Detection of subclinical atherosclerosis in peripheral arterial beds with B-mode ultrasound: A proposal for guiding the decision for medical intervention and an artifact-corrected volumetric scoring index

Ram Bedi, Aslam Nagra, Takenori Fukumoto, Steven Lynum, Partho Sengupta, James Aw, Ivan Mefford, Sadik Raja Panwar, Nikhil Bansal, Puneet Insaan, Shaanemeet Singh, Rajababoo Panwar, Rajesh Vedanthan, Valentin Fuster, Jagat Narula

Research output: Contribution to journalArticle

Abstract

Objectives: To assess subclinical atherosclerotic cardiovascular disease (ASCVD) using B-mode ultrasound, with special emphasis on the incremental value of performing imaging in multiple peripheral arteries, and to compare imaging findings with traditional risk factors for medical intervention eligibility. Methods: Data from 2 asymptomatic cohorts from India with unknown ASCVD risk factors were compared to 2 cohorts from North America with known ASCVD risk factors. Carotid and iliofemoral arteries of the Indian cohorts were examined with automated ultrasound in a high-pace environment by non-experts. A simplified metric of atherosclerotic disease burden (FUster-Narula or FUN Score) was developed from 3D imaging data by summing intima-media volume (IMV) over 5-cm arterial segments. Effectiveness of ASCVD prevention guidelines to direct therapy was compared to results from direct imaging. Results: Of the 941 (mean age 44.27 ± 13.76 years, 34% female) enrollees from India, 224 (24%) demonstrated plaques in at least 1 of the 4 arterial sites examined; 107 (11%) had plaques in only the carotids, 70 (7%) in both the carotids and iliofemoral arteries, and 47 (5%) had plaques in only the iliofemoral arteries. Older age and male sex were associated with the presence of plaque, but association with systolic blood pressure was not observed. Data from 2 North American clinics (n = 481, mean age 59.68 ± 11.95 years, 39% female) showed that 203 subjects (42%) had carotid plaque; 82% of whom would not have qualified for lipid-lowering therapy under the Adult Treatment Panel (ATP) III Guidelines. Using the recently published ATP IV Guidelines, 33% of the individuals with carotid plaque would also have failed to qualify for treatment. Conclusions: B-mode ultrasound examination of bilateral iliofemoral arteries provided an incremental yield in identifying subclinical atherosclerotic disease compared to carotid evaluation alone. Ultrasound examination allowed improved identification of individuals who could be targeted for prophylactic medical intervention compared to ATP III and ATP IV Guidelines.

Original languageEnglish (US)
Pages (from-to)367-378
Number of pages12
JournalGlobal Heart
Volume9
Issue number4
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

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Artifacts
Atherosclerosis
Cardiovascular Diseases
Guidelines
Arteries
Carotid Arteries
India
Blood Pressure
North America
Lipids
Therapeutics

ASJC Scopus subject areas

  • Epidemiology
  • Community and Home Care
  • Cardiology and Cardiovascular Medicine

Cite this

Detection of subclinical atherosclerosis in peripheral arterial beds with B-mode ultrasound : A proposal for guiding the decision for medical intervention and an artifact-corrected volumetric scoring index. / Bedi, Ram; Nagra, Aslam; Fukumoto, Takenori; Lynum, Steven; Sengupta, Partho; Aw, James; Mefford, Ivan; Panwar, Sadik Raja; Bansal, Nikhil; Insaan, Puneet; Singh, Shaanemeet; Panwar, Rajababoo; Vedanthan, Rajesh; Fuster, Valentin; Narula, Jagat.

In: Global Heart, Vol. 9, No. 4, 01.01.2014, p. 367-378.

Research output: Contribution to journalArticle

Bedi, R, Nagra, A, Fukumoto, T, Lynum, S, Sengupta, P, Aw, J, Mefford, I, Panwar, SR, Bansal, N, Insaan, P, Singh, S, Panwar, R, Vedanthan, R, Fuster, V & Narula, J 2014, 'Detection of subclinical atherosclerosis in peripheral arterial beds with B-mode ultrasound: A proposal for guiding the decision for medical intervention and an artifact-corrected volumetric scoring index', Global Heart, vol. 9, no. 4, pp. 367-378. https://doi.org/10.1016/j.gheart.2014.10.007
Bedi, Ram ; Nagra, Aslam ; Fukumoto, Takenori ; Lynum, Steven ; Sengupta, Partho ; Aw, James ; Mefford, Ivan ; Panwar, Sadik Raja ; Bansal, Nikhil ; Insaan, Puneet ; Singh, Shaanemeet ; Panwar, Rajababoo ; Vedanthan, Rajesh ; Fuster, Valentin ; Narula, Jagat. / Detection of subclinical atherosclerosis in peripheral arterial beds with B-mode ultrasound : A proposal for guiding the decision for medical intervention and an artifact-corrected volumetric scoring index. In: Global Heart. 2014 ; Vol. 9, No. 4. pp. 367-378.
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T2 - A proposal for guiding the decision for medical intervention and an artifact-corrected volumetric scoring index

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AU - Nagra, Aslam

AU - Fukumoto, Takenori

AU - Lynum, Steven

AU - Sengupta, Partho

AU - Aw, James

AU - Mefford, Ivan

AU - Panwar, Sadik Raja

AU - Bansal, Nikhil

AU - Insaan, Puneet

AU - Singh, Shaanemeet

AU - Panwar, Rajababoo

AU - Vedanthan, Rajesh

AU - Fuster, Valentin

AU - Narula, Jagat

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N2 - Objectives: To assess subclinical atherosclerotic cardiovascular disease (ASCVD) using B-mode ultrasound, with special emphasis on the incremental value of performing imaging in multiple peripheral arteries, and to compare imaging findings with traditional risk factors for medical intervention eligibility. Methods: Data from 2 asymptomatic cohorts from India with unknown ASCVD risk factors were compared to 2 cohorts from North America with known ASCVD risk factors. Carotid and iliofemoral arteries of the Indian cohorts were examined with automated ultrasound in a high-pace environment by non-experts. A simplified metric of atherosclerotic disease burden (FUster-Narula or FUN Score) was developed from 3D imaging data by summing intima-media volume (IMV) over 5-cm arterial segments. Effectiveness of ASCVD prevention guidelines to direct therapy was compared to results from direct imaging. Results: Of the 941 (mean age 44.27 ± 13.76 years, 34% female) enrollees from India, 224 (24%) demonstrated plaques in at least 1 of the 4 arterial sites examined; 107 (11%) had plaques in only the carotids, 70 (7%) in both the carotids and iliofemoral arteries, and 47 (5%) had plaques in only the iliofemoral arteries. Older age and male sex were associated with the presence of plaque, but association with systolic blood pressure was not observed. Data from 2 North American clinics (n = 481, mean age 59.68 ± 11.95 years, 39% female) showed that 203 subjects (42%) had carotid plaque; 82% of whom would not have qualified for lipid-lowering therapy under the Adult Treatment Panel (ATP) III Guidelines. Using the recently published ATP IV Guidelines, 33% of the individuals with carotid plaque would also have failed to qualify for treatment. Conclusions: B-mode ultrasound examination of bilateral iliofemoral arteries provided an incremental yield in identifying subclinical atherosclerotic disease compared to carotid evaluation alone. Ultrasound examination allowed improved identification of individuals who could be targeted for prophylactic medical intervention compared to ATP III and ATP IV Guidelines.

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