Atherosclerotic burden in coronary and peripheral arteries in patients with first clinical manifestation of coronary artery disease (original) (raw)
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a b s t r a c t Background: Carotid arterial intima-media thickness (IMT) has been a good indicator of the presence and extent of coronary artery disease (CAD) in observational studies. Since treadmill testing and stress echocardiography can have limited specificity in diagnosing CAD, other methods are required. Methods: B-mode ultrasound examinations were performed with Philips Sonos 7500, frequency of 7.0 MHz linear array transducer in order to calculate IMT. All the patients were catheterized percutaneously via the femoral vessels with standard Judkins technique.
National Journal of Medical Research, 2020
Introduction: Coronary artery disease (CAD) is rapidly developing epidemic in India due to increasing urbanization and a change to a sedentary lifestyle. Aim: Aim of study was to determine the value of ultrasound measurements of internal carotid artery intima-media thickness as a surrogate marker for coronary artery disease, to compare measurements of internal carotid artery intima-media thickness with findings of coronary angiography and to establish correlation between internal carotid artery intima-media thickness and various risk factors for coronary artery disease. Methods: The prospective study comprise of 200 patients who had clinically suspected CAD and undergone coronary angiography admitted to department of medicine and cardiology in our hospital during time period from august 2018 to February 2020. Carotid Doppler of each patients undergoing coronary angiography was done and intima media thickness of bilateral ICA were taken. Results: The largest increase in intimal medial thickness was observed in hypertensive patient. In our study 138 patients (69%) are male and 62 patients (32%) are female. Males are affected more than female by CAD in our study. Incidence of CAD is highest amongst the patients within range of 51- 60 years that is 39.5%. In the present study, 97.22 % patients having dyslipidemia had IMT > 0.8, while 93.5 % patients having hypertriglyceridemia had IMT > 0.8. Conclusion: The conclusion of this study is that increase in the carotid intramural thickness have a high and specific likelihood of CAD and that ultrasound examination of the carotid arteries can effectively predict atherosclerosis of the coronary arteries.
Iranian Red Crescent Medical Journal, 2015
Ischemic heart disease (IHD) is the most common cause of cardiovascular diseases and divided into two main categories as acute coronary syndrome (ACS) and chronic stable angina (CSA). These two groups have stenosis and atherosclerosis in the coronary artery, but are more severe in patients with ACS. We aimed to find the association between coroner and internal carotid artery, also comparing prospectively stenosis level, plaque morphology and intima-media thickness of internal carotid between patients with acute coronary syndrome (ACS) and chronic stable angina. In this study, 60 patients were enrolled as ACS group chosen from those admitted in CCU or referred to clinic. Forty-five patients of CSA group were chosen from those referred to clinic. All 105 patients underwent color Doppler sonography, and stenosis, plaque morphology and intima media thickness (IMT) were measured. In 60 patients with ACS, 49 (81.7%) had no stenosis in ultrasonography and 11 (18.3%) had some degrees of stenosis; also 28 (46.7%) and 16 (26.7%) of patients had plaque and IMT, respectively. In the rest 45 patients of CSA group, just 4 (8.9%), 17 (37.8%) and 8 (17.8%) patients had stenosis, plaque and IMT, respectively. Therefore, there was no statistically significant difference between the two groups regarding stenosis (P = 0.171), plaque morphology (P = 0.362) and IMT (P = 0.283) (Power = 90%). According to the results, there were no significant and meaningful differences comparing ACS and CSA groups of patients by ECDS using three indicators of stenosis, plaque morphology and IMT as indicators of atherosclerosis. Results also display that patients with ACS had more stenosis, more plaque and thicker intima-media, but these differences were not statistically significant (P < 0.05).
Carotid intima-media thickness and coronary atherosclerosis: weak or strong relations?
European Heart Journal, 2007
Background: There is a growing evidence that carotid intima media thickness (CIMT) is associated with coronary artery disease (CAD) and it should be used as a predictor of atherosclerotic burden of coronary arteries. However, these studies have been performed by using invasive coronary angiography (ICA) and in high-risk patients for CAD. The purpose of this study was to evaluate the correlation between CIMT by ultrasound and coronary atherosclerosis in symptomatic intermediate risk patients by coronary computed tomography angiography (CCTA). Methods: We enrolled 204 consecutive symptomatic patients (mean age: 61 ± 10; men: 118) and intermediate risk for CAD. All patients underwent CIMT ultrasound evaluation and CCTA. Coronary artery calcium score (CACS), characteristics of plaques, severity of CAD, segment involvement score (SIS) and Gensini's score were assessed and compared with CIMT values. Results: CIMT has been proved as an independent predictor of a number of coronary artery plaques, overall number of mixed and remodeled plaques, presence of obstructive CAD, high SIS and Gensini's score (HR 1.2, CI 1.05-1.42, p 0.01; HR 1.2, CI 1.01-1.41, p 0.03; HR 9.0, CI 1.37-59.7, p 0.02; HR 21.0, CI 2.40-184, p b 0.01; HR 1.2, CI 1.08-1.42, p b 0.01; HR 1.2, CI 1.08-1.42, p b 0.01, respectively). A cut-off value N 1.3 was associated with a better positive and negative predictive value (100% and 69%) to predict the combined endpoint of presence and mixed and/or remodeled coronary artery plaques. Conclusions: CIMT is an independent predictor of coronary atherosclerotic burden as detected by CCTA in symptomatic intermediate risk patients.
