Morphologic TPA (mTPA) and composite risk score for moderate carotid atherosclerotic plaque is strongly associated with HbA1c in diabetes cohort

Elisa Cuadrado-Godia; Md Maniruzzaman; Tadashi Araki; Anudeep Puvvula; Md Jahanur Rahman; Luca Saba; Harman S Suri; Ajay Gupta; Sumit K Banchhor; Jagjit S Teji; Tomaž Omerzu; Narendra N Khanna; John R Laird; Andrew Nicolaides; Sophie Mavrogeni; George D Kitas; Jasjit S Suri; Fellow AIMBE

doi:10.1016/j.compbiomed.2018.08.008

Morphologic TPA (mTPA) and composite risk score for moderate carotid atherosclerotic plaque is strongly associated with HbA1c in diabetes cohort

Comput Biol Med. 2018 Oct 1:101:128-145. doi: 10.1016/j.compbiomed.2018.08.008. Epub 2018 Aug 8.

Authors

Elisa Cuadrado-Godia¹, Md Maniruzzaman², Tadashi Araki³, Anudeep Puvvula⁴, Md Jahanur Rahman⁵, Luca Saba⁶, Harman S Suri⁷, Ajay Gupta⁸, Sumit K Banchhor⁹, Jagjit S Teji¹⁰, Tomaž Omerzu¹¹, Narendra N Khanna¹², John R Laird¹³, Andrew Nicolaides¹⁴, Sophie Mavrogeni¹⁵, George D Kitas¹⁶, Jasjit S Suri¹⁷; Fellow AIMBE

Affiliations

¹ IMIM - Hospital Del Mar, Passeig Marítim, Barcelona, Spain.
² Department of Statistics, University of Rajshahi and the JiVit A Project of John Hopkins University, Gaibandha, Bangladesh.
³ Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan.
⁴ Annu's Hospitals for Skin and Diabetes, Nellore, Andra Pradesh, India.
⁵ Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh.
⁶ Department of Radiology, A.O.U., Italy.
⁷ Brown University, Providence, RI, USA.
⁸ Brain and Mind Research Institute and Department of Radiology, Weill Cornell Medical College, NY, USA.
⁹ Global Biomedical Technologies, Inc., Roseville, CA, USA.
¹⁰ Department of Pediatrics, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Feinberg School of Medicine Mercy Hospital, Chicago, IL, USA.
¹¹ Department of Neurology, University Medical Centre Maribor, Slovenia.
¹² Department of Cardiology, Indraprastha Apollo Hospitals, New Delhi, India.
¹³ Heart and Vascular Institute, Adventist Health, St. Helena, CA, USA.
¹⁴ Vascular Screening and Diagnostic Centre, London, UK; Vascular Diagnostic Centre, University of Cyprus, Nicosia, Cyprus.
¹⁵ Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece.
¹⁶ Arthritis Research UK Epidemiology Unit, Manchester University, Manchester, UK; Department of Rheumatology, Group NHS Foundation Trust, Dudley, UK.
¹⁷ Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, USA. Electronic address: jasjit.suri@atheropoint.com.

PMID: 30138774
DOI: 10.1016/j.compbiomed.2018.08.008

Abstract

Background: This study examines the association between six types of carotid artery disease image-based phenotypes and HbA1c in diabetes patients. Six phenotypes (intima-media thickness measurements (cIMT (ave.), cIMT (max.), cIMT (min.)), bidirectional wall variability (cIMTV), morphology-based total plaque area (mTPA), and composite risk score (CRS)) were measured in an automated setting using AtheroEdge™ (AtheroPoint, CA, USA).

Method: Consecutive 199 patients (157 M, age: 68.96 ± 10.98 years), L/R common carotid artery (CCA; 398 US scans) who underwent a carotid ultrasound (L/R) were retrospectively analyzed using AtheroEdge™ system. Two operators (novice and experienced) manually calibrated all the US scans using AtheroEdge™. Logistic regression (LR) and Odds ratio (OR) was computed and phenotypes were ranked.

Results: The baseline results showed 150 low-risk patients (HbA1c < 6.50 mg/dl) and 49 high-risk patients (HbA1c ≥ 6.50 mg/dl). The fasting blood sugar (FBS) was highly associated with HbA1c (P < 0.001). Except for cIMTV, all phenotypes showed an OR > 1.0 (P < 0.001) for left common carotid artery (LCCA), right carotid artery (RCCA), and mean of left and right common carotid artery (MCCA). After adjusting the FBS, the OR for mTPA showed a higher risk for LCCA, RCCA, and MCCA. The coefficient of correlation (CC) between phenotypes and HbA1c were strong and inter-CC between cIMT and mTPA/CRS was above 0.9 (P < 0.001). The statistical tests showed that phenotypes were significantly associated with diabetes (P-value<0.0001).

Conclusions: All phenotypes using AtheroEdge™, except cIMTV, showed a strong association with HbA1c. mTPA and CRS were equally strong phenotypes as cIMT. The CRS phenotype showed the strongest relationship to HbA1c.

Keywords: AtheroEdge™; Automated six carotid risk phenotypes; Carotid morphology; Diabetes; Inter-operator variability; Logistic regression; Odds ratio; Ultrasound.

MeSH terms

Aged
Carotid Artery Diseases* / blood
Carotid Artery Diseases* / diagnostic imaging
Carotid Artery, Common / diagnostic imaging*
Carotid Intima-Media Thickness*
Diabetes Mellitus* / blood
Diabetes Mellitus* / diagnostic imaging
Female
Glycated Hemoglobin / metabolism*
Humans
Male
Middle Aged
Models, Cardiovascular*
Plaque, Atherosclerotic* / blood
Plaque, Atherosclerotic* / diagnostic imaging
Risk Assessment

Substances

Glycated Hemoglobin A
hemoglobin A1c protein, human