ScienceOpen: research and publishing network

For Researchers

Search
Advanced search

10

views

    

0

recommends

0

shares

Record: found
Abstract: found
Article: found

Is Open Access

Clinical & radiological evaluation of atherosclerotic changes in carotid & coronary arteries in asymptomatic & clinically symptomatic individuals as a tool for pre-symptomatic diagnosis of cardiovascular disease

research-article

Author(s): Venkatraman Bhat , T.N. Prasad , S. Ananthalakshmi , G.A. Karthik , George Cherian ^* , Yaligar Dayananda ^**

Publication date (Print): February 2016

Journal: The Indian Journal of Medical Research

Publisher: Medknow Publications & Media Pvt Ltd

Keywords: Atherosclerosis, carotid plaque, coronary CT angiography, HRUS, IMT, presymptomatic tool

Read this article at

ScienceOpen Publisher PMC

There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

Abstract

Background & objectives:

An increase in prevalence of atherosclerosis has been noted worldwide with reports of higher incidence of atherosclerotic vascular changes in Asian Indians. There is a need to measure vascular atherosclerotic changes and provide objective parameter to predict cardiac and cerebrovascular adverse events. Atherosclerotic changes in carotids and coronaries are generally accepted as an association. We attempted in this study to relate intimal-luminal changes in carotid arteries to luminal changes in coronary arteries. Our study presents results of high resolution ultra sonographic (HRUS) evaluation of intimal-medial-thickness (IMT) in carotid with luminal changes in coronaries on multidetector-CT (MDCT) in clinically asymptomatic and symptomatic individuals.

Methods:

In this prospective study, HRUS examination of the carotid bifurcation was performed in 151 individuals to measure IMT in asymptomatic and symptomatic groups. Assessments of coronary arteries of the same group of patients were evaluated by MDCT within a week interval. IMT changes were associated with age, sex, predisposing factors, calcium burden of coronaries and structural atherosclerotic changes in coronary arteries.

Results:

A linear association of IMT was observed with increasing age. IMT of 0.5-0.69 mm was noted in 50 per cent of patients between 51-56 yr with higher number of symptomatic patients in this group. Linear increases in coronary vascular changes were noted with increasing IMT thickness. Changes were more prevalent in diabetic, hypertensive, treadmill test (TMT) positive and clinically symptomatic patients.

Interpretation & conclusions:

Age-related progression of atherosclerosis was evident in internal carotid arteries. Significant association was observed in the IMT thickness of right common carotid (RCC) and coronary disease in symptomatic group; whereas IMT of left common carotid and internal carotid arteries did not show any association. RCC IMT between 0.5-0.7mm showed maximal association with significant symptomatic narrowing of coronary arteries. Patients with IMT beyond 0.7mm had no association with symptoms.

Related collections

Most cited references 20

Record: found
Abstract: found
Article: not found

Intimal plus medial thickness of the arterial wall: a direct measurement with ultrasound imaging.

P Pignoli, E Tremoli, A Poli … (1986)

A study in vitro of specimens of human aortic and common carotid arteries was carried out to determine the feasibility of direct measurement (i.e., not from residual lumen) of arterial wall thickness with B mode real-time imaging. Measurements in vivo by the same technique were also obtained from common carotid arteries of 10 young normal male subjects. Aortic samples were classified as class A (relatively normal) or class B (with one or more atherosclerotic plaques). In all class A and 85% of class B arterial samples a characteristic B mode image composed of two parallel echogenic lines separated by a hypoechoic space was found. The distance between the two lines (B mode image of intimal + medial thickness) was measured and correlated with the thickness of different combinations of tunicae evaluated by gross and microscopic examination. On the basis of these findings and the results of dissection experiments on the intima and adventitia we concluded that results of B mode imaging of intimal + medial thickness did not differ significantly from the intimal + medial thickness measured on pathologic examination. With respect to the accuracy of measurements obtained by B mode imaging as compared with pathologic findings, we found an error of less than 20% for measurements in 77% of normal and pathologic aortic walls. In addition, no significant difference was found between B mode-determined intimal + medial thickness in the common carotid arteries evaluated in vitro and that determined by this method in vivo in young subjects, indicating that B mode imaging represents a useful approach for the measurement of intimal + medial thickness of human arteries in vivo.

0 comments Cited 293 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: not found

Intima-media thickness: a new tool for diagnosis and treatment of cardiovascular risk.

Jean-Louis Mégnien, Alain Simon, J Gariépy … (2002)

