The Relationship between coronary artery calcification as assessed by multi-detector computed tomography and arterial stiffness

Pulse wave analysis and intima-media thickness (IMT) of carotid artery are the non-invasive indicators of subclinical atherosclerosis. Coronary artery calcification (CAC) score measured by multi-detector computed tomography (MDCT) is well known as a predictor of coronary heart disease (CHD). We investigated the association between coronary calcification assessed by MDCT and extracoronary atherosclerosis measured by pulse wave analysis and IMT of carotid artery. Arterial stiffness and carotid IMT were measured consecutively in 133 patients who underwent their first coronary MDCT angiography due to chest pain. Patients were divided into three groups according to the CAC score (group 1, score = 0, n = 62; group 2, 0 < score < 400, n = 58; group 3, score ≥ 400, n = 13). The classification of CAC score was associated with age, prevalence of hypertension and dyslipidemia, systolic blood pressure, pulse pressure, brachial-ankle pulse wave velocity, percentage of brachial mean artery pressure, upstroke time (UT), augmentation index, and carotid IMT. In a multivariate analysis, age (P = .048), hypertension (P = .007), dyslipidemia (P = .24), and mean ankle UT (P = .038) were independent variables for the classification of CAC score. The UT of pulse wave was significantly associated with the CAC score. The increased UT of pulse wave might provide incremental risk prediction in addition to that defined by conventional CHD risk assessment.     

外周动脉粥样硬化与冠心病的相关性研究

目的探讨外周动脉粥样硬化与冠状动脉粥样硬化的关系及预测价值。方法对74例可疑冠心病患者行冠状动脉造影,其中确诊冠心病57例,正常17例。同时进行颈动脉、股动脉超声检查,对各动脉内膜中层厚度(IMT)、粥样硬化斑块及心血管危险因素同冠状动脉造影结果进行统计分析。依据修正的Gensin评分系统将冠状动脉积分,并以积分的大小进行等级评分,同时对外周动脉斑块对冠脉的预测价值、外周动脉IMT与冠脉积分的对数值进行相关性分析、冠心病组和正常组的危险因素之间进行统计分析。结果冠脉造影阳性组CA、FA的IMT和粥样硬化斑块发生率高于阴性组(P<0.05),颈动脉、股动脉粥样硬化对冠心病的阳性预测值分别为59.4%和53.1%,两处为阳性的阳性预测值是71.9%。颈动脉IMT与冠心病的log(Gensin评分)之间相关系数为0.891,股动脉IMT与冠心病的(Gensin评分)之间相关系数为0.75。结论外周动脉的粥样硬化是冠心病的相关因素,可作为研究冠状动脉粥样硬化的间接指标和窗口。     

Non-invasive measures of pulse wave velocity correlate with coronary arterial plaque load in humans

OBJECTIVE: Arterial stiffness is an emerging major risk factor for cardiovascular morbidity and mortality. The aim of the present study was to assess if coronary artery plaque load correlates with non-invasive measures of arterial stiffness. DESIGN: Prospective investigational study. SETTING: Tertiary university hospital centre. PATIENTS: Patients undergoing elective diagnostic coronary angiography. INTERVENTIONS AND MAIN OUTCOME MEASURES: Coronary artery plaque burden was assessed using a 30 MHz intravascular ultrasound catheter during an automated pullback. Proximal coronary artery plaque volume was determined using a validated edge-detection algorithm following three-dimensional computerized reconstruction. Central arterial stiffness was assessed in each patient using applanation tonometry to radial, carotid and femoral pulses, with derivation of aortic pressure augmentation and pulse wave velocity using pulse wave analysis. RESULTS: In 35 patients (61 +/- 2 years), proximal coronary arterial plaque volume was 5.9 +/- 0.6 mm3/mm of vessel. Plaque volume correlated positively with carotid-radial pulse wave velocity (r = 0.47, P = 0.008) and appeared to correlate with carotid-femoral pulse wave velocity (r = 0.34, P = 0.07). Aortic augmentation (r = 0.24, P = 0.16), augmentation index (r = 0.3, P = 0.08), and pulse pressure (r = 0.22, P = 0.2) did not correlate significantly with proximal coronary artery plaque volume. CONCLUSIONS: Non-invasive measures of carotid-radial pulse wave velocity correlate with the extent of coronary artery plaque volume and may be a useful non-invasive surrogate marker for the extent of coronary atherosclerosis. Our findings are consistent with the suggestion that central aortic stiffness may promote the development of coronary atherosclerosis and ischaemic heart disease.     

