Pasierski Tomasz, Sosnowski Cezary, Szulczyk Anna, Leszczyński Lech, Rewicki Marek
Oddział Kardiologii Centralnego Szpitala Kolejowego, Warszawie.
Pol Arch Med Wewn. 2004 Jan;111(1):21-5.
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.
动脉粥样硬化在多个动脉床同时发展，这为诊断冠状动脉疾病创造了机会。本研究的目的是评估通过超声评估的外周动脉粥样硬化累及情况与血管造影显示的严重冠状动脉疾病之间的关联。研究纳入了410例计划进行冠状动脉造影的患者（73%为男性），平均年龄56.0±9.5岁。在对颈总动脉和股总动脉进行超声检查时，评估动脉壁内膜中层（IMT）厚度和动脉粥样硬化斑块的存在情况。冠状动脉造影诊断为严重冠状动脉疾病（CAD）的标准是直径狭窄>50%。有和没有严重冠状动脉疾病的两组患者的颈总动脉内膜中层厚度（IMT）没有差异（右侧分别为6.6 vs 6.4 mm，p=无统计学意义，左侧分别为6.9 vs 6.6 mm，p=无统计学意义），但股总动脉的IMT在冠状动脉疾病患者中更大（右侧分别为8.2 vs 7.1 mm，p<0.005，左侧分别为7.9 vs 7.1 mm，p=0.03）。CAD患者中颈动脉和股动脉粥样硬化斑块的检出率更高（90.1% vs 34.6%，p<0.0001）。在颈动脉或股动脉检测到斑块对CAD诊断的阳性预测值为93%，在所有动脉排除斑块后排除CAD的阴性预测值为61%。在外周动脉超声检查中寻找动脉粥样硬化斑块可能有助于特定患者群体的CAD诊断。
