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.     

颈动脉内-中膜厚度与冠心病的关系

颈动脉超声检查是一项安全、实用并且无创的诊断方法,能够准确地提供颈动脉的相关情况,可以为冠心病等心血管疾病提供前期预警。现总结近期文献的观点,认为在提供早期预警方面,颈内动脉内-中膜厚度比颈总动脉内-中膜厚度更有价值。而且颈动脉内-中膜厚度和弗雷明汉评分联用可以为冠心病等心血管疾病提供更加可靠和准确的前期预警。     

Carotid and femoral atherosclerotic lesions in patients with coronary heart disease confirmed by angiography

INTRODUCTION: Clinically evident atherosclerosis is preceded by preclinical changes in the arterial wall. These changes are characterised by increased thickness of the intima-media complex (IMT). AIMS: A complex ultrasound assessment of the peripheral vessels as well as an attempt to find ultrasound parameters correlating with the burden of atherosclerotic lesions of the coronary arteries. METHODS: 231 patients who underwent both coronary angiography and ultrasound examination of the following arteries: common carotid artery (CCA), carotid bulb and common femoral artery (CFA) were enrolled. The IMT value, presence of plaque and Doppler blood flow parameters were evaluated. Selected clinical and biochemical risk factors of atherosclerosis were assessed. Two groups of patients were analysed: 200 patients with coronary artery disease confirmed by angiography (study group), and 31 patients with normal coronary arteries (control group). RESULTS: Significantly higher values of the IMT in the peripheral arteries were observed in patients with coronary artery lesions than in those without (CCA - 0.91 vs 0.61 mm, carotid bulb -- 1.31 vs 0.67 mm, CFA -- 1.38 vs 0.63 respectively, p<0.0001). Atherosclerotic plaques were present only in patients with coronary artery disease. Additionally, IMT values of the CCA, carotid bulb and CFA were significantly higher in patients with severe coronary artery disease (three vessel disease) than in patients with lesions in one or two coronary arteries. CONCLUSIONS: Patients with coronary lesions present with increased IMT values and higher plaque occurrence. Complex ultrasound evaluation of different peripheral arteries (CCA, carotid bulb and CFA) may be used as part of the cardiovascular risk stratification.     

Carotid Intima-Media Thickness and Brachial Artery Flow-Mediated Dilatation in Patients with and without Metabolic Syndrome

BACKGROUND, Metabolic syndrome has recently emerged as a marker of future cardiovascular risk. However its incremental value for this purpose, over conventional cardiovascular risk factors and diabetes mellitus in particular, is debated. The present study was conducted to determine the extent of subclinical atherosclerosis in patients with metabolic syndrome, and compare it with the same in individuals with cardiovascular risk factors not having metabolic syndrome. METHODS, A total of 156 individuals seeking outpatient cardiac consultation for various indications were included in the study and were divided into four groups - group 1: cardiovascular risk factors present but not metabolic syndrome (n = 60) : group 2 : metabolic syndrome without diabetes mellitus or coronary artery disease (n = 21) ;group 3: metabolic syndrome with diabetes mellitus without coronary artery disease ( n = 27) ;and group 4:patients with documented coronary artery disease (n = 48). Metabolic syndrome was diagnosed on the basis of Adult Treatment Panel III (ATPIII) criteria. All patients underwent assessment of carotid intima-media thickness and brachial artery flow-mediated vasodilatation. RESULTS, Both carotid intima-media thickness and brachial artery flow-mediated vasodilatation were similar in groups 1 and 2 (carotid intima-media thickness: 0.687 -/+ 0.13mm and 0.706 -/+0.23mm, p = 0.963; brachial artery flow-mediated vasodilatation: 11.80 -/+ 5.16% and 12.87 -/+ 7.04%, respectively, p =0.883) , but group 3 patients had significantly higher carotid intima-media thickness (0.774 +/- 0.15mm, p = 0.047) and significantly lower brachial artery flow-mediated vasodilatation (7.37 -/+ 6.12%, p -/+ 0.007) as compared to group 1 patients. There was no significant difference in the two parameters between groups 3 and 4 (carotid intima-media thickness in group 4:0.789 -/+ 0.16mm,p = 0.976 and brachial artery flow-mediated vasodilatation:5.86 -/+ 3.85%, p -/+ 0.709). CONCLUSIONS, In absence of diabetes mellitus, metabolic syndrome was not associated with greater extent of subclinical atherosclerosis compared to individual cardiovascular risk factors. Presence of diabetes mellitus, however, resulted in significant endothelial dysfunction and evidence of subclinical atherosclerosis, similar to that seen in patients with already established coronary artery disease.     