Comparative performance of subclinical atherosclerosis tests in predicting coronary heart disease in asymptomatic individuals.

The prognostic performance of subclinical atherosclerosis in predicting coronary heart disease (CHD) needs to be clarified because of the existence of many non-invasive tests available for its detection in the clinical setting: ultrasound measurement of carotid intima-media thickness (IMT) and plaque, cardiac computed tomography assessment of coronary artery calcium, Doppler stethoscope measurement of ankle-arm index pressure (AAI), and mechanographic or Doppler determination of aortic pulse wave velocity (PWV). Data analysis of the main prospective studies in asymptomatic populations allows the establishment of a dose-response relationship between subclinical atherosclerosis burden and cumulative incidence of future CHD event (absolute risk). Negative subclinical atherosclerosis testing conveys a low 10-year CHD risk inferior to 10% whatever the test considered, i.e. IMT less than the 1st tertile or 1st quintile, AAI > or = 0.90, PWV less than the first tertile, no discernible carotid plaque, or zero coronary calcium score. Positive testing for IMT (>95th percentile or 5th quintile), AAI (<0.90), or PWV (>3rd tertile) conveys a moderately high 10-year CHD risk between 10 and 20%. Positive testing for carotid plaque (focal protrusion >1.5 mm or mineralization) or coronary calcium (total score >300 or 400 units) conveys a high 10-year CHD risk superior to 20%. Therefore, positive subclinical atherosclerosis measurement seems to have its place in the context of existing prediction models, namely for intermediate risk classification. It also remains to be established whether individuals with negative subclinical atherosclerosis may be considered at low CHD risk and receive conservative management.     

The Relationship between Coronary Artery Calcification as Assessed by Multi-Detector Computed Tomography and Arterial Stiffness

Pulse wave analysis and intima-media thickness (IMT) of carotid artery are the non-invasive indicators of subclinical atherosclerosis. Coronary artery calcification (CAC) score measured by multi-detector computed tomography (MDCT) is well known as a predictor of coronary heart disease (CHD). We investigated the association between coronary calcification assessed by MDCT and extracoronary atherosclerosis measured by pulse wave analysis and IMT of carotid artery. Arterial stiffness and carotid IMT were measured consecutively in 133 patients who underwent their first coronary MDCT angiography due to chest pain. Patients were divided into three groups according to the CAC score (group 1, score = 0, n = 62; group 2, 0 < score < 400, n = 58; group 3, score ≥ 400, n = 13). The classification of CAC score was associated with age, prevalence of hypertension and dyslipidemia, systolic blood pressure, pulse pressure, brachial-ankle pulse wave velocity, percentage of brachial mean artery pressure, upstroke time (UT), augmentation index, and carotid IMT. In a multivariate analysis, age (P = .048), hypertension (P = .007), dyslipidemia (P = .24), and mean ankle UT (P = .038) were independent variables for the classification of CAC score. The UT of pulse wave was significantly associated with the CAC score. The increased UT of pulse wave might provide incremental risk prediction in addition to that defined by conventional CHD risk assessment.     

Coronary artery calcium versus intima-media thickness as a measure of cardiovascular disease among asymptomatic adults (from the Rancho Bernardo Study)

