Carotid Ultrasound Phenotypes Are Biologically Distinct
2015; Lippincott Williams & Wilkins; Volume: 35; Issue: 9 Linguagem: Inglês
10.1161/atvbaha.115.306209
ISSN1524-4636
Autores Tópico(s)Cerebrovascular and Carotid Artery Diseases
ResumoHomeArteriosclerosis, Thrombosis, and Vascular BiologyVol. 35, No. 9Carotid Ultrasound Phenotypes Are Biologically Distinct Free AccessEditorialPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessEditorialPDF/EPUBCarotid Ultrasound Phenotypes Are Biologically Distinct J. David Spence J. David SpenceJ. David Spence From the Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, London, Canada. Originally published1 Sep 2015https://doi.org/10.1161/ATVBAHA.115.306209Arteriosclerosis, Thrombosis, and Vascular Biology. 2015;35:1910–1913In this issue of Arteriosclerosis, Thrombosis, and Vascular Biology, Santos et al1 report from a large Brazilian study (n=9792) that factors they analyzed explained a higher proportion of carotid intima-media thickness (IMT; ie, gave a higher R2 in multiple regression) than reported in previous studies.See accompanying article on page 2054As pointed out by Inaba et al,2 it is crucial to distinguish between IMT measured according to the Mannheim consensus (in the far wall of the distal common carotid where there is no plaque) and methods that include plaque thickness in numerous locations, including the carotid bulb (the Atherosclerosis Risk in Communities [ARIC] and related protocols). IMT measured according to the Mannheim consensus does not represent atherosclerosis3; it is another phenotype. Studies that include plaque thickness in the measurement of IMT, and then analyze participants with and without plaque as if they were the same, confuse the issue by conflating the 2 kinds of IMT.Carotid ultrasound phenotypes are different: compensatory enlargement (positive remodeling) results in enlargement of the artery to accommodate plaque progression, without narrowing of the lumen.4 Thus, plaque burden represents the effects of oxidative stress and a lifetime's exposure to coronary risk factors, whereas stenosis reflects factors that cause plaque rupture and thrombosis. An illustration of this principle is the differential relationship between Lp(a), a clotting factor,5 with carotid stenosis and occlusion, but not plaque burden.6Plaque thickness predicts cardiovascular risk.7 It is likely for that reason that the studies of IMT that include plaque thickness predicted cardiovascular risk,8 particularly in the elderly.9 In the ARIC study, the increment in risk above coronary risk factors gave an area under the curve of 0.08 with IMT, which increased to 0.17 with addition of the presence of plaque. However, meta-analyses found that IMT measured without plaque is a weak predictor of cardiovascular risk,10 and progression of IMT did not predict cardiovascular risk11 nor did regression of IMT.12 A meta-analysis by Inaba et al2 concluded that plaque area was a stronger predictor of risk than IMT. Adam and Bojara13 also found, in a workplace health program study in >4000 participants, that plaque area and plaque type, but not IMT, predicted coronary stenosis and cardiovascular risk.A report from the Multi-Ethnic Study of Atherosclerosis (MESA) indicated that coronary calcium, but not IMT, predicted cardiovascular risk in the overall population.14 Brook et al15 reported that carotid total plaque area was more specific for exclusion of coronary artery stenosis that either IMT or coronary calcium score. Chan et al16 found that both total plaque area and impaired flow-mediated vasodilation predicted risk among patients with coronary artery disease; in that study, IMT without plaque did not correlate with either IMT or flow-mediated vasodilation, and did not predict risk. In a study of residual risk after statin response among patients with coronary artery disease,17 carotid plaque echolucency, but not IMT, predicted cardiovascular risk.The largest population-based study in which both IMT and plaque burden were measured was the Tromsø study, in >6000 participants. In the 7-year follow-up report of that study, IMT in the common carotid did not predict coronary risk, IMT in the carotid bulb (including plaque