Ultrasonic correlates of common carotid atherosclerosis in patients with coronary artery disease

Increased intima-media thickness and plaque development in the extracranial carotid arteries reportedly correlate well with the prevalence of coronary artery diseases. The location of these atherosclerotic lesions in the carotid artery varies with age in patients with coronary artery atherosclerosis. Intima-media thickness, plaque, and calcification in the common carotid artery and bifurcation were assessed with high-resolution B-mode ultrasonography. Forty patients with severe atherosclerosis of the coronary artery and 56 healthy control subjects with no risk factors for coronary atherosclerosis were included in this study. The subjects were divided into a middle-age group (40-59 yr) and an old-age group (60-79 yr). In both groups, the intimamedia thickness in the patients was significantly higher than that in the controls. Intima-media thickness of at least 0.7 mm in the middle-age group and at least 1.0 mm in the old-age group was specific and positively predictive of coronary artery disease. Plaque (> 1.0 mm) and calcification were more significant in patients than in controls. In the middle-age group, intimamedia thickness in the common carotid artery was correlated with coronary atherosclerotic severity. Conversely, in the old-age group, the presence of plaque and calcification at the bifurcation was correlated with coronary atherosclerotic severity. The characteristic manifestation of the atherosclerotic lesion in the carotid artery varied with age in patients with coronary artery disease.     

Carotid intima-media thickness and brachial-ankle pulse wave velocity in patients with and without coronary artery disease

BACKGROUND: Carotid intima-media thickness and pulse wave velocity are non-invasive markers of atherosclerosis and have been shown to reliably predict presence and extent of atherosclerotic vascular disease. However, studies examining their association with each other have shown inconsistent results. Hence it was sought to assess correlation between carotid intima-media thickness and pulse wave velocity in patients with and without coronary artery disease. METHODS AND RESULTS: Sixty-four patients with angiographically proven coronary artery disease and 84 age-matched individuals without coronary artery disease but having one or more conventional cardiovascular risk factors were included in the study. Individuals with established cerebrovascular disease and peripheral vascular disease were excluded from the study. Carotid intima-media thickness of far wall was measured at three predefined sites (distal common carotid, carotid bifurcation and proximal internal carotid artery) on each side. Brachial-ankle pulse wave velocity was measured non-invasively using VP 1000 (Colin Corporation) automated ABI/ PWV analyzer. There was no significant difference in gender and presence of cardiovascular risk factors in the two groups. Mean and maximum carotid intima-media thickness and brachial-ankle pulse wave velocity were all significantly higher in coronary artery disease patients as compared to patients without coronary artery disease (0.842 v. ( 0.657 mm, p <0.0001; 1.076 v. 0.795 mm, p <0.0001; 1708.63 v. 1547.26 cm/s, p <0.0004 respectively). There was a significant correlation between brachial-ankle pulse wave velocity and both mean and maximum carotid intima-media thickness in patients with coronary artery disease (r = 0.47, p <0.0001 and r=0.41, p < 0.0008 respectively) but not in individuals without coronary artery disease (r=0.01 and -0.1 respectively). CONCLUSIONS: Presence of significant correlation between carotid intima-media thickness and brachial-ankle pulse wave velocity in patients with coronary artery disease but absence of the same in individuals without major atherosclerotic vascular disease suggests that the correlation between carotid intima-media thickness and brachial-ankle pulse wave velocity becomes stronger with increasing extent of atherosclerosis.     