Detection and quantification of subclinical coronary heart disease by noninvasive imaging techniques offers the potential for earlier diagnosis with targeted prevention and therapy. This study, designed to determine the extent to which carotid artery intima-media thickness (IMT) predicts coronary artery calcium (CAC) in asymptomatic older adults, included 141 men and 137 women > or =55 years of age with no previous coronary heart disease who had B-mode ultrasound of the common and/or internal carotid arteries in 1997 to 1999 to measure IMT and electron beam computed tomographic scanning in 2001 to 2002 to measure CAC score. Overall, 29% of participants had a severe plaque burden (CAC score >400); 50% of these had a CAC score >800. IMT of the common and internal carotid arteries was significantly associated with the CAC score measured an average of 3 years later. The ability to correctly identify subjects with a severe CAC score (sensitivity) was 50% to 60% for an IMT of the internal or common carotid artery > 80th percentile (internal carotid IMT > or =1.9 mm and common carotid IMT > or =1.04 mm). Specificity, the ability to correctly identify those who did not have a severe CAC score (> or =400), was approximately 75%. In conclusion, IMT of the carotid arteries predicted the severity of CAC burden an average of 3 years later in community-dwelling asymptomatic older adults.     

Carotid plaques, but not common carotid intima-media thickness, are independently associated with aortic stiffness.

OBJECTIVE: It has been suggested that non-invasive aortic stiffness measurements can be used as an indicator of atherosclerosis. The relationships of arterial stiffness with arterial wall hypertrophy and atherosclerosis however, have rarely been investigated in large-scale studies. The present study reports the associations of carotid arterial structure assessed by B-mode ultrasound with carotid-femoral pulse-wave velocity in hypertensive and non-hypertensive subjects. DESIGN AND METHODS: Free health examinations were performed on 564 subjects (age 58.2 +/- 10.8 years, 31.9% of women, 53.2% of all were hypertensive). Carotid-femoral pulse-wave velocity (PWV) was used to assess aortic stiffness. Carotid ultrasound examination included measurements (at sites free of plaques) of intima-media thickness (IMT) at the common carotid arteries (CCA), CCA-lumen diameter, and assessment of atherosclerotic plaques in the extracranial carotid arteries. RESULTS: Subjects with carotid plaques had significantly higher mean sex-adjusted values of PWV than those without carotid plaques (12.7 +/- 0.2 versus 11.1 +/- 0.1 m/s, P < 0.001). Multivariate analyses showed that this association was independent of sex, age, height, body mass index, mean blood pressure, pulse pressure, diabetes, hypercholesterolaemia and smoking habits (P < 0.009). PWV was positively associated with CCA-IMT and CCA-lumen diameter in sex-adjusted analysis (partial correlation coefficients (r ) were respectively 0.39 and 0.42, P < 0.001 for each). However, the association of PWV with CCA-IMT, but not that with CCA-lumen diameter, disappeared after further adjustment for age and blood pressure measurements (mean blood pressure and/or pulse pressure). CONCLUSION: This study shows that there is a differential association of PWV with CCA-IMT and carotid plaques. The nature of the independent positive association between atherosclerosis and arterial stiffness should be thoroughly investigated.     

超声检测股动脉、腹主动脉及颈动脉粥样硬化与冠状动脉粥样硬化的相关性

目的:探讨股动脉、腹主动脉及颈动脉粥样硬化与冠状动脉粥样硬化的相关性。方法: 采用高频超声测量109例行冠状动脉造影术后1周的患者股动脉、腹主动脉及颈动脉的内-中膜厚度（IMT）、斑块积分及斑块数目。结果: 股动脉、腹主动脉及颈动脉粥样硬化与冠状动脉粥样硬化呈正相关（P<0.01、P<0.05）;股动脉斑块预测冠状动脉粥样硬化的灵敏度为89%,特异度为77%,准确度84%;腹主动脉斑块预测冠状动脉粥样硬化的灵敏度为73%,特异度为72%,准确度72%;颈动脉斑块预测冠状动脉粥样硬化的灵敏度为83%,特异度为79%,准确度82%。结论: 超声检查股动脉、腹主动脉及颈动脉IMT及斑块可间接预测不同程度的冠状动脉粥样硬化;股动脉的灵敏度与准确度较腹主动脉更好。     