thickness) was a weak predictor, and total plaque area was a strong predictor of coronary risk.18 In a 10-year follow-up report, IMT did not predict stroke, whereas total plaque area was a strong predictor of stroke.19 In the Tromsø study, total cholesterol, systolic blood pressure, and smoking were stronger predictors of progression of TPA than of IMT, whereas sex and age were stronger predictors of IMT.20Previous studies have reported that traditional coronary risk factors explained 52% to 57% of total plaque area,21,22 but only 13% of carotid stenosis.23 O'Leary et al24 reported, in a study using IMT methods that included plaque thickness, that 17% of IMT in the common carotid and 18% of IMT in the bulb were explained by coronary risk factors. In the Northern Manhattan Study, only 11% of IMT was explained by traditional risk factors; age and male sex accounted for most of the explained variance; glucose and smoking (pack-years) also contributed, and low-density lipoprotein cholesterol was a marginally significant factor. An extended model, including inflammatory biomarkers, adiponectin, homocysteine, and renal function, explained 16% of the variance in carotid intima-media thickness (cIMT); only adiponectin was an additional significant contributor to the variance in cIMT.In the study of Santos et al,1 factors such as race, pulse pressure, and neck circumference made a greater contribution to the prediction of IMT (ie, had higher beta values) than to the traditional coronary risk factors. IMT was predicted less strongly among participants with a predicted coronary risk >10%. Thus, the authors have expanded the explained variance of IMT, by including additional predictors of IMT.Besides assessment of cardiovascular risk, ultrasound phenotypes of atherosclerosis are useful for genetic studies and for evaluation of new therapies. As would be expected, genetic factors for IMT are different from those for plaque burden.25 It would be expected that genetic factors affecting stenosis would again be different, as they would preferentially affect plaque rupture and thrombosis. Similarly, genetic factors affecting coronary calcium scores would be expected to be different, preferentially affecting calcification.26Ultrasound phenotypes of atherosclerosis are also importantly different with regard to studies of new therapies. Recommended sample sizes for IMT studies of a therapy causing a 30% difference between placebo and active therapy are ≈300 participants per group, followed for 2 years.27 This large sample size and duration of study are because of the small magnitude of average progression of IMT (≈0.15 mm/y) in relation to the spatial resolution of carotid ultrasound (≈0.3 mm).Two-dimensional (2D, total plaque area) and 3D (total plaque volume [TPV]) measurement of plaque burden, however, change by much greater quantities in relation to the spatial resolution of carotid ultrasound, so are much more sensitive to effects of therapy (Figure).Download figureDownload PowerPointFigure. Ultrasound images used for determinations of right carotid anatomy in 1, 2, and 3 dimensions from 2 study subjects. Three top panels are images from one subject and 3 bottom panels are images from the other. The left panels show typical images used to determine intima-media thickness (IMT), with arrows at the far carotid wall showing where IMT was determined. Both subjects had IMT of ≈1 mm. The middle panels show images used to determine total plaque area (PA) of the shaded plaques, with values shown for each subject. The right panels show images used to determine total plaque volume (PV) of the colored regions, with values shown. Reproduced from Al-Shali et al45 with permission of the publisher. Copyright © 2005, Elsevier.Early work in 3D ultrasound by Delcker and Diener,28 Hennerici et al,29 and Fenster's group30–32 led to increasingly automated methods for measuring TPV33–35 and vessel wall volume (VWV).Total plaque area changes by ≈10 mm2/y, and 3D TPV by ≈50 to 100 mm3/y, so it is much easier to measure change in these quantities.36,37 It was possible to show a significant change in carotid plaque volume with atorvastatin in only 3 months, in only ≈20 patients per group.38 In patients