Carotid intima-media thickness in patients with isolated coronary artery ectasia

OBJECTIVE: Carotid artery intima-media thickness (IMT) is now widely used as a surrogate marker for atherosclerotic disease. Carotid IMT measured by ultrasound has been shown to be correlated with coronary artery disease as defined by angiography. However, the relation between carotid IMT and isolated coronary artery ectasia (CAE) has not been investigated. The aim of our study was to assess this relation. METHODS: Twenty-five patients with isolated CAE without stenosis and 25 control subjects with angiographically normal coronary arteries were included in this study. These were examined by B-mode ultrasound to measure the IMT at the far wall of the common carotid artery. RESULTS: Patients with isolated CAE had significantly higher carotid IMT compared to control subjects with angiographically normal coronary arteries (0.95+/-0.12 versus 0.71+/-0.10mm respectively, p<0.0001). In addition, we detected a significant positive correlation between the presence of CAE and carotid IMT (r=0.748, p<0.001). CONCLUSION: We have shown for the first time an association between increased carotid IMT and isolated CAE, suggesting that atherosclerosis may be involved in the pathogenesis of isolated CAE in the adult population.     

Decreased nitrate-mediated dilatation in patients with coronary artery ectasia: an ultrasonographic evaluation of brachial artery

BACKGROUND: Coronary artery ectasia has been defined as localized or diffuse nonobstructive lesions of the epicardial coronary arteries with a luminal dilation exceeding the 1.5-fold of normal adjacent segment or vessel diameter. Although coronary artery disease is supposed to be responsible for more than 50% of coronary ectasia, the precise pathology of coronary artery ectasia is not clearly understood. The brachial artery ultrasound test for flow-mediated endothelial-dependent vasodilatory function includes administration of sublingual nitrates to examine the vasodilating effect of an exogenous source of nitric oxide. In the present study, we aimed to compare flow-mediated and nitrate-mediated responses of brachial artery in patients with coronary artery ectasia and patients with coronary artery disease. MATERIALS AND METHODS: Thirty-six consecutive patients with coronary artery ectasia in combination with coronary artery disease and 42 age-matched and sex-matched patients with coronary artery disease alone were included in the study. Flow-mediated and nitrate-mediated dilatations were measured in all patients using a high-resolution B-mode ultrasonographic system. RESULTS: Baseline brachial artery diameters in patients with coronary artery ectasia were not statistically different from those in patients with coronary artery disease (4.2+/-0.6 vs. 4.0+/-0.6 mm, respectively, P=0.16). Although the forearm flow-mediated dilatation of the patients with coronary artery ectasia did not differ from that of patients with coronary artery disease alone (5.5+/-3.8 vs. 4.8+/-3.6%, respectively, P=0.41), nitrate-mediated dilatation was significantly lower than that of patients with coronary artery disease alone (7.9+/-5.2 vs. 10.9+/-5.4%, respectively, P=0.02). CONCLUSION: We have shown that patients with coronary artery ectasia have decreased nitrate-mediated response of brachial artery compared with patients with coronary artery disease alone, suggesting more severe dysfunction or, possibly, destruction of the media layer in coronary artery ectasia than in coronary artery disease.     

Common carotid intima-media thickness is correlated with myocardial flow reserve in patients with coronary artery disease: a useful non-invasive indicator of coronary atherosclerosis

BACKGROUND: The common carotid intima-media thickness (IMT) is correlated with the angiographically determined coronary artery stenosis. However, their correlation is weak, which limits the clinical application of the IMT as a predictor of coronary artery stenosis. The IMT reflects diffuse early-phase atherosclerosis, whereas the angiographically determined coronary artery stenosis is a late-phase phenomenon. The latter is localized and rapidly progressive with plaque rupture and acute thrombosis. Instead of the angiographically determined coronary artery stenosis, we employed myocardial flow reserve (MFR) that reflects diffuse early-phase coronary atherosclerosis and impaired coronary vasodilatation function. We evaluated the relationship between the IMT and the MFR. METHODS: Twenty-three patients with angiographically diagnosed coronary artery disease (CAD) underwent B-mode ultrasound examination to measure their common carotid IMT and positron emission tomography (PET) with dipyridamole intervention to obtain their MFR. We also performed B-mode ultrasound examination in 21 patients with hypertension without CAD and in 15 control subjects. RESULTS: The common carotid IMT in patients with CAD was thickened (0.92+/-0.15 vs. 0.81+/-0.14 mm in patients with hypertension (P<0.05) and 0.69+/-0.13 mm in control subjects (P<0.01)). The IMT was inversely correlated with the MFR (r=0.51, P<0.01). The correlations between the MFR and most of the coronary risk factors (age, blood pressure, serum cholesterol level and triglyceride level, HbA1c level, smoking index) did not reach statistical significance. CONCLUSIONS: Thickened common carotid IMT is also an indicator of reduced MFR or early-phase coronary atherosclerosis.     