Association of increased carotid intima-media thickness with the extent of coronary artery disease
Heart, 2004
Objective: To investigate (a) the relation between intima-media thickness (IMT) in carotid arteries and the extent of coronary artery disease (CAD); and (b) whether IMT is predictive of coronary atherosclerosis. The coexistence of severe extracranial atherosclerosis in patients with CAD was also analysed. Methods: Coronary angiography and carotid ultrasound evaluation were performed in 558 consecutive patients (438 men), with a mean (SD) age of 58.8 (9.2) years and suspected CAD. Mean IMT was measured at both carotid arteries and expressed as the mean aggregate value. The relation between IMT and severity of CAD was determined. Results: A significant correlation between mean IMT and advancing CAD (p , 0.0001) was found. Four independent predictors of CAD were found in the discriminant analysis: age (p = 0.0193), hyperlipidaemia (p , 0.0001), smoking (p = 0.0032), and IMT (p , 0.0001). A significant increase in IMT was observed among patients with one, two, and three vessel CAD. A log normal distribution of IMT values showed that if mean IMT was over 1.15 mm, patients had a 94% probability of having CAD, with sensitivity of 65% and specificity of 80% in the patients with a high risk of CAD. The number of critically stenosed extracranial arteries increased with advancing CAD. None of the patients with normal coronary arteries had severe stenosis of the extracranial arteries. Severe carotid, vertebral, or subclavian stenosis was found in 16.6% of patients with three vessel CAD. Conclusions: IMT increases with advancing CAD, patients with mean IMT over 1.15 mm have a 94% likelihood of having CAD, and the coexistence of CAD with severe stenosis of aortic arch arteries is relatively high and was found in 16.6% of patients with three vessel CAD.
The assessment of atherosclerosis on vascular structures in patients with acute coronary syndrome
Clinical and investigative medicine. Médecine clinique et experimentale, 2010
Endothelial dysfunction plays a crucial role in the process of atherosclerotic diseases and has been accepted as an early stage of atherosclerosis. Carotid intima-media-thickness (CIMT) and flow-mediated-dilatation (FMD) of the brachial artery have been recommended as noninvasive methods to assess endothelial structure and function. Angiographic properties of patients with acute coronary syndrome (ACS) are closely associated with cardiovascular events. In this study, we investigated the relation of atherosclerotic properties of coronary, brachial and carotid arteries with CIMT, FMD and coronary angiography in patients with ACS. We enrolled 133 patients who were diagnosed with ACS into this study. Exclusion criteria were known coronary artery disease, diabetes mellitus and hypertension. Coronary angiography, CIMT and FMD were measured in all patients. The numbers of major stenotic coronary vessels with > or = 50% or > or = 70% were defined as diseased vessel. Gensini score was ...
International Journal of Cardiology, 2014
Background: There is a growing evidence that carotid intima media thickness (CIMT) is associated with coronary artery disease (CAD) and it should be used as a predictor of atherosclerotic burden of coronary arteries. However, these studies have been performed by using invasive coronary angiography (ICA) and in high-risk patients for CAD. The purpose of this study was to evaluate the correlation between CIMT by ultrasound and coronary atherosclerosis in symptomatic intermediate risk patients by coronary computed tomography angiography (CCTA). Methods: We enrolled 204 consecutive symptomatic patients (mean age: 61 ± 10; men: 118) and intermediate risk for CAD. All patients underwent CIMT ultrasound evaluation and CCTA. Coronary artery calcium score (CACS), characteristics of plaques, severity of CAD, segment involvement score (SIS) and Gensini's score were assessed and compared with CIMT values. Results: CIMT has been proved as an independent predictor of a number of coronary artery plaques, overall number of mixed and remodeled plaques, presence of obstructive CAD, high SIS and Gensini's score (HR 1.2, CI 1.05-1.42, p 0.01; HR 1.2, CI 1.01-1.41, p 0.03; HR 9.0, CI 1.37-59.7, p 0.02; HR 21.0, CI 2.40-184, p b 0.01; HR 1.2, CI 1.08-1.42, p b 0.01; HR 1.2, CI 1.08-1.42, p b 0.01, respectively). A cutoff value N 1.3 was associated with a better positive and negative predictive value (100% and 69%) to predict the combined endpoint of presence and mixed and/or remodeled coronary artery plaques. Conclusions: CIMT is an independent predictor of coronary atherosclerotic burden as detected by CCTA in symptomatic intermediate risk patients.
