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Published on: November 17, 2017
Detection of subclinical atherosclerosis in familial hypercholesterolemia using non-invasive imaging modalities
Paloma Caballero1, Rodrigo Alonso, Paloma Rosado
1Department of Radiology, Hospital de la Princesa, Madrid, Spain.
Insights
Asymptomatic familial hypercholesterolemia (FH) patients show increased atherosclerosis burden compared to controls. Advanced imaging like MRI detected lipid-rich plaques, linked to early heart disease history.
Area of Science:
- Cardiovascular Imaging
- Atherosclerosis Research
- Genetic Lipid Disorders
Background:
- Familial hypercholesterolemia (FH) is a genetic disorder leading to high LDL cholesterol and premature cardiovascular disease.
- Subclinical atherosclerosis assessment in asymptomatic FH patients is crucial for risk stratification.
- Non-invasive imaging techniques offer valuable insights into early atherosclerotic changes.
Purpose of the Study:
- To quantify subclinical atherosclerosis in asymptomatic familial hypercholesterolemia (FH) patients.
- To compare atherosclerotic burden between FH patients and healthy controls using imaging.
- To explore the correlation between different imaging markers and family history.
Main Methods:
- Magnetic Resonance Imaging (MRI) of the descending thoracic aorta to measure aortic wall volume and characterize plaques.
- B-mode carotid ultrasound to assess carotid intima-media thickness (cIMT) and detect carotid plaques.
- Comparison of imaging findings between 36 FH patients and 19 controls.
Main Results:
- FH patients exhibited significantly higher aortic wall volume, cIMT, and aortic plaques compared to controls (P<0.001).
- A significant positive correlation was found between aortic wall volume and cIMT (P<0.01).
- MRI detected plaques in 94% of FH cases; lipid-rich plaques were identified in 33% and associated with a family history of premature coronary artery disease (P<0.05).
Conclusions:
- Asymptomatic FH patients have a substantially elevated atherosclerotic burden.
- cIMT correlates with aortic wall volume, suggesting widespread atherosclerosis.
- MRI is effective in detecting lipid-rich plaques in FH patients, indicating increased cardiovascular risk.
Objectives:
To investigate the extent of subclinical atherosclerosis in asymptomatic familial hypercholesterolemia (FH) patients using non-invasive images techniques.
Patients, Methods And Results:
The atherosclerotic burden of 36 molecularly defined FH patients (18 males, 45.7±10.9 years) without evidence of cardiovascular disease receiving lipid-lowering treatment and 19 (47.8±11.3 years) controls was investigated. Descending thoracic aorta magnetic resonance imaging (MRI) was performed in a 1.5 T equipment with T1 and T2 sequences to characterize atherosclerotic plaques and to measure aortic wall volumen. Carotid intima-media thickness (cIMT) and presence of plaques were measured using B-mode carotid ultrasound. Mean aortic wall volumen, cIMT and atherosclerotic plaques in aorta were significantly higher in FH cases (P<0.001). A significant correlation between aortic wall volume and cIMT was observed (P<0.01). Aortic MRI detected plaques in 94% and carotid ultrasound in 14% of cases. Lipid-rich plaques were observed only in FH cases (33%) and were associated with family history of premature coronary artery disease (P<0.05).
Conclusions:
Asymptomatic middle-aged FH patients have significantly higher atherosclerotic burden than controls. cIMT has shown a significant correlation with aortic wall volume and MRI allowed the detection of lipid-rich plaques in FH subjects that were associated with family history of premature coronary artery disease.
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