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Ultrasound Detection of Below-the-Knee Medial Arterial Calcifications in Asymptomatic Patients Is an Early Negative
Giulia Baldazzi1, Nicola Lamberti2, Martina Saladini3
1School of Vascular Surgery, University of Ferrara, 44121 Ferrara, Italy.
Insights
Ultrasound can detect below-the-knee medial arterial calcification (MAC) in asymptomatic patients. This finding predicts a higher risk of major adverse cardiovascular events (MACE) within five years, particularly in those with diabetes mellitus.
Area of Science:
- Vascular Medicine
- Cardiovascular Imaging
- Medical Diagnostics
Background:
- Medial arterial calcification (MAC) affects the arterial media layer and is a known predictor of adverse limb events in diabetes mellitus (DM) patients.
- The clinical significance of detecting MAC in below-the-knee (BTK) vessels using ultrasound (US) for predicting major adverse cardiovascular events (MACE) in asymptomatic individuals remains under investigation.
Purpose of the Study:
- To investigate whether ultrasound-detected MAC in BTK vessels serves as a negative predictor of MACE in asymptomatic patients.
- To assess the association between BTK MAC and secondary outcomes including peripheral arterial disease (PAD) development, survival rates, revascularizations, and amputations.
Main Methods:
- A single-center retrospective observational study involving 584 patients who underwent lower limb US.
- Assessment of BTK MAC by a single operator, with a primary outcome of MACE during a 5-year follow-up.
- Propensity score matching was employed to compare outcomes between patients with and without MAC.
Main Results:
- The MAC-positive (MAC+) group showed younger age, higher prevalence of DM and chronic kidney disease (CKD).
- The MAC-negative (MAC-) group had a higher incidence of prior myocardial infarction, stroke, and smoking.
- After matching, the MAC+ group had a significantly higher risk of MACE (HR: 1.84; CI: 1.01-3.38; p=0.047) over a median follow-up of 57 months. Age and MAC were independent predictors of MACE.
Conclusions:
- Ultrasound detection of BTK MAC is associated with DM and CKD.
- BTK MAC is an independent predictor of MACE, conferring an approximately 1.8-fold increased risk within 5 years in asymptomatic patients.
- New PAD diagnoses were more frequent in the MAC-negative group; no significant differences were found in amputations, revascularizations, or overall survival.
Abstract:
Background: Medial arterial calcification (MAC) is a vascular disorder that affects the arterial media layer. It represents a predictor of major adverse limb events in patients affected by diabetes mellitus (DM). This single-center retrospective observational study investigates whether ultrasound (US) detection of MAC in below-the-knee (BTK) vessels represents a negative predictor of major adverse cardiovascular events (MACE) in asymptomatic patients. Methods: In 2019, 584 patients, referred to the Vascular Surgery Unit for lower limb US, were examined by the same operator, who assessed the presence of BTK MAC. The primary outcome was the rate of MACE during a 5-year follow-up period. The secondary outcomes included the development of peripheral arterial disease (PAD), the overall survival rates, lower limb revascularizations, and major amputations. Results: MAC in BTK vessels was highlighted in 239 patients (MAC+) who exhibited a younger age (p < 0.001), DM (p < 0.001), and chronic kidney disease (CKD) (p = 0.048). The 345 subjects without MAC (MAC-) showed prior myocardial infarction (p < 0.001), stroke (p = 0.034), and smoking habits (p < 0.001). After propensity score matching, the MAC+ group presented a higher risk of MACE (HR: 1.84; CI: 1.01-3.38; p = 0.047) during a median follow-up of 57 months. Age (HR: 1.06; CI: 1.01-1.12) and MAC (HR: 1.22; CI: 1.06-1.57) were independently associated with MACE. New diagnoses of PAD mainly occurred in the MAC- group (p < 0.001). No differences were observed in major amputations, revascularization procedures, or overall survival rates. Conclusions: Ultrasound detection of BTK MAC was associated with the presence of DM and CKD and with a 1.8-fold increased risk of developing a MACE within 5 years in asymptomatic patients.
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