The Predictive Value Of Carotid Ultrasound In Coronary Artery Lesions

Objective: To investigate the value of non-invasive carotid ultrasound (CAU) inpredicting and Screening coronary heart disease(CHD) patients in high-risk populationand the possibility to presume coronary plaque character by carotid plaque characteristics.Methods: CAU and coronary angiography (CAG) were performed in 80 patientssuspected of CHD. 20 of them received further coronary intravascular ultrasonography(IVUS). Subjects were divided into 3 groups (CAG normal group, 1 vascular lesion groupand multi-vessel lesion group) according to the results of CAG. The correlation betweencarotid vascular lesions detected by CAU and coronary artery lesions detected by CAG,the correlation between carotid vascular lesions detected by CAU and coronary arterylesions detected by IVUS were analyzed.Results: 1. Comparing the results of CAU and CAG: The occurrence of carotidatherosclerosis plaques predicts the presence of CHD with a sensitivity of 90.9%, aspecificity of 72.2%, and a positive predictive value of 80%, a negative predictive value of86.7%, and a diagnosis coincidence rate of 82.5%. IMT≥1.0mm by CAU predicts CHDwith a sensitivity of 93.1%, a specificity of 55.6%, and a positive predictive value of71.9%, a negative predictive value of 86.9%, and a diagnosis coincidence rate of 76.3%.2. The relationship between the carotid atherosclerosis degree and the degree ofcoronary artery lesion:①The max IMT, plaque Crouse score and plaque index (PI) in themulti-vessel lesion group were higher than those in the CAG normal group and 1-vessellesion group(p value respectively＜0.05, 0.01). These parameters in 1-vessel lesion grouphad were also higher than those in CAG normal group, but had no statistically significantdifference (p＞0.05).②the occurrence rate of carotid artery stenosis in multi-vessel lesiongroup and 1-vessel lesion group was higher than that in CAG normal group (p＜0.01), but no significant difference between the multi-vessel lesion group and 1-vessel lesion group(p＞0.05).③correlation analyzing: The max IMT, plaque Crouse score, PI and theoccurrence rate of carotid artery stenosis were positive correlated with the degree ofcoronary artery lesions (Spearman r_i respectively: 0.82, 0.71, 0.52, 1.0).④Theratio of the peak flow speed in both internal carotid artery (ICA) and common carotidartery (CCA) was not significantly different among the three groups (p＞0.05).3. The correlation between carotid vascular lesions by CAU and coronary arterylesions by IVUS: Our results showed the detection ratio of plaques in carotid and coronaryartery with two methods had no significant variance (McNemar p values respectively:applanation plaque 0.289, soft plaque 1.00, calcification plaque 0.508, commixture plaque1.00). Consistency test showed that the Kappa values respectively were 0.49, 0.483 in thedetection ratio of soft and commixture plaque with two methods. It indicated that twomethods possessed midrange consistency. The soft and commixture plaque in carotidartery detected by non-invasive CAU indirectly reflected the plaque character in coronaryartery to a degree.20 patients received IVUS were divided into 2 groups (soft plaque group and non-softplaque group) according to the character of the plaque. There were 11 cases in the formergroup(mean EI 3.64±1.37, mean RI 1.26±0.24) and 9 cases in the latter((mean EI1.94±1.67, mean RI 0.97±0.14). The EI and RI in the soft plaque group weresignificantly higher than those in the non-soft plaque group (EI p=0.002, RI p=0.005, all＜0.01).4. Comparing the results between CAG and IVUS: The stenosis extent of coronaryartery by IVUS was significantly different compared with that by CAG (p=0.001). IVUSwas superior to CAG in estimating the extent of coronary artery lesions. The CAGpossibly underestimated the stenosis caused by vascular lesions.5. Multi-vessel lesion group have higher mortality of diabetics, smoking, and higherSBP, TG, LDL-C compared with CAG normal group. HDL-C in former group was lowerthan that in the latter group (p＜0.05). But no differences were found between multi-vesselgroup and 1-vessel group; and no differences were found between 1-vessel group and CAG normal group (p＞0.05).Conclusion: The atherosclerosis occurrence rate and extent in carotid and incoronary artery had good correlation. The stenosis extent of carotid artery (＞50%), maxIMT, plaque Crouse score and PI are the sensitive parameters for predicting coronaryartery AS lesions. The soft and commixture plaque in carotid artery detected by CAUindirectly reflected the plaque character of coronary artery to a degree. CAU may be asimple and non-invasive method to reflect the plaque character of coronary artery.ⅣUS issuperior to CAG in estimating the extent of coronary artery lesions. With CAG it ispossible to underestimate the extent of coronary vascular lesions. Aging, history of DMsmoking, high SBP, high TG, high LDL-C and low HDL-C are the risk factors of CHD.CAU can be used as a screen method to detect CHD in high risk population.