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.     

The correlation of irregularities in carotid arterial intima-media thickness with coronary artery disease

Noninvasive ultrasonographic assessment of carotid artery intima-media thickness (IMT) can improve risk stratification for coronary artery disease (CAD) in certain patients. Several measurements have been used to evaluate carotid atherosclerosis by ultrasonography. Although it has been reported that angiographic arterial irregularities correlate with pathologic changes of atherosclerosis and the occurrence of cardiovascular events, only a few studies have assessed carotid arterial wall irregularity by ultrasonography. The purpose of this study was to evaluate the irregularity of IMT quantitatively, and its association with the presence or absence of CAD. The correlation of maximum and mean IMT values, and IMT irregularity with the presence or absence of CAD, was investigated in 90 patients who had undergone coronary angiography. IMT was measured by manual tracking of the far wall of the common carotid arteries, carotid bulbs, and internal carotid arteries. The IMT irregularity was defined as the root mean square (RMS) difference between each IMT and averaged IMT. Multiple logistic regression analysis, after adjustment for coronary risk factors, indicated that the RMS difference was a more accurate predictor of CAD than were the mean or maximum IMT values. These results indicate that the evaluation of IMT irregularity by ultrasonography is a useful predictor for the presence of coronary atherosclerosis. Received: March 13, 2002 / Accepted: June 15, 2002 Acknowledgment We are grateful to Hitachi Medical Corporation, Tokyo, Japan, for the computer software used for ultrasonographic measurement of intima-media thickness. Correspondence to T. Ishimitsu     

Effect of high-density lipoprotein cholesterol levels on carotid artery geometry in a Mediterranean female population.

BACKGROUND: Controversy remains on the relationship between high-density lipoprotein cholesterol (HDL-C) and atherosclerotic cerebrovascular disease. METHODS: Over 5000 women living in the area of Naples, Southern Italy, were recruited for a prospective study on the etiology of cardiovascular disease in the female population (the 'Progetto ATENA' study). A sample of 310 participants underwent high-resolution B-mode ultrasound examination and the intima-media thickness and diameters of common carotid artery were measured. In addition to routine biochemical tests, these women also had oxidation markers determined. RESULTS: Women in the upper HDL-C quartile (HDL-C>1.89 mmol/L) had significantly lower body mass index and waist-to-hip ratio values, and triglycerides concentrations when compared with women in the first three quartiles. A linear negative association was found between HDL-C and carotid intima-media thickness (1.07+/-0.16 mm for the IV quartile versus 1.10+/-0.20 mm for the III quartile, 1.15+/-0.26 mm for the II quartile and 1.19+/-0.23 mm for the I quartile; P<0.01 by ANOVA). No difference was found between groups with regard to carotid diameters and oxidation markers. After adjustment for other cardiovascular risk factors, women in the highest quartile of HDL-C had a decreased risk of carotid intima-media thickening (OR 0.42, 95%CI 0.23-0.94). CONCLUSIONS: In asymptomatic middle-aged women, HDL-C levels were independently and negatively associated with preclinical atherosclerotic changes of the carotid artery wall.     

Grosor íntima-media carotídeo en población española: valores de referencia y asociación con los factores de riesgo cardiovascular

Introduction and objectives

Carotid intima-media thickness as measured with ultrasonography is an inexpensive and noninvasive predictor of cardiovascular events. The objectives of this study were to determine the population reference ranges of carotid intima-media thickness for individuals aged 35-84 years in Spain and to analyze the association of carotid intima-media thickness with cardiovascular risk factors (age, smoking, diabetes, pulse pressure, lipid profile, and body mass index).

