Role Of Carotid Intima-media Thickness Research Articles

Role of Carotid Intima-Media Thickness and Carotid Plaque in Predicting Significant Coronary Artery Stenosis in Thai Patients with Chronic Coronary Syndrome: A Cross-Sectional Study

Objective: To evaluate the diagnostic role of carotid artery intima-media thickness and plaque for significant coronary artery disease (CAD) in Thai patients with chronic coronary syndrome (CCS) when coronary angiography (CAG) was indicated. Material and Methods: The present study cross-sectional study included adult patients diagnosed with CCS admitted for elective CAG. One day prior or on the day of the procedure, carotid ultrasonography was performed, and diagnostic values of this test were calculated. Results: One hundred patients, including 69 males and 31 females, with a mean age ± standard deviation of 62.6±12.2 years were recruited. Sixty-three patients had significant CAD, of which carotid plaque (CP) was an independent risk factor (adjusted odds ratio 3.63, 95% confidence interval 1.17 to 11.22, p=0.025). From which, CP had a 29% prevalence, and provided a sensitivity, specificity, positive predictive value, and negative predictive value of 38%, 86%, 83%, and 45%, respectively, in predicting the disease. There was a weak correlation between carotid intima-media thickness and a significant disease (r=0.279, p=0.05), in addition to poor diagnostic accuracy of the calculated optimal cut-off value (area under the curve=0.68, p<0.05). Conclusion: CP was common, and specific for significant CAD in CCS with mild symptoms. This parameter might facilitate discriminating those having significant disease. Keywords: Carotid plaque; Coronary artery disease; Intima-media thickness; Ultrasonography

Carotid Artery Plaque Progression: Proposal of a New Predictive Score and Role of Carotid Intima-Media Thickness

Background: We aimed to investigate if the carotid intima-media thickness (IMT) at baseline and the HAD2S score, composed of the sum of single risk factors (hypertension, age ≥ 75 years, diabetes, dyslipidemia, smoking), were predictive of plaque progression. Methods: We performed a retrospective analysis on real-life prospectively collected data from patients with any detectable carotid plaque at follow up. The plaque score, calculated at baseline (T0) and at a median follow up of 36.6 months (IQR 39.6–34.3) (T3), was defined as 0: no plaque or stenosis < 30%; 1: stenosis in the range 30–49%; 2: in the range 50–69%; 3: in the range 70–99% and 4: occlusion. Carotid IMT was measured at T0 and T3; HAD2S score was calculated at baseline. Results: We included 340 patients with a mean age of 69.9 (9.1) years and 25.3% subjects had plaque progression. Individuals with progression had a median HAD2S score of 3 (1) while those without progression had 2 (1). Patients with progression had a mean baseline IMT of 0.86 (0.17) while those without progression had 0.77 (0.18) (p < 0.0001). A correlation between progression and baseline IMT was found (p = 0.002). Conclusion: Baseline IMT could be considered a predictor of progression. Patients with progression had an HAD2S score higher than those without evolution.

Carotid artery plaque progression: Proposal of a new predictive score and role of carotid intima-media thickness

Longitudinal changes in carotid intima-media thickness (IMT) and plaque are considered markers of atherosclerosis progression and predictors of cardio and cerebrovascular events. However, a clinical predictive risk score of plaque progression is currently lacking. We aimed to investigate if a new proposed risk score (HAD2S score) composed by the sum of single vascular risk factors (Hypertension, Age ≥ 75 years, Diabetes, Dyslipidemia and Smoking) and baseline IMT were predictive of plaque progression.

Diagnostic Role of Carotid Intima-Media Thickness for Coronary Artery Disease: A Meta-Analysis.

Background The present meta-analysis was conducted to confirm whether carotid intima-media thickness (IMT) could serve as an accurate diagnostic method for coronary artery disease (CAD). Methods Databases of PubMed, Google Scholar, and Embase were searched for potential articles. The articles were selected according to inclusion criteria. Pooled sensitivity and specificity with corresponding 95% confidence interval (CI) were used to confirm the diagnostic role of IMT for CAD. I2 and P value were used to assess the existence of heterogeneity. I2 and P value were used to assess the existence of heterogeneity. Results 22 eligible articles were selected in the present meta-analysis. Pooled sensitivity and specificity of IMT for diagnosing CAD were 0.68 (0.57–0.77) and 0.70 (0.64–0.75), respectively. The corresponding AUC was 0.74 (0.70–0.78). Subgroup analyses based on cutoff value of IMT were performed. A cutoff value of 1 mm was demonstrated to be much more accurate diagnostic criteria for CAD (sensitivity: 0.66; specificity: 0.79; AUC: 0.80). Sensitivity analysis indicated that the pooled results were robust. Deek's funnel plot indicated no significant publication bias (P value were used to assess the existence of heterogeneity. Conclusion Carotid IMT may serve as an accurate diagnostic tool. A cutoff value of 1 mm seems to provide much more accurate diagnostic results for CAD.

