In the Journals

PESA: 3-D vascular ultrasound detects plaque burden for CV risk prediction

Valentin Fuster, MD
Valentin Fuster

A 3-D vascular ultrasound detected elevated plaque burden in middle-aged men, especially within the femoral territory, according to a study published in the Journal of the American College of Cardiology.

The technology “is a feasible, reproducible and novel imaging technique for quantifying early carotid and femoral atherosclerotic burden in large populations,” Valentin Fuster, MD, PhD, director of Mount Sinai Heart and physician-in-chief of The Mount Sinai Hospital, said in a press release. “This novel method is valid for imaging superficial peripheral atherosclerosis burden from early to advanced stages of disease and can be applied to identification of individuals at risk, targeting or monitoring treatment.”

Ultrasound in low-risk participants

The PESA study was an ongoing observational prospective cohort study in which researchers analyzed data from 3,860 participants (mean age, 46 years; 63% men) without prior CVD. Most participants (79.4%) were low risk. A baseline visit included 3-D vascular ultrasound (Philips iU22) of the femoral and carotid territories, 12-lead ECG and other tests. Participants were followed up at 3 and 6 years.

A random sample (n = 32) was selected from the cohort to assess reproducibility of volume measurement and plaque detection with 3-D vascular ultrasound.

Global plaque burden was more evident in men (63.4 mm3; interquartile range [IQR], 23.8-144.8) vs. women (25.7 mm3; IQR, 11.5-61.6; P < .001). Plaque burden was more common in the femoral territory (64 mm3; IQR, 27.6-140.5) compared with the carotid territory (23.1 mm3; IQR, 9.9-48.7; P < .001), and it increased with age (P < .001).

Similar results were found for plaque presence.

Plaque burden

Femoral disease burden had a stronger link to sex, age, dyslipidemia and smoking vs. carotid disease burden. Hypertension and diabetes did not show significant territorial differences.

Plaque burden was associated with higher CV risk independent of territories affected or number of plaques (P for trend < .01).

“Our results suggest that the ability of global plaque burden to predict cardiovascular risk is likely to be improved by adding evaluation of the femoral arteries at early stages of cardiovascular disease,” the researchers wrote.

“[A] question is how important it will be to include femoral plaque measurement in addition to carotid measurement,” J. David Spence, MD, MBA, professor of neurology and clinical pharmacology and director of the Stroke Prevention and Atherosclerosis Research Centre at the Robarts Research Institute at Western University in London, Ontario, wrote in a related editorial. “Our experience has been that whereas carotid imaging is very comfortable for both the patient and the technologist, it is more difficult to deal with the disrobing (and sometimes the hygiene issues) involved in assessing the femoral arteries.” – by Darlene Dobkowski

Disclosures: The study was funded by the Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III and Banco Santander. The authors report no relevant financial disclosures. Spence reports serving as an officer for Vascularis Inc.

Valentin Fuster, MD
Valentin Fuster

A 3-D vascular ultrasound detected elevated plaque burden in middle-aged men, especially within the femoral territory, according to a study published in the Journal of the American College of Cardiology.

The technology “is a feasible, reproducible and novel imaging technique for quantifying early carotid and femoral atherosclerotic burden in large populations,” Valentin Fuster, MD, PhD, director of Mount Sinai Heart and physician-in-chief of The Mount Sinai Hospital, said in a press release. “This novel method is valid for imaging superficial peripheral atherosclerosis burden from early to advanced stages of disease and can be applied to identification of individuals at risk, targeting or monitoring treatment.”

Ultrasound in low-risk participants

The PESA study was an ongoing observational prospective cohort study in which researchers analyzed data from 3,860 participants (mean age, 46 years; 63% men) without prior CVD. Most participants (79.4%) were low risk. A baseline visit included 3-D vascular ultrasound (Philips iU22) of the femoral and carotid territories, 12-lead ECG and other tests. Participants were followed up at 3 and 6 years.

A random sample (n = 32) was selected from the cohort to assess reproducibility of volume measurement and plaque detection with 3-D vascular ultrasound.

Global plaque burden was more evident in men (63.4 mm3; interquartile range [IQR], 23.8-144.8) vs. women (25.7 mm3; IQR, 11.5-61.6; P < .001). Plaque burden was more common in the femoral territory (64 mm3; IQR, 27.6-140.5) compared with the carotid territory (23.1 mm3; IQR, 9.9-48.7; P < .001), and it increased with age (P < .001).

Similar results were found for plaque presence.

Plaque burden

Femoral disease burden had a stronger link to sex, age, dyslipidemia and smoking vs. carotid disease burden. Hypertension and diabetes did not show significant territorial differences.

Plaque burden was associated with higher CV risk independent of territories affected or number of plaques (P for trend < .01).

“Our results suggest that the ability of global plaque burden to predict cardiovascular risk is likely to be improved by adding evaluation of the femoral arteries at early stages of cardiovascular disease,” the researchers wrote.

“[A] question is how important it will be to include femoral plaque measurement in addition to carotid measurement,” J. David Spence, MD, MBA, professor of neurology and clinical pharmacology and director of the Stroke Prevention and Atherosclerosis Research Centre at the Robarts Research Institute at Western University in London, Ontario, wrote in a related editorial. “Our experience has been that whereas carotid imaging is very comfortable for both the patient and the technologist, it is more difficult to deal with the disrobing (and sometimes the hygiene issues) involved in assessing the femoral arteries.” – by Darlene Dobkowski

Disclosures: The study was funded by the Fundación Centro Nacional de Investigaciones Cardiovasculares Carlos III and Banco Santander. The authors report no relevant financial disclosures. Spence reports serving as an officer for Vascularis Inc.