Reproducibility of Three-Dimensional Vascular Ultrasound for the Detection and Quantification of Early Atherosclerosis: A FAMILIA Substudy

Abstract

Introduction: Three-dimensional vascular ultrasound (3DVUS) offers promise for cardiovascular risk stratification in the general population. However, 3DVUS reproducibility in early stages of atherosclerosis disease has not been well stablished.

Objective: To determine 3DVUS agreement and reproducibility for plaque detection and focal atherosclerosis disease burden quantification in bilateral carotid and ileofemoral territories in adults enrolled in the “Family-Based Approach in a Minority Community Integrating Systems-Biology for Promotion of Health” (FAMILIA) study.

Methods: A total of 772 vascular territories were studied by 3DVUS at baseline in a random sample of 193 adults, including parents/caregivers and staff, recruited in the FAMILIA study from 15 Head Start preschools in Harlem (New York). The acquired images were analyzed off-line using the Vascular Plaque Quantification tool in QLAB, by two independent experienced technicians. Prevalence-adjusted and bias-adjusted kappa (PABAK) coefficients were calculated to assess the intraobserver and interobserver agreement for plaque detection. For intraobserver and interobserver reproducibility analyses of focal atherosclerosis disease burden (plaque volume quantification), the intraclass correlation coefficient (ICC) and Bland-Altman plots were employed in all plaque-positive participants recruited in the FAMILIA trial (n = 46 adult participants).

Results: Mean age of studied FAMILIA adult participants was 37.8±11.4 years, 85% female, 64% Hispanic/Latino, 26% Non-Hispanic Black. The overall prevalence of atherosclerosis was 8.3 %. Intraobserver and interobserver agreement was excellent for the detection of plaque (PABAK ranging from 0.97 to 1) and good for focal disease burden quantification (average ICC >0.85 in all cases). No significant intraobserver or interobserver bias was detected in Bland-Altman plots.

Conclusion: 3DVUS shows excellent intraobserver and interobserver agreement and good reproducibility for the detection and quantification of focal disease in early stages of atherosclerosis. Thus, 3DVUS could be used as a tool for subclinical atherosclerosis screening and for promoting healthy habits in the general population.