Effects of lacidipine on vascular responses in patients with coronary artery disease

BACKGROUND: To evaluate the effects of the calcium channel blocker lacidipine on vascular responses, such as endothelial function and carotid intima-media thickness (IMT), and on levels of high-sensitivity C-reactive protein (hs-CRP) in patients with coronary artery disease (CAD). METHODS: Endothelial function was assessed by measuring the flow-mediated vasodilation (FMD) of the brachial artery and IMT was measured in the common, bifurcating, and in the internal carotid artery by using high-resolution ultrasound. The study population consisted of 96 consecutive patients [mean age 60 years, male (n) = 70] who showed at least one coronary artery narrowed by more than 50% (coronary angiography). These patients were randomly assigned to lacidipine treatment (4 mg/day, n = 48) or to a placebo (n = 48). We measured FMD, IMT, and hs-CRP prior to and after 6 months of treatment and following coronary angiography in all patients. RESULTS: Clinical and medical history revealed no significant differences between the groups. IMT of the common carotid artery was significantly diminished from 0.92 +/- 0.15 to 0.87 +/- 0.15 mm 6 months after treatment with lacidipine (p < 0.005). However, IMT of any region in the carotid artery did not show any significant changes in the placebo group. Endothelial function and hs-CRP levels were slightly improved (insignificant) in the lacidipine group. In the placebo group, there were no significant changes. CONCLUSION: Lacidipine leads to a significant reduction of the common carotid artery IMT as well as to a decrease in markers of inflammation in patients with CAD during a relatively short period (6 months).     

Carotid intima-media thickness as an independent predictor of coronary artery disease.

BACKGROUND: A noninvasive technique of measuring carotid artery intima-media thickness has recently generated considerable interest as a marker of atherosclerosis and in the prediction of clinical coronary events and coronary artery disease. The present study evaluated the association of carotid artery intima-media thickness in the prediction of coronary artery disease in a western Indian population. METHODS AND RESULTS: Carotid artery intima-media thickness was measured with a B-mode scan in an ongoing study of 266 patients, who were further subdivided into 4 subgroups: those with non-insulin dependent diabetes mellitus; hypertension; diabetes mellitus with hypertension; and those without diabetes or hypertension (labeled as controls). The maximal intima-media thickness greater than 0.8 mm at the far wall of the common carotid artery, excluding raised lesions and plaques, was selected as the highest value for comparison. The subgroups were further divided into those with and without apparent coronary artery disease. A statistically significant intima-media thickness greater than 0.8 mm was observed in 59.2% of the subjects with coronary artery disease as against 40.8% in those without the disease on univariate analysis. A higher incidence of intima-media thickness of more than 0.8 mm was observed in all subgroups with coronary artery disease as against those without the disease, which was most marked in the hypertensive group (22.2% v. 3.6%) and contributed to the increased arterial thickness in diabetics with concomitant hypertension. Multivariate regression analysis revealed carotid artery intima-media thickness to be associated with coronary artery disease with an odds ratio of 2.40. CONCLUSIONS: Carotid artery intima-media thickness is a simple, noninvasive and reproducible clinical tool to evaluate atherosclerosis and predict coronary artery disease in Indian subjects. Prospective studies in a larger number of subjects, particularly in those undergoing coronary angiography, will help in establishing the role of this technique.     

