Kasliwal Ravi R, Bansal Manish, Gupta Hansa, Agrawal Sweta
Department of Cardiology, Escorts Heart Institute and Research Centre, New Delhi, India.
Indian Heart J. 2007 Jan-Feb;59(1):50-5.
Previous studies have shown that carotid intima-media thickness correlates well with the presence and extent of coronary artery disease. This study was conducted to determine whether it could reliably predict the presence of left main coronary artery disease.
Common carotid intima-media thickness was measured in 50 patients with angiographically proven significant (> or =50%stenosis) left main coronary artery disease and in another 50 age- and sex-matched patients with coronary artery disease without the involvement of the left main coronary artery. Measurements of the carotid intima-media thickness were made on the far wall 1 cm from the distal end of the common carotid artery bilaterally, and the average and the greater of the two values thus obtained for each patient were used for analysis. Plaques were not included in the measurement of carotid intima-media thickness.
The average and greater of the two values were significantly higher in patients with left main coronary artery disease as compared to those without it (average intima-media thickness: 0.926 +/- 0.12 vs. 0.78 9 +/- 0.16 mm; p< 0.001; greater intima-media thickness: 0.994 +/- 0.13 vs. 0.844 +/- 0.20 mm; p< 0.001). The cut-off values of 0.81 mm for the average carotid intima-media thickness and 0.87 mm for the greater carotid intima-media thickness were found to have optimum sensitivity (92% and 90%, respectively) and specificity (60% and 64%, respectively) for the detection of left main coronary artery disease. A higher cut-off value of 1.0 mm increased specificity to 92% and 84%, respectively, for the average and greater thicknesses, but sensitivity decreased markedly.
There is a significant association between increased carotid intima-media thickness and the presence of left main coronary artery disease. The measurement of carotid intima-media thickness can be used with reasonably good sensitivity and specificity for the detection of left main coronary artery disease in patients who are undergoing evaluation for suspectedcoronary artery disease.
既往研究表明，颈动脉内膜中层厚度与冠状动脉疾病的存在及程度密切相关。本研究旨在确定其能否可靠预测左主干冠状动脉疾病的存在。
对50例经血管造影证实存在显著（≥50%狭窄）左主干冠状动脉疾病的患者以及另外50例年龄和性别匹配的无左主干冠状动脉受累的冠状动脉疾病患者测量颈总动脉内膜中层厚度。双侧在距颈总动脉远端1 cm处的远壁测量颈动脉内膜中层厚度，将每位患者由此获得的两个值的平均值及较大值用于分析。测量颈动脉内膜中层厚度时不包括斑块。
与无左主干冠状动脉疾病的患者相比，左主干冠状动脉疾病患者的两个值的平均值及较大值显著更高（平均内膜中层厚度：0.926±0.12 vs. 0.789±0.16 mm；p<0.001；较大内膜中层厚度：0.994±0.13 vs. 0.844±0.20 mm；p<0.001）。发现平均颈动脉内膜中层厚度的截断值为0.81 mm以及较大颈动脉内膜中层厚度的截断值为0.87 mm时，对检测左主干冠状动脉疾病具有最佳敏感性（分别为92%和90%）和特异性（分别为60%和64%）。较高的截断值1.0 mm分别使平均厚度和较大厚度的特异性提高到92%和84%，但敏感性显著降低。
颈动脉内膜中层厚度增加与左主干冠状动脉疾病的存在之间存在显著关联。在对疑似冠状动脉疾病进行评估的患者中，测量颈动脉内膜中层厚度可用于检测左主干冠状动脉疾病，其敏感性和特异性相当不错。
