Two imaging tests could be an effective and non-invasive way to determine which patients are at a high risk of having a heart attack, stroke or premature death, a new study has suggested.
Researchers at the Icahn School of Medicine at Mount Sinai found that these non-invasive imaging tests could be used to detect disease in carotid or coronary arteries before it causes symptoms.
The study, published in the Journal of the American College of Cardiology (JACC), assessed patients using traditional cardiovascular disease (CVD) risk factor assessments for high blood pressure, abnormal cholesterol, diabetes, sedentary lifestyle, obesity, and smoking. In addition, they also used two imaging tests: novel 3D vascular ultrasound and coronary artery calcium score via a low-dose computed tomography scan.
The team found that, by adding these two imaging tests, they were able to identify subclinical atherosclerosis in 60 per cent of the patients who had appeared healthy with no clinical symptoms.
Dr Valentin Fuster, director of Mount Sinai Heart and Physician-in-Chief of the Mount Sinai Hospital and the study's principal investigator, said using only traditional risk factors to assess cardiovascular disease could "imprecisely classify a patient's risk".
He added: "Our study shows simply adding one of our available cardiac imaging resources may more accurately predict a patient's risk or diagnose their disease, also giving us an opportunity to prevent them from experiencing a future cardiac event and possibly save more lives from the burdens of cardiovascular diseases."
The BioImage Study was developed with the aim of identifying new ways to determine a person's heart disease risk before they present recognised symptoms. For three years the project followed nearly 6,000 healthy men (ages 55 to 80 years) and women (60 to 88 years) with no history or symptoms of cardiovascular disease.
Using novel 3D vascular ultrasound imaging technology, the researchers were able to measure the amount of carotid artery plaque burden lining each patient's carotid arteries in their neck, while a coronary artery calcium score CT scan allowed them to identify any narrowing or hardening of the coronary arteries due to the buildup of fatty cholesterol and calcified plaque.
These are both signs of diseased arteries, which could only be identified by these imaging techniques in healthy participants.
According to Dr Fuster's study, the 'healthy' individuals identified were two to three times more likely to have an adverse event such as an artery blockage or loosened plaque causing a heart attack or stroke.
Across the research period, there were a total of 216 adverse events reported among study participants, which included 108 deaths of which 27 were cardiovascular-related. In addition, there were 34 heart attacks, 30 strokes, 18 experienced unstable angina and 79 needed revascularisation procedures.
Dr Fuster adds: "For our patients' lives and for the health of our global economies we need to improve our predictive measures for cardiovascular disease and can no longer just rely on traditional risk factors. Our results prove adding imaging-based biomarkers that directly quantify atherosclerosis are ideal adjuncts to the current conventional CVD risk factors and these imaging biomarkers may be a true game-changer to our practice of cardiovascular medicine."
Posted by Phillip Briggs
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