Prognostic role of carotid intima-media thickness in off-pump coronary artery bypass surgery

Carotid intima-media thickness (IMT) is a well-known predictor of adverse outcomes in the ischemic heart disease patients; however, evidence is lacking in patients undergoing off-pump coronary artery bypass surgery (OPCAB). Data from 407 patients who underwent OPCAB between April 2013 and August 2016 were retrospectively reviewed. A composite of cardiovascular morbidity endpoints was defined as the presence of stroke, acute myocardial infarction, new cardiac arrhythmia (newly developed atrial fibrillation, atrial flutter, or atrioventricular block), cardiovascular death, or cerebrovascular death within 30 days after surgery. Increased carotid IMT was defined as ≥0.9 mm on one or both sides. The incidence of a composite of cardiovascular morbidity endpoints was 24.0% in the normal IMT group (n = 221) and 34.4% in the increased IMT group (n = 186) (p = 0.021). Multivariable analysis revealed increased IMT (odds ratio 1.719, 95% confidence interval 1.108 to 2.666, p = 0.016) and preoperative renal replacement therapy (odds ratio 4.264, 95% confidence interval 1.679 to 10.829, p = 0.002) as independent predictors of a composite of cardiovascular morbidity endpoints. In patients undergoing OPCAB, preoperative assessment of carotid IMT may help predicting the development of a postoperative composite of cardiovascular morbidity endpoints.

Role of CIMT, eGFR, and Serum HbA1c in Predicting CAD in Non-Diabetic Patients Undergoing Elective Coronary Angiography

Background: Pre-diabetic state, renal function, atherosclerosis burden are the major predictors for development of coronary artery disease (CAD). Present study aims to analyze the role of carotid intima-media thickness (CIMT), glomerular filtration rate (eGFR) and serum glycosylated hemoglobin (HbA1c) levels in predicting CAD on coronary angiography in non-diabetic patients. Methods: CAD and its severity according to SYNTAX score (SX score) was evaluated in 450 non-diabetic patients hospitalized with acute coronary syndrome or stable angina and underwent coronary angiography. CIMT, eGFR, and serum HbA1c values were obtained during admission. Spearman correlation and linear regression were used in the analysis of the data. Receiver operating characteristic (ROC) curve was constructed to calculate cutoff values, area under curve (AUC), sensitivity and specificity. Results:Statistically significant positive correlation was observed between HbA1c (r: 0.242, p = 0.001); CIMT (r: 0.231, p = 0.001), patient’s age (r: 0.148, p = 0.002) and SX score, whereas eGFR was negatively correlated (r: -0.148, p = 0.002). On regression analysis, CIMT, eGFR, HbA1c and patient’s age collectively predicted 36% of change in the SYNTAX score. Patient’s age > 56 years (AUC = 0.622), CIMT > 0.86 mm (AUC = 0.642), HbA1c > 6 (AUC = 0.620), eGFR 2 (AUC = 0.601) were the cutoff values on ROC curve analysis. CIMT, HbA1c had relatively high specificity (88.5%, 90.2% respectively) and eGFR had relatively high sensitivity (71.3%) among the studied variables in predicting CAD in present study. Conclusions: CIMT, HbA1c, eGFR and patient’s age at the time of admission predict CAD in non-diabetic patients undergoing coronary angiography.

Carotid Atherosclerosis and Cognitive Impairment in Nonstroke Patients.

