Three-dimensional ultrasound used to monitor patients’ plaque qualities showed a clearer picture of vascular risks than using their Framingham score in a study published July 17 in Stroke.
An international group of scientists led by Arna van Engelen, PhD, of Erasmus MC in Rotterdam, The Netherlands, attempted to compare plaque texture and volume noted on 3D ultrasound scans and other risk factors to determine patient cardiovascular event risk.
As they noted, calcification and lipid areas resounded differently in ultrasound. By reviewing the size, shape, and consistency of the plaque and the changes to plaque over time, physicians had a better understanding of how flow is maintained. Engelen et al posited that risk of myocardial infarction, transient ischemic attack, stroke, and other cardiovascular events could also be revealed through this data.
The study’s 298 high-risk patients were followed over the course of approximately five years. During that time, 11 patients had a transient ischemic attack, nine patients had a stroke, and seven experienced a myocardial infarction. In total, two patients died.
The values that separated high, middle and low risk groups were 0.7 and 1.3 for the combination of texture and total plaque volume, 0.9 and 1.1 for texture change, and −21 and 59 mm3 for TPV change.
Changes in total plaque volume and plaque texture were significant predictors of risk for vascular events (hazard ratio of 1.5 vs. 1.4).
van Engelen et al wrote that the Framingham score was not a predictor of risk. All patients had an increased Framingham score from baseline. Plaque status was more variable.
The findings are in line with previous work.
“Our findings can be used both for patient monitoring and evaluation of therapies,” van Engelen et al wrote. “The present study shows that including plaque texture in the monitoring of patients contributes to improved risk assessment using ultrasound.”
“A yearly follow-up, including ultrasound in an atherosclerosis clinic, is practically feasible. More regular follow-up of high-risk patients would be possible to enable adjustment of therapy in a more timely fashion.”