Ultrafast Ultrasound Cuts CV Risk Assessment Time

Could carotid stiffening assessed with ultrafast ultrasound provide new insight on cardiovascular risk in younger populations without traditional cardiovascular risk factors?

For the retrospective study, recently published in European Radiology, researchers utilized ultrasound to assess ultrafast pulse wave velocity (ufPWV) measurements of carotid stiffening in 180 apparently healthy individuals (mean age of 31.6).

The cohort was comprised of:

• a cardiovascular risk factor (CVRF)-free group of 60 participants with no major CVRFs and normal levels of CVRFs;

• a CVRF-optimal group of 54 participants with no major CVRFs and optimal levels of CVRFs; and

• an atherosclerosis (AS) risk group of 66 participants with one or multiple major CVRFs.

In a multivariable analysis that included adjustments for age, sex and body mass index (BMI), the study authors found that increased pulse wave velocity-end of systole (PWV-ES) was associated with more than double the CVRF-estimated cardiovascular risk in the CVRF-free group and a 7.71-fold higher risk in the AS-risk cohort.

When researchers added systolic blood pressure (SBP), diastolic blood pressure (DBP), fasting blood glucose (FBG) and high-density lipoprotein (HDL) adjustments to the multivariable analysis, they found that increased PWV-ES was linked to nearly fourfold higher CVRF-estimated cardiovascular risk in the CVRF-free group. However, they found no elevated risk with higher PWV-ES in the AS-risk cohort.

“These findings may underscore the aforementioned failure of major conventional CVRFs in predicting individual risks. Thus, carotid stiffening could be employed for predicting cardiovascular risk in young

individuals generally categorized as low-risk populations,”wrote lead study author Zhengqiu Zhu, M.D., who is affiliated with the Department of Ultrasound at the Affiliated Hospital of Nanjing University of Chinese Medicine and the Jiangsu Province Hospital of Chinese Medicine in Nanjing, China, and colleagues.

While healthy individuals without CVRFs are considered low risk as per current preventive recommendations, the study authors suggested these recommendations employ “fixed, arbitrary thresholds” for “continuous variables,” such as SBP and FGB, that contribute to cardiovascular risk.

“Although such cutoffs are needed to guide intervention strategies, they give the false impression that individuals, particularly young populations, with values below these thresholds are free of CVD risk,” maintained Zhu and colleagues.

(Editor’s note: For related content, see “Study Links PTSD to Higher Carotid Atherosclerosis and White Matter Hyperintensity in Midlife Women,” “GE HealthCare Launches Vivid Pioneer Ultrasound Platform at ESC Conference” and “Philips Unveils Cardiovascular Ultrasound Software Transcend Plus.”)

In regard to study limitations, the authors acknowledged that while the ultrasound device evaluated in the study is optimized for ufPWV acquisition and measurement in the carotid artery, other research has demonstrated that the femoral artery is more suitable for diagnosing early asymptomatic atherosclerosis. The researchers also conceded a lack of follow-up evaluation to examine the capacity of ufPMV measurements to predict long-term cardiovascular risks.