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Plaque volume compression ratio, a novel biomechanical index, is independently associated with ischemic cerebrovascular events

Zhang, Peng Feia; Su, Hai Junb; Yao, Gui Huaa; Wu, Weic; Zhang, Meia; Liu, Chun Xia; Jiang, Honga; Ding, Shi Fanga; Zhang, Chenga; Zhao, Yu Xiaa; Zhang, Yuna

doi: 10.1097/HJH.0b013e3283193e50
Original papers: Stroke

Objective The purpose of this study was to develop a new biomechanical index for assessing the elastic characteristics of carotid plaques and to test the association between carotid plaque elasticity and ischemic cerebrovascular events (ICEs).

Methods One hundred and eighteen carotid plaques were detected with real-time three-dimensional ultrasonography in 104 patients. All patients received MRI and were divided into two groups according to the history of ICEs: patients with ICEs (n = 58, including 20 patients with transient ischemic attack and 38 with ischemic stroke) and patients without ICEs (n = 46). The carotid plaque volume at end diastole (Vd) and end systole (Vs) was measured by use of a TomTec (Munich, Germany) workstation. Plaque volume compression ratio (VCR) was calculated as (Vd − Vs)/Vd × 100 and the reproducibility of VCR measurement was analyzed. The carotid intima–media thickness, plaque area and plaque acoustic density were also measured. Multivariate logistic regression was used to test the association between ICEs and plaque ultrasonic parameters or traditional risk factors including age, sex, smoking, blood pressure, history of coronary heart disease, levels of serum low-density lipoprotein, triglyceride and glucose.

Results Satisfactory images of carotid plaques were obtained in all patients by real-time three-dimensional ultrasonography. Patients with ICEs and patients without ICEs differed significantly in VCR (22.19 ± 8.42 vs. 13.95 ± 7.86, P < 0.01). Regression analysis revealed that systolic blood pressure, [odds ratio (OR) = 1.054, 95% confidence interval (CI) = 1.028–1.081, P < 0.001] and VCR (OR = 1.074, 95% CI = 1.022–1.128, P < 0.001) were associated with ICEs independently. Plaque volume had only a marginal association with ICEs (OR = 1.007, 95% CI = 1.000–1.013, P = 0.05).

Conclusion Measurement of VCR provides a noninvasive approach to the evaluation of the elasticity of carotid plaques, which is associated independently with ICEs. Thus, real-time three-dimensional ultrasonography-derived VCR holds a great potential in identifying patients with high risk of ICEs.

aKey Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education and Chinese Ministry of Health, Shandong University Qilu Hospital, P.R. China

bShandong University School of Mathematics and Systematic Science, P.R. China

cDepartment of Cerebrovascular Disease, Shandong University Qilu Hospital, Jinan, Shandong, P.R. China

Received 30 March, 2008

Revised 19 August, 2008

Accepted 10 September, 2008

Correspondence to Yun Zhang, MD, PhD, Shandong University Qilu Hospital, No. 107, Wen Hua Xi Road, Jinan, Shandong 250012, P.R. China Tel: +86 531 82169139; fax: +86 531 86169356; e-mail:

© 2009 Lippincott Williams & Wilkins, Inc.