Implication of ultrasound contrast‐enhancement of carotid plaques in prevalence of acute coronary syndrome and occurrence of cardiovascular outcomes

• Published in: Journal of clinical ultrasound Vol. 46; no. 7; pp. 461 - 466
• Main Authors: Choi, Sang‐Woong, Kim, Hyungseop, Kim, In‐Cheol, Lee, Cheol‐Hyun, Hwang, Jongmin, Park, Hyoung‐Seob, Cho, Yun‐Kyeong, Yoon, Hyuck‐Jun, Nam, Chang‐Wook, Han, Seongwook, Hur, Seung‐Ho
• Format: Journal Article
• Language: English
• Published: Hoboken, USA John Wiley & Sons, Inc 01.09.2018; Wiley Subscription Services, Inc
• Subjects: acute coronary syndrome; Acute Coronary Syndrome - epidemiology; Acute coronary syndromes; Aged; Arteriosclerosis; Atherosclerosis; Cardiovascular disease; Cardiovascular Diseases - epidemiology; Carotid Arteries - diagnostic imaging; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - epidemiology; carotid plaque; Contrast Media; contrast‐enhanced ultrasonography; Coronary artery; Coronary artery disease; Coronary vessels; Female; Follow-Up Studies; Health risks; Heart; Heart diseases; Humans; Image Enhancement - methods; Kaplan-Meier Estimate; Lipids; Male; Middle Aged; Myocardial infarction; Patients; Phospholipids; Plaque, Atherosclerotic - diagnostic imaging; Plaque, Atherosclerotic - epidemiology; Plaques; Prevalence; Reproducibility of Results; Retrospective Studies; Risk analysis; Risk factors; Smoking; Sulfur Hexafluoride; Ultrasonic imaging; Ultrasonography - methods; Ultrasound; Vascularization; contrast-enhanced ultrasonography; acute coronary syndrome; carotid plaque
• ISSN: 0091-2751; 1097-0096
• DOI: 10.1002/jcu.22638

Purpose Ultrasonographic contrast enhancement of carotid plaque (CECP) has been used to detect neovascularization of vasa vasorum and plaque. However, it is uncertain whether CECP can provide risk stratification of coronary artery disease (CAD). This study aimed to evaluate the relationship between CECP and manifestations of acute coronary syndrome (ACS) in established CAD patients and to explore the prognostic implication of CECP for cardiovascular (CV) clinical outcomes. Methods A medical record review revealed that contrast‐enhanced ultrasonography was performed to evaluate carotid atherosclerosis in 209 coronary artery‐stented and 105 non‐stented patients. The rate of ACS manifestations was compared depending on contrast uptake patterns: grade 0, absent; grade 1, dot; and grade 2, diffuse pattern. CV primary outcomes were assessed during a mean 7.6 months of follow‐up. Results Male sex, smoking, history of old myocardial infarction, intensive medications, and a favorable lipid profile were common in the stented versus non‐stented group. Patients with grade 2 CECP had a higher rate of ACS, greater plaque thickness, and class I‐II of Gray‐Weale plaque echogenicity. During follow‐up, 10 coronary revascularizations (nine ACSs), six strokes, and four heart failures occurred. Grade 2 CECP was more closely related with CV primary outcomes and showed a tendency toward more acute CV outcomes. Conclusion ACS manifestations were proportionate to CECP grade. Diffuse CECP uptake could be a risk factor for acute CV outcomes.