Author + information
- Received October 4, 2011
- Revision received December 27, 2011
- Accepted January 18, 2012
- Published online April 1, 2012.
- Vittorio Schiano, MD, PhD,
- Giusy Sirico, MD,
- Giuseppe Giugliano, MD,
- Eugenio Laurenzano, MD,
- Linda Brevetti, MD,
- Cinzia Perrino, MD, PhD,
- Gregorio Brevetti, MD and
- Giovanni Esposito, MD, PhD⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Giovanni Esposito, Division of Cardiology, Department of Clinical Medicine, Cardiovascular and Immunological Sciences, University of Naples “Federico II,” via Pansini 5, 80131 Naples, Italy
Objectives The present study was designed to verify whether the evaluation of femoral plaque echogenicity might be a useful tool for cardiovascular risk assessment in patients affected by lower extremity peripheral arterial disease.
Background Lower extremity peripheral arterial disease is a common manifestation of atherosclerosis and is associated with a high risk of developing major cardiovascular events. Vulnerable atherosclerotic plaque plays a central role in the occurrence of acute ischemic events in different vascular territories. Furthermore, atherosclerosis is a systemic disease, and the presence of an unstable atherosclerotic plaque in a certain vascular district, characterized by low echogenicity at B-mode ultrasound, is associated to a greater prevalence of unstable plaques in other vascular beds.
Methods Femoral plaque echogenicity of 246 claudicants with ankle/brachial index ≤0.90 was evaluated at B-mode ultrasound by visual analysis and by calculating the grayscale median (GSM) value. In these patients, the occurrence of myocardial infarction and stroke was prospectively assessed.
Results Femoral GSM values and plaque types assessed by visual analysis were highly correlated by Spearman analysis (rho = 0.905, p < 0.001). During a median follow-up of 30 months, 32 patients (13%) had a major cardiovascular event. Compared with patients without events, those who experienced an event during the follow-up had a lower femoral plaque GSM value (42.9 ± 26.2 vs. 58.8 ± 19.3, p = 0.002) and a higher prevalence of hypoechoic femoral plaque at visual analysis (68.8% vs. 19.6%, p < 0.001). At Cox analysis, femoral GSM showed an inverse relationship with cardiovascular risk, even after adjustment for possible confounders (hazard ratio: 0.96, 95% confidence interval [CI]: 0.95 to 0.98, p < 0.001). Furthermore, patients with hypoechoic femoral plaques at visual analysis had a 7.24-fold increased cardiovascular risk compared with patients with hyperechoic plaques after adjustment for possible confounders (95% CI: 3.23 to 16.22, p < 0.001).
Conclusions This study demonstrates that the presence of hypoechoic atherosclerotic femoral plaques is associated with higher cardiovascular risk in lower extremity peripheral arterial disease patients.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose. Drs. Schiano and Sirico contributed equally to this work.
- Received October 4, 2011.
- Revision received December 27, 2011.
- Accepted January 18, 2012.
- American College of Cardiology Foundation