颈动脉多普勒超声与心绞痛患者冠状动脉病变的关系

目的采用彩色多普勒超声仪分析心绞痛患者颈动脉病变,探讨其在冠状动脉病变中的临床诊断价值。方法选择因心绞痛行冠状动脉造影的住院患者328例,根据冠状动脉造影结果分为4组:对照组(80例)、单支病变组(102例)、2支病变组(62例)和多支病变组(84例)。用彩色多普勒超声仪测量颈总动脉内膜中层厚度(intimamediathickness,IMT)及颈动脉分叉处IMT,记录颈动脉斑块的位置、数量。结果与对照组比较,2支病变组分叉处IMT和斑块积分明显增高,多支病变组颈总动脉IMT、分叉处IMT和斑块积分明显增高,差异有统计学意义(P0.05,P0.01)。与对照组比较,多支病变组颈总动脉IMT增厚比例明显增高,差异有统计学意义(P0.05);与单支病变组比较,多支病变组颈总动脉IMT增厚比例明显增高,差异有统计学意义(P0.05)。糖尿病是冠状动脉病变的主要危险因素(OR=2.8,95% CI:1.18～6.63)。结论颈动脉粥样硬化与冠状动脉病变有相关性,采用彩色多普勒超声分析颈动脉病变情况,对冠心病患者具有较好的筛查及预测价值。     

无创性动脉硬化检测技术对冠心病早期诊断价值的评估

目的：探讨无创性动脉硬化指标颈动脉内中膜厚度（IMT）、踝臂指数（ABI）、脉搏波传导速度（PWV）与冠状动脉粥样硬化程度的相关性以及对冠心病的早期预测价值. 方法：随机选择我院进行冠状动脉造影的133例可疑冠心病患者,进行IMT、ABI、PWV检测.用Gensini积分评价冠状动脉病变程度,采用线性相关系数分析Gensini积分与IMT、ABI和PWV的相关性,观察这些无创性动脉硬化指标对冠心病的早期预测价值. 结果：（1） IMT与Gensini积分明显相关（P=0.000）,IMT数值越大Gensini积分越高;ABI和PWV与Gensini积分无相关性.（2）绘制IMT、ABI和PWV预测冠心病的ROC曲线,IMT的曲线下面积为0.815,预测冠心病的灵敏度为62.7％,特异度为92.9％;ABI和PWV对冠心病的预测价值不显著. 结论：无创性动脉硬化指标IMT与冠状动脉粥样硬化的严重程度有明显的相关性,对冠心病有较好的早期预测价值,而ABI和PWV对冠心病无明显早期预测价值.     

高血压病患者动态血压与动脉顺应性的相关性研究

目的:探讨高血压病患者动脉顺应性的变化,及其与动态血压监测(ABPM)各指标间的相互关系。方法:对262例高血压病患者和104例正常人进行动态血压监测(ABPM)和脉搏波速度(PWV)测定。结果:高血压组的颈动脉-桡动脉(G-R)PWV、颈动脉-股动脉(C-F)PWV,24 h、白昼及夜间平均血压,平均脉压,心率,血压负荷均显著高于正常对照组(P<0.05~<0.01)。C-F PWV及C-R PWV与24 h、白昼及夜间平均血压,心率,血压负荷均呈显著正相关(r=0.108~0.406,P<0.05~<0.001)。C-F PWV比C-R PWV与平均收缩压和收缩压负荷的相关性更强。C-F PWV与动态脉压、年龄显著正相关(r=0.205~0.406,P<0.001)。结论:动脉顺应性减退是高血压的重要改变,大动脉顺应性与动态脉压、收缩压和年龄的关系更为密切。     

