A Study Of The Relationship Between Intima Thickness Of Arteries Measured By Non-invasive High Resolution Ultrasound And Cardiovascular Risk Factors

BackgroundCoronary atherosclerosis is the main pathological change of myocardial ischemia caused by coronary artery disease(CAD).As a systemic disease,atherosclerosis(AS)often involves coronary artery,cerebral artery and other important organs,as well as carotid artery and peripheral artery.Carotid artery is the predilection site of AS,carotid atherosclerosis can be evaluated by the carotid intima-media thickness(CIMT)detection of ultrasound.However,IMT contains the intima and the medial thickness.The commonly used ultrasound technology in clinical practice today cannot distinguish the boundary between the intima and the medial thickness due to resolution and frequency,and the early lesions of AS mainly occur in the intima of artery.Affected by the artery media thickness,IMT has some limitations in the reflection of early atherosclerotic diseases,If other pathological changes lead to the proliferation of the media,it can cause the false positive of AS.Therefore,the measurement of the intima alone may be a better reflection of early AS lesions.Meanwhile,radial artery and dorsal podiatric artery have also been proved to be the predilection site of AS lesions.So far,there was no reported on the relationship between the intimal thickness of carotid artery,radial artery and dorsalis pedis artery and cardiovascular risk factors by ultrasound.Therefore,this study intends to use the latest 24-MHz high-resolution ultrasound technology to detect the intima thickness of artery,analyzes the related factors that lead to intima thickening,provides theoretical basis for early identification and intervention of AS lesions.And discusses the relationship between intima thickness and coronary artery stenosis and coronary heart disease.Objectives1.To explore the related factors and differences of intima thickening of carotid,radial and dorsal arteries,so as to provide theoretical basis for early identification and intervention of atherosclerosis.2.To investigate the relationship between intima thickness of carotid artery,radial artery,dorsalis pedis artery and coronary artery lesions,and to investigate the predictive value of coronary atherosclerotic lesions.3.To explore the correlation and difference of intima thickness between different arteries.Methods1.Study population95 patients with coronary atherosclerotic heart disease diagnosed by coronary angiography were enrolled as coronary heart disease group in Shandong University Qilu Hospital from May 2019 to November 2019,and another 50 subjects without coronary heart disease were included as the control group.2.Data collection2.1 General dataGender,age,height,weight,history of hypertension,history of diabetes,history of smoking,history of statins,systolic blood pressure,diastolic blood pressure and other general information were recorded,calculate body mass index according to height and weight.And the total cholesterol,low-density lipoprotein cholesterol,high density lipoprotein cholesterol,triglyceride,fasting blood glucose,homocysteine,creatinine,alanine aminotransferase and other laboratory indicators were collected at the same time.2.2 Ultrasonography and indexA 24-MHz frequency linear transducer was connected to an ultrasound system(Aplio i900,Canon-Toshiba Ultrasound,Tochigi-ken,Japan).Ultrasound images of the carotid artery were collected at the posterior wall of the vessels 2cm and 1cm away from the bifurcation of the carotid artery on both sides of the common carotid artery,and at the posterior wall of the vessels 1cm away from the bifurcation on both sides of the internal carotid artery.Ultrasound images of the radial artery were collected at the posterior wall of the vessels 1-2cm above the styloid on both sides,Ultrasound images of the dorsal podiatric artery were collected at the posterior wall 2-3cm below the line of medial and lateral malleolus on both sides.At the end of diastole,the carotid intima thickness(CIT),carotid intima thickness(CMT),radial intima thickness(RIT),radial intima thickness(RMT),dorsalis pedis artery intima thickness(PIT),dorsalis pedis artery intima thickness(PMT)were measured in all subjects.All the above data were taken from the