Association of common carotid intima-media thickness and lipoprotein(a) with coronary artery disease

BACKGROUND: Carotid artery intimal medial thickness is a simple, non-invasive and reproducible clinical tool to evaluate atherosclerosis and predict coronary artery disease. Lipoprotein(a) levels are related to both atherogenesis and thrombogenesis and may be a key link between lipid and coronary artery disease. This study evaluated the association of carotid intimal medial thickness and lipoprotein(a) with coronary artery disease. METHODS AND RESULTS: We studied 185 randomly selected patients hospitalized for coronary angiogram in our institute. There were 110 angiographically proven patients of coronary artery disease with mean age of 55.8 +/- 9 years (range 34-72 years) and 75 subjects with normal coronary artery anatomy with mean age of 54.8 +/- 8 years (range 34-68 years). The mean carotid intimal medial thickness of subjects with coronary artery disease was significantly higher than in subjects without coronary artery disease (0.84 +/- 0.16 mm v. 0.65 +/- 0.15 mm, p<0.001). The mean carotid intimal medial thicknesses in patients with triple vessel, double vessel and single vessel disease were 0.96 +/- 0.12 mm, 0.84 +/- 0.11 mm and 0.78 +/- 0.13 mm, respectively (p=0.05). The mean lipoprotein(a) of subjects with coronary artery disease was significantly higher than in subjects without coronary artery disease (35.9 +/- 22.3 mg/dl v. 19.1 +/- 21.2 mg/dl, p<0.001). Mean lipoprotein(a) levels in subjects with carotid intimal medial thickness <0.80 was 26.4 +/- 24.2 mg/dl and in subjects with carotid intimal medial thickness > or = 0.80 was 32.1 +/- 22.1 mg/dl (p=0.05). CONCLUSIONS: There is a strong correlation between carotid and coronary atherosclerosis and carotid intimal medial thickness is a good predictor of presence and extent of coronary artery disease. Lipoprotein(a) level is a powerful independent risk factor for atherosclerosis. Carotid intimal medial thickness and lipoprotein(a) in conjoint can predict coronary artery disease reliably.     

Carotid intima-media thickness in pre-and postmenopausal women with suspected coronary artery disease

Carotid intima-media thickness (CIMT) is an early marker of coronary artery disease (CAD). This study aimed to evaluate CIMT value for CAD prediction in pre-and postmenopausal women referred for coronary angiography with angina-like symptoms and a positive result of the treadmill test. The study comprised 321 women referred for coronary angiography with symptoms suggesting CAD. Carotid intima-media thickness was measured in common, bifurcation, and internal carotid artery, and expressed as the mean maximum value. Coronary angiography showed coronary stenosis >/=50% in 211 (65.7%) women, including 27 with regular menses (47.3 +/- 3.4 years) and 184 postmenopausal (65.8 +/- 7.2 years). Normal coronary arteries were found in 110 women: 17 (47.3 +/- 4.9 years) with regular menses and 93 postmenopausal (64.3 +/- 6.5 years). The highest CIMT values were found in postmenopausal CAD women (1.360 +/- 0.32 mm), as compared to premenopausal with CAD (1.178 +/- 0.36 mm, P = 0.005), pre-(0.860 +/- 0.23 mm, P < 0.001) and postmenopausal (1.022 +/- 0.30 mm, P < 0.001) women without CAD. Carotid intima-media thickness (P < 0.001), hyperlipidemia (P = 0.018), and myocardial infarction (P < 0.001), but not menopause itself or the number of years since menses cessation, were found to be independent CAD predictors. By receiver operating characteristic calculation, the mean maximum CIMT cut-off values discriminating CAD were lower in premenopausal (>/=0.933 mm) than in postmenopausal women (>/=1.075 mm; P < 0.05) resulting in similar sensitivity (85.2% and 82.6%) and specificity (70.6% and 69.9%). Carotid intima-media thickness is a strong CAD predictor in both pre-and postmenopausal women, in contrast to the menopausal status.     

