TY - JOUR
TI - Integration of estimated glomerular filtration rate biomarker in image-based cardiovascular disease/stroke risk calculator: A South Asian-Indian diabetes cohort with moderate chronic kidney disease
AU - Viswanathan, V.
AU - Jamthikar, A.D.
AU - Gupta, D.
AU - Puvvula, A.
AU - Khanna, N.N.
AU - Saba, L.
AU - Viskovic, K.
AU - Mavrogeni, S.
AU - Turk, M.
AU - Laird, J.R.
AU - Pareek, G.
AU - Miner, M.
AU - Ajuluchukwu, J.
AU - Sfikakis, P.P.
AU - Protogerou, A.
AU - Kitas, G.D.
AU - Nicolaides, A.
AU - Sharma, A.
AU - Suri, J.S.
JO - International Angiology
PY - 2020
VL - 39
TODO - 4
SP - 290-306
PB - Edizioni Minerva Medica
SN - 0392-9590
TODO - 10.23736/S0392-9590.20.04338-2
TODO - biological marker;  glucose;  hemoglobin A1c;  high density lipoprotein cholesterol;  low density lipoprotein cholesterol;  biological marker, adult;  age;  aged;  area under the curve;  arterial wall thickness;  Article;  atherosclerosis;  body mass;  cardiovascular disease;  cardiovascular risk;  carotid atherosclerosis;  carotid intima-media thickness;  cerebrovascular accident;  chronic kidney failure;  common carotid artery;  controlled study;  coronary artery calcification;  diabetes mellitus;  diagnostic accuracy;  dyslipidemia;  estimated glomerular filtration rate;  ethnicity;  female;  gender;  glomerulus filtration rate;  hospitalization;  human;  hypertension;  major clinical study;  male;  non insulin dependent diabetes mellitus;  peripheral occlusive artery disease;  phenotype;  QRISK score;  receiver operating characteristic;  retrospective study;  risk assessment;  risk factor;  smoking;  spondylolisthesis;  systolic blood pressure;  ultrasound;  cardiovascular disease;  cerebrovascular accident;  chronic kidney failure;  diabetes mellitus;  diagnostic imaging;  middle aged, Biomarkers;  Cardiovascular Diseases;  Carotid Intima-Media Thickness;  Diabetes Mellitus;  Female;  Glomerular Filtration Rate;  Humans;  Male;  Middle Aged;  Renal Insufficiency, Chronic;  Retrospective Studies;  Stroke
TODO - Background: Recently, a 10-year image-based integrated calculator (called AtheroEdge Composite Risk Score-AECRS1.0) was developed which combines conventional cardiovascular risk factors (CCVRF) with image phenotypes derived from carotid ultrasound (CUS). Such calculators did not include chronic kidney disease (CKD)-based biomarker called estimated glomerular filtration rate (eGFR). The novelty of this study is to design and develop an advanced integrated version called-AECRS2.0 that combines eGFR with image phenotypes to compute the composite risk score. Furthermore, AECRS2.0 was benchmarked against QRISK3 which considers eGFR for risk assessment. Methods: The method consists of three major steps: 1) five, current CUS image phenotypes (CUSIP) measurements using AtheroEdge system (AtheroPoint, CA, USA) consisting of: average carotid intima-media thickness (cIMTave), maximum cIMT (cIMTmax), minimum cIMT (cIMTmin), variability in cIMT (cIMTV), and total plaque area (TPA); 2) five, 10-year CUSIP measurements by combining these current five CUSIP with 11 CCVRF (age, ethnicity, gender, body mass index, systolic blood pressure, smoking, carotid artery type, hemoglobin, low-density lipoprotein cholesterol, total cholesterol, and eGFR); 3) AECRS2.0 risk score computation and its comparison to QRISK3 using area-under-the-curve (AUC). Results: South Asian-Indian 339 patients were retrospectively analyzed by acquiring their left/right common carotid arteries (678 CUS, mean age: 54.25±9.84 years; 75.22% males; 93.51% diabetic with HbA1c ≥6.5%; and mean eGFR 73.84±20.91 mL/min/1.73m2). The proposed AECRS2.0 reported higher AUC (AUC=0.89, P<0.001) compared to QRISK3 (AUC=0.51, P<0.001) by ~74% in CKD patients. Conclusions: An integrated calculator AECRS2.0 can be used to assess the 10-year CVD/stroke risk in patients suffering from CKD. AECRS2.0 was much superior to QRISK3. © 2020 EDIZIONI MINERVA MEDICA.
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