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MRI Used to Predict Heart Attack, Stroke Risk Increases with Atherosclerosis in Abdominal Aorta

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Researchers at the UT Southwestern Medical Center have discovered that magnetic resonance imaging (MRI) of aortic atherosclerosis can foresee the risk of heart attacks and other cardiovascular issues in healthy people.

The study, which was published in the June issue of Radiology, is the first of its kind in assessing the extrapolative significance of MRI measures of aortic atherosclerosis for possible cardiac episodes.

"This is an important study, because it demonstrates that atherosclerosis in an artery outside the heart is an independent predictor of adverse cardiovascular events. MRI is a promising tool for quantifying atherosclerosis through plaque and arterial wall thickness measurements,” said radiology resident at the University of Texas Southwestern Medical Center in Dallas and lead author, Christopher D. Maroules, M.D.

Atherosclerosis is a condition in which fat, cholesterol and other substances gather within the arteries, forming plaque. As plaque amasses, the artery narrows, obstructing blood flow. The condition can take place in any artery, including the cerebral (brain) and coronary (heart) arteries and the aorta, which delivers oxygenated blood from the heart through the abdomen to the rest of body. The aorta is the largest artery body.

Over 2,200 healthy adults (average age 44) from the Dallas Heart Study, a pioneering multiethnic examination of cardiovascular disease in Dallas County residents, were subjected to abdominal aortic MRI as part of the research study.

Two key findings from the study were the average abdominal aortic wall thickness, or the thickness of the vessel wall, and the volume of plaque buildup.

mri predict heart attackAfter the MRI, participants were observed for a time-period of 7.8 years. Throughout that period, 143 participants had an unfavorable cardiac episode where arterial blood flow was limited, leading to death or medical attention. Researchers grouped the events as associated to the heart (cardiac events) or to other arteries (called extra-cardiac vascular events) like those in the brain or abdomen.

From the 143 cardiovascular episodes, 34 resulted in death. Seventy-three were non-fatal cardiac events, which included heart attack or coronary revascularization, and 46 were non-fatal extra-cardiac vascular events, including stroke or carotid revascularization.

By using MRIs, the study discovered that a rise in abdominal wall thickness is connected to a great chance for all kinds of cardiovascular episodes. A rise in both wall thickness and aortic plaque was linked to a risk for non-fatal extra-cardiac vascular events.

"These MRI measurements may add additional prognostic value to traditional cardiac risk stratification models," said Maroules.

Through MRIs, the abdominal aorta poses less of a practical challenge compared to other vascular imaging methods, due to the great size of the vessel and its independence of being around any mobile organ, such as the heart or lungs. Additionally, images of the abdominal aorta can be attained even if patients undergo different procedures, such as MRI of the spine or abdomen.

"The abdominal aorta is incidentally imaged on a regular basis. Radiologists can infer prognostic information from routine MRI exams that may benefit patients by identifying subclinical disease,” said Maroules.

For now Maroules believes further MRI studies will produce a greater understanding of the development of atherosclerosis, which scientists assume begins with a reconstruction or thickening of the vessel wall before any buildup of plaque can occur.

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