DOI QR코드

DOI QR Code

Analysis of Carotid Ultrasound Findings on Cardiovascular Events in Patients with Coronary Artery Disease during Seven-Year Follow-Up

  • Yuk, Hyung Bin (Division of Cardiology, Heart Center, Konyang University Hospital) ;
  • Park, Hyun Woong (Division of Cardiology, Heart Center, Konyang University Hospital) ;
  • Jung, Ik Ju (Division of Cardiology, Heart Center, Konyang University Hospital) ;
  • Kim, Wan Ho (Division of Cardiology, Heart Center, Konyang University Hospital) ;
  • Kim, Ki-Hong (Division of Cardiology, Heart Center, Konyang University Hospital) ;
  • Yang, Dong-Ju (Division of Cardiology, Heart Center, Konyang University Hospital) ;
  • Park, Yo Han (Division of Cardiology, Heart Center, Konyang University Hospital) ;
  • Kim, Yong Kyun (Division of Cardiology, Heart Center, Konyang University Hospital) ;
  • Song, In Geol (Division of Cardiology, Heart Center, Konyang University Hospital) ;
  • Bae, Jang-Ho (Division of Cardiology, Heart Center, Konyang University Hospital)
  • Received : 2014.07.16
  • Accepted : 2014.09.24
  • Published : 2015.01.30

Abstract

Background and Objectives: Both carotid intima-media thickness (CIMT) and carotid plaque are important factors in the primary prevention of cardiac disease. However, it is unclear which one is more important for prognosis, especially in patients with coronary artery disease (CAD). Subjects and Methods: In total, 1426 consecutive CAD patients, proven by angiography, were followed-up for a mean of 85 months. The study population was divided into four groups depending on the CIMT (${\geq}0.83mm$, >95 percentile in Korea) and the presence or absence of carotid plaque. Results: Patients with carotid plaque and thick CIMT (n=237, 16.6%) had a higher prevalence of hypertension, diabetes mellitus, and dyslipidemia than those had plaque and thin CIMT (n=213, 14.9%), those without plaque and thick CIMT (n=265, 18.6%) and those without plaque and thin CIMT (n=711, 49.9%). The patients with carotid plaque and thick CIMT group had a higher cardiac mortality rate (20.7% vs. 13.1%, 9.4% and 3.9%, respectively, p<0.001) and higher major adverse cardiovascular events (MACE) including death, acute myocardial infarction, and stroke (27.8% vs. 18.8%, 15.5% and 9.3%, respectively, p<0.001) than any other groups. Multivariate Cox regression analysis showed that the presence of carotid plaque with thick CIMT had the highest hazard ratio (HR) compared to other groups (HR 2.23 vs. 1.81, 2.01) for cardiac mortality. Also, carotid plaque had a higher HR than CIMT for mortality (HR 1.56 vs. 1.37) and MACE (HR 1.54 vs. 1.36) in the total study population. Conclusion: Carotid plaque is a more important prognostic factor than CIMT in patients with CAD, and adding a thick CIMT to carotid plaque increases the prognostic power for cardiac events.

