Pipitone S, Corrado E, Muratori I, Novo G, Evola S, Fabbiano A, Trapani R, Zarcone P, Assennato P, Hoffmann E, Novo S
Department of Cardiovascular Diseases, Post-graduate School of Cardiology, University Hospital, University of Palermo, Palermo, Italy.
Int Angiol. 2007 Dec;26(4):346-52.
The aim of the present study was to investigate the prevalence of carotid and/or peripheral atherosclerotic lesions in patients with chronic ischemic heart disease (previous acute myocardial infarction [AMI] or stable angina).
We studied 248 patients (168 male and 80 female), mean age 63+/-10 years, which were investigated for traditional risk factors. Systolic blood pressure, body mass index, lipid profile, fasting glucose and plasma fibrinogen were also measured. We assessed the prevalence of atherosclerotic lesions in carotid and lower limb arteries, by ultrasound duplex scanning (UDS).
Angina was present in 33% of the patients, a previous AMI in 67%, a previous transient ischemic attack in 4% and a previous ischemic stroke in 6% of patients. A total of 195 patients underwent coronary angiography: 1 vessel was involved in 48% of patients, 2 vessels in 33%, and 3 vessels in 19%. Detecting peripheral atherosclerotic lesions by UDS, increased intima-media thickness (IMT) or plaques in carotid arteries were found in 232 patients (94%) and carotid stenosis >70% in 13 patients (5%). In lower limb arteries, IMT or plaques were present in 202 patients (82%) and a stenosis >70% in 18 patients (7%). Severity of coronary artery disease (CAD) was correlated to extracoronary atherosclerosis: carotid and lower limb arterial atherosclerosis was detected in 73% of patients with 1 vessel, in 83% of patients with 2 vessel, in 87% of those with 3 vessel CAD.
Our study suggests that in patients with CAD, it is useful to screen the peripheral circulation by non-invasive tests, such as UDS. Patients with the diagnosis of ischemic heart disease and combined extracoronary atherosclerosis need a careful follow-up and a more aggressive therapy for secondary prevention.
本研究旨在调查慢性缺血性心脏病（既往急性心肌梗死[AMI]或稳定型心绞痛）患者中颈动脉和/或外周动脉粥样硬化病变的患病率。
我们研究了248例患者（男性168例，女性80例），平均年龄63±10岁，对其进行了传统危险因素调查。还测量了收缩压、体重指数、血脂谱、空腹血糖和血浆纤维蛋白原。我们通过超声双功扫描（UDS）评估颈动脉和下肢动脉粥样硬化病变的患病率。
33%的患者有稳定型心绞痛，67%的患者有既往AMI，4%的患者有既往短暂性脑缺血发作，6%的患者有既往缺血性卒中。共有195例患者接受了冠状动脉造影：48%的患者单支血管受累，33%的患者双支血管受累，19%的患者三支血管受累。通过UDS检测外周动脉粥样硬化病变，232例患者（94%）发现颈动脉内膜中层厚度（IMT）增加或有斑块，13例患者（5%）颈动脉狭窄>70%。在下肢动脉，202例患者（82%）有IMT增加或斑块，18例患者（7%）狭窄>70%。冠状动脉疾病（CAD）的严重程度与冠状动脉外动脉粥样硬化相关：单支血管CAD患者中73%检测到颈动脉和下肢动脉粥样硬化，双支血管CAD患者中83%检测到，三支血管CAD患者中87%检测到。
我们的研究表明，对于CAD患者，通过UDS等非侵入性检查筛查外周循环是有用的。诊断为缺血性心脏病合并冠状动脉外动脉粥样硬化的患者需要仔细随访并采取更积极的二级预防治疗。