Methods

Population-based cross-sectional study conducted in Gerona (Spain). We described the mean and maximal values of carotid intima-media thickness of the carotid artery and of its 3 segments (common carotid, carotid bulb and internal carotid). We assessed cardiovascular risk factors and analyzed their association with carotid intima-media thickness using adjusted linear regression models.

Results

A total of 3161 individuals (54% women) were included, with mean age 58 years. Men showed significantly higher mean common carotid intima-media thickness than did women (0.71 vs 0.67 mm). The strongest predictors of this measure were age (coefficients for 10-year increase: 0.65 and 0.58 for women and men, respectively), smoking in men (coefficient: 0.26), high-density lipoprotein cholesterol in women (coefficient for 10 mg/dL, increase: −0.08) and pulse pressure in both sexes (coefficients for 10 mmHg increase: 0.08 and 0.23 for women and men, respectively). The results were similar for the mean carotid intima-media thickness of all the segments.

Conclusions

This population-based study presents the reference ranges for carotid intima-media thickness in the Spanish population. The main determinants of carotid intima-media thickness were age and pulse pressure in both sexes.Full English text available from:www.revespcardiol.org     

Common carotid intima-media thickness and von Willebrand factor serum levels in rheumatoid arthritis female patients without cardiovascular risk factors

High atherosclerosis prevalence was found in rheumatoid arthritis (RA), and the von Willebrand factor (vWF) was shown to be a marker for endothelial damage. The aim of this study was to evaluate the association of intima-media thickness of the left common carotid artery with vWF serum levels in rheumatoid arthritis patients without cardiovascular risk factors. We included 55 RA female patients, each with at least 5 years of duration of the disease, and 20 healthy female subjects as members of the control group. The vWF, cholesterol, triglycerides, and the immune variables—rheumatoid factor and reactive C protein—were evaluated. The media thickness and intima-media thickness (IMT) in patients and in the control subjects were assessed by Doppler ultrasound of the left common carotid artery. Although the ages for RA patients and healthy female controls were not different, the IMT of the left common carotid artery (IMT CCA) in rheumatoid arthritis patients was increased in comparison with healthy control measurements, the mean being 0.67 mm (SD 0.18) vs 0.58 mm (SD 0.10) with a p value 0.01. The vWF serum levels showed differences in RA patients from those in control patients, 145.6 (SD 30.08) vs 121.8 (SD 37.17), respectively, with p=0.007. A correlation was also found between vWF with IMT CCA in the RA patients: r=0.390 and p<0.05. We concluded that the measurements of the left common carotid artery intima-media thickness together with the von Willebrand factor serum levels could give valuable information about the artery status and the atherosclerosis process in early stages in patients with rheumatoid arthritis without cardiovascular risk factors.     

Decreased carotid intima-media thickness in patients with coronary artery ectasia compared with patients with coronary artery disease

BACKGROUND: Although atherosclerosis is supposed to be responsible for more than 50% of coronary artery ectasia, the precise pathology of coronary artery ectasia is not clearly understood. A histopathological examination of ectatic segments has revealed mainly destruction of the media layer of the artery. In the present study, we assessed carotid intima-media thickness and common carotid artery diameter in patients with and without coronary artery ectasia. MATERIALS AND METHODS: Thirty-five consecutive patients with coronary artery ectasia and coronary artery disease and 35 age and sex-matched patients with coronary artery disease alone were included in the study. The common carotid artery was studied as the longitudinal plane within 10 mm from the bifurcation of the common carotid artery. The intima-media thickness was measured in the far wall at end-diastole from the B-mode screen to a point within the 10-mm segment proximal to the bifurcation by one investigator blinded to clinical data. RESULTS: No significant differences with respect to age, body mass index, hypertension, diabetes mellitus, hypercholesterolemia and smoking habits were observed between the two groups studied. Intima-media thickness of the common carotid artery of the patients with coronary artery ectasia was significantly lower than that of the patients with coronary artery disease alone (0.71 +/- 0.13 vs. 0.77 +/- 0.09 mm, respectively, P = 0.04). CONCLUSION: Decreased intima-media thickness of the carotid artery in patients with coronary artery ectasia and coronary artery disease may have pathogenic mechanisms different from coronary artery disease per se.     