Keywords

References

  1. Stein JH, Korcarz CE, Hurst RT, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk:a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr 2008;21:93-111; quiz 189-90. https://doi.org/10.1016/j.echo.2007.11.011
  2. O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 1999;340:14-22. https://doi.org/10.1056/NEJM199901073400103
  3. Fathi R, Haluska B, Isbel N, Short L, Marwick TH. The relative importance of vascular structure and function in predicting cardiovascular events. J Am Coll Cardiol 2004;43:616-23. https://doi.org/10.1016/j.jacc.2003.09.042
  4. Xu Y, Arora RC, Hiebert BM, et al. Non-invasive endothelial function testing and the risk of adverse outcomes: a systematic review and meta- analysis. Eur Heart J Cardiovasc Imaging 2014;15:736-46. https://doi.org/10.1093/ehjci/jet256
  5. Corretti MC, Anderson TJ, Benjamin EJ, et al. Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. J Am Coll Cardiol 2002;39:257-65.
  6. Bae JH, Kim WS, Rihal CS, Lerman A. Individual measurement and significance of carotid intima, media, and intima-media thickness by Bmode ultrasonographic image processing. Arterioscler Thromb Vasc Biol 2006;26:2380-5. https://doi.org/10.1161/01.ATV.0000240420.36229.f9
  7. Inaba Y, Chen JA, Bergmann SR. Carotid plaque, compared with carotid intima-media thickness, more accurately predicts coronary artery disease events: a meta-analysis. Atherosclerosis 2012;220:128-33. https://doi.org/10.1016/j.atherosclerosis.2011.06.044
  8. Chambless LE, Heiss G, Folsom AR, et al. Association of coronary heart disease incidence with carotid arterial wall thickness and major risk factors: the Atherosclerosis Risk in Communities (ARIC) Study, 1987-1993. Am J Epidemiol 1997;146:483-94. https://doi.org/10.1093/oxfordjournals.aje.a009302
  9. Chambless LE, Folsom AR, Clegg LX, et al. Carotid wall thickness is predictive of incident clinical stroke: the Atherosclerosis Risk in Communities (ARIC) study. Am J Epidemiol 2000;151:478-87. https://doi.org/10.1093/oxfordjournals.aje.a010233
  10. Lorenz MW, von Kegler S, Steinmetz H, Markus HS, Sitzer M. Carotid intima-media thickening indicates a higher vascular risk across a wide age range: prospective data from the Carotid Atherosclerosis Progression Study (CAPS). Stroke 2006;37:87-92. https://doi.org/10.1161/01.STR.0000196964.24024.ea
  11. Simon A, Megnien JL, Chironi G. The value of carotid intima-media thickness for predicting cardiovascular risk. Arterioscler Thromb Vasc Biol 2010;30:182-5. https://doi.org/10.1161/ATVBAHA.109.196980
  12. Nambi V, Chambless L, Folsom AR, et al. Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk: the ARIC (Atherosclerosis Risk In Communities) study. J Am Coll Cardiol 2010;55:1600-7. https://doi.org/10.1016/j.jacc.2009.11.075
  13. Petersen C, Peçanha PB, Venneri L, Pasanisi E, Pratali L, Picano E. The impact of carotid plaque presence and morphology on mortality outcome in cardiological patients. Cardiovasc Ultrasound 2006;4:16. https://doi.org/10.1186/1476-7120-4-16
  14. Park HW, Kim WH, Kim KH, et al. Carotid plaque is associated with increased cardiac mortality in patients with coronary artery disease. Int J Cardiol 2013;166:658-63. https://doi.org/10.1016/j.ijcard.2011.11.084
  15. Hirano M, Nakamura T, Kitta Y, et al. Assessment of carotid plaque echolucency in addition to plaque size increases the predictive value of carotid ultrasound for coronary events in patients with coronary artery disease and mild carotid atherosclerosis. Atherosclerosis 2010;211:451-5. https://doi.org/10.1016/j.atherosclerosis.2010.03.003
  16. Prati P, Vanuzzo D, Casaroli M, et al. Prevalence and determinants of carotid atherosclerosis in a general population. Stroke 1992;23:1705-11. https://doi.org/10.1161/01.STR.23.12.1705
  17. Cho DK, Kwon SU, Kim SW, et al. Risk factors and predictors for the progression of carotid atherosclerotic stenosis in Korean adults. Korean Circ J 2005;35:834-40. https://doi.org/10.4070/kcj.2005.35.11.834
