Cardiovascular Center, Konkuk University Hospital, Seoul, Korea.
Korean Circ J. 2010 Dec;40(12):665-70. doi: 10.4070/kcj.2010.40.12.665. Epub 2010 Dec 31.
Coronary artery disease (CAD) is a major cause of heart failure associated with left ventricular systolic dysfunction (LVSD). The prognosis of LVSD is significantly influenced by the etiology of heart failure and therefore, differentiation of significant CAD from other etiologies is important. Carotid intima-media thickness (IMT) and plaque are useful predictors for cardiovascular events, including stroke and CAD. The purpose of this study was to evaluate the predictive value of carotid IMT and plaque for the diagnosis of CAD in LVSD patients.
Seventy-three (n= 73, 47 male, 67.6±12.4 years) patients hospitalized for heart failure with severe LVSD were retrospectively enrolled. The severity of CAD was analyzed by the Duke Jeopardy Score system, and carotid IMT and plaque were measured according to the Mannheim Carotid IMT Consensus.
Significant CAD was found in 41 patients (56.1%, CAD group) on coronary angiography. Mean common carotid artery (CCA) IMT (0.74±0.05 mm vs. 1.04±0.04 mm, p<0.01) was significantly higher in the CAD group. Plaque in CCA (6.25% vs. 19.5%, p<0.01) and plaque in bulb (25.0% vs. 60.9%, p<0.001) were significantly higher in the CAD group. Mean CCA IMT {odds ratio (OR) 2.61, 95% confidence interval (CI) 1.134-4.469, p<0.01} and plaque in bulb (OR 4.69, 95% CI 1.702-12.965, p<0.01) were significant predictors for the diagnosis of CAD according to multivariate logistic regression analysis.
In patients with severe LVSD, mean CCA IMT and bulb plaque can be useful additional predictors for the diagnosis of CAD.
冠心病（CAD）是心力衰竭合并左心室收缩功能障碍（LVSD）的主要原因。LVSD 的预后受心力衰竭病因的显著影响，因此，区分 CAD 和其他病因至关重要。颈动脉内膜中层厚度（IMT）和斑块是心血管事件（包括中风和 CAD）的有用预测指标。本研究旨在评估颈动脉 IMT 和斑块对 LVSD 患者 CAD 诊断的预测价值。
回顾性纳入 73 名（n=73，47 名男性，67.6±12.4 岁）因严重 LVSD 住院的心力衰竭患者。通过 Duke 危险评分系统分析 CAD 的严重程度，并根据曼海姆颈动脉 IMT 共识测量颈动脉 IMT 和斑块。
冠状动脉造影显示 41 名患者（56.1%，CAD 组）存在显著 CAD。CAD 组的颈总动脉（CCA）平均 IMT（0.74±0.05mm 比 1.04±0.04mm，p<0.01）显著更高。CCA 斑块（6.25%比 19.5%，p<0.01）和球部斑块（25.0%比 60.9%，p<0.001）在 CAD 组中也显著更高。多变量逻辑回归分析显示，CCA 平均 IMT（优势比（OR）2.61，95%置信区间（CI）1.134-4.469，p<0.01）和球部斑块（OR 4.69，95% CI 1.702-12.965，p<0.01）是 CAD 诊断的显著预测因子。
在严重 LVSD 患者中，CCA 平均 IMT 和球部斑块可作为 CAD 诊断的有用附加预测因子。