randomized to placebo, TPV increased by 16.81±74.10 mm3; on atorvastatin, it regresses by −90.25±85.12 mm3 (P<0.001). Progression of TPV, but not of IMT or plaque area, predicted cardiovascular events among patients attending vascular prevention clinics.39For patients or study participants without plaque, it is possible to measure VWV,40 which also changes by quantities easy to measure in small samples over short durations. Atorvastatin significantly reduced VWV in 3 months in ≈20 patients per group.41 Even weight loss and blood pressure reduction by diet was sufficient to show significant changes in VWV in 2 years with a mean reduction in VWV by −58.1 mm3 (95% confidence interval, −81.0 to −35.1 mm3; P<0.001).A systematic review42 of intravascular ultrasound and other methods concluded that regression of atherosclerotic plaque using statin therapy in those studies documenting regression occurred after an average time of 19.7 months. This suggests that patients should undergo ≈2 years of aggressive lipid reduction before considering a reduction of statin therapy. However, because carotid plaque is focal, it is much more sensitive to effects of treatment than coronary plaque volume on intravascular ultrasound. Carotid plaques change in length, along the axis of flow, 2.4× faster than they thicken.43 Plaques also grow and regress circumferentially, so they can change in 3 dimensions: thickness, length, and circumferential extent. Coronary plaques, in contrast, extend around the entire circumference of the artery and along the entire length of the pullback, so they are not focal. Thus, the change over time reduces to a single dimension: average thickness.44Santos et al1 have shown that traditional coronary risk factors explain only a small fraction of IMT, and adding neck circumference, race, and pulse pressure brought the proportion of explained variance (the R2) up to only 0.3. This illustrates again the differences between IMT and plaque burden.Ultrasound phenotypes of the carotid arteries thus differ in their relation to coronary risk factors and genetic factors and in response to therapy. Stenosis, IMT, and plaque burden are biologically distinct.Sources of FundingDr Spence has received grants from the Canadian Institutes of Health Research, Heart & Stroke Foundation of Canada (Ontario), National Institutes of Health (National Institutes for Nervous Diseases and Stroke), and grants from industry for investigator-initiated research projects (Pfizer and Merck). Lecture honoraria/travel support/consulting fees were provided by Bayer, Merck, and Boehringer-Ingelheim. Contract research was conducted with all of the above pharma companies and Takeda Pharmaceuticals, Bristol-Myers Squibb, Servier, Wyeth, Miles, Roussel-Uclaf, and AstraZeneca, as well as with manufacturers of devices for percutaneous closure of patent foramen ovale (NMT, AGA, and Gore).DisclosuresDr Spence is a member of the Editorial Boards of Hypertension, Stroke and Arteriosclerosis, Thrombosis and Vascular Biology. He receives royalties on books from Vanderbilt University Press and McGraw-Hill Medical. He is a shareholder and officer of Vascularis Inc.FootnotesCorrespondence to J. David Spence, MD, Stroke Prevention and Atherosclerosis Research Centre, Robarts Research Institute, Western University, 1400 Western Rd, London, ON N6G 2V4, Canada. E-mail [email protected]References1. Santos IS, Alencar AP, Rundek T, Goulart AC, Barreto SM, Pereira AC, Bensenor IM, Lotufo PA. Low impact of traditional risk factors on carotid intima-media thickness: the ELSA-Brasil cohort.Arterioscler Thromb Vasc Biol. 2015;35:2054–2059. doi: 10.1161/ATVBAHA.115.305765.LinkGoogle Scholar2. Inaba Y, Chen JA, Bergmann SR. Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: a meta-analysis.Atherosclerosis. 