  18. Ebrahim S, Papacosta O, Whincup P, et al. Carotid plaque, intima media thickness, cardiovascular risk factors, and prevalent cardiovascular disease in men and women: the British Regional Heart Study. Stroke 1999;30:841-50. https://doi.org/10.1161/01.STR.30.4.841
  19. Lee SK, Hwang HY, Kim HS, et al. The carotid artery intima-media thickness measured with B-mode ultrasonography in adult volunteers. Korean Circ J 1999;29:1201-11. https://doi.org/10.4070/kcj.1999.29.11.1201
  20. Conroy RM, Pyörälä K, Fitzgerald AP, et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. Eur Heart J 2003;24:987-1003. https://doi.org/10.1016/S0195-668X(03)00114-3
  21. Voss R, Cullen P, Schulte H, Assmann G. Prediction of risk of coronary events in middle-aged men in the Prospective Cardiovascular Münster Study (PROCAM) using neural networks. Int J Epidemiol 2002;31:1253-62; discussion 1262-4. https://doi.org/10.1093/ije/31.6.1253
  22. Kannel WB, McGee D, Gordon T. A general cardiovascular risk profile: the Framingham Study. Am J Cardiol 1976;38:46-51. https://doi.org/10.1016/0002-9149(76)90061-8
  23. Battes L, Barendse R, Steyerberg EW, et al. Development and validation of a cardiovascular risk assessment model in patients with established coronary artery disease. Am J Cardiol 2013;112:27-33. https://doi.org/10.1016/j.amjcard.2013.02.049
  24. Naghavi M, Falk E, Hecht HS, et al. From vulnerable plaque to vulnerable patient--Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. Am J Cardiol 2006;98(2A):2H-15H. https://doi.org/10.1016/S0002-9149(06)01666-3
  25. Finn AV, Kolodgie FD, Virmani R. Correlation between carotid intimal/medial thickness and atherosclerosis: a point of view from pathology. Arterioscler Thromb Vasc Biol 2010;30:177-81. https://doi.org/10.1161/ATVBAHA.108.173609
  26. Brook RD, Bard RL, Patel S, et al. A negative carotid plaque area test is superior to other noninvasive atherosclerosis studies for reducing the likelihood of having underlying significant coronary artery disease. Arterioscler Thromb Vasc Biol 2006;26:656-62.
  27. Held C, Hjemdahl P, Eriksson SV, Björkander I, Forslund L, Rehnqvist N. Prognostic implications of intima-media thickness and plaques in the carotid and femoral arteries in patients with stable angina pectoris. Eur Heart J 2001;22:62-72. https://doi.org/10.1053/euhj.1999.2006
  28. Komorovsky R, Desideri A, Coscarelli S, et al. Predictive value of associations between carotid and coronary artery disease in patients with acute coronary syndromes. Am J Cardiol 2005;95:116-9. https://doi.org/10.1016/j.amjcard.2004.08.075
  29. Kawai T, Ohishi M, Takeya Y, et al. Carotid plaque score and intima media thickness as predictors of stroke and mortality in hypertensive patients. Hypertens Res 2013;36:902-9. https://doi.org/10.1038/hr.2013.61
  30. Wannarong T, Parraga G, Buchanan D, et al. Progression of carotid plaque volume predicts cardiovascular events. Stroke 2013;44:1859-65. https://doi.org/10.1161/STROKEAHA.113.001461

Cited by

  1. Associations between Carotid Artery Plaque Score, Carotid Hemodynamics and Coronary Heart Disease vol.12, pp.11, 2015, https://doi.org/10.3390/ijerph121114275
  2. Risk Factors for Poor Prognosis of Coronary Artery Bypass Grafting in the Patients with Diabetes vol.22, pp.4, 2015, https://doi.org/10.7793/jcoron.22.16-00014
  3. The coexistence of carotid and lower extremity atherosclerosis further increases cardio-cerebrovascular risk in type 2 diabetes vol.15, pp.None, 2015, https://doi.org/10.1186/s12933-016-0360-2
  4. Pre-clinical carotid atherosclerosis and sCD163 among virally suppressed HIV patients in Botswana compared with uninfected controls vol.12, pp.6, 2015, https://doi.org/10.1371/journal.pone.0179994
  5. Association between Colorectal Adenoma and Carotid Atherosclerosis in Korean Adults vol.15, pp.12, 2015, https://doi.org/10.3390/ijerph15122762