Reproducibility of extracranial carotid atherosclerotic lesions assessed by B-mode ultrasound: The atherosclerosis risk in communities study

doi:10.1016/0301-5629(96)00084-1

Ultrasound in Medicine & Biology

Volume 22, Issue 7, 1996, Pages 791-799

https://doi.org/10.1016/0301-5629(96)00084-1 Get rights and content

Abstract

The reproducibility in the identification of carotid artery lesions using B-mode ultrasound was studied in a large random sample selected from the Atherosclerosis Risk in Communities (ARIC) Study. Carotid lesions were defined as plaque with or without acoustic shadowing (indicative of mineralization). A weighted kappa (κ_W) statistic was used as a chance-adjusted measure of repeatability. In the ARIC baseline survey, the κ_W values for the assessment of lesions on repeat reading were 0.47, 0.60 and 0.69 in the left common carotid artery, the carotid bifurcation and the internal carotid artery, respectively. In a repeat scanning, the κ_W values ranged from 0.59 to 0.79 in the left carotid segments. The results were similar in the left and right carotid arteries. Covariates (age, race, gender, body mass index, study center) did not influence the reproducibility. Similar results were also found in both the baseline survey and the first follow-up examination. In conclusion, reproducibility in the assessment of carotid lesions by B-mode ultrasound can be achieved in multicenter studies at fair to good levels of agreement.

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ARIC (Atherosclerosis Risk In Communities) initiated community-based surveillance in 1987 for myocardial infarction and coronary heart disease (CHD) incidence and mortality and created a prospective cohort of 15,792 Black and White adults ages 45 to 64 years. The primary aims were to improve understanding of the decline in CHD mortality and identify determinants of subclinical atherosclerosis and CHD in Black and White middle-age adults. ARIC has examined areas including health disparities, genomics, heart failure, and prevention, producing more than 2,300 publications. Results have had strong clinical impact and demonstrate the importance of population-based research in the spectrum of biomedical research to improve health.
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Biomarkers and degree of atherosclerosis are independently associated with incident atherosclerotic cardiovascular disease in a primary prevention cohort: The ARIC study
2016, Atherosclerosis
Biomarkers and atherosclerosis imaging have been studied individually for association with incident cardiovascular disease (CVD); however, limited data exist on whether the biomarkers are associated with events with a similar magnitude in the presence of atherosclerosis. In this study, we assessed whether the presence of atherosclerosis as measured by carotid intima media thickness (cIMT) affects the association between biomarkers known to be associated with coronary heart disease (CHD) and incident cardiovascular disease (CVD) in a primary prevention cohort.
8127 participants from the ARIC study (4th visit, 1996–1998) were stratified as having minimal, mild, or substantial atherosclerosis by cIMT. Levels of C-reactive protein, lipoprotein-associated phospholipase A2, cardiac troponin T, N-terminal pro-brain natriuretic peptide, lipoprotein(a), cystatin C, and urine albumin to creatinine ratio were measured in each participant. Hazard ratios were used to determine the relationship between the biomarkers and incident CHD, stroke, and CVD in each category of atherosclerosis.
While each of the biomarkers was significantly associated with risk of events overall, we found no significant differences noted in the strength of association of biomarkers with CHD, stroke, and CVD when analyzed by degree of atherosclerosis.
These findings suggest that the level of atherosclerosis does not significantly influence the association between biomarkers and CVD.
Genetic association and gene-smoking interaction study of carotid intima-media thickness at five GWAS-indicated genes: The Bogalusa Heart Study
2015, Gene
Citation Excerpt :
Trained sonographers measured far wall IMTs of the left and right common carotids using high-resolution B-mode ultrasound and a previously reported protocol (Urbina et al., 2002). Briefly, images were scanned using a Toshiba SonoLayer SSH 160A ultrasound system (Toshiba Medical, Tokyo, Japan), a 7.5-MHz linear-array transducer that recorded images at both sides of the common carotid, carotid bulbs, and internal carotid arteries using protocols developed for the Atherosclerosis Risk in Communities Study (Li et al., 1996). Measurements of IMT were then performed by a single reader with the help of a semi-automated border-detection program.
To examine the associations of five GWAS-identified genes with carotid intima-media thickness (IMT) in a biracial sample from the Bogalusa Heart Study, and evaluate their participation in gene-smoking interactions.
Far wall IMTs of common carotid arteries were measured using high-resolution B-mode ultrasound. Both the gene-smoking interactions and single-marker associations were evaluated by linear models of carotid IMT levels, while the gene-based analyses were assessed through the truncated product method. A Bonferroni multiple testing correction was applied.
Marker rs7840785 (PINX1) was significantly associated with right carotid IMT (p = 0.0003) using all participants; mean levels for the CC, TC, and TT genotypes were 0.74 (0.73 to 0.75), 0.76 (0.75 to 0.78), and 0.78 (0.75, 0.81), respectively. Similar trends were observed in blacks (p = 0.0031) and whites (p = 0.0118). Marker rs7844465 (ZHX2) was significantly associated with left carotid IMT in whites (p = 0.0005); mean IMT levels for the GG, TG, and TT genotypes were 0.73 (0.71 to 0.74), 0.75 (0.74 to 0.77) and 0.78 (0.75 to 0.81), respectively. Marker rs6841473 (EDNRA) modified the association between smoking and left carotid IMT in blacks (p = 2.79 × 10^− 5). In addition, gene-based analysis demonstrated that EDNRA and ZHX2 were associated with left carotid IMT in the white and overall participants, respectively, while PINX1 was associated with right carotid IMT in both blacks and whites.
We identified two novel markers that were associated with IMT in both blacks and whites. One gene-smoking interaction was identified in blacks only. Three genes showed gene-based associations with IMT levels. However, genetic markers with small effects may have been missed due to the limited number of black participants.
Military combat and burden of subclinical atherosclerosis in middle aged men: The ARIC Study
2010, Preventive Medicine
Studies of the cardiovascular consequences of combat stress are few and inconclusive.
The association between combat exposure and subclinical atherosclerosis at Atherosclerosis Risk in Communities (ARIC) Study visits 1 (1987–1989) and 2 (1990–1992) was assessed among 5347 men from four U.S. communities.
Measured an average of 36 years after military entry, carotid intima-media thickness (CIMT) and carotid plaque among non-combat veterans (n = 2127) were compared with non-veterans (n = 2042) and veterans reporting combat experience (n = 1178).
Compared to non-combat veterans, non-veterans (risk difference (RD): 10.61; 95% confidence interval (CI): 0.81, 20.41) and combat veterans (RD: 12.79; 95% CI: 0.72, 24.86) had higher age-adjusted mean CIMT. Differences remained for combat veterans after adjustment for race, father's education and age at service entry but not years of service and for non-veterans after adjustment for race but not father's education. No differences in carotid plaque were noted.
Results do not suggest that combat has a long-term detrimental effect on subclinical atherosclerosis among men.
Carotid Intima-Media Thickness and Presence or Absence of Plaque Improves Prediction of Coronary Heart Disease Risk. The ARIC (Atherosclerosis Risk In Communities) Study
2010, Journal of the American College of Cardiology
Citation Excerpt :
For this analysis, we excluded patients with prevalent CHD or prevalent stroke (n = 763), missing prevalent CHD data (n = 339), missing CIMT or plaque data (n = 909), missing information on traditional CHD risk factors (TRF) (n = 533), races other than black or white (n = 48), and black participants from the Minnesota or Washington field center (n = 55), providing us with a sample of 13,145 patients for the analysis. The ultrasound procedure in the ARIC study has been previously described (14–17). Briefly, a Biosound 2000 (Biosound, Indianapolis, Indiana) IISA system was used and images recorded on a VHS tape.
We evaluated whether carotid intima-media thickness (CIMT) and the presence or absence of plaque improved coronary heart disease (CHD) risk prediction when added to traditional risk factors (TRF).
Traditional CHD risk prediction schemes need further improvement as the majority of the CHD events occur in the “low” and “intermediate” risk groups. On an ultrasound scan, CIMT and presence of plaque are associated with CHD, and therefore could potentially help improve CHD risk prediction.
Risk prediction models (overall, and in men and women) considered included TRF only, TRF plus CIMT, TRF plus plaque, and TRF plus CIMT plus plaque. Model predictivity was determined by calculating the area under the receiver-operating characteristic curve (AUC) adjusted for optimism. Cox proportional hazards models were used to estimate 10-year CHD risk for each model, and the number of subjects reclassified was determined. Observed events were compared with expected events, and the net reclassification index was calculated.
Of 13,145 eligible subjects (5,682 men, 7,463 women), ∼23% were reclassified by adding CIMT plus plaque information. Overall, the CIMT plus TRF plus plaque model provided the most improvement in AUC, which increased from 0.742 (TRF only) to 0.755 (95% confidence interval for the difference in adjusted AUC: 0.008 to 0.017) in the overall sample. Similarly, the CIMT plus TRF plus plaque model had the best net reclassification index of 9.9% in the overall population. Sex-specific analyses are presented in the manuscript.
Adding plaque and CIMT to TRF improves CHD risk prediction in the ARIC (Atherosclerosis Risk In Communities) study.

