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Tobe A, Tanaka A, Furusawa K, Shirai Y, Funakubo H, Otsuka S, Kubota Y, Kunieda T, Yoshioka N, Sato S, Kudo N, Ishii H, Murohara T. Heterogeneous Carotid Plaque Predicts Cardiovascular Events after Percutaneous Coronary Intervention. J Atheroscler Thromb 2023; 30:1187-1197. [PMID: 36503894 PMCID: PMC10499458 DOI: 10.5551/jat.63622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 10/25/2022] [Indexed: 09/05/2023] Open
Abstract
AIM The relationship between carotid artery ultrasound findings and clinical outcomes in patients who undergo percutaneous coronary intervention (PCI) has not been completely elucidated. METHODS This single-center retrospective study investigated 691 patients who underwent PCI and carotid ultrasound testing. Maximum carotid intima-media thickness (CIMT) was defined as the greatest CIMT at the maximally thick point among the common carotid artery, carotid bulb, and internal carotid artery. A carotid plaque was defined as vessel wall thickening with a CIMT ≥ 1.5 mm. The characteristics of carotid plaque (heterogeneity, calcification, or irregular/ulcerated surface) were evaluated visually. Patients were divided into those with and without heterogeneous carotid plaque (maximum CIMT ≥ 1.5 mm and heterogeneous texture). The endpoint was the incidence of a major adverse cardiovascular event (MACE) defined as a composite of cardiovascular (CV) death, myocardial infarction, and ischemic stroke. RESULTS Among 691 patients, 309 were categorized as having a heterogeneous plaque. Patients with heterogeneous plaques were at a higher risk of MACE than those without (p=0.002). A heterogeneous plaque was independently associated with MACE after adjusting for covariates (hazard ratio [HR], 1.71; 95% confidence interval [CI], 1.01-2.90; p=0.046). Calcified or irregular/ulcerated plaques were correlated with a higher incidence of MACE, but both were not independently associated with MACE (HR, 1.35; 95% CI, 0.69-2.64, p=0.38 and HR, 0.98; 95% CI, 0.57-1.69; p=0.95, respectively). CONCLUSION The presence of a heterogeneous carotid plaque in patients who underwent PCI predicted future CV events. These patients may require more aggressive medical therapy and careful follow-up.
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Affiliation(s)
- Akihiro Tobe
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Akihito Tanaka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Kenji Furusawa
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshinori Shirai
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroshi Funakubo
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Satoshi Otsuka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Yoshiaki Kubota
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Takeshige Kunieda
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Naoki Yoshioka
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Sara Sato
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Nobutaka Kudo
- Department of Cardiology, Handa City Hospital, Aichi, Japan
| | - Hideki Ishii
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Cardiology, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Toyoaki Murohara
- Department of Cardiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Yuan Y, Li C, Xu L, Zhu S, Hua Y, Zhang J. CSM-Net: Automatic joint segmentation of intima-media complex and lumen in carotid artery ultrasound images. Comput Biol Med 2022; 150:106119. [PMID: 37859275 DOI: 10.1016/j.compbiomed.2022.106119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/25/2022] [Accepted: 09/17/2022] [Indexed: 11/18/2022]
Abstract
The intima-media thickness (IMT) is an effective biomarker for atherosclerosis, which is commonly measured by ultrasound technique. However, the intima-media complex (IMC) segmentation for the IMT is challenging due to confused IMC boundaries and various noises. In this paper, we propose a flexible method CSM-Net for the joint segmentation of IMC and Lumen in carotid ultrasound images. Firstly, the cascaded dilated convolutions combined with the squeeze-excitation module are introduced for exploiting more contextual features on the highest-level layer of the encoder. Furthermore, a triple spatial attention module is utilized for emphasizing serviceable features on each decoder layer. Besides, a multi-scale weighted hybrid loss function is employed to resolve the class-imbalance issues. The experiments are conducted on a private dataset of 100 images for IMC and Lumen segmentation, as well as on two public datasets of 1600 images for IMC segmentation. For the private dataset, our method obtain the IMC Dice, Lumen Dice, Precision, Recall, and F1 score of 0.814 ± 0.061, 0.941 ± 0.024, 0.911 ± 0.044, 0.916 ± 0.039, and 0.913 ± 0.027, respectively. For the public datasets, we obtain the IMC Dice, Precision, Recall, and F1 score of 0.885 ± 0.067, 0.885 ± 0.070, 0.894 ± 0.089, and 0.885 ± 0.067, respectively. The results demonstrate that the proposed method precedes some cutting-edge methods, and the ablation experiments show the validity of each module. The proposed method may be useful for the IMC segmentation of carotid ultrasound images in the clinic. Our code is publicly available at https://github.com/yuanyc798/US-IMC-code.
