Sinha Dhurjati Prasad, Das Munna, Banerjee Amal Kumar, Ahmed Shageer, Majumdar Sonali
Cardiology Division, Institute of Cardiovascular Sciences, Institute of Postgraduate Medical Education and Research and SSKM Hospital, Kolkata.
J Indian Med Assoc. 2008 Feb;106(2):86, 88, 90 passim.
Anginal symptoms are less predictive of abnormal coronary anatomy in women. The diagnostic accuracy of exercise treadmill test for obstructive coronary artery disease is less in young and middle aged women. High sensitive C-reactive protein has shown a strong and consistent relationship to the risk of incident cardiovascular events. Carotid intima media thickness is a non-invasive marker of atherosclerosis burden and also predicts prognosis in patients with coronary artery disease. We investigated whether incorporation of high sensitive C-reactive protein and carotid intima media thickness along with exercise stress results improved the predictive accuracy in perimenopausal non-diabetic women subset. Fifty perimenopausal non-diabetic patients (age 45 +/- 7 years) presenting with typical angina were subjected to treadmill test (Bruce protocol). Also carotid artery images at both sides of neck were acquired by B-mode ultrasound and carotid intima media thickness were measured. High sensitive C-reactive protein was measured. Of 50 patients, 22 had a positive exercise stress result. Coronary angiography done in all 50 patients revealed coronary artery disease in 10 patients with positive exercise stress result and in 4 patients with negative exercise stress result. Treadmill exercise stress test had a sensitivity of 71.4%, specificity of 66.7% and a negative predictive accuracy of 85.7% in this study group. High sensitive C-reactive protein in patients with documented coronary artery disease was not significantly different from those without coronary artery disease (4.8 +/- 0.9 mg/l versus 3.9 +/- 1.7 mg/l, p=NS). Also carotid intima media thickness was not significantly different between either of the groups with coronary artery disease positivity and negativity respectively (left: 1.25 +/- 0.55 versus 1.20 +/- 0.51 mm, p=NS; right:1.18 +/- 0.54 versus 1.15 +/- 0.41 mm, p=NS). High sensitive C-reactive protein and carotid intima media thickness were not helpful in further adding to the predictability of coronary artery disease in perimenopausal patients with typical angina as assessed by treadmill exercise stress test.
心绞痛症状对女性冠状动脉解剖异常的预测价值较低。运动平板试验对中青年女性阻塞性冠状动脉疾病的诊断准确性较低。高敏C反应蛋白与心血管事件发生风险之间存在强烈且一致的关联。颈动脉内膜中层厚度是动脉粥样硬化负担的无创标志物，也可预测冠状动脉疾病患者的预后。我们研究了将高敏C反应蛋白和颈动脉内膜中层厚度与运动应激结果相结合，是否能提高围绝经期非糖尿病女性亚组的预测准确性。50例出现典型心绞痛的围绝经期非糖尿病患者（年龄45±7岁）接受了平板试验（Bruce方案）。同时，通过B型超声获取双侧颈部的颈动脉图像并测量颈动脉内膜中层厚度。检测高敏C反应蛋白。50例患者中，22例运动应激结果为阳性。对所有50例患者进行冠状动脉造影，结果显示运动应激结果阳性的10例患者及运动应激结果阴性的4例患者患有冠状动脉疾病。在该研究组中，平板运动应激试验的敏感性为71.4%，特异性为66.7%，阴性预测准确性为85.7%。有冠状动脉疾病记录的患者与无冠状动脉疾病的患者相比，高敏C反应蛋白无显著差异（4.8±0.9mg/L对3.9±1.7mg/L，p=无统计学意义）。同样，冠状动脉疾病阳性组和阴性组之间的颈动脉内膜中层厚度也无显著差异（左侧：1.25±0.55对1.20±0.51mm，p=无统计学意义；右侧：1.18±0.54对1.15±0.41mm，p=无统计学意义）。通过平板运动应激试验评估，高敏C反应蛋白和颈动脉内膜中层厚度无助于进一步提高围绝经期典型心绞痛患者冠状动脉疾病的预测性。
