HOME SUBSCRIPTIONS CURRENT ISSUE PAST ISSUES CARDIOSOURCE SEARCH HELP FEEDBACK		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Figures Only Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Honda, O. Articles by Ogawa, H. Search for Related Content PubMed PubMed Citation Articles by Honda, O. Articles by Ogawa, H.

CLINICAL RESEARCH: ATHEROSCLEROSIS

Echolucent carotid plaques predict future coronary events in patients with coronary artery disease

Osamu Honda, MD^*, Seigo Sugiyama, MD, PhD^*,*, Kiyotaka Kugiyama, MD, PhD, Hironobu Fukushima, MD^*, Shinichi Nakamura, MD^*, Shunichi Koide, MD^*, Sunao Kojima, MD^*, Nobutaka Hirai, MD^*, Hiroaki Kawano, MD, PhD^*, Hirofumi Soejima, MD, PhD^*, Tomohiro Sakamoto, MD, PhD^*, Michihiro Yoshimura, MD, PhD^* and Hisao Ogawa, MD, PhD^*

^* Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
Second Department of Internal Medicine, Graduate School of Yamanashi University, Yamanashi, Japan

Manuscript received April 23, 2003; revised manuscript received July 31, 2003, accepted September 29, 2003.

^* Reprint requests and correspondence: Dr. Seigo Sugiyama, 1-1-1 Honjo, Kumamoto City, Kumamoto, Japan 860-8556.
ssugiyam{at}kumamoto-u.ac.jp

OBJECTIVES: The purpose of this study was to examine whether echolucent carotid plaques predict future coronary events in patients with clinically stable coronary artery disease (CAD).

BACKGROUND: Although rupture of coronary plaques is considered a major cause of acute coronary syndromes (ACS), the clinical estimation of coronary vulnerability still remains inconclusive. Ultrasound evaluation of carotid plaques with integrated backscatter (IBS) analysis can indicate the consistency/structure of the plaques. Lipid-rich lesions known as "unstable plaques" appear as echolucent plaques with low IBS values using this technique.

METHODS: We investigated the echogenicity of carotid plaques using ultrasound with IBS in 286 consecutive CAD patients (71 with ACS and 215 with stable CAD). Coronary plaque complexity was also determined angiographically in stable CAD patients followed up for 30 months or until the occurrence of coronary events.

RESULTS: The calibrated IBS values of carotid plaques in ACS patients were significantly lower than those in stable CAD patients (p < 0.01). Echolucent carotid plaques accurately predicted the existence of complex coronary plaques (predictive power of 83%). Kaplan-Meier analysis demonstrated a significantly higher probability of coronary events developing in patients with echolucent carotid plaques than in patients without this type of plaque (p < 0.001). The presence of echolucent carotid plaques in stable CAD patients predicted future coronary events independent of other risk factors (odds ratio 7.0, 95% confidence interval 2.3 to 21.4; p < 0.001).

CONCLUSIONS: Echolucent carotid plaques with low IBS values predicted coronary plaque complexity and the development of future coronary complications in patients with stable CAD. Qualitative evaluation of carotid plaques using ultrasound with IBS is a clinically useful procedure for risk assessment of CAD patients.

Abbreviations and Acronyms   ACS = acute coronary syndromes   AMI = acute myocardial infarction   CAD = coronary artery disease   (c)IBS = (calibrated) integrated backscatter   IMT = intima-media thickness   HDL = high-density lipoprotein   hs-CRP = high-sensitivity C-reactive protein   LDL = low-density lipoprotein   OMI = old myocardial infarction   PCI = percutaneous coronary intervention   ROI = region of interest   UAP = unstable angina pectoris

This article has been cited by other articles:

				M. Reiter, I. Effenberger, S. Sabeti, W. Mlekusch, O. Schlager, P. Dick, S. Puchner, J. Amighi, R. A. Bucek, E. Minar, et al. Increasing Carotid Plaque Echolucency is Predictive of Cardiovascular Events in High-Risk Patients Radiology, September 1, 2008; 248(3): 1050 - 1055. [Abstract] [Full Text] [PDF]

				R. M. Martin, D. Gunnell, E. Whitley, A. Nicolaides, M. Griffin, N. Georgiou, G. Davey Smith, S. Ebrahim, and J. M. P. Holly Associations of Insulin-Like Growth Factor (IGF)-I, IGF-II, IGF Binding Protein (IGFBP)-2 and IGFBP-3 with Ultrasound Measures of Atherosclerosis and Plaque Stability in an Older Adult Population J. Clin. Endocrinol. Metab., April 1, 2008; 93(4): 1331 - 1338. [Abstract] [Full Text] [PDF]

