Research

Cardiovascular magnetic resonance parameters of atherosclerotic plaque burden improve discrimination of prior major adverse cardiovascular events

Venkatesh Mani¹ , Paul Muntner² , Samuel S Gidding⁴ , Silvia H Aguiar¹ , Hamza El Aidi¹ , Karen B Weinshelbaum¹ , Hiroaki Taniguchi¹ , Rob van der Geest⁵ , Johan HC Reiber⁵ , Sameer Bansilal³ , Michael Farkouh³ , Valentin Fuster³ , John E Postley⁶ , Mark Woodward^2,3 and Zahi A Fayad¹

¹  Imaging Science Laboratories; Translational and Molecular Imaging Institute, Department of Radiology, Mount Sinai School of Medicine, New York, NY, USA

²  Department of Community Medicine, Mount Sinai School of Medicine, New York, NY, USA

³  Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA

⁴  A.I. DuPont Hospital for Children, Wilmington, Delaware, USA

⁵  Leiden University Medical Center, Leiden, The Netherlands

⁶  Columbia University, New York, NY, USA

author email corresponding author email

Journal of Cardiovascular Magnetic Resonance 2009, 11:10doi:10.1186/1532-429X-11-10

Published:	24 April 2009

Abstract

Aims

Patients with prior major cardiovascular or cerebrovascular events (MACE) are more likely to have future recurrent events independent of traditional cardiovascular disease risk factors. The purpose of this study was to determine if patients with traditional risk factors and prior MACE had increased cardiovascular magnetic resonance (CMR) plaque burden measures compared to patients with risk factors but no prior events.

Methods and Results

Black blood carotid and thoracic aorta images were obtained from 195 patients using a rapid extended coverage turbo spin echo sequence. CMR measures of plaque burden were obtained by tracing lumen and outer vessel wall contours. Patients with prior MACE had significantly higher MR plaque burden (wall thickness, wall area and normalized wall index) in carotids and thoracic aorta compared to those without prior MACE (Wall thickness carotids: 1.03 ± 0.03 vs. 0.93± 0.03, p = 0.001; SD wall thickness carotids: 0.137 ± 0.0008 vs. 0.102 ± 0.0004, p < 0.001; wall thickness aorta: 1.63 ± 0.10 vs. 1.50 ± 0.04, p = 0.009; SD wall thickness aorta: 0.186 ± 0.035 vs. 0.139 ± 0.012, p = 0.009 respectively). Plaque burden (wall thickness) and plaque eccentricity (standard deviation of wall thickness) of carotid arteries were associated with prior MACE after adjustment for age, sex, and traditional risk factors. Area under ROC curve (AUC) for discriminating prior MACE improved by adding plaque eccentricity to models incorporating age, sex, and traditional CVD risk factors as model inputs (AUC = 0.79, p = 0.05).

Conclusion

A greater plaque burden and plaque eccentricity is prevalent among patients with prior MACE.