Carotid intima-media thickness and coronary artery disease: an Indian perspective

To determine whether carotid intima-media thickness is associated with coronary artery disease and cardiovascular risk factors in the Indian population, carotid intima-media thickness was measured using high-resolution B-mode ultrasonography in 101 patients with coronary artery disease and 140 control subjects. Carotid intima-media thickness was measured at 3 predefined sites on each side. The maximum carotid intima-media thickness was significantly higher in the coronary disease group compared to the controls (1.02 vs. 0.80 mm). The average intima-media thickness was also significantly higher in the coronary disease group (0.82 vs. 0.67 mm). On multivariate logistic regression analysis, carotid intima-media thickness was the only factor found to be an independent predictor of coronary artery disease. There was a significant association between risk factor count and the average and maximum intima-media thickness values in the combined study population. These results indicate that raised values of average and maximum carotid intima-media thickness are significantly associated with the presence of coronary artery disease and this association is independent of the presence of other conventional cardiovascular risk factors.     

Ankle-brachial index as a predictor of the extent of coronary atherosclerosis and cardiovascular events in patients with coronary artery disease

Resting ankle-brachial pressure index (ABI) is a noninvasive method to assess the patency of the lower extremity arterial system. This study aimed to examine the relation between ABI and the extent of coronary atherosclerosis, the extracoronary atherosclerosis lesions, and the prognosis of patients referred for elective coronary angiography. One hundred sixty-five consecutive patients underwent coronary angiography, ultrasound imaging for intima-media thickness measurement of carotid and femoral arteries and ABI evaluation; subjects were followed up for 14.5 +/- 2.4 months. With regard to vascular risk factors, only smoking (p = 0.025) and diabetes (p = 0.01) were related to ABI in the multiple regression analysis. ABI was independently and inversely related to carotid bifurcation (p = 0.0002) and common femoral artery intima-media thickness (p = 0.018). ABI was related to the extent of coronary artery disease as measured by number of coronary arteries diseased (analysis of variance, p = 0.04) and Gensini angiographic score (p = 0.01). In the follow-up study ABI < 0.90 was a univariate predictor of cardiovascular events (cardiac death, nonfatal myocardial infarction, unstable angina) and revascularization procedures. The estimated cumulative rate free of cardiovascular events was 90% for ABI > 0.90 and 73% for ABI < 0.90 (p = 0.02). In logistic regression analysis, ABI < 0.90 was an independent predictor for cardiovascular events after adjustment for age, low-density lipoprotein cholesterol, carotid and femoral intima-media thickness, and Gensini score. Further adjustment for the confounding effect of insulin weakened the relation between ABI and cardiovascular events (p = 0.1). In conclusion, ABI is a simple index related to the extent of atherosclerosis in coronary and noncoronary arterial beds, reflecting generalized atherosclerosis. ABI could be useful in assessing the risk for cardiovascular events in patients with coronary artery disease.     

Prevention of atherosclerosis progression using atorvastatin in normolipidemic coronary artery disease patients--a controlled randomized trial

