Correlation between Carotid artery ultrasound and CHD in our environment patient

Background: Atherosclerosis is a systemic process, involving multiple arterial districts at the same time. Carotid doppler ultrasound is an easy and non-invasive test, able to evaluate the layers of the neck arteries and the involvement of this district in the atherosclerotic process. Carotid intima-media-thickness (IMT) is known to be a marker of the systemic atherosclerotic process. Dopper ultrasound could become useful, allowing a correct risk stratification in the systemic involvement by the atherosclerotic process. Moreover, it could be functional, in association with the other already-validated rulers, in targeting the best therapeutic choice for acute coronary heart disease [6]. An increase of IMT or the presence of atherosclerotic plaque in asymptomatic patients have been associated to an increased risk for coronary heart disease (CHD) in large, perspective studies [1–4]. On the other hand, a recent meta-analysis [5] showed that neither the presence of an increased IMT neither the presence of a plaque were discriminatory enough to be considered a reliable screening test among patients with symptomatic CHD. Aims of the study: To evaluate a correlation between carotid arteries ultrasonographic pattern and coronaric pathology extension among symptomatic CHD patients living in our region. Materials and methods: In the period 01/2007–01/2008, we enrolled 100 consecutive patients admitted to our Internal Medicine Department for acute coronary syndrome (ACS). For each patient, we evaluated the classical risk factors (familiarity, known CHD, diabetes mellitus, dyslipidemia, hypertension, smoke and obesity), the extent of the atherosclerotic pathology (cerebrovascular events, peripheral arteries pathology and CHD) and the therapy at the moment of the admission. Every subject underwent to doppler ultrasound: IMT, presence of carotid plaque and degree of stenosis were evaluated. Coronarographic assessment evaluated the number of arteries with significant obstruction, the total coronary score (TCS), the site and the degree of stenosis. We performed the statistical analysis with SPSS 13.0 package for Windows systems. Results: The absence of a previous history of CHD and a negative carotid ultrasound (normal IMT, no evidence of any plaque) were the strongest protective factors for multiple-vessel coronary disease (CHD: OR = 0.132; 95% CI 0.027–0.628, p\0.05; Negative US: OR = 0.223; 95% CI: 0.067–0.742, p\0.05). Lower percentages of stenosis were associated to lower TCS as detected at coronarography (0–30% stenosis at US: OR = 6.76 [95% CI: 19.25–2.37, p\0.05] of obtaining a low TCS) with a decrease of the risk of low TCS with proportional to the increase of carotid stenosis. Discussion: In this small, retrospective analysis we correlate a normal carotid ultrasonographic pattern with a low risk of multiple-vessel involvment at coronarography. Moreover, in this population of symptomatic patients, we correlate the percentage of carotid stenosis with a proportional increase of the risk of an higher TCS at coronarography. These data suggest that among high-risk, symptomatic patients, carotid ultrasound and doppler evaluation can be a reliable indicator of the extent of coronary pathology. References 1. Simon A, Chironi G, Levenson J (2007) Comparative performance of subclinical atherosclerosis tests in predicting coronary heart disease in asymptomatic individuals. Eur Heart J 28(24):2967–2971 (review) 2. Chambless LE, Heiss G, Folsom AR, Rosamond W, Szklo M, Sharrett AR, Clegg LX (1997) 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 146:483–494 3. O’Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr (1999) 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 340:14–22 4. Salonen T, Salonen R (1991) Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb 11:1245–1249 5. Wald DS, Bestwick JP (2009) Carotid ultrasound screening for coronary heart disease: results based on a meta-analysis of 18 studies and 44,861 subjects. J Med Screen 16(3):147–154 6. Flu WJ, van Kuijk JP, Hoeks SE, Kuiper R, Schouten O, Goei D, Winkel T, van Gestel YRBM, Verhagen HJM, Bax JJ, Poldermans D, Rotterdam, and Leiden, The Netherlands, Coronary Artery Disease Intima media thickness of the common carotid artery in vascular surgery patients: a predictor of postoperative cardiovascular events