International Journal of Cardiology, 2013
Background: Despite being a relatively widely-used non-invasive parameter of endothelial dysfunction, little is known regarding the relationship between flow-mediated dilatation (FMD) and coronary plaque vulnerability in patients with coronary artery disease (CAD). Methods: 111 CAD patients (age; 68.9 ± 9.3) who underwent both coronary intervention and FMD were enrolled. Spectral analyses of intravascular ultrasound radiofrequency data for both culprit and non-culprit lesions were performed using Virtual Histology™ software. Plaque burden was described based on fibrotic, fibro-fatty, dense calcium, and necrotic core (NC) components, and thin-cap fibroatheroma (TCFA) was defined as focal NC rich (>10%) plaques touching the lumen with a percent-plaque volume exceeding 40%. Results: Averaged %FMD was 2.86 ± 2.03% (median 2.27%, 25th 1.40%, 75th 4.20%). NC volumes were negatively correlated with log%FMD for both culprit and non-culprit lesions (P = 0.001, r = 0.31 and P = 0.03, r = 0.21, respectively). We divided the patients into three tertiles according to %FMD; 38 were lower (≤ 1.75%), 41 were middle (> 1.75%, but ≤3.5%), and 32 were upper tertile (> 3.5%). The prevalence rate of TCFA increased with decreasing %FMD tertile and the incidence of major adverse cardiac events was significantly higher in lower %FMD tertile. Multivariate logistic regression analyses showed that the most powerful predictive factor for TCFA was log%FMD (P b 0.0001), and ROC curve analysis identified %FMD of b 2.81% (AUC = 0.82, sensitivity: 91.2%, specificity: 66.7%) as the optimal cutoff point for predicting the presence of TCFA. Conclusions: Impaired endothelial function in brachial arteries may be associated with whole coronary plaque vulnerability and poor clinical outcome in patients with CAD.
Espessamento médio-intimal da carótida e função endotelial na doença arterial coronariana
Arquivos Brasileiros de Cardiologia, 2006
To investigate the correlation between the endothelial function and the carotid intimal-medial thickening (IMT) in a population of patients with coronary artery disease, as well as that between the endothelial function and carotid IMT with the severity of the coronary lesions. METHODS Forty-three patients aged 60.5±9.2 years, (67.4% males) with coronary artery disease at the coronariography were studied. Endothelial function was assessed using the brachial artery reactivity test (BART), which measured the percentage of fl ow-mediated dilatation (%FMD). The carotid IMT was evaluated through vascular ultrasound. RESULTS The mean %FDM was 4.7 ± 3.6 and the mean carotid IMT was 1.08 ± 0.23 mm. The carotid MIT and %FMD measurements showed a statistically signifi cant correlation, with Spearman's coefficient of 0.315, p= 0.042, demonstrating that lower %FMD values corresponded to an increased carotid IMT (r =-0.315, p = 0.042). There was no correlation between %FMD or IMT and the severity of coronary lesions. CONCLUSION The presence of a correlation between carotid IMT and %FMD demonstrates a concomitance of anatomical and functional vascular alterations in coronary artery disease, regardless of the severity of the atherosclerotic lesions.
Journal of Cardiovascular and Thoracic Research
Introduction : Coronary artery calcium score (CACS) and carotid artery intima-media thickness (CIMT) are the markers of atherosclerosis. An association between CACS and CIMT with presence of atherosclerotic coronary artery disease (CAD) is well established. However relationship between severity of CAD with CACS and CIMT is less clear. This study aimed to investigate the correlation between severity of CAD assessed by SYNTAX and Gensini scores with CACS and CIMT. Methods: This prospective study was conducted on 351 patients with CAD between June 2015 to December 2016. CACS was obtained using AGATSTON algorithm with 128 slice multidetector computer tomography (MDCT) before conventional coronary angiography (CCA). CIMT was measured by using Philips IE33 Echo machine. The severity of CAD was assessed by SYNTAX score (SS) and Gensini score on CCA. Correlation between severity of CAD with CACS and CIMT was analysed. Results: Mean CACS was 241.5±463.7, and this was positively correlated wi...