BACKGROUND: Statins have been known to reduce progression of atherosclerosis when used in high dosage in patients with elevated cholesterol. A large majority of Indian patients, however, develop coronary artery disease with average or below average cholesterol level. There is insufficient data on effect of low-dose statins on progression of atherosclerosis in such patients with normal/average lipid levels. METHODS AND RESULTS: In this prospective study, 150 patients with angiographically proven coronary artery disease and baseline total cholesterol <200 mg/dl and low-density lipoprotein cholesterol <130 mg/dl were randomized to treatment with low-dose atorvastatin (10 mg) or placebo. Both groups were comparable in demographic characteristics. Progression of atherosclerosis was assessed using carotid intima media thickness as surrogate marker using standard protocol on B-mode ultrasound including common carotid artery, common carotid bifurcation and internal carotid artery measurements. Follow-up study for carotid intima media thickness was done at end of one year. A decrease in mean maximum carotid intima media thickness was recorded for all the three carotid segments individually from basal to end of one year in atorvastatin group [common carotid artery -0.008 mm (p = 0.01), common carotid bifurcation-0.022 mm (p = 0.001), internal carotid artery -0.009 mm (p = 0.01)] while the same showed an increase in placebo group [common carotid artery +0.011 mm (p = NS), common carotid bifurcation +0.013 mm (p=NS), internal carotid artery +0.007 mm (p=NS)]. The average mean carotid intima media thickness (all three segments included) decreased from 0.739 +/- 0.114 mm to 0.726 +/- 0.115 mm (difference -0.013 mm) in statin group and increased from 0.733 +/- 0.124 mm to 0.742 +/- 0.117 mm (difference + 0.009 mm) in placebo group (p < 0.001). Along side, there was a reduction in the total cholesterol from 144 +/- 26 mg/dl to 130 +/- 18 mg/dl (decreased arrow 9.7%, p = 0.05) and in low-density lipoprotein cholesterol from 86 +/- 24 mg/dl to 74 +/- 19 mg (decreased arrow 13.9%, p = 0.05) in study group and an increase in total cholesterol from 148 +/- 32 mg/dl to 154 +/- 8 mg/dl (increased arrow 4.05%, p=NS) and in low-density lipoprotein cholesterol from 84 +/- 19 mg/dl to 87 +/- 16 mg/dl (increased arrow 3.57%, p=NS) in placebo group at end of one year (p=NS). No adverse effects of statins were reported in the treatment arm. CONCLUSIONS: We conclude that low-dose statins reduce progression of atherosclerosis as observed by carotid intima media thickness in Indian patients with known coronary heart disease and normal lipid values independent of lipid lowering. The study favors use of this therapy in patients with normal/below average cholesterol levels.     

Increased aortic stiffness in patients with coronary artery ectasia

OBJECTIVE: Alterations in aortic stiffness may reflect the elastic properties of the larger arteries. In many diseases, aortic elastic properties have been investigated to show whether the larger arteries are involved. The elastic properties of aorta in patients with coronary artery ectasia, however, have not been studied yet. We aimed to investigate aortic stiffness parameters in patients with coronary artery ectasia and to compare patients with coronary artery ectasia and coronary artery disease with the control group. METHOD: Thirty-three patients with coronary artery ectasia, 31 patients with coronary artery disease and 30 patients with angiographically normal coronary arteries were included in this study. Aortic diameters were measured on the M-mode tracing obtained at a level 3 cm beyond the aortic valve at parasternal long-axis view. Aortic diameter change, aortic strain, aortic distensibility and stiffness parameters were measured as aortic stiffness parameters. RESULTS: Aortic diameter changes were fewer in the coronary artery ectasia and coronary artery disease group than in the control group (0.4 +/- 0.1 and 0.3 +/- 0.1 vs. 0.8 +/- 0.2; P < 0.001). Aortic distensibility and aortic strain were significantly lower in patients with coronary artery ectasia and coronary artery disease than in the controls (for aortic distensibility P < 0.001 and for aortic strain P < 0.001, < 0.001, respectively). In contrast, a significantly higher aortic stiffness index was observed in patients with coronary artery ectasia and coronary artery disease than in the control group (14.2+/-2.6 and 18.1 +/- 2.9 vs. 5.9 +/- 1.8; P < 0.001, respectively). CONCLUSIONS: The impairment in aortic elastic properties in patients with coronary artery ectasia indicates that this disease is a generalized disease rather than a localized disease of the coronary arteries.     

Intima-media complex of both the brachial artery and the common carotid artery are associated with left ventricular hypertrophy in patients with previous myocardial infarction