				B. A. Wasserman, A. R. Sharrett, S. Lai, A. S. Gomes, M. Cushman, A. R. Folsom, D. E. Bild, R. A. Kronmal, S. Sinha, and D. A. Bluemke Risk Factor Associations With the Presence of a Lipid Core in Carotid Plaque of Asymptomatic Individuals Using High-Resolution MRI: The Multi-Ethnic Study of Atherosclerosis (MESA) Stroke, February 1, 2008; 39(2): 329 - 335. [Abstract] [Full Text] [PDF]

				T. Amano, T. Matsubara, T. Uetani, M. Nanki, N. Marui, M. Kato, T. Yoshida, K. Arai, K. Yokoi, H. Ando, et al. Abnormal Glucose Regulation Is Associated With Lipid-Rich Coronary Plaque: Relationship to Insulin Resistance J. Am. Coll. Cardiol. Img., January 1, 2008; 1(1): 39 - 45. [Abstract] [Full Text] [PDF]

				S. Sabeti, O. Schlager, M. Exner, W. Mlekusch, J. Amighi, P. Dick, G. Maurer, K. Huber, R. Koppensteiner, O. Wagner, et al. Progression of Carotid Stenosis Detected by Duplex Ultrasonography Predicts Adverse Outcomes in Cardiovascular High-Risk Patients Stroke, November 1, 2007; 38(11): 2887 - 2894. [Abstract] [Full Text] [PDF]

				S. H. Johnsen, E. B. Mathiesen, O. Joakimsen, E. Stensland, T. Wilsgaard, M.-L. Lochen, I. Njolstad, and E. Arnesen Carotid Atherosclerosis Is a Stronger Predictor of Myocardial Infarction in Women Than in Men: A 6-Year Follow-Up Study of 6226 Persons: The Tromso Study Stroke, November 1, 2007; 38(11): 2873 - 2880. [Abstract] [Full Text] [PDF]

				E. Mahmud, J. J. Cavendish, and A. Salami Current Treatment of Peripheral Arterial Disease: Role of Percutaneous Interventional Therapies J. Am. Coll. Cardiol., August 7, 2007; 50(6): 473 - 490. [Abstract] [Full Text] [PDF]

				R. Klein, B. E. K. Klein, M. D. Knudtson, M. F. Cotch, T. Y. Wong, K. Liu, G. L. Burke, M. F. Saad, D. R. Jacobs Jr, and A. R. Sharrett Subclinical Atherosclerotic Cardiovascular Disease and Early Age-Related Macular Degeneration in a Multiracial Cohort: The Multiethnic Study of Atherosclerosis Arch Ophthalmol, April 1, 2007; 125(4): 534 - 543. [Abstract] [Full Text] [PDF]

				T. Amano, T. Matsubara, T. Uetani, M. Nanki, N. Marui, M. Kato, K. Arai, K. Yokoi, H. Ando, H. Ishii, et al. Impact of Metabolic Syndrome on Tissue Characteristics of Angiographically Mild to Moderate Coronary Lesions: Integrated Backscatter Intravascular Ultrasound Study J. Am. Coll. Cardiol., March 20, 2007; 49(11): 1149 - 1156. [Abstract] [Full Text] [PDF]

				R. A Wyman, M. E Mays, P. E McBride, and J. H Stein Ultrasound-detected carotid plaque as a predictor of cardiovascular events Vascular Medicine, May 1, 2006; 11(2): 123 - 130. [Abstract] [PDF]

				A. N. DeMaria, J. Narula, E. Mahmud, and S. Tsimikas Imaging vulnerable plaque by ultrasound. J. Am. Coll. Cardiol., April 18, 2006; 47(8 Suppl): C32 - C39. [Abstract] [Full Text] [PDF]

				K. Watanabe, S. Sugiyama, K. Kugiyama, O. Honda, H. Fukushima, H. Koga, Y. Horibata, T. Hirai, T. Sakamoto, M. Yoshimura, et al. Stabilization of Carotid Atheroma Assessed by Quantitative Ultrasound Analysis in Nonhypercholesterolemic Patients With Coronary Artery Disease J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2022 - 2030. [Abstract] [Full Text] [PDF]

				H. Yokoyama, M. Kawasaki, Y. Ito, S. Minatoguchi, and H. Fujiwara Effects of Fluvastatin on the Carotid Arterial Media as Assessed by Integrated Backscatter Ultrasound Compared With Pulse-Wave Velocity J. Am. Coll. Cardiol., December 6, 2005; 46(11): 2031 - 2037. [Abstract] [Full Text] [PDF]

				J. Narula, A. V. Finn, and A. N. DeMaria Picking Plaques That Pop ... J. Am. Coll. Cardiol., June 21, 2005; 45(12): 1970 - 1973. [Full Text] [PDF]