2012; 220:128–133. doi: 10.1016/j.atherosclerosis.2011.06.044.CrossrefMedlineGoogle Scholar3. Finn AV, Kolodgie FD, Virmani R. Correlation between carotid intimal/medial thickness and atherosclerosis: a point of view from pathology.Arterioscler Thromb Vasc Biol. 2010; 30:177–181. doi: 10.1161/ATVBAHA.108.173609.LinkGoogle Scholar4. Glagov S, Weisenberg E, Zarins CK, Stankunavicius R, Kolettis GJ. Compensatory enlargement of human atherosclerotic coronary arteries.N Engl J Med. 1987; 316:1371–1375. doi: 10.1056/NEJM198705283162204.CrossrefMedlineGoogle Scholar5. Spence JD, Koschinsky M. Mechanisms of lipoprotein(a) pathogenicity: prothrombotic, proatherosclerotic, or both?Arterioscler Thromb Vasc Biol. 2012; 32:1550–1551. doi: 10.1161/ATVBAHA.112.251306.LinkGoogle Scholar6. Klein JH, Hegele RA, Hackam DG, Koschinsky ML, Huff MW, Spence JD. Lipoprotein(a) is associated differentially with carotid stenosis, occlusion, and total plaque area.Arterioscler Thromb Vasc Biol. 2008; 28:1851–1856. doi: 10.1161/ATVBAHA.108.169292.LinkGoogle Scholar7. Rundek T, Arif H, Boden-Albala B, Elkind MS, Paik MC, Sacco RL. Carotid plaque, a subclinical precursor of vascular events: the Northern Manhattan Study.Neurology. 2008; 70:1200–1207. doi: 10.1212/01.wnl.0000303969.63165.34.CrossrefMedlineGoogle Scholar8. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, Clegg LX. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993.Am J Epidemiol. 1997; 146:483–494.CrossrefMedlineGoogle Scholar9. O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group.N Engl J Med. 1999; 340:14–22. doi: 10.1056/NEJM199901073400103.CrossrefMedlineGoogle Scholar10. Lorenz MW, Markus HS, Bots ML, Rosvall M, Sitzer M. Prediction of clinical cardiovascular events with carotid intima-media thickness: a systematic review and meta-analysis.Circulation. 2007; 115:459–467. doi: 10.1161/CIRCULATIONAHA.106.628875.LinkGoogle Scholar11. Lorenz MW, Polak JF, Kavousi M, et al; PROG-IMT Study Group. Carotid intima-media thickness progression to predict cardiovascular events in the general population (the PROG-IMT collaborative project): a meta-analysis of individual participant data.Lancet. 2012; 379:2053–2062. doi: 10.1016/S0140-6736(12)60441-3.CrossrefMedlineGoogle Scholar12. Costanzo P, Perrone-Filardi P, Vassallo E, Paolillo S, Cesarano P, Brevetti G, Chiariello M. Does carotid intima-media thickness regression predict reduction of cardiovascular events? A meta-analysis of 41 randomized trials.J Am Coll Cardiol. 2010; 56:2006–2020. doi: 10.1016/j.jacc.2010.05.059.CrossrefMedlineGoogle Scholar13. Adams A, Bojara W. [Prediction of coronary artery stenosis by measurement of total plaque area and thickness versus intima media thickness of the carotid artery (published online ahead of print May 22, 2015)]. Herz. doi: 10.1007/s00059-015-4312-5. http://link.springer.com/article/10.1007%2Fs00059-015-4312-5.Google Scholar14. Yeboah J, McClelland RL, Polonsky TS, Burke GL, Sibley CT, O'Leary D, Carr JJ, Goff DC, Greenland P, Herrington DM. Comparison of novel risk markers for improvement in cardiovascular risk assessment in intermediate-risk individuals.JAMA. 2012; 308:788–795. doi: 10.1001/jama.2012.9624.CrossrefMedlineGoogle Scholar15. Brook RD, Bard RL, Patel S, Rubenfire M, Clarke NS, Kazerooni EA, Wakefield TW, Henke PK, Eagle KA. A negative carotid plaque area test is superior to other noninvasive atherosclerosis studies for reducing the likelihood of having underlying significant coronary artery disease.Arterioscler Thromb Vasc Biol. 2006; 26:656–662. doi: 10.1161/01.ATV.0000200079.18690.60.LinkGoogle Scholar16. Chan SY, Mancini GB, Kuramoto L, Schulzer M, Frohlich J, Ignaszewski A. The prognostic importance of endothelial dysfunction and carotid atheroma burden in patients with coronary artery disease.J Am Coll Cardiol. 2003; 42:1037–1043.CrossrefMedlineGoogle Scholar17. Uematsu M, Nakamura T, Sugamata W, Kitta Y, Fujioka D, Saito Y, Kawabata K, Obata JE, Watanabe Y, Watanabe K, Kugiyama K. Echolucency of carotid plaque is useful for assessment of residual cardiovascular risk in patients with chronic coronary artery disease who achieve LDL-C goals on statin therapy.Circ J. 2014; 78:151–158.CrossrefMedlineGoogle Scholar18. Johnsen SH, Mathiesen EB, Joakimsen O, Stensland E, Wilsgaard T, Løchen ML, Njølstad I, Arnesen E. Carotid atherosclerosis is a stronger predictor of myocardial infarction in women than in men: a 6-year follow-up study of 6226 persons: the Tromsø Study.Stroke. 