老年人外周动脉粥样硬化与冠心病的相关性

目的 探讨老年人外周动脉粥样硬化与冠心病的相关性. 方法 选择拟行冠状动脉造影的老年住院患者152例,年龄62～91岁.于冠状动脉造影前1周内行颈动脉和股动脉超声检查.分别测量颈动脉和股动脉内膜-中膜厚度(IMT)、斑块总面积及颈动脉斑块总积分,并判断颈动脉粥样硬化分型,冠心病病变的程度和范围以冠状动脉病变支数及Gensini积分表示. 结果颈动脉IMT、斑块发生率、斑块总面积及斑块总积分在冠心病单支病变组(16例)分别为(0.93±0.10)mm、61.3%、(0.58±0.11)mm~2及(3.82±2.11)分;双支病变组(41例)分别为(0.92±0.14)mm、72.5%、(1.57±0.37)mm~2及(4.59±3.39)分;3支病变组(72例)分别为(0.95±0.11)mm、87.3%、(1.88±0.15)mm~2及(6.67±5.90)分;非冠心病组(23例)分别为(0.81±0.13)mm、42.7%、(0.28±0.69)mm~2及(1.83±1.65)分.股动脉IMT、斑块发生率及斑块总面积在冠心病单支病变组分别为(0.97±0.11)mm、38.3%及(0.24±0.26)mm~2;双支病变组分别为(1.07±0.15)mm、57.9%及(0.51±0.21)mm~2;3支病变组分别为(1.15±0.14)mm、59.5%及(0.59±0.23)mm~2;非冠心病组分别为(0.90±0.13)mm、26.8%及(0.20±0.17)mm~2.冠心病各组上述各项指标高于非冠心病组(均P<0.05),其中双支病变组和3支病变组颈动脉斑块总面积、股动脉斑块总面积及股动脉IMT高于单支病变组(均P<0.05),3支病变组颈动脉斑块总积分高于单支病变组和双支病变组(均P<0.05).相关分析结果表明.颈动脉粥样硬化分型、斑块总积分及面积与冠脉病变支数间呈正相关(r分别为0.282、0.307及0.494,均P<0.01);颈动脉粥样硬化斑块面积与Gensini积分呈正相关(r=0.472,P<0.01).股动脉IMT、斑块总面积与冠脉病变支数呈正相关(r分别为0.415及0.692,均P<0.01),与Gensini积分亦呈正相关(r分别为0.404、0.648,均P<0.01).颈动脉斑块总面积(OR=2.2;95%CI 0.79～2.46)、股动脉斑块总面积(OR=1.6;95%CI 0.28～1.35)及股动脉IMT(OR=1.6;95% CI 1.20～15.10)是冠状动脉Gensini积分的独立预测因子. 结论 超声检查结果评价老年人外周动脉粥样硬化与冠心病的严重程度相关.     

冠心病患者冠状动脉粥样硬化程度与颈动脉粥样硬化的相关性研究

目的 探讨冠心病患者颈动脉粥样硬化与冠状动脉硬化程度之间的关系.方法 选取2012年1月至2013年6月河北大学附属医院心内科治疗的冠心病患者350例,依据冠状动脉造影结果将患者分为冠心病组和非冠心病组,其中冠心病组260例,非冠心病组90例;依据造影结果将冠心病组患者进行再次分组,其中单支病变组113例,双支病变组89例,三支病变组58例.比较冠心病组及非冠心病组间及不同冠状动脉病变支数三组间的颈动脉内-中膜厚度（IMT）、斑块积分及Gensini评分;统计分析冠状动脉病变支数与以上观察指标的相关性.结果 冠心病组的颈动脉IMT、斑块积分、Gensini积分分别为（1.37±0.23）、（5.37±3.98）、（23.32±7.33）,均高于非冠心病组,两组间比较差异有统计学意义（P＜0.05）.双支病变组和三支病变组的斑块检出率为79.8％和81.0％,双支病变组及三支病变组患者颈动脉IMT分别为（1.31±0.21）mm和（1.37±0.27）mm,双支病变组和三支病变组患者的斑块检出率与颈动脉IMT值均高于单支病变组,三组间比较差异有统计学意义（P＜0.05）.冠状动脉病变支数与IMT、颈动脉斑块积分呈显著正相关;Gensini评分与IMT及颈动脉斑块积分呈显著正相关.结论 冠状动脉的粥样硬化程度随着患者的颈动脉粥样硬化程度的升高而加重,冠心病的严重程度可以通过颈动脉超声检测反映出来.     

