New publication by CINQ

Presence of Calcium-Like Tissue Composition in Carotid Plaque is Indicative of Significant Coronary Artery Disease in High-Risk Patients

Julia E. Herr, MSc, Marie-France Hétu, MSc, PhD, Terry Y. Li, MSc, Paul Ewart, DCS, Amer M. Johri, MSc, MD, FRCPC, FASE
Article in press: JASE


Grayscale pixel ranges from ultrasound images, indicating differences in atherosclerotic plaque echogenicity, have been shown to represent different tissue types. Our objective was to determine whether carotid plaque composition was correlated with severity of coronary artery disease (CAD) and risk of cardiovascular (CV) events.


A focused carotid ultrasound was performed in 522 participants who had recently undergone coronary angiography. In 468 participants found to have atherosclerotic plaque in at least one carotid artery, plaque composition was assessed for tissue-like types: grayscale ranges 0-4 (blood), 8-26 (fat), 41-76 (muscle), 112-196 (fibrous), and 211-255 (calcium). Logistic regression was used to evaluate correlations with significant CAD (≥50% stenosis). Cox proportional hazards models were used to determine risk for 5-year CV outcomes.


Carotid plaque percent fibrous and percent calcium increased with severity of CAD (P < .02). When adjusted for age, sex, body mass index, estimated glomerular filtration rate, and traditional cardiac risk factors, maximum plaque height and percent calcium remained independent contributors of significant CAD (P < .01). Plaque height (≥2.74 mm), percent calcium (≥0.11%), and percent fat (11.6%) were associated with increased risk for CV events. Combined plaque height and percent fat gave the highest risk for events (risk ratio = 2.02; CI, 1.41-2.94, P = .0002).


Carotid plaque fibrous and calcium-like tissues are correlated with increased CAD. Increased percent fat or percent calcium is associated with risk for CV events; however, a combination of plaque height, percent calcium, and/or percent fat increases risk for CV events. Incorporating ultrasound carotid plaque composition into screening practice may improve patient risk stratification for heart disease.

Fig. 2

CINQ at Science Rendezvous 2018

Thank you to everyone who joined us this year at Science Rendezvous 2018 at the K-Rock Centre! This year we demonstrated hand-held ultrasound on both a teaching model and our generous volunteers, displayed plasticized heart specimens, and made origami hearts with our visitors!

Thank you to Dr. Pang, the simulation lab at Queen’s, and to all our tireless volunteers!

We hope to see you all again next year.


Healthscape news feature

Dr. Amer Johri and CINQ were recently featured on in an article entitle: “Moving forward on meaningful patient engagement in research.”

“During our recent visit to Kingston Health Sciences Centre for the grand opening of the W.J. Henderson Centre for Patient-Oriented Research, we saw many examples of meaningful patient engagement. Dr. Amer Johri, a clinician-scientist at the Kingston Health Sciences Centre and a Queen’s University professor, is one such example. Through his work on metabolic syndrome – a complex condition that includes obesity, high blood pressure, high cholesterol and diabetes – with the CINQ lab (Cardiovascular Imaging Network at Queen’s), Dr. Johri is leading the way on involving patients in the research process.”

Dr. Amer Johri in the news.

Healthscape is a topical eNewsletter and website from the Ontario Hospital Association (OHA) that offers current news and information aimed at helping its readers navigate the fascinating and complex landscape of Ontario’s ever-changing health care system.