Abstract 3846: Carotid Plaque Remodeling in a 10-Year, Follow-Up Study. The San Valentino Vascular Screening Project
Subclinical arteriosclerotic lesions at carotid/femoral bifurcations are related to the future cardiovascular events and occult, developing-into-clinical arteriosclerotic coronary disease. High- resolution ultrasound of carotid/femoral bifurcations provide a cost-effective screening to select within a population asymptomatic subjects at higher risk of events. Plaque remodeling (PR) is also related to events. In the San Valentino study 13221 low-risk, asymptomatics were included in a 10-year follow-up evaluating carotid/femoral bifurcation morphology (high-resolution ultrasound). Four classes were considered at inclusion (I: normal wall, II: wall thickening, III: nonstenosing plaques, IV: stenosing plaques): 10000 subjects (75.6% of included subjects; 6055 males) completed the follow-up. At 10 years there were 10 events (out of 7989 subjects) in class I; 81 events in II (incidence = 8.6%); 239 events in class III (39.28%) and 381 events (81.06%) in IV; 61 deaths occurred in classes III + IV (death rate within these two classes = 5.5%; 81.5% in class IV). The increased event rates in classes III and IV were significant (log rank; P < 0.02) in comparison with I and II. Remodeling was evaluated on the basis of size/volume, considering:
- morphology (homogeneneous, disomogeneous plaques);
- density (echogenicity, echolucency) and combinations.
The degree of PR on a remodeling scale (1–10) was evaluated.
CONCLUSIONS: Carotid-femoral wall/plaque morphology identified subjects (20.1% of the population) in classes II,III,IV including 98.6% of cardiovascular events and deaths in the following 10 years. A higher (P < 0;0.05) rate of progression in classes III and IV in comparison with I,II was observed. The ultrasound carotid/femoral classification is useful in selecting subjects at very low risk of events (class I), those at limited risk (II), at moderate risk (III) and at higher risk of events (IV). The evaluation of PR indicated that, high plaque volumes, disomogeneity, echolucency, a high rate of PR (indicating more active remodeling) are more frequently associated to events including death.