Relationship of carotid intima-media thickness, pulse wave velocity, and ankle brachial index to the severity of coronary artery atherosclerosis

BACKGROUND: Carotid intima-media thickness (IMT), pulse wave velocity (PWV), and the ankle brachial index (ABI) are widely used noninvasive modalities for evaluating atherosclerosis. HYPOTHESIS: The aim of this study was to determine the relationship of carotid IMT, PWV, and ABI with the severity of coronary artery disease (CAD), expressed as the Gensini score, and the presence of coronary risk factors. METHODS: We examined 205 consecutive patients (mean age 65 +/- 12 years) who were clinically suspected of having CAD and were scheduled to undergo coronary angiography. Carotid intima-media thickness, brachial-ankle PWV (baPWV), and ABI were measured in all subjects before they underwent coronary angiography. RESULTS: Of the 205 patients, 124 patients were diagnosed as having CAD based on the presence of >50% stenosis in a major coronary artery; the remaining 81 patients did not have CAD. A relatively good correlation was obtained between carotid IMT and the Gensini score (R = 0.411, p < 0.0001), whereas baPWV correlated only weakly with the Gensini score (R = 0.203, p = 0.0035), and ABI did not correlate with it. A multiple regression analysis revealed that the Gensini score correlated significantly and independently with age, male gender, and carotid IMT. CONCLUSIONS: Of the three noninvasive methods, carotid IMT may be more useful for determining coronary artery atherosclerosis than baPWV or ABI.     

杓型和非杓型高血压病患者动脉重构的改变

目的通过比较杓型与非杓型原发性高血压患者动脉重构的参数变化，探讨原发性高血压患者血压节律类型与动脉重构的相关性。方法选取1、2级原发性高血压患者128例，行动态血压监测，根据夜间平均动脉压下降10％以上或以下的标准分为杓型组（56例）与非杓型组（72例），应用彩色多普勒超声检测颈总动脉内膜中层厚度（IMT）、脉搏波速度测定仪同时检测颈动脉-桡动脉（C-RPWV）、颈动脉-股动脉（C-FPWV）的脉搏波速度，测定血清中内皮素1（ET-1）和一氧化氮（N0）浓度。比较两组间上述检测指标。结果非杓型组IMT较杓型组明显增厚；C-RPWV和C-FPWV在非杓型组明显高于杓型组；血清ET-1浓度在非杓型组明显高于杓型组，而NO浓度低于杓型组，两因子在两组间比较具有统计学差异。结论非杓型血压较杓型血压对动脉结构及功能的影响可能更明显。     

Interrelationship between non-invasive measurements of atherosclerosis: flow-mediated dilation of brachial artery, carotid intima-media thickness and pulse wave velocity

Flow-mediated dilation (FMD) of the brachial artery, carotid intima-media thickness (IMT) and pulse wave velocity (PWV) have been shown to be good surrogate markers of clinical atherosclerosis. We determined the interrelation between these measurements, and examined whether their combination would be of clinical significance. One hundred and thirty-five consecutive subjects (79 women/56 men) were enrolled, including 110 patients with risk factors for atherosclerosis, and 33 patients with atherosclerotic disease such as coronary heart disease, stroke or arteriosclerosis obliterans. IMT and plaque formation of the carotid artery and FMD of the brachial artery were assessed using ultrasonography. Brachial-ankle PWV (baPWV) was measured using an automated device (form ABI/PWV, Colin). Age, FMD, IMT and PWV were significantly correlated with each other. Multivariate analysis revealed an independent correlation between the parameters except for FMD, and all four parameters were independently correlated with each other in subjects <70 years. Next, we classified the subjects by tertile according to the values of FMD, IMT and PWV. Each of the worst tertiles was associated with a higher prevalence of atherosclerotic disease and carotid plaques compared to the other tertiles. Moreover, subjects with the worst tertiles of all three measurements had a markedly higher prevalence of atherosclerotic disease and carotid plaques. These results suggest that FMD, IMT and PWV are related to each other, but the combination of these measurements will be of stronger clinical relevance.     

