Intima Media Thickness of Carotid and Femoral Artery as predictor of Cardiovascular Events
Keywords:Artery, Intima Media Thickness, coronary artery disease, screening, myocardial infarction, sudden death
Objective: To establish the correlation between IMT (presence and severity) of carotid and femoral artery detected on Doppler study and presence of subclinical CAD in asymptomatic patients for early detection of CAD and risk stratification by a non-invasive method.
Methodology: This cross-sectional analytic study was conducted in the Cardiology department of Mayo Hospital Lahore for a period of 1 year. One hundred and twenty asymptomatic subjects with and without conventional risk factors for CAD were included The thickness of the intima-media of carotid and the femoral artery was assessed by high-resolution B mode Ultrasonography. The patients enrolled in our study underwent coronary angiography. Data was entered and analyzed through SPSS (Statistical package for social science) version 16. Results: There were a total of 120 patients with a male-to-female ratio of 1.8:1 The mean age of patients was 32.40 ± 10.74 years, minimum age of patients was 20years while the maximum age was 40 years. Most of our patients were overweight, smokers, and had established family history of heart disease. Most of the patients had a single-vessel disease and had severe CAD at the time of presentation. There were 93 patients whose IMT was >0.8 mm. There were 16 patients whose CMIT was <0.8 mm. Sensitivity, specificity, PPV, NPV and diagnostic accuracy of B-mode USG (using CIMT and FA-IMT) were calculated as 85.32%, 72.73%, 96.88%, 33.33% and 84.17% respectively for CMIT. For FA-IMT sensitivity, specify, PPV, NPV and Diagnostic accuracy of B-mode USG was 84.4%, 54.55%, 94.85%, 26.09% and 81.67% respectively.
Conclusion: The increased IMT is a predictor of coronary vascular disease, measured non-invasively with B-mode ultrasound. It can be used to predict future cardiovascular events and risk stratification. If patients are diagnosed in the earlier stages then timely treatment can prevent or regress the progression of the disease.
Paul J, Shaw K, Dasgupta S, Ghosh MK. Measurement of intima media thickness of carotid artery by B-mode ultrasound in healthy people of India and Bangladesh, and relation of age and sex with carotid artery intima media thickness: An observational study. J Cardiovasc Dis Res. 2012;3(2):128-31. Available From: doi: 10.4103/0975-3583.95367.
Mensah GA, Wei GS, Sorlie PD, Fine LJ, Rosenberg Y, Kaufmann PG, Mussolino ME, Hsu LL, Addou E, Engelgau MM, Gordon D. Decline in Cardiovascular Mortality: Possible Causes and Implications. Circ Res. 2017;120(2):366-380. Available from: doi: 10.1161/CIRCRESAHA.116.309115.
Eckel RH, Cornier MA. Update on the NCEP ATP-III emerging cardiometabolic risk factors. BMC Med. 2014 Aug 26;12:115. Available from: doi: 10.1186/1741-7015-12-115.
Amato M, Montorsi P, Ravani A, Oldani E, Galli S, Ravagnani PM, Tremoli E, Baldassarre D. Carotid intima-media thickness by B-mode ultrasound as surrogate of coronary atherosclerosis: correlation with quantitative coronary angiography and coronary intravascular ultrasound findings. Eur Heart J. 2007;28(17):2094-101. Available from: doi: 10.1093/eurheartj/ehm244. Epub 2007 Jun 27.
Navas-Nacher EL, Colangelo L, Beam C, Greenland P. Risk factors for coronary heart disease in men 18 to 39 years of age. Ann Intern Med. 2001 Mar 20;134(6):433-9. Available from: doi: 10.7326/0003-4819-134-6-200103200-00007. Erratum in: Ann Intern Med 2001 Jul 3;135(1):71.
S. Preventive Services Task Force. Using nontraditional risk factors in coronary heart disease risk assessment: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2009 Oct 6;151(7):474-82. Available from doi: 10.7326/0003-4819-151-7-200910060-00008.
Dobs AS, Nieto FJ, Szklo M, Barnes R, Sharrett AR, Ko WJ. Risk factors for popliteal and carotid wall thicknesses in the Atherosclerosis Risk in Communities (ARIC) Study. Am J Epidemiol. 1999;150(10):1055-67. Available from : doi: 10.1093/oxfordjournals.aje.a009929.
