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Bedside quantification of atherosclerosis severity for cardiovascular risk stratification: a prospective cohort study

Patrick R. Hunziker, MD^*,*, Christophe Imsand, MD, Dagmar Keller, MD, Niki Hess, MD, V.ânia Barbosa, MD, Fabian Nietlispach, MD, Noah Liel-Cohen, MD, Arthur E. Weyman, MD, FACC, Matthias Pfisterer, MD, FACC and Peter Buser, MD, FACC

^* Medical Intensive Care Unit, University Hospital, Basel,Switzerland
Division of Cardiology, University Hospital, Basel,Switzerland
Cardiac Unit, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA

View larger version (33K): [in a new window]   Figure 1 Rationale of study.

View larger version (85K): [in a new window]   Figure 2 Method for determination of specific aortic elastance by transthoracic echocardiography: Wave front propagation time from the left ventricular outflow tract to the common femoral artery is measured using pulsed wave Doppler. The wave front is defined as the extrapolation of the first segment of the Doppler flow profile to the baseline. Average aortic diameter is determined from measurements in the ascending aorta, the aortic arch and the abdominal aorta. All measurements are made using a conventional echocardiograph.

View larger version (29K): [in a new window]   Figure 3 Validation of the new bedside method for quantification of the severity of atherosclerosis by determination of elastic properties of the aortic wall. Specific elastance of the aorta shows an excellent correlation with plaque extent (left upper panel), with plaque thickness (left lower panel) and thus with overall atherosclerotic plaque burden (right panel), determined by direct visualization in transesophageal echo.

View larger version (56K): [in a new window]   Figure 4 The relation of age, cardiovascular risk factors and specific aortic elastance. In a cohort with a moderate number of risk factors (A) and with the age distribution given in C that reflects the referral pattern for cardiologic examination, specific aortic elastance spans a wide range (B). Specific elastance does not simply reflect age (E) or the number of risk factors (D).

View larger version (20K): [in a new window]   Figure 5 Relative risk for the primary end point (death attributable to atherosclerosis, nonfatal myocardial infarction or stroke) of different levels of multiple risk factors. An increase in specific elastance leads to a marked increase in event risk for each tertile of specific elastance.