Prediction of coronary atherosclerosis in young patients with coronary artery disease using a non-invasive biomarker

Abstract

Aim . To develop a combined biomarker for non-invasive diagnostics of the severity of coronary artery (CA) atherosclerosis in patients with coronary artery disease (CAD) and in those without clinical manifestations of atherosclerosis under 50 years of age using structural and functional parameters of large arteries and the lipid profile. Material and methods . A total of 92 patients with CAD and 28 healthy ones were included. Depending on the results of coronary angiography, patients with CAD were divided into 3 groups: without hemodynamically significant stenosis (HSS) (HSS 1<50% , n=30), with HSS of one CA (HSS 1>50% , n=37), with HSS of 2 and more CA (HSS 2>50% , n=25). The subjects underwent a biochemical blood test, carotid duplex ultrasound, volumetric sphygmography. Results . In individuals with HSS1<50%, lipid metabolism disorders were diagnosed in 63,3% (n=19), in HSS 1>50% group — 78,4% (n=29), in HSS2>50% group — 92% of cases (n=23) (p 1-3 <0,05). Carotid intima-media thickness exceeding the threshold level was found in 40% of patients with HSS 1<50% , in 51% of patients with HSS 1>50% and 64% of patients with HSS 2>50% (p 1-3 <0,05). According to the results of volumetric sphygmography, the severity of CA atherosclerosis was associated with a higher pulse wave velocity and L-/CAVI 1 . At the next stage, a complex parameter for predicting coronary atherosclerosis (CA biomarker) was developed, including sex, structural and functional indicators of the arteries (intima-media thickness, в-stiffness index, L-/CAVI 1 ) and biochemical parameters (total cholesterol, triglycerides, low density lipoproteins). In healthy people, the level of CA biomarker was 2,7 (95% CI, 2,3-3,9); in patients with CAD with any degree of CA lesion — 6,4 (95% CI, 5,2-9,6). The CA biomarker threshold of 5 points with a sensitivity of 87,5% and a specificity of 90,5% was determined as the optimal cut-off point; area under the curve — 0,965 (95% CI, 0,943-0,987) (p<0,0001). Conclusion . In patients with CAD, the presence and degree of coronary atherosclerosis are associated with the deterioration of most structural and functional artery parameters. The developed complex CA biomarker is of interest for non-in-vasive screening of preclinical CA atherosclerosis in patients with a low relative risk.