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Affiliation(s)
- Yanchao Yuan
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China; Hefei Innovation Research Institute, Beihang University, Hefei, China; Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Cancheng Li
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China; Hefei Innovation Research Institute, Beihang University, Hefei, China; Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Lu Xu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China; Hefei Innovation Research Institute, Beihang University, Hefei, China; Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Shangming Zhu
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China; Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China
| | - Yang Hua
- Department of Vascular Ultrasonography, XuanWu Hospital, Capital Medical University, Beijing, China; Beijing Diagnostic Center of Vascular Ultrasound, Beijing, China; Center of Vascular Ultrasonography, Beijing Institute of Brain Disorders, Collaborative Innovation Center for Brain Disorders, Capital Medical University, Beijing, China.
| | - Jicong Zhang
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China; Hefei Innovation Research Institute, Beihang University, Hefei, China; Beijing Advanced Innovation Centre for Biomedical Engineering, Beihang University, Beijing, China.
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Jiao Y, Qin Y, Zhang Z, Zhang H, Liu H, Li C. Early identification of carotid vulnerable plaque in asymptomatic patients. BMC Cardiovasc Disord 2020; 20:429. [PMID: 33003997 PMCID: PMC7528473 DOI: 10.1186/s12872-020-01709-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/20/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study was to explore the influencing factors of atherosclerotic plaque formation and stability in patients with asymptomatic carotid atherosclerotic plaques, so as to identify the vulnerable plaques at early stage, and then find high-risk group of cardio-cerebrovascular events for early clinical intervention to reduce related mortality and disability. METHODS A total of 302 enrolled patients with asymptomatic carotid atherosclerotic plaques were divided into 3 groups based on the results of carotid artery color Doppler ultrasound: atherosclerotic unstable plaque (UP) group, atherosclerotic stable plaque (SP) group, and control group without plaques. Serum markers were measured by ELISA. χ2 test, t test, Pearson correlation analysis, and Logistic multivariate regression analysis were used in the analysis, and P < 0.05 was considered statistically significant. RESULTS It revealed that high MMP-9, LOX-1and YKL-40 were independent risk factors for unstable plaque formation. The area under the curve (AUC) of serum markers combined with MMP-9, LOX-1 and YKL-40 was 0.850, with sensitivity 87.67%, specificity 81.13%, and diagnostic accuracy 84.92%, which was significantly better than the individual diagnostic efficacy of other three factors. The accuracy rate of Crouse Plaque Score (CPS) in the diagnosis of vulnerable plaques was 61.90%, the 10-year ICVD diagnosis accuracy rate was 56.75%, and the diagnostic accuracy of serum markers was significantly better than CPS and 10-year ICVD. CONCLUSION Noninvasive cervical color Doppler ultrasound combined with serum markers MMP-9, LOX-1 and YKL-40 have significant early recognition effect on asymptomatic carotid vulnerable plaque patients.
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Affiliation(s)
- Yungen Jiao
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 45# Taizhou road, Yangzhou, 225000, Jiangsu Province, China.
| | - Yahong Qin
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 45# Taizhou road, Yangzhou, 225000, Jiangsu Province, China.,521 Hospital of Norinco Group, 12# Zhangba East Road, Xi'an, 710065, Shaanxi Province, China
| | - Zhengang Zhang
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 45# Taizhou road, Yangzhou, 225000, Jiangsu Province, China
| | - Hao Zhang
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 45# Taizhou road, Yangzhou, 225000, Jiangsu Province, China
| | - Haiwei Liu
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 45# Taizhou road, Yangzhou, 225000, Jiangsu Province, China
| | - Chen Li
- Department of Cardiology, The Affiliated Hospital of Yangzhou University, Yangzhou University, 45# Taizhou road, Yangzhou, 225000, Jiangsu Province, China
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Costanzo L, Capodanno D, Manichino D, Sole A, Ronsivalle G, Di Pino L, Tamburino C, Giaimo V, Tamburino C. SYNTAX Score II predicts carotid disease in a multivessel coronary disease population. Int J Cardiol 2015; 196:145-8. [PMID: 26093529 DOI: 10.1016/j.ijcard.2015.06.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Accepted: 06/12/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The SYNTAX Score (SxScore) is an angiographic tool that evaluates CAD complexity, which we previously reported lacking correlation with the presence of carotid disease. Recently, SxScore II has been developed including both angiographic and clinical variables, which could increase the prognostic accuracy for detection of carotid disease. METHODS AND RESULTS From January 2013 to June 2014, 244 patients with multivessel CAD (mean age 65.37 years, 84% males) underwent carotid ultrasound scan. At least one carotid lesion (CL) was found in 77% of patients with significant carotid disease (SCD) in 23.4% of cases. Logistic regression analysis revealed no relation between SxScore and CL/SCD (p=0.781 and p=0.368) while SxScore II well correlated with CL (SxScore II-PCI: odds ratio [OR] 1.036; 95% confidence interval [CI]:1.006-1.067; p=0.019; SxScore II-CABG: OR 1.045; 95% CI: 1.015-1.076, p=0.003) and SCD (SxScore II-PCI: OR 1.042; 95% CI: 1.012-1.073, p=0.006; SxScore-CABG: OR 1.054; 95% CI: 1.029-1.080, p<0.0001). The areas under the receiver-operating characteristic curves were: for SxScore 0.512 (95% CI: 0.448-0.577; p=0.77), for SxScore II-PCI and SxScore II-CABG 0.600 (95% CI: 0.536-0.662; p=0.01) and 0.645 (95% CI: 0.581-0.705; p=0.0008), respectively, and 0.527 (95% CI 0.462-0.591; p=0.56), 0.619 (95% CI: 0.555-0.681; p=0.01) and 0.681 (95% CI: 0.619-0.739; p=0.0001), respectively, for the identification of SCD. CONCLUSIONS The SxScore II, with inclusion of clinical variables over angiographic complexity, seems more suited to predict the presence of carotid disease than the SxScore.
