Department of Cardiology, Cardinal Wyszynski Hospital, Lublin, Poland.
Kardiol Pol. 2013;71(8):810-7. doi: 10.5603/KP.2013.0192.
The lumen diameter (LD) of the extracranial carotid arteries determined by B-mode ultrasound has been provedto be associated with most atherosclerotic risk factors and cardiovascular events. This raises the question as to whether LDmay also predict coronary artery disease.
To elucidate whether LD of the common carotid and/or femoral artery could be a clinically useful marker of the extentof coronary atherosclerosis.
A duplex ultrasonography and a quantitative coronary angiography were used to assess carotid, femoral and coronary atherosclerosis for 204 patients with angina pectoris. Intima-media thickness (IMT) and LD assessments were performed in peripheral arteries. We used three coronary angiographic scores: Vessel, Gensini and Extent. The following parameterswere recorded: gender, age, diagnoses of arterial hypertension and diabetes, history of myocardial infarction (MI) and stroke, smoking status, body mass index (BMI) and body surface area (BSA).
Significant correlations between LD, IMT and coronary scores were found, but the strongest correlations were betweenLD of the common carotid arteries and angiographic scores. In the case of LD in all investigated arteries, and IMT ofthe right carotid and left femoral arteries, significantly higher values were observed for patients with three-vessel disease (3VD) than for patients without it. Univariate analysis showed the important role played by LD of the carotid arteries in predicting 3VD (OR = 2.7). We obtained two multivariate logistic regression models which could estimate the probability P of 3VD. The first model:logit P = 0.05 age + 0.94 RCCALD + 0.70 MI - 9.1; AUC=0.80 (0.03) is based on the value of the right common carotid artery lumen diameter (RCCALD), age and history of MI; the second oneis based on LD of the left common carotid artery, gender, age and previous MI. ROC analysis indicated the optimal cut-offvalue for prediction of 3VD (P = 0.36), with high sensitivity (80%) and specificity (70%) for the first model.
According to our results, LD of the common carotid artery appears to be an independent predictor of 3VD. RCCLD turned out to be a basic prognostic variable (called 'risk variable') of the extent of coronary atherosclerosis afteradjustment for age and prior MI. Measurements of common carotid artery LD, together with age, history of MI (and gender in the case of the left common carotid artery LD), could estimate the probability of 3VD. Other studies will be necessary to confirm our results before the obtained method can be used in clinical practice as a simple non-invasive diagnostic tool for a specific group of patients.
经 B 型超声检测的颅外颈动脉腔直径（LD）已被证实与大多数动脉粥样硬化危险因素和心血管事件相关。这引发了一个问题，即 LD 是否也可以预测冠状动脉疾病。
阐明颈总动脉和/或股动脉的 LD 是否可以作为冠状动脉粥样硬化严重程度的临床有用标志物。
对 204 例心绞痛患者进行了双功能超声和定量冠状动脉造影，以评估颈动脉、股动脉和冠状动脉的粥样硬化。在周围动脉中进行了内膜中层厚度（IMT）和 LD 评估。我们使用了三个冠状动脉评分：血管、Gensini 和程度。记录了以下参数：性别、年龄、动脉高血压和糖尿病的诊断、心肌梗死（MI）和中风史、吸烟状况、体重指数（BMI）和体表面积（BSA）。
发现 LD、IMT 和冠状动脉评分之间存在显著相关性，但颈总动脉 LD 与血管造影评分之间的相关性最强。在所有研究动脉的 LD 和右颈动脉及左股动脉的 IMT 中，三血管病变（3VD）患者的数值明显高于无 3VD 患者。单变量分析显示颈动脉 LD 在预测 3VD 中的重要作用（OR=2.7）。我们获得了两个可以估计 3VD 概率 P 的多元逻辑回归模型。第一个模型：logit P = 0.05 年龄+0.94 RCCALD+0.70 MI-9.1；AUC=0.80（0.03）基于右侧颈总动脉腔直径（RCCALD）、年龄和 MI 史的值；第二个模型基于左颈总动脉 LD、性别、年龄和先前的 MI。ROC 分析表明，预测 3VD 的最佳截断值为 P=0.36，第一个模型的灵敏度为 80%，特异性为 70%。
根据我们的结果，颈总动脉 LD 似乎是 3VD 的独立预测因子。在调整年龄和先前的 MI 后，RCCLD 被证明是冠状动脉粥样硬化严重程度的基本预后变量（称为“风险变量”）。测量颈总动脉 LD，结合年龄、MI 史（在左颈总动脉 LD 的情况下为性别），可以估计 3VD 的概率。在获得的方法可作为特定患者群体的简单无创诊断工具用于临床实践之前，还需要进行其他研究来证实我们的结果。
