DOI QR코드

DOI QR Code

Carotid Artery End-Diastolic Velocity and Future Cerebro-Cardiovascular Events in Asymptomatic High Risk Patients

  • Chung, Hyemoon (Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Jung, Young Hak (Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Ki-Hyun (Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kim, Jong-Youn (Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Min, Pil-Ki (Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Yoon, Young Won (Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Lee, Byoung Kwon (Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Hong, Bum-Kee (Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Rim, Se-Joong (Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Kwon, Hyuck Moon (Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine) ;
  • Choi, Eui-Young (Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine)
  • Received : 2015.03.22
  • Accepted : 2015.07.14
  • Published : 2016.01.30

Abstract

Background and Objectives: Prognostic value of additional carotid Doppler evaluations to carotid intima-media thickness (IMT) and plaque has not been completely evaluated. Subjects and Methods: A total of 1119 patients with risk factors for, but without, overt coronary artery disease (CAD), who underwent both carotid ultrasound and Doppler examination were included in the present study. Parameters of interest included peak systolic and end-diastolic velocities, resistive indices of the carotid arteries, IMT, and plaque measurements. The primary end-point was all-cause cerebro-cardiovascular events (CVEs) including acute myocardial infarction, coronary revascularization therapy, heart failure admission, stroke, and cardiovascular death. Model 1 covariates comprised age and sex; Model 2 also included hypertension, diabetes and smoking; Model 3 also had use of aspirin and statin; and Model 4 also included IMT and plaque. Results: The mean follow-up duration was $1386{\pm}461days$ and the mean age of the study population was $60{\pm}12years$. Amongst 1119 participants, 43% were women, 57% had a history of hypertension, and 23% had diabetes. During follow-up, 6.6% of patients experienced CVEs. Among carotid Doppler parameters, average common carotid artery end-diastolic velocity was the independent predictor for future CVEs after adjustments for all models variables (HR 0.95 per cm/s, 95% confident interval 0.91-0.99, p=0.034 in Model 4) and significantly increased the predictive value of Model 4 (global ${\chi}^2=59.0$ vs. 62.8, p=0.029). Conclusion: Carotid Doppler measurements in addition to IMT and plaque evaluation are independently associated with future CVEs in asymptomatic patients at risk for CAD.

Keywords

Acknowledgement

Supported by : Korean Society of Circulation

References

  1. Polak JF, Pencina MJ, Pencina KM, O'Donnell CJ, Wolf PA, D'Agostino RB Sr. Carotid-wall intima-media thickness and cardiovascular events. N Engl J Med 2011;365:213-21. https://doi.org/10.1056/NEJMoa1012592
  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. N Engl J Med 1999;340:14-22. https://doi.org/10.1056/NEJM199901073400103
  3. Yuk HB, Park HW, Jung IJ, et al. Analysis of carotid ultrasound findings on cardiovascular events in patients with coronary artery disease during seven-year follow-up. Korean Circ J 2015;45:28-37. https://doi.org/10.4070/kcj.2015.45.1.28
  4. Grant EG, Benson CB, Moneta GL, et al. Carotid artery stenosis: grayscale and Doppler US diagnosis--Society of Radiologists in Ultrasound Consensus Conference. Radiology 2003;229:340-6. https://doi.org/10.1148/radiol.2292030516
  5. Bai CH, Chen JR, Chiu HC, Pan WH. Lower blood flow velocity, higher resistance index, and larger diameter of extracranial carotid arteries are associated with ischemic stroke independently of carotid atherosclerosis and cardiovascular risk factors. J Clin Ultrasound 2007;35:322-30. https://doi.org/10.1002/jcu.20351
  6. Wolff T, Guirguis-Blake J, Miller T, Gillespie M, Harris R. Screening for carotid artery stenosis: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med 2007;147:860-70. https://doi.org/10.7326/0003-4819-147-12-200712180-00006
  7. 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
  8. Beach KW, Leotta DF, Zierler RE. Carotid Doppler velocity measurements and anatomic stenosis: correlation is futile. Vasc Endovascular Surg 2012;46:466-74. https://doi.org/10.1177/1538574412452159
  9. Pickett CA, Jackson JL, Hemann BA, Atwood JE. Carotid bruits as a prognostic indicator of cardiovascular death and myocardial infarction: a meta-analysis. Lancet 2008;371:1587-94. https://doi.org/10.1016/S0140-6736(08)60691-1
  10. Chuang SY, Bai CH, Chen JR, et al. Common carotid end-diastolic velocity and intima-media thickness jointly predict ischemic stroke in Taiwan. Stroke 2011;42:1338-44. https://doi.org/10.1161/STROKEAHA.110.605477
  11. Dijk JM, Algra A, van der Graaf Y, Grobbee DE, Bots ML, SMART study group. Carotid stiffness and the risk of new vascular events in patients with manifest cardiovascular disease. The SMART study. Eur Heart J 2005;26:1213-20. https://doi.org/10.1093/eurheartj/ehi254
  12. Janzen J. The microscopic transitional zone between elastic and muscular arteries. Arch Mal Coeur Vaiss 2004;97:909-14.
  13. Barutcu I, Esen AM, Degirmenci B, et al. Acute cigarette smokinginduced hemodynamic alterations in the common carotid artery--a transcranial Doppler study--. Circ J 2004;68:1127-31. https://doi.org/10.1253/circj.68.1127
  14. Manabe S, Okura T, Watanabe S, Higaki J. Association between carotid haemodynamics and inflammation in patients with essential hypertension. J Hum Hypertens 2005;19:787-91. https://doi.org/10.1038/sj.jhh.1001898

Cited by

  1. Methods for Ultrasound Screening of Cardiovascular Diseases in Type 2 Diabetic Patients vol.45, pp.1, 2016, https://doi.org/10.2478/amb-2018-0010
  2. Outcomes and Associated Factors of Discrepant Coronary and Carotid Atherosclerosis vol.61, pp.6, 2020, https://doi.org/10.1536/ihj.20-318