Echolucent Carotid Plaque is Associated with Future Renal Dysfunction in Patients with Stable Coronary Artery Disease
Tetsuji Mochida1, Takamitsu Nakamura, Kazuto Nakamura
1Department of Internal Medicine II, University of Yamanashi.
Insights
Echolucent carotid plaque, indicating instability, is linked to future kidney dysfunction in coronary artery disease patients. This finding suggests plaque instability mechanisms may contribute to renal decline.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Medical Imaging
Background:
- Peripheral arterial abnormalities correlate with renal dysfunction, irrespective of renal artery stenosis.
- Echolucent carotid plaque, characterized by low integrated backscatter (IBS), signifies unstable, lipid-rich plaque.
Purpose of the Study:
- To investigate the association between echolucent carotid plaque and the future decline in renal function.
- To assess if carotid plaque echolucency predicts renal dysfunction in patients with coronary artery disease (CAD).
Main Methods:
- Ultrasound with integrated backscatter (IBS) analysis of carotid plaque echolucency in 327 stable CAD patients with normal baseline renal function (eGFR ≥60 mL/min/1.73 m²).
- Follow-up for 36 months to monitor for renal dysfunction (eGFR <45 mL/min/1.73 m²).
Main Results:
- 39 patients developed renal dysfunction during follow-up.
- Low IBS values (echolucent plaque) significantly predicted progression to renal dysfunction (OR 0.48; p=0.003).
- Echolucent plaque improved the prediction of renal dysfunction beyond established risk factors (AUC increase, p=0.04; NRI=0.549, p=0.001; IDI=0.068, p=0.002).
Conclusions:
- Carotid artery echolucency is associated with future renal dysfunction in stable CAD patients.
- Plaque instability mechanisms may play a role in the development of renal dysfunction.
Aim:
Functional and structural abnormalities of the peripheral arteries are associated with renal dysfunction, independent of the presence of renal artery stenosis. This study investigated whether echolucent carotid plaque is associated with a future decline in the renal function in patients with coronary artery disease (CAD).
Methods:
Ultrasound assessments of carotid plaque echolucency with integrated backscatter (IBS) analyses were performed in 327 patients with stable CAD and carotid plaque who exhibited a normal renal function (estimated glomerular filtration rate [eGFR] ≥60 mL/min/1.73 m(2)) at baseline. A lower IBS value reflects the presence of echolucent and lipid-rich unstable plaque. All patients were followed up for 36 months or until the occurrence of renal dysfunction, defined as an eGFR of ＜45 mL/min/1.73 m(2).
Results:
During the follow-up period, 39 patients developed renal dysfunction. A multivariate logistic regression analysis showed that the presence of carotid plaque with a low IBS value was significantly associated with progression to renal dysfunction (odds ratios 0.48; 95% CI 0.30-0.78, p= 0.003). In addition, carotid plaque with a low IBS value had a significant incremental effect on the predictive value of known risk factors for renal dysfunction in analyses using c-statistics (AUC of the baseline risk model with and without IBS: 0.83 vs. 0.79, respectively, p=0.04), net reclassification improvement (index=0.549, p=0.001) and integrated discrimination improvement (index=0.068, p=0.002).
Conclusions:
Echolucency of the carotid arteries is associated with future renal dysfunction in patients with stable CAD, indicating that the mechanisms related to plaque instability may be involved in the onset of renal dysfunction.
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