2007; 38:2873–2880. doi: 10.1161/STROKEAHA.107.487264.LinkGoogle Scholar19. Mathiesen EB, Johnsen SH, Wilsgaard T, Bønaa KH, Løchen ML, Njølstad I. Carotid plaque area and intima-media thickness in prediction of first-ever ischemic stroke: a 10-year follow-up of 6584 men and women: the Tromsø Study.Stroke. 2011; 42:972–978. doi: 10.1161/STROKEAHA.110.589754.LinkGoogle Scholar20. Herder M, Johnsen SH, Arntzen KA, Mathiesen EB. Risk factors for progression of carotid intima-media thickness and total plaque area: a 13-year follow-up study: the Tromsø Study.Stroke. 2012; 43:1818–1823. doi: 10.1161/STROKEAHA.111.646596.LinkGoogle Scholar21. Spence JD. Technology Insight: ultrasound measurement of carotid plaque–patient management, genetic research, and therapy evaluation.Nat Clin Pract Neurol. 2006; 2:611–619. doi: 10.1038/ncpneuro0324.CrossrefMedlineGoogle Scholar22. Spence JD. Genetics of atherosclerosis: the power of plaque burden and progression: invited commentary on Dong C, Beecham A, Wang L, Blanton SH, Rundek T, Sacco RL. Follow-up association study of linkage regions reveals multiple candidate genes for carotid plaque in Dominicans atherosclerosis 223 (1) (2012) 177-183.Atherosclerosis. 2012; 223:98–101. doi: 10.1016/j.atherosclerosis.2012.03.040.CrossrefMedlineGoogle Scholar23. Spence JD, Hegele RA. Noninvasive phenotypes of atherosclerosis: similar windows but different views.Stroke. 2004; 35:649–653. doi: 10.1161/01.STR.0000116103.19029.DB.LinkGoogle Scholar24. O'Leary DH, Polak JF, Kronmal RA, Savage PJ, Borhani NO, Kittner SJ, Tracy R, Gardin JM, Price TR, Furberg CD. Thickening of the carotid wall. A marker for atherosclerosis in the elderly? Cardiovascular Health Study Collaborative Research Group.Stroke. 1996; 27:224–231.LinkGoogle Scholar25. Pollex RL, Hegele R. Genetic determinants of carotid ultrasound traits.Curr Atheroscler Rep. 2006; 8:206–215.CrossrefMedlineGoogle Scholar26. Demer LL, Tintut Y. Mineral exploration: search for the mechanism of vascular calcification and beyond: the 2003 Jeffrey M. Hoeg Award lecture.Arterioscler Thromb Vasc Biol. 2003; 23:1739–1743. doi: 10.1161/01.ATV.0000093547.63630.0F.LinkGoogle Scholar27. Bots ML, Evans GW, Riley WA, Grobbee DE. Carotid intima-media thickness measurements in intervention studies: design options, progression rates, and sample size considerations: a point of view.Stroke. 2003; 34:2985–2994. doi: 10.1161/01.STR.0000102044.27905.B5.LinkGoogle Scholar28. Delcker A, Diener HC. Quantification of atherosclerotic plaques in carotid arteries by three-dimensional ultrasound.Br J Radiol. 1994; 67:672–678. doi: 10.1259/0007-1285-67-799-672.CrossrefMedlineGoogle Scholar29. Hennerici M, Kleophas W, Gries FA. Regression of carotid plaques during low density lipoprotein cholesterol elimination.Stroke. 1991; 22:989–992.LinkGoogle Scholar30. Picot PA, Rickey DW, Mitchell R, Rankin R, Fenster A. Three- dimensional colour doppler imaging of the carotid artery.SPIE Med Imaging. 1991; 1444:206–213.Google Scholar31. Sherebrin S, Fenster A, Rankin R, Spence D. Freehand three-dimensional ultrasound: Implementation and applications.SPIE Phys Med Imaging. 1996; 2708:296–303.Google Scholar32. Fenster A, Lee D, Sherebrin S, Rankin R, Spence D, Downey D. Three-dimensional ultrasound imaging of carotid occlusive disease., Klingelhöfer J, , et al, eds. In: New Trends in Cerebral Hemodynamics and Neurosonology. Amsterdam: Elsevier Science BV; 1997:17–24.Google Scholar33. Zahalka A, Fenster A. An automated segmentation method for three-dimensional carotid ultrasound images.Phys Med Biol. 2001; 46:1321–1342.CrossrefMedlineGoogle Scholar34. Landry A, Spence JD, Fenster A. Measurement of carotid plaque volume by 3-dimensional ultrasound.Stroke. 2004; 35:864–869. doi: 10.1161/01.STR.0000121161.61324.ab.LinkGoogle Scholar35. Cheng J, Li H, Xiao F, Fenster A, Zhang X, He X, Li L, Ding M. Fully automatic plaque segmentation in 3-D carotid ultrasound images.Ultrasound Med Biol. 2013; 39:2431–2446. doi: 10.1016/j.ultrasmedbio.2013.07.007.CrossrefMedlineGoogle Scholar36. Bogiatzi C, Spence JD. Ezetimibe and regression of carotid atherosclerosis: importance of measuring plaque burden.Stroke. 2012; 43:1153–1155. doi: 10.1161/STROKEAHA.111.640789.LinkGoogle Scholar37. Spence JD. The importance of distinguishing between diffuse carotid intima medial thickening and focal plaque.Can J Cardiol. 