Objective:As a vascular risk factor, carotid atherosclerosis is crucial to cognitive impairment. While carotid intima-media thickness, carotid artery plaque, and carotid stenosis can reflect carotid atherosclerosis in different stages, this review aimed to explore researches on the role of carotid intima-media thickness, carotid artery plaque, and carotid stenosis in the progress of cognitive impairment in nonstroke patients and tried to illustrate the possible mechanisms.Data Sources:We searched the PubMed database for recently published research articles up to July 2017, with the key words of “carotid atherosclerosis,” “carotid intima-media thickness,” “carotid plaque,” “carotid stenosis,” “nonstroke,” and “cognitive impairment.”Study Selection:Articles were obtained and reviewed to analyze the role of carotid atherosclerosis such as carotid intima-thickness, carotid plaque, and carotid stenosis in the progress of cognitive impairment in nonstroke patients and the possible mechanisms.Results:In recent years, most studies proved that by evaluating carotid atherosclerosis with ultrasonography, carotid atherosclerosis accounts for the development of cognitive decline in nonstroke patients. Carotid atherosclerosis not only impairs the subtle general cognitive function but also decreases the specific domains of cognitive function, such as memory, motor function, visual perception, attention, and executive function. But, it is still controversial. The possible mechanisms of cognitive impairment in nonstroke patients with carotid atherosclerosis can be classified as systemic global cerebrovascular function, small-vessel diseases, and the mixed lesions.Conclusions:Carotid atherosclerosis can be used to predict the risk of cognitive impairment. Furthermore, diagnosing and treating carotid atherosclerosis at early stage might help clinicians prevent and treat vascular cognitive impairment in nonstroke patients.

Carotid Intima Media Thickness and Its Utility as a Predictor of Cardiovascular Disease: A Review of Evidence.

Cardiovascular (CV) disease is still the leading cause of death in the developed world, despite the considerable progress in CV medical and surgical therapeutics. Many risk factors are associated with the development of future adverse CV events, such as age, hypertension, body mass index, and other comorbidities. Carotid intima media thickness (CIMT) is one method of calculating plaque burden by assessing the level of arterial thickening present. CIMT can be used as a noninvasive marker of atherosclerotic disease with increasing CIMT linked to an increased risk of subsequent CV events. In this review, the association of CIMT with CV disease is explored. Current literature on the role of CIMT in predicting CV outcomes is reviewed to determine whether it is a predictor of CV events, both in the general population and in the high-risk groups, such as those with hypertension, diabetes mellitus, and chronic kidney disease.

The Role of Carotid Intima-Media Thickness in Predicting Longitudinal Cognitive Function in an Older Adult Cohort

Background and Purpose: Carotid atherosclerosis is a risk factor for cerebrovascular disease in older adults. Although age-related cognitive decline has been associated with cerebrovascular disease, not much is known about the consequences of carotid atherosclerosis on longitudinal cognitive function. This study examines the longitudinal relationship between atherosclerosis and cognition in a sample of non-demented older subjects using baseline measurements of carotid intima media thickness (CIMT) and annual cognitive measures of executive function (EXEC) and verbal memory (MEM). Methods: Baseline measurements included CIMT derived from B-mode carotid artery ultrasound, structural T1-weighted images of white matter hypointensities (WMH), white matter lesions (WML), and cerebral infarct. Hypertension, low-density lipoprotein (LDL), diabetes, and waist to hip ratios (WHR) were included as covariates in our models to control for cerebrovascular risks and central adiposity. Annual composite scores of EXEC and MEM functions were derived from item response theory. Linear mixed models were used to model longitudinal cognitive change. Results: A significant inverse relationship was found between baseline CIMT and annual EXEC score, but not annual MEM score. Subjects included in the highest 4th quartile of CIMT showed a rate of annual decline in EXEC score that was significant relative to subjects in lower quartile groups (p < 0.01). The relationship between the 4th quartile of CIMT and annual EXEC score remained significant after independently adjusting for imaging measures of white matter injury and cerebral infarct. Conclusions: Older adult subjects with the highest index of CIMT showed an annual decline in EXEC scores that was significant relative to subjects with lower quartile measurements of CIMT, independent of our measures of white matter injury and cerebral infarct. Our findings suggest that elevated measures of CIMT may mark an atherosclerotic state, resulting in a decline in executive function and not memory in non-demented older adults. i 2014 S. Karger AG, Basel

Carotid intima-media thickness is associated with incident heart failure among middle-aged whites and blacks: the Atherosclerosis Risk in Communities study.