Salonen JT, Salonen R. Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb. 1991;11(5):1245-9. Available From doi: 10.1161/01.atv.11.5.1245.
Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, Clegg LX. 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(6):483-94. Available from doi: 10.1093/oxfordjournals.aje.a009302.
van der Meer IM, Bots ML, Hofman A, del Sol AI, van der Kuip DA, Witteman JC. Predictive value of noninvasive measures of atherosclerosis for incident myocardial infarction: the Rotterdam Study. Circulation. 2004 ;109(9):1089-94. Available from : doi: 10.1161/01.CIR.0000120708.59903.1B. Epub 2004 Mar 1.
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(1):14-22. Available from: doi: 10.1056/NEJM199901073400103.
Lorenz MW, Schaefer C, Steinmetz H, Sitzer M. Is carotid intima media thickness useful for individual prediction of cardiovascular risk? Ten-year results from the Carotid Atherosclerosis Progression Study (CAPS). Eur Heart J. 2010;31(16):2041-8. Available From : doi: 10.1093/eurheartj/ehq189. Epub 2010 Jun 8.
Probstfield JL, Margitic SE, Byington RP, Espeland MA, Furberg CD. Results of the primary outcome measure and clinical events from the Asymptomatic Carotid Artery Progression Study. Am J Cardiol. 1995 ;76(9):47C-53C. Available From: doi: 10.1016/s0002-9149(99)80470-6.
Organization WH. Global database on Body Mass Index: BMI Classification. 2006..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(1):14-22. Epub 1999/01/08.
Lorenz MW, Schaefer C, Steinmetz H, Sitzer M. Is carotid intima media thickness useful for individual prediction of cardiovascular risk? Ten-year results from the Carotid Atherosclerosis Progression Study (CAPS). Eur Heart J. 2010;31(16):2041-8. Epub 2010/06/10.
Probstfield JL, Margitic SE, Byington RP, Espeland MA, Furberg CD. Results of the primary outcome measure and clinical events from the Asymptomatic Carotid Artery Progression Study. Am J Cardiol. 1995;76(9):47C-53C. Epub 1995/09/28.
Ludwig M, von Petzinger-Kruthoff A, Von Buquoy M, Stumpe K. [Intima media thickness of the carotid arteries: early pointer to arteriosclerosis and therapeutic endpoint]. Ultraschall in der Medizin (Stuttgart, Germany: 1980). 2003;24(3):162-74.
Suurküla M, Fagerberg B, Wendelhag I, Agewall S, Wikstrand J. Atherosclerotic Disease in the Femoral Artery in Hypertensive Patients at High Cardiovascular Risk The Value of Ultrasonographic Assessment of Intima-Media Thickness and Plaque Occurrence. Arteriosclerosis, thrombosis, and vascular biology. 1996;16(8):971-7.
Hansson GK, Hamsten A. Atherosclerosis, thrombosis, and vascular biology. In: Goldman L, Schafer AI, eds. Cecil Medicine. 24th ed. Philadelphia, PA: Saunders Elsevier. 2011: chap 70.
Greenland P, Abrams J, Aurigemma GP, Bond MG, Clark LT, Criqui MH, et al. Prevention Conference V: Beyond secondary prevention: identifying the high-risk patient for primary prevention: noninvasive tests of atherosclerotic burden: Writing Group III. Circulation. 2000;101(1):E16-22. Epub 2000/01/05.
McGill HC, Jr., McMahan CA, Herderick EE, Tracy RE, Malcom GT, Zieske AW, et al. Effects of coronary heart disease risk factors on atherosclerosis of selected regions of the aorta and right coronary artery. PDAY Research Group. Pathobiological Determinants of Atherosclerosis in Youth. Arterioscler Thromb Vasc Biol. 2000;20(3):836-45. Epub 2000/03/11.
Virmani R, Burke AP, Farb A, Kolodgie FD. Pathology of the vulnerable plaque. J Am Coll Cardiol. 2006;47(8 Suppl):C13-8. Epub 2006/04/25.
Greenland P, LaBree L, Azen SP, Doherty TM, Detrano RC. Coronary artery calcium score combined with Framingham score for risk prediction in asymptomatic individuals. JAMA. 2004;291(2):210-5. Epub 2004/01/15.