2008; 24:61C–64C.CrossrefMedlineGoogle Scholar38. Ainsworth CD, Blake CC, Tamayo A, Beletsky V, Fenster A, Spence JD. 3D ultrasound measurement of change in carotid plaque volume: a tool for rapid evaluation of new therapies.Stroke. 2005; 36:1904–1909. doi: 10.1161/01.STR.0000178543.19433.20.LinkGoogle Scholar39. Wannarong T, Parraga G, Buchanan D, Fenster A, House AA, Hackam DG, Spence JD. Progression of carotid plaque volume predicts cardiovascular events.Stroke. 2013; 44:1859–1865. doi: 10.1161/STROKEAHA.113.001461.LinkGoogle Scholar40. Egger M, Spence JD, Fenster A, Parraga G. Validation of 3D ultrasound vessel wall volume: an imaging phenotype of carotid atherosclerosis.Ultrasound Med Biol. 2007; 33:905–914. doi: 10.1016/j.ultrasmedbio.2007.01.013.CrossrefMedlineGoogle Scholar41. Krasinski A, Chiu B, Spence JD, Fenster A, Parraga G. Three-dimensional ultrasound quantification of intensive statin treatment of carotid atherosclerosis.Ultrasound Med Biol. 2009; 35:1763–1772. doi: 10.1016/j.ultrasmedbio.2009.05.017.CrossrefMedlineGoogle Scholar42. Noyes AM, Thompson PD. A systematic review of the time course of atherosclerotic plaque regression.Atherosclerosis. 2014; 234:75–84. doi: 10.1016/j.atherosclerosis.2014.02.007.CrossrefMedlineGoogle Scholar43. Barnett PA, Spence JD, Manuck SB, Jennings JR. Psychological stress and the progression of carotid artery disease.J Hypertens. 1997; 15:49–55.CrossrefMedlineGoogle Scholar44. Spence JD. Time course of atherosclerosis regression.Atherosclerosis. 2014; 235:347–348. doi: 10.1016/j.atherosclerosis.2014.05.929.CrossrefMedlineGoogle Scholar45. Al-Shali K, House AA, Hanley AJ, Khan HM, Harris SB, Mamakeesick M, Zinman B, Fenster A, Spence JD, Hegele RA. Differences between carotid wall morphological phenotypes measured by ultrasound in one, two and three dimensions [published correction appears in Atherosclerosis. 2005;182:379–380].Atherosclerosis. 2005; 178:319–325.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Zhou R, Guo F, Azarpazhooh M, Spence J, Gan H, Ding M and Fenster A (2023) Carotid Vessel-Wall-Volume Ultrasound Measurement via a UNet++ Ensemble Algorithm Trained on Small Data Sets, Ultrasound in Medicine & Biology, 10.1016/j.ultrasmedbio.2022.12.005, 49:4, (1031-1036), Online publication date: 1-Apr-2023. Zhou R, Ou Y, Fang X, Azarpazhooh M, Gan H, Ye Z, Spence J, Xu X and Fenster A (2023) Ultrasound carotid plaque segmentation via image reconstruction-based self-supervised learning with limited training labels, Mathematical Biosciences and Engineering, 10.3934/mbe.2023074, 20:2, (1617-1636), . Yuan Y, Li C, Zhang K, Hua Y and Zhang J (2022) HRU-Net: A Transfer Learning Method for Carotid Artery Plaque Segmentation in Ultrasound Images, Diagnostics, 10.3390/diagnostics12112852, 12:11, (2852) Yuan Y, Li C, Xu L, Zhu S, Hua Y and Zhang J (2022) CSM-Net: Automatic joint segmentation of intima-media complex and lumen in carotid artery ultrasound images, Computers in Biology and Medicine, 10.1016/j.compbiomed.2022.106119, 150, (106119), Online publication date: 1-Nov-2022. Woolsey A, Arsang-Jang S, Spence J, Hackam D and Azarpazhooh M (2022) The impact of socioeconomic status on the burden of atherosclerosis, and the effect of intensive preventive therapy on its progression: A retrospective cohort study, Atherosclerosis, 10.1016/j.atherosclerosis.2022.08.013, 358, (29-33), Online publication date: 1-Oct-2022. Pechlaner R, Friedrich N, Staudt A, Gande N, Bernar B, Stock K, Kiechl S, Hochmayr C, Griesmacher A, Petersmann A, Budde K, Stuppner H, Sturm S, Dörr M, Schminke U, Cannet C, Fang F, Schäfer H, Spraul M, Geiger R, Mayr M, Nauck M, Kiechl S, Kiechl-Kohlendorfer U, Knoflach M, Staudt A, Bernar B, Winder B, Reiter C, Burger C, Hochmayr C, Brössner G, Stuppner H, Klingenschmid J, Marxer J, Stock K, Asare M, Mayr M, Bock-Bartl M, Kothmayer M, Bohl M, Pircher M, Knoflach M, Gande N, Pechlaner R, Geiger R, Sturm S, Kiechl S, Kiechl S, Heisinger T and Kiechl-Kohlendorfer U (2022) Association of adolescent lipoprotein subclass profile with carotid intima-media thickness and comparison to adults: Prospective population-based cohort studies, Atherosclerosis, 10.1016/j.atherosclerosis.2021.12.007, 