冠心病病人冠状动脉与颈动脉粥样硬化相关分析

目的 探讨冠心病病人颈动脉与冠状动脉粥样硬化的关系。方法 冠心病病人122例，经冠状动脉造影确诊，用颈动脉超声检测颈动脉内膜-中膜厚度（intima-media thickness，IMT）及粥样硬化程度。结果 病人病变冠状动脉支数分组间，IMT、颈动脉斑块积分和斑块发生率的差异有统计学意义。冠状动脉病变支数与IMT相关（r=0.73），与颈动脉斑块积分相关（r=0.67）。冠状动脉造影积分与IMT相关（r=0.69），与颈动脉斑块积分相关（r=0.68）。结论 冠心病病人颈动脉粥样硬化与冠状动脉粥样硬化呈正相关，颈动脉病变可间接反映冠状动脉粥样硬化病变程度。     

老年患者股动脉粥样硬化与冠心病关系的研究

目的　研究老年患者股动脉粥样硬化与冠心病的关系。方法　对 110例冠状动脉造影的老年患者作双侧股动脉超声检查 ,测量股动脉后壁内中膜厚度 (IMT) ,斑块厚度 ,及粥样斑块发生率 ,并与冠脉造影结果进行对比分析。结果　 (1)冠心病组IMT ,斑块积分及斑块发生率明显高于正常对照组 (P <0. 0 1)。 (2 )随冠脉病变支数增加 ,斑块积分及IMT增加 ,各组比较有显著性差异 (P <0. 0 1)。 (3)以IMT >0 .85mm和 (或 )出现粥样斑预测冠心病 ,特异性 75. 0 % ,敏感性 87 .1% ,阳性预测率 89. 3%。结论　老年患者股动脉粥样硬化严重程度与冠心病发生率成正比 ;通过股动脉超声检查可为冠心病的诊断提供依据。     

颈动脉粥样硬化与冠心病关系的研究

目的:研究颈动脉粥样硬化与冠心病的关系。方法:对301例冠状动脉造影的患者作双侧颈动脉超声检查,根据冠脉造影结果分为正常组及冠心病组,冠心病组根据冠状动脉病变支数再分为一支病变组,二支病变组,三支病变组3个亚组。测量颈总动脉后壁内中膜厚度(IMT),斑块厚度,计算斑块积分及粥样斑块发生率。结果:(1)冠心病组IMT,斑块积分及斑块发生率明显高于正常对照组(P<0.01)。(2)随冠脉病变支数增加,斑块积分及IMT增加,亚组比较有显著性差异(P<0.01)。(3)以IMT>0.85mm和(或)出现粥样斑块预测冠心病,特异性75.3％,敏感性84.6％,阳性预测率88.4％。结论:通过颈动脉超声检查可为冠心病的诊断提供依据。     

不稳定型心绞痛患者血清妊娠相关蛋白A与颈动脉粥样硬化的相关性

目的探讨颈动脉粥样硬化、血清妊娠相关性蛋白A与不稳定型心绞痛、稳定型心绞痛、非冠心病的相关性。方法因胸痛入院的患者1 w内行冠脉造影,排除急性及亚急性心梗后,不稳定型心绞痛、稳定型心绞痛、非冠心病各40例被纳入研究中,进行冠状动脉Gensini评分;彩超检测颈动脉内中膜厚度、斑块形成情况,应用酶联免疫吸附法测定血清妊娠相关蛋白A水平,并进行统计学分析。结果除吸烟史外,各组间其余基线资料匹配;不稳定型心绞痛、稳定型心绞痛的冠脉Gensini评分、颈动脉粥样硬化指标均较非冠心病高(P<0.001);不稳定型心绞痛组比稳定型心绞痛及非冠心病组血清妊娠相关蛋白A的浓度高(P<0.001),妊娠相关蛋白A在不稳定型心绞痛患者明显升高,其与颈动脉粥样硬化指标、冠脉Gensini积分正相关;Crouse积分预测心绞痛型冠心病,敏感度、特异度分别为0.79、0.92;颈动脉内中膜厚度平均值预测心绞痛型冠心病敏感度、特异度分别为0.97、0.85;妊娠相关蛋白A预测不稳定型心绞痛敏感度、特异度分别为0.825、0.937。结论颈动脉粥样硬化指标与冠状动脉Gensini积分有较好的相关性,而妊娠相关蛋白A可作为预测不稳定型心绞痛的指标;二者联合检测可能是预测不稳定型心绞痛的重要临床依据。