Increased intima-media thickness (IMT) is a non-invasive marker of early arterial wall alteration, which is easily assessed in the carotid artery by B-mode ultrasound, and more and more widely used in clinical research. Methods of IMT measurement can be categorized by two approaches: (i) measurement at multiple extracranial carotid sites in near and far walls and (ii) computerized measurement restricted to the far wall of the distal common carotid artery. Because IMT reflects global cardiovascular risk, its normal value might be better defined in terms of increased risk rather than in terms of statistical distribution within a healthy population. The available epidemiological data indicate that increased IMT (at or above 1 mm) represents a risk of myocardial infarction and/or cerebrovascular disease. Close relationships have been shown between: (i) most traditional cardiovascular risk factors; (ii) certain emerging risk factors such as lipoproteins, psychosocial status, plasma viscosity, or hyperhomocysteinemia; and (iii) various cardiovascular or organ damages such as white matter lesion of the brain, left ventricular hypertrophy, microalbuminuria or decreased ankle to brachial systolic pressure index. Thus, IMT gives a comprehensive picture of the alterations caused by multiple risk factors over time on arterial walls. Prospective primary and secondary prevention studies have also shown that increased IMT is a powerful predictor of coronary and cerebrovascular complications (risk ratio from 2 to 6) with a higher predictive value when IMT is measured at multiple extracranial carotid sites than solely in the distal common carotid artery. Therapeutic double-blind trials have shown that lipid-lowering drugs, such as resin and overall statines, and to a lesser extent antihypertensive drugs, such as calcium antagonists, may have a beneficial effect on IMT progression in asymptomatic or in coronary patients. However, methodological standardization of IMT measurement still needs to be implemented before routine measurement of IMT can be proposed in clinical practice as a diagnostic tool for stratifying cardiovascular risk in primary prevention and for aggressive treatment decision. It can be anticipated however, that the presence of increased carotid IMT in one individual with intermediate cardiovascular risk would lead to his classification into the high-risk category and thus influence the aggressiveness of risk factor modifications.

0 comments Cited 89 times – based on 0 reviews      Review now

Record: found
Abstract: found
Article: found

Is Open Access

The Value of Carotid Artery Plaque and Intima‐Media Thickness for Incident Cardiovascular Disease: The Multi‐Ethnic Study of Atherosclerosis

Joseph F. Polak, Moyses Szklo, Richard A Kronmal … (2013)

Background Carotid artery plaques are associated with coronary artery atherosclerotic lesions. We evaluated various ultrasound definitions of carotid artery plaque as predictors of future cardiovascular disease (CVD) and coronary heart disease (CHD) events. Methods and Results We studied the risk factors and ultrasound measurements of the carotid arteries at baseline of 6562 members (mean age 61.1 years; 52.6% women) of the Multi‐Ethnic Study of Atherosclerosis (MESA). ICA lesions were defined subjectively as >0% or ≥25% diameter narrowing, as continuous intima‐media thickness (IMT) measurements (maximum IMT or the mean of the maximum IMT of 6 images) and using a 1.5‐mm IMT cut point. Multivariable Cox proportional hazards models were used to estimate hazard ratios for incident CVD, CHD, and stroke. Harrell's C‐statistics, Net Reclassification Improvement, and Integrated Discrimination Improvement were used to evaluate the incremental predictive value of plaque metrics. At 7.8‐year mean follow‐up, all plaque metrics significantly predicted CVD events (n=515) when added to Framingham risk factors. All except 1 metric improved the prediction of CHD (by C‐statistic, Net Reclassification Improvement, and Integrated Discrimination Improvement. Mean of the maximum IMT had the highest NRI (7.0%; P=0.0003) with risk ratio of 1.43/mm; 95% CI 1.26–1.63) followed by maximum IMT with an NRI of 6.8% and risk ratio of 1.27 (95% CI 1.18–1.38). Conclusion Ultrasound‐derived plaque metrics independently predict cardiovascular events in our cohort and improve risk prediction for CHD events when added to Framingham risk factors.

0 comments Cited 89 times – based on 0 reviews      Review now

Author and article information

Journal

Journal ID (nlm-ta): Indian J Med Res

Journal ID (iso-abbrev): Indian J. Med. Res

Journal ID (publisher-id): IJMR

Title: The Indian Journal of Medical Research

Publisher: Medknow Publications & Media Pvt Ltd (India )

ISSN (Print): 0971-5916

Publication date (Print): February 2016

Volume: 143

Issue: 2

Pages: 197-204

Affiliations

[1] Department of Radiology, Narayana Health, Narayana Hrudayalaya & Mazumdar Shaw Medical Center, Bengaluru, India

[* ] Department of Cardiology, Narayana Health, Narayana Hrudayalaya & Mazumdar Shaw Medical Center, Bengaluru, India

[** ] Department of Medicine, Narayana Health, Narayana Hrudayalaya & Mazumdar Shaw Medical Center, Bengaluru, India

Author notes

Reprint requests: Dr Venkatraman Bhat, 309, Greenwoods Apt, Royal Gardenia, Bommasandra, Bengaluru 560 099, Karnataka, India e-mail: bvenkatraman@ 123456gmail.com

Article

Publisher ID: IJMR-143-197

DOI: 10.4103/0971-5916.180207

PMC ID: 4859128

PubMed ID: 27121517

SO-VID: f35861ed-57f9-40fb-bb10-0a1fa099d4a2

Copyright © Copyright: © Indian Journal of Medical Research

License:

This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.

History

Date received : 19 February 2014

Categories

Subject: Original Article

ScienceOpen disciplines: Medicine

Keywords: atherosclerosis,carotid plaque,coronary ct angiography,hrus,imt,presymptomatic tool

Data availability:

ScienceOpen disciplines: Medicine

Keywords: atherosclerosis, carotid plaque, coronary ct angiography, hrus, imt, presymptomatic tool

Comments

Comment on this article