341, (34-42), Online publication date: 1-Jan-2022. Chiu B, Zhao Y and Chen X (2022) Three-Dimensional Ultrasound for Sensitive Assessment of the Effects of Nutritional Therapy on Carotid Atherosclerosis Biomarkers in Nutrition, 10.1007/978-3-031-07389-2_38, (631-650), . Tattersall M and Stein J (2022) Carotid Intima-Media Thickness and Plaque Assessment Cardiovascular Risk Assessment in Primary Prevention, 10.1007/978-3-030-98824-1_24, (487-503), . Chiu B, Zhao Y and Chen X (2022) Three-Dimensional Ultrasound for Sensitive Assessment of the Effects of Nutritional Therapy on Carotid Atherosclerosis Biomarkers in Nutrition, 10.1007/978-3-030-81304-8_38-2, (1-20), . Chiu B, Zhao Y and Chen X (2022) Three-Dimensional Ultrasound for Sensitive Assessment of the Effects of Nutritional Therapy on Carotid Atherosclerosis Biomarkers in Nutrition, 10.1007/978-3-030-81304-8_38-1, (1-20), . 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Zhou R, Guo F, Azarpazhooh M, Spence J, Ukwatta E, Ding M and Fenster A A Voxel-Based Fully Convolution Network and Continuous Max-Flow for Carotid Vessel-Wall-Volume Segmentation From 3D Ultrasound Images, IEEE Transactions on Medical Imaging, 10.1109/TMI.2020.2975231, 39:9, (2844-2855) Johnson M, Brook J, Brook R, Oiamo T, Luginaah I, Peters P and Spence J (2020) Traffic‐Related Air Pollution and Carotid Plaque Burden in a Canadian City With Low‐Level Ambient Pollution, Journal of the American Heart Association, 9:7, Online publication date: 9-Apr-2020. Paraskevas K, Sillesen H, Rundek T, Mathiesen E and Spence J (2019) Carotid Intima–Media Thickness Versus Carotid Plaque Burden for Predicting Cardiovascular Risk, Angiology, 10.1177/0003319719878582, 71:2, (108-111), Online publication date: 1-Feb-2020. Chen X, Lin M, Cui H, Chen Y, van Engelen A, de Bruijne M, Azarpazhooh M, Sohrevardi S, Chow T, Spence J and Chiu B (2020) Three-dimensional ultrasound evaluation of the effects of pomegranate therapy on carotid plaque texture using locality preserving projection, Computer Methods and Programs in Biomedicine, 10.1016/j.cmpb.2019.105276, 184, (105276), Online publication date: 1-Feb-2020. González Cantero Á and Rodriguez Padial L (2019) ¿Cuál es el mejor método para medir el riesgo cardiovascular en pacientes con psoriasis?, Piel, 10.1016/j.piel.2019.02.005, 34:8, (449-451), Online publication date: 1-Oct-2019. Msoka T, Van Guilder G, van Furth M, Smulders Y, Meek S, Bartlett J, Vissoci J and van Agtmael M (2019) The effect of HIV infection, antiretroviral therapy on carotid intima-media thickness: A systematic review and meta-analysis, Life Sciences, 10.1016/j.lfs.2019.116851, 235, (116851), Online publication date: 1-Oct-2019. Dempsey A, Parraga G, Altamirano-Diaz L, Welisch E, Park T, Grattan M, Al-Khazraji B and Norozi K (2019) Increased blood pressure is associated with increased carotid artery intima–media thickness in children with repaired coarctation of the aorta, Journal of Hypertension, 10.1097/HJH.0000000000002077, 37:8, (1689-1698), Online publication date: 1-Aug-2019. Gonzalez-Cantero A, Gonzalez-Cantero J, Sanchez-Moya A, Rodriguez-Padial L, Perez-Hortet C and Gonzalez-Calvin J (2019) Is intima-media thickness a predictor for cardiovascular risk?, The Lancet, 10.1016/S0140-6736(19)30348-4, 394:10196, (380-381), Online publication date: 1-Aug-2019. Gonzalez-Cantero A, Gonzalez-Cantero J, Sanchez-Moya A, Schoendorff-Ortega C, Barderas M and Perez-Hortet C (2018) Psoriasin (S100A7) and koebserisin (S100A15) as potential markers of atherosclerosis in patients with psoriasis, Clinical and Experimental Dermatology, 10.1111/ced.13764, 44:2, (234-234), Online publication date: 1-Mar-2019. Gonzalez-Cantero A, Gonzalez-Cantero J, Sanchez-Moya A, Perez-Hortet C, Arias-Santiago S, Schoendorff-Ortega C, Gonzalez-Calvin J and Kirchmair R (2019) Subclinical atherosclerosis in psoriasis. Usefulness of femoral artery ultrasound for the diagnosis, and analysis of its relationship with insulin resistance, PLOS ONE, 10.1371/journal.pone.0211808, 14:2, (e0211808) González-Cantero Á, González-Cantero J, Sánchez-Moya A, Pérez-Hortet C and Schoendorff-Ortega C (2018) Comment on "Cardiovascular Risk Factors and Carotid Intima-Media