Biochemical and clinical correlation of intraplaque neovascularization using contrast-enhanced ultrasound of the carotid artery

• Published in: Atherosclerosis Vol. 233; no. 2; pp. 579 - 583
• Main Authors: Kim, Hyun Soo, Woo, Jong Shin, Kim, Bu Yong, Jang, Hyun Hee, Hwang, Seung Joon, Kwon, Sung Jin, Choi, Eun Young, Kim, Jin Bae, Cheng, Xianwu, Jin, Enze, Kim, Woo Shik, Kim, Kwon Sam, Kim, Weon
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.04.2014
• Subjects: Age Factors; Aged; Atherosclerosis; Biomarker; Biomarkers; Cardiovascular; Carotid Artery Diseases - blood; Carotid Artery Diseases - diagnostic imaging; Carotid Artery, Common - diagnostic imaging; Carotid Intima-Media Thickness; Carotid-enhanced ultrasound; Cathepsin L - blood; Comorbidity; Contrast Media; Female; Fluorocarbons; Humans; Intraplaque neovascularization; Male; Matrix Metalloproteinase 2 - blood; Matrix Metalloproteinase 9 - blood; Matrix metalloproteinase-9; Middle Aged; Neovascularization, Pathologic - blood; Neovascularization, Pathologic - diagnostic imaging; Phospholipids; Plaque, Atherosclerotic - blood; Plaque, Atherosclerotic - diagnostic imaging; Prospective Studies; Sulfur Hexafluoride; Ultrasonography, Doppler, Color; Ultrasonography, Doppler, Pulsed; Matrix metalloproteinase-9; Biomarker; Intraplaque neovascularization; Carotid-enhanced ultrasound; Atherosclerosis
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2014.01.042

Abstract Objective Several biomarkers reflecting inflammatory or proteolytic activity have been known to represent plaque vulnerability. Moreover, a recent study confirmed that contrast-enhanced ultrasound (CEUS) can visualize intraplaque neovascularization (IPN) and demonstrate plaque vulnerability. In this study, we tried to demonstrate that IPN detected by CEUS was correlated with several well-known biomarkers and clinical outcome in patients with coronary artery disease (CAD). Methods Patients with stable CAD were screened by conventional carotid ultrasound and patients with carotid plaque thickness more than 2 mm were performed by CEUS for the presence of IPN. Plasma levels of biomarkers and clinical outcomes were evaluated. Results Among consecutive 89 patients fulfilled the inclusion criteria, 30 patients without IPN (group 1) and 59 patients with IPN (group 2) were analyzed. There were no significant difference in baseline characteristics except for mean age (62.9 ± 10.1 yrs versus 68.4 ± 9.6 yrs, p  = 0.015). On multivariate analysis, only MMP-9 ( p  = 0.021, 95% CI 1.002–1.027) showed a significant association with IPN. But patients with IPN showed only trend for a history of cardiovascular disease (CVD) (44% versus 30%, p  = 0.19) and one-year cardiovascular events (CVE) (6.8% versus 3.3%, p  = 0.50) compared to group 1. Maximum plaque thickness ( p  = 0.04, 95% CI 1.230–6.322) showed a significant correlation with the clinical outcome including CVD or CVE. Conclusion MMP-9 correlated with IPN on CEUS. For clinical implication, however, large prospective studies are needed.