Achilles Tendon Ultrasonography for Diagnosis of Familial Hypercholesterolemia Among Japanese Subjects.
BACKGROUND
Difficulty in detecting and measuring Achilles tendon (AT) xanthomas may be responsible for underdiagnosis of familial hypercholesterolemia (FH). We aimed to determine a cutoff value for AT thickness (AT-T) using ultrasonography to diagnose FH, and to investigate the relationship between AT-T and atherosclerosis.Methods and Results:Ultrasonographic AT-T and carotid intima-media thickness (IMT) were evaluated in 130 genetically diagnosed FH patients and 155 non-FH patients. The outline and internal properties of the AT could be clearly determined using ultrasonography, and a good correlation in AT-T was observed between ultrasonography and the conventional method of X-ray radiography (r=0.924, P<0.001). Cutoff values for the diagnosis of FH derived from receiver-operating curves were 5.8 mm (sensitivity 71%, specificity 78%) in men, and 5.5 mm (sensitivity 80%, specificity 81%) in women. Importantly, increased AT-T was positively associated with carotid IMT only in the FH group. Additionally, increased AT-T was associated with the presence of coronary artery disease in a logistic regression analysis adjusted for traditional cardiovascular risk factors.


CONCLUSIONS
This is the first study to determine a cutoff value for AT-T based on ultrasonography for the diagnosis of FH in Japanese subjects. Clearer detection and easier measurement of AT-T using ultrasonography would encourage clinicians to diagnose FH more actively, and could solve the problem of underdiagnosis of FH.
['Michikura|Masahito|M|', 'Ogura|Masatsune|M|', 'Yamamoto|Masahiro|M|', 'Sekimoto|Masahiko|M|', 'Fuke|Chizuru|C|', 'Hori|Mika|M|', 'Arai|Koji|K|', 'Kihara|Shinji|S|', 'Hosoda|Kiminori|K|', 'Yanagi|Koji|K|', 'Harada-Shiba|Mariko|M|']
D000125:Achilles Tendon D000328:Adult D000368:Aged D044466:Asians D005260:Female D006801:Humans D006938:Hyperlipoproteinemia Type II D008297:Male D008875:Middle Aged D012680:Sensitivity and Specificity D014463:Ultrasonography
Achilles tendon Ultrasonography Familial hypercholesterolemia Carotid intima-media thickness Coronary artery disease