Thickness in a Colombian Population With Psoriasis", Actas Dermo-Sifiliográficas (English Edition), 10.1016/j.adengl.2018.02.025, 109:9, (848-849), Online publication date: 1-Nov-2018. González-Cantero Á, González-Cantero J, Sánchez-Moya A, Pérez-Hortet C and Schoendorff-Ortega C (2018) Réplica a «Factores de riesgo cardiovascular y grosor de la íntima media carotídea en una población colombiana con psoriasis», Actas Dermo-Sifiliográficas, 10.1016/j.ad.2018.02.020, 109:9, (848-849), Online publication date: 1-Nov-2018. González-Cantero Á, González-Cantero J, Sánchez-Moya A, Pérez-Hortet C and Schoendorff-Ortega C (2018) Psoriasis and subclinical atherosclerosis in a Chinese population, Australasian Journal of Dermatology, 10.1111/ajd.12804, 59:3, (e235-e236), Online publication date: 1-Aug-2018. Peixoto de Miranda É, Bittencourt M, Staniak H, Pereira A, Foppa M, Santos I, Lotufo P and Benseñor I (2017) Thyrotrophin levels and coronary artery calcification: Cross-sectional results of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil), Clinical Endocrinology, 10.1111/cen.13393, 87:5, (597-604), Online publication date: 1-Nov-2017. Kešnerová P (2017) Atherosclerotic plaque evaluation in the carotid arteries by duplex sonography, Neurologie pro praxi, 10.36290/neu.2017.003, 18:4, (229-232), Online publication date: 1-Oct-2017. Chung C, Chou K, Chen W, Liu L, Lee W, Huang A, Chen L, Lin C and Wang P (2017) Location of Cerebral Microbleeds And Their Association with Carotid Intima-media Thickness: A Community-based Study, Scientific Reports, 10.1038/s41598-017-12176-y, 7:1 Spence J (2017) Approaching Automated 3-Dimensional Measurement of Atherosclerotic Plaque Volume ∗, Journal of the American College of Cardiology, 10.1016/j.jacc.2017.05.036, 70:3, (314-317), Online publication date: 1-Jul-2017. Santos I, Bittencourt M, Goulart A, Schmidt M, Diniz M, Lotufo P and Benseñor I (2017) Insulin resistance is associated with carotid intima-media thickness in non-diabetic subjects. A cross-sectional analysis of the ELSA-Brasil cohort baseline, Atherosclerosis, 10.1016/j.atherosclerosis.2017.03.011, 260, (34-40), Online publication date: 1-May-2017. Spence J (2017) Carotid plaque burden is associated with higher levels of total homocysteine, BMJ, 10.1136/svn-2017-000076, 2:1, (40-40), Online publication date: 1-Mar-2017. Lee D and Park J (2017) Diagnostic and Therapeutic Approach of Carotid and Cerebrovascular Plaque on the Basis of Vessel Imaging, Journal of Lipid and Atherosclerosis, 10.12997/jla.2017.6.1.15, 6:1, (15), . Santos I, Goulart A, Pereira A, Lotufo P and Benseñor I (2016) Association between Cardiovascular Health Score and Carotid Intima-Media Thickness: Cross-Sectional Analysis of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) Baseline Assessment, Journal of the American Society of Echocardiography, 10.1016/j.echo.2016.09.001, 29:12, (1207-1216.e4), Online publication date: 1-Dec-2016. Spence J (2016) Determinants of carotid plaque burden, Atherosclerosis, 10.1016/j.atherosclerosis.2016.10.045, 255, (122-123), Online publication date: 1-Dec-2016. Pacheco A, Grinsztejn B, Fonseca M, Griep R, Lotufo P, Bensenor I, Mill J, Moreira R, Moreira R, Friedman R, Santini-Oliveira M, Cardoso S, Veloso V, Chor D and De Socio G (2016) HIV Infection Is Not Associated with Carotid Intima-Media Thickness in Brazil: A Cross-Sectional Analysis from the INI/ELSA-Brasil Study, PLOS ONE, 10.1371/journal.pone.0158999, 11:7, (e0158999) Spence J and Dresser G (2016) Overcoming Challenges With Statin Therapy, Journal of the American Heart Association, 5:1, Online publication date: 13-Jan-2016. Zhang H, Liu M, Ren T, Wang X, Liu D, Xu M, Han L, Wu Z, Li H, Zhu Y, Wen Y and Sun W (2015) Associations between Carotid Artery Plaque Score, Carotid Hemodynamics and Coronary Heart Disease, International Journal of Environmental Research and Public Health, 10.3390/ijerph121114275, 12:11, (14275-14284) September 2015Vol 35, Issue 9 Advertisement Article InformationMetrics © 2015 American Heart Association, Inc.https://doi.org/10.1161/ATVBAHA.115.306209PMID: 26310810 Originally publishedSeptember 1, 2015 PDF download Advertisement
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