Comparing Carotid and Coronary Plaque Composition Using Noninvasive Imaging Modalities for Cardiovascular Risk Stratification
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Authors
Kersche, Georgia
Date
Type
thesis
Language
eng
Keyword
Cardiovascular imaging , Ultrasound , Atherosclerosis
Alternative Title
Abstract
Noninvasive imaging and early identification of atherosclerosis is one of the most important tools for the prevention of cardiovascular events. Coronary artery calcium (CAC) scoring and stress echocardiography are widely used for the assessment of coronary artery disease (CAD) and to stratify patients for their risk of experiencing adverse cardiac events. Patients that have a low or intermediate pretest probability of CAD are at the greatest risk of being misclassified and experiencing an unexpected event. We looked into whether carotid ultrasound shared associations with CAC scoring. In a sample of low-intermediate risk patients with no history of CAD we assessed relationships using Spearman correlation coefficients between carotid plaque composition and burden with their CAC scores. We found that plaque burden measures including total plaque area (TPA) and carotid intima media thickness (CIMT) share a moderate and significant association with CAC score. Carotid composition measures, including calcium and fibrous tissue content, did not align with CAC scores. This suggests that carotid ultrasound plaque assessment may be useful for predicting CAC scores and the presence of CAD, and that CAC scoring can underestimate the presence of soft plaques vulnerable to rupture. To further understand how carotid ultrasound changes physician assessments of risk and to identify barriers to implementing the tool for this population we surveyed staff cardiologists. We identified that the presence of plaque tends to increase their perceptions of patient risk compared to stress echo alone. The majority of respondents reported that carotid ultrasound would be feasible to add to all stress echoes and would be useful when considering the initiation of statin therapy. Our results suggest that the addition of carotid ultrasound to cardiovascular risk assessment algorithms does have potential to identify subclinical atherosclerosis and inform patient stratification. Using carotid plaque measures may improve sensitivity and reduce the occurrence of cardiovascular events in the low and intermediate risk population.
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Queen's University's Thesis/Dissertation Non-Exclusive License for Deposit to QSpace and Library and Archives Canada
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This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NonCommercial-NoDerivatives 4.0 International
ProQuest PhD and Master's Theses International Dissemination Agreement
Intellectual Property Guidelines at Queen's University
Copying and Preserving Your Thesis
This publication is made available by the authority of the copyright owner solely for the purpose of private study and research and may not be copied or reproduced except as permitted by the copyright laws without written authority from the copyright owner.
Attribution-NonCommercial-NoDerivatives 4.0 International