bilateral average level,and to measure 3 times take its average.3.Statistical analysisSPSS 23 and MedCalc 19 statistical software were used for analysis.The measurement data was expressed as mean± standard deviation,and the classification data was expressed as percentage.K-S test was used to test the normality.T-test was used for comparison of two independent groups.Chi-square test was used for comparison of categorical data.The-one-way ANOVA test was used for comparison of multi group.Multiple linear regression and Logistic regression were used for multifactor analysis.ROC curve analysis was used for the diagnostic value,The level of statistical significance was set at p<0.05.Results1.Baseline data1.1 General data comparisonCompared with the control group,the age,BMI,prevalence of hypertension,prevalence of diabetes,history of statins,TG,HCY and CR levels of patients in the coronary heart disease group were significantly increased,the difference is statistically significant(P<0.05),and the levels of TC,HDL-C and LDL-C were significantly decreased(P<0.01).There was no significant difference in gender,smoking history,SBP,DBP,GLU and ALT between the two groups(P>0.05).1.2 Ultrasonic data comparisonCompared with the control group,CIT,RIT and PIT in the coronary heart disease group were significantly increased(P<0.01).There was no significant difference between CMT,RMT and PMT(P>0.05).2.Related factors of intima thickness2.1 Comparison of ultrasonic indicators among subgroups with different risk factors combinedAll subjects were further divided into subgroups according to the main related factors of atherosclerosis:CIT,CMT,RIT,RMT and PIT in the hypertension group were significantly higher than those in the non-hypertension group(P<0.05).CIT,RIT and PIT in the diabetic group were significantly higher than those in the non-diabetic group(P<0.01).RIT and PIT in the obese group were significantly higher than those in the non-obese group(P<0.05).CIT,RIT,RMT and PIT in the smoking group were significantly higher than those in the non-smoking group(P<0.05).CIT,RIT and PIT in the dyslipidemia group were significantly higher than those in the non-dyslipidemia group(P<0.01).2.2 Comparison of ultrasonic indicators with different numbers of risk factors combinedCIT,RIT and PIT were significantly higher in the 2 risk factors group and the?3 risk factors group than in the 0 risk factor group(P<0.05).CIT,RIT and PIT were significantly higher in the 2 risk factor groups and the?3 risk factors group than in the 1 risk factor group(P<0.05).PIT was significantly higher in the?3 risk factors group than in the 2 risk factors group(P<0.05),and CIT,RIT and PIT showed an increasing trend as the number of risk factors increased.RMT in the?3 risk factors group was significantly higher than that in the 1 risk factor group(P<0.05),and there was no statistically significant difference in ultrasound indicators between the other groups(P>0.05).2.3 Linear correlation analysisLinear correlation analysis indicated that CIT was significantly correlated with RIT,PIT,age,hypertension history,TG,TC,HDL-C,LDL-C,HCY and CR(P<0.05).RIT was significantly correlated with CIT,PIT,BMI,age,TG,TC,HDL-C,LDL-C and HCY(P<0.05).PIT was significantly correlated with CIT,RIT,BMI,age,SBP,hypertension history,TC,HDL-C and LDL-C(P<0.05).2.4 Linear regression analysisMultiple linear regression analysis indicated that the main influencing factors of CIT were age,hypertension,smoking and HDL-C(P<0.05).The main influencing factors of RIT were age,BMI,hypertension,diabetes,smoking and HDL-C(P<0.05).The main influencing factors of PIT were age,BMI,smoking,HDL-C,and GLU(P<0.05).3.Relationship between intima thickness and coronary heart disease3.1 Comparison of general data between subgroups and control groupAmong patients in coronary heart disease group,the differences of general data between the single-vessel disease group,the double-vessel disease group,the triple-vessel disease group and the control group were compared.The results showed that there were significant differences in BMI,smoking history,hypertension prevalence rate,history of statins,TG,TC,HDL-C,LDL-C,HCY and CR among the four groups(P<0.05).The BMI,prevalence rate of hypertension,history of statins,TG and CR in the single-vessel disease group were