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

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.

Association of HIV viral load with monocyte chemoattractant protein-1 and atherosclerosis burden measured by magnetic resonance imaging.

BACKGROUND: HIV-infected individuals may be at increased risk for atherosclerosis. Although this is partially attributable to metabolic factors, HIV-associated inflammation may play a role. OBJECTIVE: To investigate associations of HIV disease with serum monocyte chemoattractant protein-1/chemokine (C-C motif) ligand 2 (MCP-1/CCL2) levels and atherosclerosis burden. DESIGN: A cross-sectional analysis. METHODS: : Serum MCP-1/CCL2, fasting lipids, and glucose tolerance were measured in 98 HIV-infected and 79 demographically similar uninfected adults. Eighty-four participants had MRI of the carotid arteries and thoracic aorta to measure atherosclerosis burden. Multivariate analyses were performed using linear regression. RESULTS: Mean MCP-1/CCL2 levels did not differ between HIV-infected and uninfected participants (P = 0.65). Among HIV-infected participants, after adjusting for age, BMI, and cigarette smoking, HIV-1 viral load was positively associated with MCP-1/CCL2 (P = 0.02). Multivariate analyses adjusting for sex, low-density lipoprotein cholesterol, total cholesterol:high-density lipoprotein cholesterol ratio, cigarette smoking, MCP-1/CCL2, and protease inhibitor use found that HIV infection was associated with greater mean thoracic aorta vessel wall area (VWA, P < 0.01) and vessel wall thickness (VWT, P = 0.03), but not with carotid artery parameters. Compared with being uninfected, having detectable HIV-1 viremia was associated with greater mean thoracic aorta VWA (P < 0.01) and VWT (P = 0.03), whereas being HIV-infected with undetectable viral load was associated with greater thoracic aorta VWA (P = 0.02) but not VWT (P = 0.15). There was an independent positive association of MCP-1/CCL2 with thoracic aorta VWA (P = 0.01) and VWT (P = 0.01). CONCLUSION: HIV-1 viral burden is associated with higher serum levels of MCP-1/CCL2 and with atherosclerosis burden, as assessed by thoracic aorta VWA and VWT.

Cross-sectional, prospective study of MRI reproducibility in the assessment of plaque burden of the carotid arteries and aorta.

BACKGROUND: The reliability of imaging techniques to assess early atherosclerosis remains unclear. We did a cross-sectional, prospective study to test reproducibility of MRI when imaging arteries, to assess risk of cardiovascular disease and correlations with age and sex. METHODS: Between January 2003 and December 2006 we performed black-blood MRI of both common carotid arteries and the thoracic descending aorta in patients with cardiovascular risk factors who were referred from clinics in New York, NY, USA. Mean wall area, wall thickness, lumen area, total vessel area, and ratio of the mean wall area to the mean total vessel area (WA/TVA) were manually measured. Reproducibility within and between readers was tested on subsets of images from randomly chosen patients. RESULTS: MRI was performed on 300 patients. Intrareader reproducibility, assessed in images from 20 patients, was high for all parameters (intraclass correlation coefficients >0.8), except WA/TVA ratio in the descending aorta. The inter-reader reproducibility, assessed in images from 187 patients, was acceptable (intraclass correlation coefficients >0.7) for the mean wall, lumen, and total vessel areas. Values for all MRI parameters in all vessels increased with increasing age for both sexes (all P <0.0005) but were always significantly higher in men than in women, except for aortic mean wall thickness and WA/TVA ratio in the carotid arteries. Mean wall area values correlated well between the carotid arteries and aorta, reflecting the systemic nature of atherosclerosis. CONCLUSIONS: Our findings support MRI as a reproducible measurement of plaque burden and demonstrate the systemic distribution of atherosclerosis.

Carotid black blood MRI burden of atherosclerotic disease assessment correlates with ultrasound intima-media thickness.

The aim of this study was to correlate carotid black blood MRI based measurements with those obtained by ultrasound intima-media thickness (IMT). Seventeen patients with intermediate to high Framingham cardiovascular risk score underwent both carotid ultrasound and rapid extended coverage double inversion recovery black blood carotid MRI. Overall, there was good correlation between wall area, wall thickness, and plaque index measured by MRI and the IMT measurements obtained from the ultrasound images (max r2 = 0.72, p < 0.05). Patients with mean IMT > or = 1.2 mm had significantly higher values of wall area, plaque index and wall thickness compared to patients with mean IMT < 1.2 mm. Vessel wall measurements assessed by black-blood MRI may be potentially used clinically to evaluate plaque progression and regression.