OBJECTIVES: Prospective trials have established intima-media thickness (IMT) of the carotid artery, flow-mediated dilation (FMD) of the brachial artery and cardiac left ventricular hypertrophy (LVH) as predictors of cardiovascular events. The aim of this study was to examine the relationship between intima-media complex of the brachial artery to FMD, intima-media complex of the common carotid artery and cardiac hypertrophy in patients with coronary heart disease. METHODS AND PROCEDURES: Cross-sectional design. Procedures were undertaken within the Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden. A total of 123 patients with a previous acute myocardial infarction (MI) were investigated. Calculated intima-media area (cIMa) of the brachial and common carotid arteries and FMD of the brachial artery and left ventricular dimensions were examined. RESULTS: The brachial cIMa was significantly associated with age, p-triglycerides, common carotid cIMa, ejection fraction, septum thickness, posterior wall thickness and left ventricular mass index (P < 0.05). Brachial cIMa also tended to be associated with systolic blood pressure (P = 0.056). Common carotid cIMa was significantly associated with age, systolic blood pressure, brachial cIMa, FMD and septum thickness (P < 0.05). FMD was significantly associated with age and carotid cIMa (P < 0.05). CONCLUSION: Both cIMa of the common carotid artery and the cIMa of the brachial artery were independently and significantly associated with ventricular septum thickness of the heart in patients with previous myocardial infarction.     

The role of ultrasonography of the peripheral arteries in diagnosing coronary artery disease

Atherosclerosis develops simultaneously in multiple arterial beds, that creates opportunity to diagnose of coronary artery disease. Aim of the study was the evaluation of association between atherosclerotic involvement of peripheral arteries assessed by ultrasound and significant coronary artery disease revealed by angiography. Study included 410 patients, (73% males), mean age 56.0 +/- 9.5 year scheduled for coronary angiography. During ultrasound examination of common carotid and common femoral arteries arterial wall intima-media (IMT) thickness and atherosclerotic plaques presence were assessed. Significant coronary artery disease (CAD) was diagnosed with coronary angiography as diameter stenosis > 50%. Intimo-media thickness (IMT) of common carotid arteries did not differ between groups with and without significant coronary artery disease (right 6.6 vs 6.4 mm, p = ns, left 6.9 vs 6.6 mm, p = ns) but in common femoral arterial was greater in patients with coronary artery disease (right 8.2 vs 7.1 mm, p < 0.005, left 7.9 vs 7.1 mm, p = 0.03). Atherosclerotic plaques in carotid and femoral arteries was detected more often in CAD patients (90.1% vs 34.6%, p < 0.0001). Positive predictive value for CAD diagnosis with detection of plaque in carotid or femoral artery was 93% and negative prognostic value for exclusion CAD after plaque exclusion in all arteries was 61%. Search for atherosclerotic plaques in ultrasound examination of peripheral arteries may facilitate CAD diagnosis in selected patients groups.     

Comparison of carotid intima-media thickness in patients with stable angina pectoris versus patients with acute coronary syndrome

In this study, we found that carotid intima-media thickness (IMT) was significantly increased and carotid artery atherosclerotic plaques were detected more frequently in patients who had early-onset coronary artery disease compared with control subjects (0.73 +/- 0.10 vs 0.60 +/- 0.10 mm, p <0.001, and 40% vs 11%, p <0.001, respectively). Further, patients who had coronary artery disease and presented with an acute coronary syndrome were found to have significantly increased carotid IMT compared with patients who had stable angina pectoris (0.76 +/- 0.10 vs 0.70 +/- 0.10 mm, p <0.05). The IMT was greater in the patients who had acute coronary syndrome than in those who had stable angina pectoris.     

