Abstract 4002: Combined Ultrasound Assessment of Brachial Endothelial Vasomotor Function and Carotid Plaque Echolucency has an Additive Value on the Prediction of Cardiovascular Events in Metabolic Syndrome
Metabolic syndrome is prevalently associated with future cerebrovascular events as well as coronary events. Single assessment of either carotid plaque echolucency or flow-mediated vasodilatation of the brachial artery (FMD) provides prognostic information for both cerebro-vascular and coronary events. Thus, this study tested the hypothesis that the combined assessment of carotid echolucency and FMD may have an additive effect on the prediction of cardiovascular events in patients with metabolic syndrome.
Methods: Ultrasound assessement of FMD and carotid plaque echolucency with integrated backscatter (IBS) analysis (intima-media IBS value minus adventitia IBS) was performed in 286 consecutive patients with metabolic syndrome. All study patients were prospectively followed up for a period of ≤ 36 months until the occurrence of one of the following cardiovascular events: cardiac death, nonfatal myocardial infarction, recurrent or refractory angina pectoris requiring coronary revascularization, or stroke.
Results: During a mean follow-up period of 23 ± 2 months, 40 cardiovascular events occurred (2 patients: nonfatal myocardial infarction, 24 patients: unstable angina with coronary revascularization, 14 patients: stroke). In a multivariate Cox hazards analysis, impaired FMD (< 4.4% dilation from baseline diameter, the median value) and echolucent carotid plaque (IBS < −15.5 dB, the median value) were each a significant predictor of future cardiovascular events (odds ratio; 3.1 and 3.4, 95%CI 1.6 - 5.9 and 1.5 -7.7, respectively, both p < 0.01). The predictive value was independent of components of metabolic syndrome, age, and adiponectin levels. When outcomes were stratified according to impaired FMD and echolucent carotid plaque in combination or alone, the combination of the impaired FMD and echolucent carotid plaque was the strongest event predictor (adjusted relative risk; 18.8), followed by the impaired FMD (10.4) and echolucent carotid plaque (7.8).
Conclusions: Combined assessment of brachial endothelial function and carotid plaque echolucency has an additive value on the prediction of cardiovascular events, and these noninvasive ultrasound measurements may be clinically useful for risk stratification in metabolic syndrome.