BackgroundIncreased carotid intima‐media thickness (IMT) is associated with subclinical left ventricular myocardial dysfunction, suggesting a possible role of carotid IMT in heart failure (HF) risk determination.Methods and ResultsMean far wall carotid IMT, measured by B‐mode ultrasound, was available for 13 590 Atherosclerosis Risk in Communities study participants aged 45 to 64 years and free of HF at baseline. HF was defined using ICD‐9 428 and ICD‐10 I‐50 codes from hospitalization records and death certificates. The association between carotid IMT and incident HF was assessed using Cox proportional hazards analysis with models adjusted for demographic variables, major CVD risk factors, and interim CHD. There were 2008 incident HF cases over a median follow‐up of 20.6 years (8.1 cases per 1000 person‐years). Mean IMT was higher in those with HF than in those without (0.81 mm±0.23 versus 0.71 mm±0.17, P<0.001). Unadjusted rate of HF for the fourth compared with the first quartile of IMT was 15.4 versus 3.9 per 1000 person‐years; P<0.001. In multivariable analysis, after adjustment, each standard deviation increase in IMT was associated with incident HF (HR 1.20 [95% CI: 1.16 to 1.25]). After adjustment, the top quartile of IMT was associated with HF (HR 1.60 [95% CI: 1.37 to 1.87]). Results were similar across race and gender groups.ConclusionsIncreasing carotid IMT is associated with incident HF in middle‐aged whites and blacks, beyond risks explained by major CVD risk factors and CHD. This suggests that carotid IMT may be associated with HF through mechanisms different from myocardial ischemia or infarction.

Relationship of stroke and carotid intima-media thickness and traditional Chinese medicine intervention progress：a review

Stroke is one of the major diseases that threaten human health, early diagnosis and treatment are very important for stroke. Carotid intima-media thickness (CIMT) is measured noninvasively to diagnosis stroke, and it is a independent predictor for stroke because its thickening can timely predict the incidence and development of stroke. As an important predictor of cardiovascular disease, more and more attention is played on CIMT. In this review, we will make a summary on the important role of CIMT in stroke and the mechanisms of carotid intima-media thickening in stroke as well as the potential use of traditional Chinese medicine in treating carotid intima-media thickening.

Still waters run deep: progression of left ventricular mass and stagnant atherosclerosis of carotid artery in patients with type 2 diabetes mellitus and coronary heart disease - insights from a long-term CMR study

Patients with type 2 diabe tes mellitus (T2DM) and coronary artery disease (CAD) are at high cardiovascular risk. Both carotid intima-media thickness (CIMT) and left ventricular (LV) mass are predictors for cardiovascular events and are commonly increased in these patients. However, the mechanism of association is poorly understood. This study sought to determine that relationship and to evaluate the role of CIMT in risk prediction in T2DM patients with and without CAD. Methods Cardiovascular magnetic resonance (CMR) imaging was performed at baseline and at 2-year follow-up in 88 patients with type 2 diabetes (52 men, mean age 61 ± 8 years) including 31 patients with CAD. LV mass index (LVMI) was determined by indexing LV mass to body surface area. For carotid arteries lumen area and total vessel area were assessed and vessel wall area and vessel wall ratio (VWR = vessel wall area/body surface area) were calculated. CIMT was measured by ultrasound. Results All patients were under optimal medical treatment. Patients with and without CAD had similar age (62 ± 8 vs. 60 ± 9 years, p = 0.217) and duration of T2DM (12.6 ± 7.2 vs. 10 ± 8 years, p = 0.133). Patients with CAD showed a higher LVMI at both baseline (67.42 ± 13.21 vs. 57.75 ± 12.87, p = 0.001) and follow-up (72.43 ± 17.27 vs. 62.47 ± 15.14 g/m2, p = 0.006) compared to patients without CAD. After 2 years, both groups had a significant higher LVMI (CAD: p = 0.031; no CAD:

Ultrasonographic Markers of Vascular Risk in Patients with Asymptomatic Carotid Stenosis

Six-hundred twenty-one subjects with unilateral asymptomatic severe internal carotid artery (ICA) stenosis were prospectively evaluated with a median follow-up of 27 months (min=6, max=68). Vascular risk profile, plaque characteristic, stenosis progression, and common carotid artery intima-media thickness (IMT) were investigated in all patients. Outcome measures were occurrence of ischemic stroke ipsilateral to ICA stenosis and vascular death, while myocardial infarction, contralateral strokes, and transient ischemic attack were considered as competing events. A total of 99 subjects (15.9%) suffered from a vascular event. Among them, 39 were strokes ipsilateral to the stenosis (6.3%). Degree of stenosis, stenosis progression, and common carotid artery IMT resulted as independent predictive factors of ipsilateral stroke. Considering a stenosis of 60% to 70% as reference, a degree between 71% and 90% increased the risk by 2.45, while a degree between 91% and 99% increased the risk by 3.26. The progression of stenosis was a strong risk factor (hazard ratio=4.32). Finally, the role of carotid IMT was confirmed as crucial additional measure, with an increased risk by 25% for each 0.1 mm IMT increase. Our data suggest that IMT, stenosis progression and severity should be considered as risk factors for cerebrovascular events in asymptomatic subjects with severe ICA stenosis.