Inci Mehmet Fatih, Özkan Fuat, Ark Bilal, Vurdem Ümit Erkan, Ege Meltem Refiker, Sincer Isa, Zorlu Ali
Department of Radiology, Sütçü İmam University Medical School, Kahramanmaraş, Turkey.
Ultrasound Q. 2013 Jun;29(2):125-30. doi: 10.1097/RUQ.0b013e318291580e.
The aim of our study was to investigate the relationship between age, sex, obesity, nonalcoholic fatty liver disease (NAFLD), carotid intima-media thickness (CIMT), and both the presence and severity of coronary artery disease (CAD) and their predictive value for the presence and severity of CAD.
Our study population consisted of 136 patients who underwent coronary angiography for various reasons. Gensini scoring was used to determine the severity of coronary atherosclerosis. Carotid intima-media thickness was estimated by carotid duplex ultrasound. Nonalcoholic fatty liver disease was diagnosed by abdominal ultrasonography. Body mass index (BMI) was calculated as kilograms divided by meters squared.
Coronary artery disease was detected in 74 patients (54%). In the whole group, patients with CAD had significantly higher CIMT measurements compared with those without CAD (0.93 [SD, 0.14] and 0.72 [SD, 0.12] mm, respectively, P < 0.001). Carotid intima-media thickness was correlated with BMI (P < 0.001, r = 0.453), age (P = 0.001, r = 0.389), and grade 2-3 NAFLD (P < 0.001, r = 0.356). In the multiple logistic regression model, CIMT (odds ratio, 1.189; 95% confidence interval, 1.122-1.261; P < 0.001) was the only independent predictor of the presence of CAD. In receiver operating characteristic curve analysis, optimal cutoff value of CIMT to predict the presence of CAD was found as greater than 0.75 mm with 93.2% sensitivity and 71% specificity. In CAD group patients, Gensini score was correlated with CIMT (P < 0.001, r = 0.604), grade 2-3 NAFLD (P < 0.001, r = 0.534), BMI (P < 0.001, r = 0.498), and age (P = 0.001, r = 0.385). In the multiple stepwise linear regression model, CIMT (β = 0.444, P < 0.001) and grade 2-3 NAFLD (β = 0.353, P < 0.001) were associated with severity of CAD.
Our data suggest that CIMT is a strong independent predictor for the presence and severity of CAD. Furthermore, moderate to severe hepatosteatosis is also significantly associated with the severity of CAD. Therefore, detection of CIMT and NAFLD by ultrasonography, which is a very cheap, safe, and noninvasive radiological modality, can be used to improve CAD risk prediction.
本研究旨在探讨年龄、性别、肥胖、非酒精性脂肪性肝病（NAFLD）、颈动脉内膜中层厚度（CIMT）与冠状动脉疾病（CAD）的存在及严重程度之间的关系，以及它们对CAD存在及严重程度的预测价值。
我们的研究人群包括136例因各种原因接受冠状动脉造影的患者。采用Gensini评分来确定冠状动脉粥样硬化的严重程度。通过颈动脉双功超声估计颈动脉内膜中层厚度。通过腹部超声诊断非酒精性脂肪性肝病。体重指数（BMI）计算为千克除以米的平方。
74例患者（54%）检测出患有冠状动脉疾病。在整个研究组中，CAD患者的CIMT测量值显著高于无CAD患者（分别为0.93[标准差，0.14]和0.72[标准差，0.12]mm，P<0.001）。颈动脉内膜中层厚度与BMI（P<0.001，r=0.453）、年龄（P=0.001，r=0.389）和2-3级NAFLD（P<0.001，r=0.356）相关。在多元逻辑回归模型中，CIMT（比值比，1.189；95%置信区间，1.122-1.261；P<0.001）是CAD存在的唯一独立预测因素。在受试者工作特征曲线分析中，预测CAD存在时CIMT的最佳截断值被发现大于0.75mm，敏感性为93.2%，特异性为71%。在CAD组患者中，Gensini评分与CIMT（P<0.001，r=0.604）、2-3级NAFLD（P<0.001，r=0.534）、BMI（P<0.001，r=0.498）和年龄（P=0.001，r=0.385）相关。在多元逐步线性回归模型中，CIMT（β=0.444，P<0.001）和2-3级NAFLD（β=0.353，P<0.001）与CAD的严重程度相关。
我们的数据表明，CIMT是CAD存在及严重程度的有力独立预测因素。此外，中度至重度肝脂肪变性也与CAD的严重程度显著相关。因此，通过超声检查检测CIMT和NAFLD，这是一种非常廉价、安全且无创的影像学检查方法，可用于改善CAD风险预测。
