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Novel Biomarkers and Imaging Indices for the "Vulnerable Patient" with Carotid Stenosis: A Single-Center Study

Nikolaos Kadoglou1, Konstantinos G Moulakakis2, George Mantas3

  • 1Medical School, University of Cyprus, 2029 Nicosia, Cyprus.

Biomolecules
|September 28, 2023
PubMed

Insights

Matrix metalloproteinases (MMPs), cardio-ankle vascular index (CAVI), and Gray-Scale Median (GSM) score predict major adverse cardiovascular events (MACE) after carotid revascularization. These biomarkers identify vulnerable patients at risk for future cardiovascular events.

Area of Science:

  • Vascular Biology and Cardiovascular Medicine
  • Biomarkers and Diagnostic Imaging
  • Clinical Atherosclerosis Research

Background:

  • Carotid atherosclerosis poses a significant risk for major adverse cardiovascular events (MACE).
  • Identifying vulnerable plaque and predicting MACE after carotid revascularization remains a clinical challenge.
  • Matrix metalloproteinases (MMPs), cardio-ankle vascular index (CAVI), and Gray-Scale Median (GSM) score are potential indicators of atherosclerosis severity and vulnerability.

Purpose of the Study:

  • To investigate the association of MMPs, CAVI, and GSM with carotid atherosclerosis severity and vulnerability.
  • To determine the predictive value of these biomarkers for MACE following carotid artery revascularization.
  • To identify novel imaging and biochemical markers for stratifying MACE risk in patients undergoing carotid revascularization.

Main Methods:

  • A cohort study involving 262 patients undergoing carotid revascularization therapy (GRT), 109 asymptomatic patients with low-grade stenosis (GCT), and 92 controls (GCO).
  • Baseline assessments included clinical parameters, metabolic profile, CAVI, GSM, and serum levels of hsCRP, MMP-3, -7, -9, and TIMP-1.
  • Follow-up averaged 55 months to ascertain MACE occurrences.

Main Results:

  • Elevated CAVI, MMPs, and TIMP-1 levels were observed in both GRT and GCT groups compared to GCO (p < 0.001).
  • Higher levels correlated with symptomatic disease or greater stenosis degree (p < 0.001).
  • In GRT patients, diabetes, smoking, high CAVI, elevated MMP-9, and low GSM independently predicted MACE (p < 0.05), despite optimal medical therapy.

Conclusions:

  • Novel imaging and biochemical biomarkers are linked to atherosclerosis severity.
  • CAVI, MMP-9, and low GSM independently predict MACE after carotid revascularization.
  • These markers help identify "vulnerable patients" at higher risk for cardiovascular events.
Abstract

Keywords:
cardio-ankle vascular indexcarotid atherosclerosiscarotid plaque instabilitymatrix metalloproteinasesvulnerable patient

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