J Cardiovasc Ultrasound.  2013 Jun;21(2):72-80.

Association of Carotid Artery Parameters of Atherosclerosis in Coronary Artery Disease

• Kim HS
• Cho KI

Abstract

BACKGROUND
Although carotid intima-media thickness (IMT) is the most commonly used ultrasonic measurement of atherosclerosis, plaque burden can be also assessed by ultrasound (US). We investigated the relationship between IMT, total plaque area (TPA) and total plaque volume (TPV) in patients with coronary artery disease (CAD).
METHODS
One hundred and seven patients with suspected CAD and carotid plaques identified by duplex ultrasound underwent 3-dimensional US and coronary angiography. The mean IMT, TPA, and TPV were analyzed for patients with CAD according to the severity of CAD.
RESULTS
In the 107 participants, IMT, TPA and TPV averaged 0.90 +/- 0.26 mm, 0.42 +/- 0.39 cm2 and 237.0 +/- 301.2 mm3, respectively. We found significant correlations for mean IMT : TPA, mean IMT : TPV and TPA : TPV of 0.448, 0.587 and 0.873, respectively (all p < 0.005). Although there was no significant association of IMT and the severity of CAD, TPA and TPV showed significant positive correlation with CAD severity (r = 0.340, p = 0.0003 for TPA and r = 0.465, p < 0.0001 for TPV). Multivariate linear regression analysis showed age was the only significant attributor to IMT, TPA, and TPV. Mean IMT was significantly associated only with hypertension. TPA was significantly associated with male sex, hypertension, and low density lipoprotein-cholesterol (LDL-C). TPV was significantly associated with male sex, C-reactive protein, and LDL-C.
CONCLUSION
Although there were significant correlations among the various US measures of carotid artery morphology, there seemed to be different biological determinants of IMT, TPA, and TPV. We might need to be selective about the particular measurements for specific applications.

Keyword

Atherosclerosis; Carotid arteries; Imaging; Plaque; Ultrasonography

MeSH Terms

Atherosclerosis
C-Reactive Protein
Carotid Arteries
Carotid Intima-Media Thickness
Coronary Angiography
Coronary Artery Disease
Coronary Vessels
Humans
Hypertension
Linear Models
Male
Ultrasonics
C-Reactive Protein

Figure

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  Fig. 1 The process of measurement of total plaque area (TPA) by manual planimetry. This patient showed diffuse plaques in near (A) and far (B) wall of the common carotid artery and carotid bulb (C). Measurement of plaque area was acquired from tracing the each plaque border, and TPA was the sum of the areas of all plaques (A + B + C).

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  Fig. 2 The process of measurement of total plaque volume (TPV) by manual planimetry. Three-dimensional ultrasound images of plaque volumes were acquired from the longitudinal and cross sectional carotid scans. Plaque boundaries were traced using a mouse driven cross-haired cursor and cross-sectional area of the plaque was delineated from 8-12 transverse sections of the image between the edges of the plaque, and the mean plaque volume value of 3 measurements of each plaque was used for analysis. In this patient, plaques were visualized in left internal carotid artery (A) and right bulb (B), and TPV was the sum of the areas of all plaques (A + B).

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  Fig. 3 Calculation of a modified plaque volume as the 2 dimensional ultrasound plaque area in the longitudinal plane (A) multiplied by plaque width (B) measured in the cross sectional plane (1 × 2).

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  Fig. 4 Linear regression analysis among the mean carotid intima-media thickness (IMT) (A), total plaque area (TPA) (B), total plaque volume (TPV) (C), and the severity of the coronary artery disease (CAD). Although there was no significant association of IMT and the severity of CAD (group 0 having normal coronary arteries, group 1 with one vessel CAD, group 2 with two vessel CAD, and group 3 with three vessel CAD), TPA and TPV showed significant positive correlation with CAD severity (r = 0.340, p = 0.0003 for TPA and r = 0.465, p < 0.0001 for TPV). CAG: coronary angiography.

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  Fig. 5 Bland-Altman's plot of the difference between plaque volume (PV) measured by 3-dimensional (3D) and 2-dimensional (2D) method. A solid horizontal line gives the mean difference of 4.8 mm3 and the dotted horizontal lines give the 95% limit of agreement from -171.8 to 181.5 mm3. The difference is calculated by subtracting 2D PV from the 3D PV. The 95% limit of agreement is drawn at mean difference plus and minus 1.96 times the standard deviation (SD) of the differences.

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