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.     

The relative importance of vascular structure and function in predicting cardiovascular events

OBJECTIVES: We sought to assess the prognostic utility of brachial artery reactivity (BAR) in patients at risk of cardiovascular events. BACKGROUND: Impaired flow-mediated vasodilation measured by BAR is a marker of endothelial dysfunction. Brachial artery reactivity is influenced by risk factors and is responsive to various pharmacological and other treatments. However, its prognostic importance is uncertain, especially relative to other predictors of outcome. METHODS: A total of 444 patients were prospectively enrolled to undergo BAR and follow-up. These patients were at risk of cardiovascular events, based on the presence of risk factors or known or suspected cardiovascular disease. We took a full clinical history, performed BAR, and obtained carotid intima-media thickness (IMT) and left ventricular mass and ejection fraction. Patients were followed up for cardiovascular events and all-cause mortality. Multivariate Cox regression analysis was performed to assess the independent association of investigation variables on outcomes. RESULTS: The patients exhibited abnormal BAR (5.2 +/- 6.1% [mean +/- SD]) but showed normal nitrate-mediated dilation (9.9 +/- 7.2%) and normal mean IMT (0.67 +/- 0.12 mm [average]). Forty-nine deaths occurred over the median follow-up period of 24 months (interquartile range 10 to 34). Patients in the lowest tertile group of BAR (<2%) had significantly more events than those in the combined group of highest and mid-tertiles (p = 0.029, log-rank test). However, mean IMT (rather than flow-mediated dilation) was the vascular factor independently associated with mortality, even in the subgroup (n = 271) with no coronary artery disease and low risk. CONCLUSIONS: Brachial artery reactivity is lower in patients with events, but is not an independent predictor of cardiovascular outcomes in this cohort of patients.     

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.     

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.     

Association between abnormal uterine artery Doppler flow velocimetry, risk of preeclampsia, and indices of arterial structure and function: a pilot study

Preeclampsia increases the risk of future cardiovascular disease. The association between abnormal uterine artery Doppler flow velocimetry, risk of preeclampsia, and indices of arterial structure and function is investigated in this study. The carotid intima-media thickness of 34 pregnant women with normal uteroplacental flow was compared with 30 women with abnormal uterine artery Doppler analysis during the transvaginal assessment of the uterine arteries at the routine anomaly scan (20-23 weeks of gestation). Women with abnormal uterine artery Doppler results had a greater mean internal (but not common) carotid intima-media thickness (0.58 +/- 0.06 vs 0.53 +/- 0.08, respectively, P = .005) and risk of developing preeclampsia (6 of 30 vs 0 of 34 or 20% vs 0%, respectively, P = .0079) compared with those with normal uteroplacental flow. Women with abnormal uterine artery Doppler results may be at increased risk not only for developing subsequent preeclampsia but also for future cardiovascular disease.     

Ability of ambulatory blood pressure monitoring and myocardial/carotid ultrasound to predict the location and the severity of coronary artery lesions in normotensive patients: a clinical study.

Pulse pressure has been recognized as a marker of cardiovascular disease in normotensives. Moreover, internal carotid artery intima-media thickness (IMT) has been proposed to reflect coronary artery lesions. The aim of the present study was to evaluate the predictive value of other parameters derived from ambulatory blood pressure monitoring (ABPM), myocardial ultrasound, and carotid ultrasound to predict the location and the severity of coronary artery disease in normotensives. One hundred and thirteen patients with suspected coronary artery disease underwent coronary angiography, 24-h ABPM and myocardial/carotid ultrasound. Multivariate analysis was applied and equations were extrapolated based on independent variables derived from ABPM and ultrasound. The Gensini score was independently correlated with male gender, pulse pressure, average heart rate for both 24-h (p=0.001) and night (p=0.006) values, as well as percentage of high systolic blood pressure (BP), average diastolic BP, average mean BP, and heart rate concerning daily mesurements (p=0.001). Moreover, the Gensini score was independently correlated with end-systolic volume, posterior wall thickness during systole and intraventricular septum thickness during diastole, along with male gender and age (p=0.001), as well as mean internal and right common carotid artery IMT (p=0.002). Similar mathematical formulas have been calculated separately for the coronary arteries and their main branches. In conclusion, the location and the severity of coronary disease can be effectively evaluated by ABPM and myocardial/carotid ultrasound in normotensives. This approach could be useful for determining atypical patients at risk and/or for treating patients with suspected coronary disease who refuse coronary angiography.     