significantly higher than those in the control group,while HDL-C and LDL-C were significantly lower than those in the control group(P<0.05).The prevalence rate of hypertension,history of statins,GLU,HCY and CR in the double-vessel disease group were significantly higher than those in the control group,while TC,HDL-C and LDL-C were significantly lower than those in the control group(P<0.05).Age,BMI,smoking,hypertension,statins history,TG,GLU and CR were significantly higher in the triple-vessel disease group than in the control group,while TC,HDL-C and LDL-C were significantly lower in the control group(P<0.05).The smoking rate of the triple-vessel disease group was significantly higher than that in the single-vessel disease group,while the diastolic blood pressure was significantly higher than that in the double-vessel disease group(P<0.05).3.2 Comparison of ultrasonic data between subgroups and control groupThe results showed that there were significant differences in CIT,RIT and PIT between the four groups(P<0.01).CIT,RIT and PIT in the single-vessel disease group were significantly higher than those in the control group(P<0.05).CIT,RIT and PIT in the double-vessel disease group were significantly higher than those in control group,while CIT and CMT were significantly higher than those in the single-vessel disease group(P<0.05).CIT,RIT and PIT in the triple-vessel disease group were significantly higher than those in control group,while CMT and RIT were significantly higher than those in the single-vessel disease group and RIT were significantly higher than those in double-vessel disease group(P<0.05).The thickness of intima showed an increasing trend as the severity of coronary artery disease increased.3.3 Analysis of risk factors for coronary heart diseaseBinary Logistic regression analysis suggested that CIT,RIT and PIT were independently correlated with coronary heart disease(P<0.01),and other related factors included TC,HDL-C,LDL-C and hypertension(P<0.05).3.4 The diagnostic value of intimal thickness and traditional risk factors for coronary heart diseaseThe AUC of CIT in diagnosis of coronary heart disease was 0.919(P<0.01),the sensitivity was 86%and the specifCcity was 90%with the cut-off value was 29×10-2mm.The AUC of RIT in diagnosis of coronary heart disease was 0.879(P<0.01),the sensitivity was 79%and the specificity was 90%with the cut-off value was 12.5×10-2mm.The AUC of PIT in diagnosis of coronary heart disease was 0.833(P<0.01),the sensitivity was 94%and the specificity was 58%with the cut-off value was 10.5×10-2mm The AUC of CIT,PIT combined in diagnosis of coronary heart disease was 0.95,the sensitivity was 94%and the specificity was 84%.Compared with CIT,RIT and PIT,the diagnostic value of this model for CHD was significantly increased(P<0.05).The AUC of traditional risk factors in diagnosis of coronary heart disease was 0.888(P<0.01).Compared with traditional risk factors,the diagnostic ability of CHD was significantly increased when CIT(AUC:0.888 vs.0.941),RIT(AUC:0.888 vs.0.936),PIT(AUC:0.888 vs.0.927)were introduced separately and simultaneously(AUC:0.888 vs.0.954)on the basis of traditional risk factors(P<0.05).However,when CIT,RIT and PIT were introduced simultaneously on the basis of traditional risk factors,compared with CIT,RIT and PIT alone,its diagnostic value did not increase significantly(P>0.05).Conclusions1.Intimal thickness of carotid,radial and dorsal foot arteries was closely related to cardiovascular risk factors.The intima thickness of patients with hypertension,diabetes,smoking,obesity and dyslipidemia is significantly higher than those without above factors.The thickness of intima shows an increasing trend as the number of risk factors increases.The influencing factors of intima thickness at different sites are consistent and different.Moreover,there is a good correlation among CIT,RIT and PIT.2.CIT,RIT and PIT in CHD patients are significantly higher than those in non-CHD patients.The thickness of intima shows an increasing trend as the range of coronary artery disease increases.CIT,RIT and PIT have high independent and combined diagnostic value for CHD.The introduction of CIT,RIT,PIT separately and simultaneously on the basis of traditional risk factors can increase the diagnostic ability of CHD significantly.