3D vascular ultrasound better estimates cardiovascular risk

Three-dimensional vascular ultrasound (3DVUS) is a novel experimental imaging technique that may become an important addition to cardiovascular risk profiling, according to researchers from The Mount Sinai Hospital, New York City, NY, who successfully used 3DVUS to identify higher plaque burden in men, in the femoral territory, and with increasing age during midlife. Their results from the Progression of Early Subclinical Atherosclerosis (PESA) Study are published in The Journal of the American College of Cardiology.

“3DVUS is a feasible, reproducible, and novel imaging technique for quantifying early carotid and femoral atherosclerotic burden in large populations,” said senior author, Valentin Fuster, MD, PhD, director, Mount Sinai Heart, and Physician-in-Chief, The Mount Sinai Hospital.

“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. Further studies are needed, however, to assess the cost utility of this method compared with others when used in large-scale practice settings and population-based epidemiological studies,” added Dr. Fuster.

Currently, the clinical application of 3DVUS techniques are in the research-and-development stages, but direct quantification of atherosclerotic plaque volume with 3DVUS is more reproducible than 2-dimensional techniques. 3DVUS also offers the advantage of being a radiation-free technology and is relatively inexpensive.

For this ongoing, observational, prospective cohort study, Dr. Fuster and colleagues included 3,860 subjects (man age: 45.9 years; 63% men) from the PESA study, in whom they used 3DVUS to assess the number of plaques and territories affected in the bilateral carotid and femoral areas, and to quantify global plaque burden (sum of all plaque volumes).

These 3DVUS exams were performed using a new Phillips iU22 ultrasound system that was equipped with a VL13-5 3D volume-linear array transducer. Researchers then used linear regression and proportional odds models to assess associations of plaque burden with CVRFs and estimated 10-year cardiovascular risk.

Researchers found a higher plaque burden in men compared with women (63.4 vs 25.7 mm³, respectively; P < 0.001), in the femoral territory compared with the carotid territory (64 vs 23.1 mm³; P < 0.001), and with increasing age.

In addition, they observed a stronger association between age, sex, smoking, and dyslipidemia with femoral compared with carotid disease burden, and found no territorial differences with hypertension and diabetes. Finally, they found a direct association between plaque burden and estimated cardiovascular risk independently of the number of plaques or territories affected (P < 0.001).

This study is part of an international initiative that is being conducted through partnerships with the National Center for Cardiovascular Research in Spain, the Icahn School of Medicine at Mount Sinai, and the Framingham Heart Study.