[Importance of ischemic heart disease in patients with carotid arteriosclerosis and lower extremity arteriopathy. Results of a prospective study].

OBJECTIVES

Myocardial ischemia (MI) is a frequent cause of morbility and mortality in patients with carotid atherosclerosis (CA) independently of the symptomatology. The objective of our study was the identification of MI through clinical-history or as revealed by the stress test.

METHODS

The study considered a consecutive series of patients with significant CA (stenosis > or = 50%), studied with echo-B mode and Doppler velocity scans chosen from all patients in the diagnostic vascular cerebral laboratory, between May 1992 and January 1994, for a non invasive study of neck arteries. The protocol of the multidisciplinary study included: history of risk factors (RF); neurologic evaluation; peripheral vascular evaluation with Doppler velocity scans; cardiac evaluation, and patients without clinical history of MI underwent a maximal stress test (ST). If there was bilateral carotid occlusion or non-evaluated ST the patients underwent echo-stress with dipyridamole (ED) or myocardial scintigraphy stress test (MS); haematologic tests, CT in patients with symptoms of cerebral ischemia; arteriography of epi-aortic arteries in patients with indication for carotid enderterectomy.

RESULTS

133 patients were studied (age 48-80). Neurologic symptoms were present in 67.67%; of the RF, smoke was present in 62.48%, blood hypertension (BH) in 58.64% and family history in 36.84%. The MI was affirmed in 64 patients (48.12%): in 41 with clinical history, in 23 with ST. Of the 92 patients without clinical history: 4 with bilateral carotid occlusion underwent ED; 3 did not undergo ST, 85 underwent ST with negative results in 50, positive in 21, non-evaluated in 14 who underwent ED or MS with positive results of MI in 2. In 25% (23/92) ST revealed MI without previous history.

CONCLUSIONS

The patients with CA have high incidence of MI and of peripheral artery disease (PAD), in MI could be studied by ST. Age, smoke, BH, contribute substantially to the development of CA. PAD develops similarly to CA. MI is distributed independently of the severity of CA. A patient with CA, whatever his presentation, must be studied to reveal an eventual, latent or silent MI. It is this, in fact, which heavily conditions the prognosis.