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Original contributionReproducibility of extracranial carotid atherosclerotic lesions assessed by B-mode ultrasound: The atherosclerosis risk in communities study

Abstract

J Clin Epidemiol

J Clin Epidemiol

J Clin Epidemiol

Ultrasound Med Biol

Maximum likelihood estimation of agreement in the constant predictive probability model, and its relation to Cohen's kappa

Biometrics

The measurement of observer disagreement in the recording of signs

J R Stat Soc Ser A

A comparison of methods for calculating a stratified kappa

Stat Med

Carotid artery velocity patterns in normal and stenotic vessels

Stroke

A new procedure for assessing reliability of scoring EEG sleep recordings

Am J EEG Technol

Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit

Psychol Bull

Mathematical methods of statistics

Interpretation of low kappa values

Int J Biomed Comput

Statistical methods for rates and proportions

Measures of association for cross classifications

J Am Stat Soc

Detection of early atherosclerotic lesions by duplex scanning of the carotid artery

J Clin Ultrasound

Duplex ultrasound screening for carotid arteriosclerotic disease in asymptomatic patients

J Ultrasound Med

Duplex carotid sonography: criteria for stenosis, accuracy, and pitfalls

Radiology

Angiography and ultrasound in the diagnosis of carotid artery disease: a comparison

Contemp Surg

Original contribution
Reproducibility of extracranial carotid atherosclerotic lesions assessed by B-mode ultrasound: The atherosclerosis risk in communities study