Mutlu Bulent, Tigen Kursat, Gurel Emre, Ozben Beste, Karaahmet Tansu, Basaran Yelda
Department of Cardiology, Marmara University Faculty of Medicine, Istanbul, Turkey.
Echocardiography. 2011 Nov;28(10):1141-7. doi: 10.1111/j.1540-8175.2011.01492.x. Epub 2011 Aug 19.
Multidetector row computed tomography (MDCT) is an attractive noninvasive alternative to assess overall coronary artery disease (CAD) burden and may reveal coronary plaques, which may be underestimated by conventional coronary angiography. The aim of this study was to determine whether brachial artery flow-mediated dilation (FMD) and carotid artery intima-media thickness (CIMT) might accurately predict patients with occult coronary plaques whose conventional coronary angiographies revealed normal coronary arteries (NCA).
Thirty-five patients with angiographically NCA were consecutively recruited into the study. They underwent MDCT and were divided into NCA group (18 patients; 8 male; 47 ± 9 years) and occult CAD group (17 patients; 11 male; 50 ± 10 years) according to presence of coronary plaque. Nineteen consecutive patients with evident CAD (16 male; 54 ± 7 years) and 19 healthy subjects (10 male; 50 ± 6 years) were included as control groups. FMD and CIMT were measured by brachial and carotid artery ultrasonography.
Occult CAD group had significantly lower FMD and insignificantly higher CIMT than NCA group whereas they had significantly higher FMD and insignificantly lower CIMT than evident CAD group. NCA group had significantly lower CIMT than evident CAD group. Receiver operating characteristic curve analysis demonstrated FMD < 8% (sensitivity: 94.4%; specificity: 73.0%; PPV: 77.3%; NPV: 93.1%) and CIMT ≥ 0.65 cm (sensitivity: 72.2%; specificity: 62.2%; PPV: 65.0%; NPV: 69.7%) could predict patients with CAD. FMD and CIMT were independent predictors of CAD (P < 0.001; OR: 45.630; 95%CI: 5.38-386.983 and P = 0.015; OR: 14.226; 95%CI: 1.666-121.467, respectively).
FMD and CIMT might predict patients with occult CAD and be helpful in selecting patients for MDCT.
多排螺旋计算机断层扫描（MDCT）是评估冠状动脉疾病（CAD）总体负担的一种有吸引力的非侵入性替代方法，它可能揭示冠状动脉斑块，而传统冠状动脉造影可能会低估这些斑块。本研究的目的是确定肱动脉血流介导的血管舒张（FMD）和颈动脉内膜中层厚度（CIMT）是否能准确预测隐匿性冠状动脉斑块患者，这些患者的传统冠状动脉造影显示冠状动脉正常（NCA）。
连续招募35例冠状动脉造影显示NCA的患者进入本研究。他们接受了MDCT检查，并根据冠状动脉斑块的存在情况分为NCA组（18例患者；8例男性；47±9岁）和隐匿性CAD组（17例患者；11例男性；50±10岁）。连续纳入19例明显CAD患者（16例男性；54±7岁）和19例健康受试者（10例男性；50±6岁）作为对照组。通过肱动脉和颈动脉超声测量FMD和CIMT。
隐匿性CAD组的FMD显著低于NCA组，CIMT略高于NCA组；而隐匿性CAD组的FMD显著高于明显CAD组，CIMT略低于明显CAD组。NCA组的CIMT显著低于明显CAD组。受试者工作特征曲线分析表明，FMD<8%（敏感性：94.4%；特异性：73.0%；阳性预测值：77.3%；阴性预测值：93.1%）和CIMT≥0.65 cm（敏感性：72.2%；特异性：62.2%；阳性预测值：65.0%；阴性预测值：69.7%）可预测CAD患者。FMD和CIMT是CAD的独立预测因素（P<0.001；OR：45.630；95%可信区间：5.38 - 386.983；P = 0.015；OR：14.226；95%可信区间：1.666 - 121.467）。
FMD和CIMT可能预测隐匿性CAD患者，并有助于选择进行MDCT检查的患者。