Stein JH, Fraizer MC, Aeschlimann SE, Nelson-Worel J, McBride PE, Douglas PS. Vascular age: integrating carotid intima-media thickness measurements with global coronary risk assessment. Clin Cardiol. 2004;27(7):388-92. Epub 2004/08/10.
Gepner AD, Keevil JG, Wyman RA, Korcarz CE, Aeschlimann SE, Busse KL, et al. Use of carotid intima-media thickness and vascular age to modify cardiovascular risk prediction. J Am Soc Echocardiogr. 2006;19(9):1170-4. Epub 2006/09/05.
Bard RL, Kalsi H, Rubenfire M, Wakefield T, Fex B, Rajagopalan S, et al. Effect of carotid atherosclerosis screening on risk stratification during primary cardiovascular disease prevention. Am J Cardiol. 2004;93(8):1030-2. Epub 2004/04/15.
Rembold KE, Ayers CR, Wills MB, Rembold CM. Usefulness of carotid intimal medial thickness and flow-mediated dilation in a preventive cardiovascular practice. Am J Cardiol. 2003;91(12):1475-7, A8. Epub 2003/06/14.
Ali YS, Rembold KE, Weaver B, Wills MB, Tatar S, Ayers CR, et al. Prediction of major adverse cardiovascular events by age-normalized carotid intimal medial thickness. Atherosclerosis. 2006;187(1):186-90. Epub 2005/10/20.
Barth JD. An update on carotid ultrasound measurement of intima-media thickness. Am J Cardiol. 2002;89(4A):32B-8B; discussion 8B-9B. Epub 2002/03/07.
Ludwig M, von Petzinger-Kruthoff A, Von Buquoy M, Stumpe K. [Intima media thickness of the carotid arteries: early pointer to arteriosclerosis and therapeutic endpoint]. Ultraschall in der
Medizin (Stuttgart, Germany: 1980). 2003;24(3):162-74.
Suurküla M, Fagerberg B, Wendelhag I, Agewall S, Wikstrand J. Atherosclerotic Disease in the Femoral Artery in Hypertensive Patients at High Cardiovascular Risk The Value
Salonen J, Salonen R. Ultrasound B-mode imaging in observational studies of atherosclerotic progression. Circulation. 1993;87(3 Suppl):II56.
Belcaro G, Nicolaides AN, Laurora G, Cesarone MR, De Sanctis M, Incandela L, et al. Ultrasound morphology classification of the arterial wall and cardiovascular events in a 6-year follow-up study. Arteriosclerosis, thrombosis, and vascular biology. 1996;16(7):851-6.
Noor L, Shah SS, Adnan Y, Sawar S, ud Din S, Amina, et al. Pattern of coronary artery disease with no risk factors under age 35 years. J Ayub Med Coll Abbottabad. 2010;22(4):115-9.
Held C, Hjemdahl P, Eriksson SV, Bjorkander 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(1):62-72.
Wald DS, Bestwick JP. Carotid ultrasound screening for coronary heart disease: results based on a meta-analysis of 18 studies and 44,861 subjects. J Med Screen. 2009;16(3):147-54.
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(1):87-92.
Akanda M, Ali S, Islam A, Rahman M, Parveen A, Kabir M, et al. Demographic profile, clinical presentation & angiographic findings in 637 patients with coronary heart disease. Faridpur Medical College Journal. 2011;6(2):82-5.
Gillani J, Bokhari M. Clinical Profile, Angiographic Characteristics and Treatment Recommendations in Patients with Coronary Artery Disease.
Soleimani A, Abbasi A, Kazzazi E, Hosseini K, Salirifar M, Darabian S, et al. Prevalence of left main coronary artery disease among patients with ischemic heart disease: insights from the Tehran Angiography Registry. Minerva cardioangiologica. 2009;57(2):175-83.
Ludwig M, von Petzinger-Kruthoff A, von Buquoy M, Stumpe KO. [Intima media thickness of the carotid arteries: early pointer to arteriosclerosis and therapeutic endpoint]. Ultraschall Med. 2003;24(3):162-74.
Kusuma Venkatesh DC, Venkatesha VT. Escalation of coronary atherosclerosis in younger people by comparison of two autopsy studies conducted a decade apart. Heart views: the official journal of the Gulf Heart Association. 2018 Oct;19(4):128
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