascularization and future vascular events in patients with asymptomatic carotid stenosis. Front Pharmacol 2022; 13: 804810
    CrossrefPubMedSearch in Google Scholar
  • 31 Motoyama R, Saito K, Tonomura S. et al. Utility of complementary magnetic resonance plaque imaging and contrast-enhanced ultrasound to detect carotid vulnerable plaques. J Am Heart Assoc 2019; 8 (08) e011302
    CrossrefPubMedSearch in Google Scholar