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。     

冠状动脉粥样硬化性心脏病患者颈总动脉中内膜厚度与冠状动脉病变的关系

目的 探讨冠状动脉粥样硬化性心脏病（冠心病）患者颈总动脉中内膜厚度与冠状动脉狭窄程度与狭窄范围的关系.方法 将211例怀疑冠心病的患者,根据冠状动脉造影结果,依有无狭窄及狭窄程度分为3组：A组（60例）为轻度狭窄组,狭窄程度＜50％;B组（97例）为中重度病变组,狭窄程度＞50％;对照组为54例冠状动脉造影阴性者.157例冠状动脉狭窄患者又依狭窄程度分为单支病变亚组（49例）、双支病变亚组（37例）、三支病变亚组（71例）.采用彩色多普勒声像仪测取颈总动脉中内膜厚度,并比较分析各组颈总动脉中内膜厚度.结果 对照组、A组、B组比较,颈动脉总中内膜厚度依次增高,对照组、A组、B组两两比较差异有统计学意义[（0.812 5±0.118 6）mm vs.（0.893 6±0.133 1）mm vs.（1.038 9±0.141 1）mm,P＜0.05].在以病变范围为基础的分组中,各亚组与对照组比较,颈动脉中内膜明显增厚,且两两比较差异有统计学意义（P＜0.05）;单支病变亚组与双支病变亚组比较,差异有统计学意义[（0.920 4±0.141 5）mm vs.（0.990 6±0.144 3）mm,P＜0.05],但双支病变组与三支病变组比较,差异无统计学意义[（0.990 6±0.144 3）mm vs.（1.031 7±0.149 6）mm,P＞0.05].结论 颈总动脉中内膜厚度能很好地反映冠状动脉狭窄程度,但无法很好地反映病变范围.     

Carotid artery intima-media thickness in Finnish families with familial combined hyperlipidemia

BACKGROUND: Familial combined hyperlipidemia (FCHL) is the most common hereditary lipid disorder that predisposes the patients to premature coronary heart disease. Members of FCHL families are categorised as affected or unaffected according to serum lipid levels. This study is aimed to evaluate whether there is a difference in carotid artery wall thickness between asymptomatic FCHL family members who are affected and those who are unaffected according to the currently used lipid criteria. METHODS AND RESULTS: Carotid artery ultrasonography with intima-media thickness (IMT) measurements was performed for 148 members of 39 Finnish FCHL families. Study subjects who had no history of coronary heart disease or stroke were divided into two groups according to their serum total cholesterol and/or triglyceride levels. The average carotid IMT of the affected subjects (0.75+/-0.15 mm) was not significantly different from that of their unaffected relatives (0.73+/-0.13 mm), P=0.90. In multivariate analysis, age, gender, and pulse pressure, but no lipid variables, contributed significantly to the variation of carotid IMT. CONCLUSIONS: The IMT findings in FCHL family members indicate that the current lipid criteria alone are of limited value in predicting long-term risk of cardiovascular disease in asymptomatic members of FCHL families.     

The effect of four-year hypolipidaemic treatment on the intimal thickness of the common carotid artery in patients with familiar hyperlipidaemia.

BACKGROUND: Cholesterol lowering in patients with above-average cholesterol levels has been shown to reduce the progression of atherosclerosis. We assess the effects of lipid lowering therapy on the progression of early, preintrusive carotid arterial atherosclerosis in high risk patients with familial hyperlipidaemia free of symptomatic cardiovascular disease. METHODS: Fifty-two patients with familial hyperlipidaemia by were treated by diet and various hypolipidaemic drugs. Eighteen individuals were not taking hypolipidaemic drugs. In a prospective study by B-mode ultrasound we assessed the intima-media thickness of the distal common carotid arterial (CCA) far wall at baseline and after 4 years. RESULTS: In a subgroup of 25 patients with familial hypercholesterolaemia there was a significant decrease in total and LDL cholesterol and reduction in the intima-media thickness (IMT) of the common carotid artery from 0.78+/-0.22 mm to 0.69+/-0.17 mm (p=0.004). In a subgroup of 27 patients with familial combined hyperlipidaemia significant decreases in total and LDL cholesterol and triglycerides were associated with a decrease in the IMT of common carotid. artery from 0.72+/-0.22 mm to 0.67+/-0.15 mm (p=0.044). In 18 individuals, who were not taking hypolipidaemic drugs, there were no significant changes in the levels of cholesterol and triglycerides and in the IMT of the common carotid artery (increase from 0.58+/-0.18 mm to 0.62+/-0.13 mm, p>0.05). CONCLUSIONS: Lipid-lowering therapy in patients with familial hyperlipidaemia free of symptomatic cardiovascular disease reverses the progression of early, preintrusive atherosclerosis of the carotid artery. It is a beneficial sign indicating the possibility for atherosclerosis regression.