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Affiliation(s)
- Luca Costanzo
- Cardiothoracovascular Department, Division of Angiology, Ferrarotto-Polyclinic Hospital, University of Catania, Via Santa Sofia 78, 95100 Catania, Italy.
| | - Davide Capodanno
- Cardiothoracovascular Department, Division of Angiology, Ferrarotto-Polyclinic Hospital, University of Catania, Via Santa Sofia 78, 95100 Catania, Italy
| | - Daniela Manichino
- Cardiothoracovascular Department, Division of Angiology, Ferrarotto-Polyclinic Hospital, University of Catania, Via Santa Sofia 78, 95100 Catania, Italy
| | - Andrea Sole
- Cardiothoracovascular Department, Division of Angiology, Ferrarotto-Polyclinic Hospital, University of Catania, Via Santa Sofia 78, 95100 Catania, Italy
| | - Giuseppe Ronsivalle
- Cardiothoracovascular Department, Division of Angiology, Ferrarotto-Polyclinic Hospital, University of Catania, Via Santa Sofia 78, 95100 Catania, Italy
| | - Luigi Di Pino
- Cardiothoracovascular Department, Division of Angiology, Ferrarotto-Polyclinic Hospital, University of Catania, Via Santa Sofia 78, 95100 Catania, Italy
| | - Claudia Tamburino
- Cardiothoracovascular Department, Division of Angiology, Ferrarotto-Polyclinic Hospital, University of Catania, Via Santa Sofia 78, 95100 Catania, Italy
| | - Valerio Giaimo
- Cardiothoracovascular Department, Division of Angiology, Ferrarotto-Polyclinic Hospital, University of Catania, Via Santa Sofia 78, 95100 Catania, Italy
| | - Corrado Tamburino
- Cardiothoracovascular Department, Division of Angiology, Ferrarotto-Polyclinic Hospital, University of Catania, Via Santa Sofia 78, 95100 Catania, Italy
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Selamet Tierney ES, Gauvreau K, Jaff MR, Gal D, Nourse SE, Trevey S, O'Neill S, Baker A, Newburger JW, Colan SD. Carotid artery intima-media thickness measurements in the youth: reproducibility and technical considerations. J Am Soc Echocardiogr 2014; 28:309-16. [PMID: 25459501 DOI: 10.1016/j.echo.2014.10.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Carotid artery intima-media thickness (CIMT), a marker of atherosclerosis, is increased in youth at risk for future cardiovascular disease. Some pediatric studies have used CIMT as a primary outcome in clinical trials, yet data are limited on the standardization of methodology in children. The goal of this study was to evaluate reproducibility of CIMT measurements using two different measurement techniques. METHODS Carotid artery ultrasound studies of children and adolescents obtained as a component of a research study in Kawasaki syndrome were retrospectively analyzed. The CIMTs of both common carotid arteries (CCAs) were measured by one of two sonographers at the time in the cardiac cycle when resolution subjectively was determined to be optimal (Opt-CIMT). These sonographers blindly remeasured a random sample of studies of their own and each other's, using the same method. Another observer made CIMT measurements using exclusively frames on the R wave (R-CIMT). A fourth observer independently measured a random sample of studies twice with the R-CIMT method. RESULTS Carotid artery images from 184 subjects (mean age, 14.7 ± 2.2 years) were analyzed. The intraclass correlation coefficient for interobserver variability was 0.86 (95% confidence interval [CI], 0.69-0.94) compared with 0.85 (95% CI, 0.65-0.93) for the right and 0.86 (95% CI, 0.67-0.94) versus 0.95 (95% CI, 0.87-0.98) for the left CCA for Opt-CIMT and R-CIMT, respectively. R-CIMT was significantly thicker than Opt-CIMT (right CCA, 0.439 ± 0.030 vs 0.428 ± 0.024 mm, P < .001; left CCA, 0.446 ± 0.030 vs 0.434 ± 0.025 mm, P < .001). CONCLUSION Pediatric CIMT measurements have excellent reproducibility when the same methodology is applied but vary significantly throughout the cardiac cycle. This report highlights the need to standardize CIMT measurements in the youth and supports the use of electrocardiographic timing, as recommended in adults, in pediatric longitudinal studies.
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Affiliation(s)
- Elif Seda Selamet Tierney
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California.
| | - Kimberlee Gauvreau
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Michael R Jaff
- Department of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Dana Gal
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Susan E Nourse
- Division of Pediatric Cardiology, Department of Pediatrics, Stanford University, Palo Alto, California
| | - Shari Trevey
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Stephen O'Neill
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Annette Baker
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Jane W Newburger
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Steven D Colan
- Department of Cardiology, Children's Hospital Boston, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
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