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.     

Prognostic implications of intima-media thickness and plaques in the carotid and femoral arteries in patients with stable angina pectoris.

BACKGROUND: Ultrasonographic assessments of intima-media thickness and plaques in the carotid artery are widely used as surrogate markers for coronary atherosclerosis, but prospective evaluations are scarce and appear to be lacking in patients with coronary artery disease. Ultrasonographic evaluations of femoral vascular changes have not been studied prospectively. METHODS AND RESULTS: In the Angina Prognosis Study in Stockholm (APSIS), 809 patients with stable angina pectoris were studied prospectively during double-blind treatment with verapamil or metoprolol. Ultrasonographic assessments of intima-media thickness, lumen diameter and plaques in the carotid and femoral arteries were evaluated in a subgroup of 558 patients (182 females) with a mean age of 60 +/-7 years, and related to the risk of cardiovascular death (n = 18) or non-fatal myocardial infarction (n = 26), or revascularization (n = 70) during follow-up (median 3.0 years). Univariate Cox regression analyses showed that carotid intima-media thickness and plaques were related to the risk of cardiovascular death or myocardial infarction. Femoral intima-media thickness was related to cardiovascular death or myocardial infarction, as well as to revascularization, whereas femoral plaques were only related to the latter. After adjustment for age, sex, smoking, previous cardiovascular disease and lipid status, carotid intima-media thickness failed to predict any cardiovascular event, whereas carotid plaques tended (P = 0.056) to predict the risk of cardiovascular death or myocardial infarction. Femoral intima-media thickness (P < 0.01) and plaques (P < 0.05) were also related to the risk of revascularization after adjustments. CONCLUSIONS: Carotid and femoral vascular changes were differently related to cardiovascular events. Carotid intima-media thickness was a weak predictor of events, whereas femoral intima-media thickness predicted revascularization. Plaques in the carotid artery were related to cardiovascular death or non-fatal myocardial infarction, whereas plaques in the femoral artery were related to revascularization. Evaluations of plaques provided better prediction than assessments of intima-media thickness in patients with stable angina.     

Can measurement of the intima-media thickness of the carotid artery improve the diagnostic value of exercise stress tests?

OBJECTIVE: The diagnostic value of the exercise electrocardiogram (ECG) for the detection of coronary artery disease is hampered by a high proportion of equivocal results, especially in asymptomatic patients. The intima-media thickness of the carotid artery correlates well with the degree of atherosclerosis, also in other vascular beds, such as the coronary arteries. The aim of this study is to evaluate whether measurements of intima-media thickness can improve the diagnostic value of stress ECG in the detection of coronary artery disease. METHODS: Patients without a history of vascular disease and with equivocal exercise stress ECG results were included. The intima-media thickness was measured with high resolution echography at the posterior wall of the common carotid artery, using an automated edge-tracking method. The diagnosis of coronary artery disease was based on the presence of reversible perfusion defects on exercise MIBI-scintigrams. RESULTS: A total of 90 patients (46 men, 44 women) with a mean age of 53.7 years were included. The MIBI-scintigraphy was positive in 17. There was no difference in mean intima-media thickness between MIBI positive and MIBI negative patients (635.76 +/- 84.56 microm and 643.89 +/- 107.06 microm, respectively, p = 0.8). Using multiple regression analysis, neither intima-media thickness measurements, nor classic risk factors could predict the result of MIBI-scintigraphy. Intima-media thickness was mainly influenced by age and hypertension. CONCLUSIONS: In this study, neither intima-media thickness measurements, nor classic risk factors could improve the diagnostic value of stress ECG in the detection of coronary artery disease. In case of equivocal stress results, additional cardiovascular imaging techniques remain recommended.     

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.