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Risk Assessment for Cardiovascular Events using Achilles Tendon Thickness and Softness and Intima-Media Thickness in
Masahito Michikura1,2, Masatsune Ogura3, Kota Matsuki4
1Department of Endocrinology and Metabolism, National Cerebral and Cardiovascular Center Hospital.
Insights
Ultrasonography of Achilles tendon thickness and carotid intima-media thickness can help assess cardiovascular risk in heterozygous familial hypercholesterolemia (HeFH) patients. These measurements, along with Achilles tendon calcification, aid in identifying individuals needing stricter management for major adverse cardiovascular events (MACEs).
Area of Science:
- Cardiovascular Medicine
- Radiology
- Genetics
Background:
- Heterozygous familial hypercholesterolemia (HeFH) is a genetic condition leading to elevated LDL cholesterol and increased risk of cardiovascular disease.
- Early identification and risk stratification are crucial for managing HeFH patients to prevent major adverse cardiovascular events (MACEs).
- Novel imaging biomarkers are needed to improve cardiovascular risk assessment in HeFH.
Purpose of the Study:
- To determine cutoff values for Achilles tendon thickness (ATT) and carotid intima-media thickness (C-IMT) for predicting MACEs in HeFH patients.
- To evaluate the effectiveness of ATT (ultrasonography and radiography) and C-IMT as risk assessment indexes.
- To assess the role of Achilles tendon calcification in MACE risk stratification.
Main Methods:
- Retrospective cohort study of 391 clinically diagnosed HeFH patients.
- ROC curve analysis to determine cutoff values for ultrasonography-measured ATT (US-ATT), radiography-measured ATT (Xp-ATT), and C-IMT.
- Kaplan-Meier curves and multivariate analysis to assess the predictive value of these indexes and AT calcification for MACEs.
Main Results:
- Cutoff values for MACEs were established: US-ATT (9.9 mm males, 7.1 mm females) and C-IMT (1.6 mm males, 1.5 mm females).
- Higher US-ATT, AT softening, AT calcification, and greater C-IMT were significantly associated with increased MACE rates (P<0.001).
- Xp-ATT did not show a significant difference in MACE rates (P=0.112).
Conclusions:
- Established thresholds for US-ATT and C-IMT, along with AT calcification assessment, can enhance cardiovascular risk stratification in HeFH patients.
- These imaging markers can guide more intensive management strategies for high-risk HeFH individuals.
- Ultrasonography of the Achilles tendon shows promise as a non-invasive tool for cardiovascular risk assessment in HeFH.
Aims:
This was a retrospective cohort study that aimed to determine cutoff values for major adverse cardiovascular events (MACEs) in patients with heterozygous FH (HeFH) for Achilles tendon (AT) thickness (ATT) measured by ultrasonography (US-ATT) and radiography (Xp-ATT), AT softness, and intima-media thickness of carotid artery (C-IMT), and to examine the effectiveness of these values as well as AT calcification as indexes in assessing risk for MACEs.
Methods:
The subjects were 391 clinically diagnosed HeFH patients. Kaplan-Meier curves were drawn based on the threshold values for the individual indexes calculated from ROC curves, and multivariate analysis was used to examine whether they were predictors of the development of MACEs.
Results:
The median observation period was 1,239 days (700-1,827 days). Twenty-one subjects (5%) had MACEs during the observation period. The cutoff values for MACEs for US-ATT were 9.9 mm in males and 7.1 mm in females, and those for C-IMT were 1.6 mm in males and 1.5 mm in females. Subjects were classified into two groups according to whether they were above or below the cutoff values and presence of calcification, and we compared MACE rates between them. MACE rates were significantly increased in groups with AT thickening determined by ultrasonography (P＜0.001), AT softening (P＜0.001), presence of calcification in AT (P=0.016) and greater C-IMT (P＜0.001). However, classification according to Xp-ATT revealed no significant difference in MACE rate (P=0.112).
Conclusions:
These thresholds and examination for AT calcification will help in risk assessment for patients in Japanese FH practice and encourage stricter and more comprehensive management for patients who exceed the thresholds.
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