Carotis Intima-Media Thickness, Coronary Calcium Score at Different Stages of Coronary Artery Disease

Yıl 2024, Cilt: 8 Sayı: 3, 626 - 633, 30.09.2024

Taha Okan , Mehmet Doruk , Ali Öztürk , Caner Topaloğlu , Mehmet Birhan Yılmaz

https://doi.org/10.30621/jbachs.1463098

Öz

Purpose: Coronary Artery Calcium Score (CACS) and Carotid Artery Intima-Media Thickness (CIMT) are surrogate markers for atherosclerosis. CACS is a recognized indicator of coronary artery disease (CAD), but CIMT's role in CAD diagnosis is debated. This study aimed to assess how well CIMT and CACS predict CAD presence and severity as detected by coronary computed tomography angiography
(CCTA).
Materials and Methods: In the study, 88 participants (57 CAD and 31 controls) underwent coronary angiography and CACS calculation using computerized tomography and CIMT measured according to the guidelines. Patients with CAD were classified by CACT results and further subdivided by CACS into three groups: Group I (<100), Group II (100-300), and Group III (≥300). The relationship between CIMT and CAD groups with zero Agatston scores, as well as the control group, was also examined.
Results: The CACS had 82% sensitivity and 100% specificity for predicting CAD, excluding CAD with 75.6% specificity. A CIMT max cut-off of ≥0.78 mm showed 76% sensitivity and 54% specificity for CAD. A CIMT max cut-off of ≥1.03 mm had 93% specificity but only 35% sensitivity, while ≤0.59 mm excluded CAD with 96% specificity but just 10% sensitivity. Patients with CIMT levels between 0.59 mm and 1.03 mm may need further testing to assess CAD risk accurately.
Conclusion: The CACS is more sensitive than CIMT in predicting CAD, and CIMT is not helpful when the CACS is zero. Determining an optimal CIMT cutoff for CAD prediction is challenging, and patients with CIMT between 0.59 mm and 1.03 mm may require additional testing.

Anahtar Kelimeler

Carotis Intima Media Thickness, Coronary Artery Disease, Coronary artery calcium score, Agatston Score

Etik Beyan

Tüm etik kurullara ve hasta haklarına uygun yapılan çalışmamız; Bakırçay Üniversitesi Etik Kurulundan onay almıştır.

Destekleyen Kurum

Yoktur

Kaynakça

• Byrne RA, Rossello X, Coughlan JJ, et al. ESC Scientific Document Group. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023;44:3720-3826.
• Obisesan OH, Osei AD, Uddin SMI, Dzaye O, Blaha MJ. An Update on Coronary Artery Calcium Interpretation at Chest and Cardiac CT. Radiol Cardiothorac Imaging 2021;3(1):e200484.
• Iwakiri T, Yano Y, Sato Y, et al. Usefulness of carotid intima-media thickness measurement as an indicator of generalized atherosclerosis: findings from autopsy analysis. Atherosclerosis 2012;225(2):359-362.
• Ling Y, Wan Y, Barinas-Mitchell E, et al. Varying Definitions of Carotid Intima-Media Thickness and Future Cardiovascular Disease: A Systematic Review and Meta-Analysis. J Am Heart Assoc 2023;12(23):e031217.
• O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med 1999;340:14-22.
• Coskun U, Yildiz A, Esen OB, et al. Relationship between carotid intima-media thickness and coronary angiographic findings: a prospective study. Cardiovasc Ultrasound 2009 ;7:59.
• Liu D, Du C, Shao W, Ma G. Diagnostic Role of Carotid Intima-Media Thickness for Coronary Artery Disease: A Meta-Analysis. Biomed Res Int 2020;2020:9879463.
• Knuuti J, Wijns W, Saraste A, et al. ESC Scientific Document Group. 2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes. Eur Heart J 2020;41:407-477.
• Antonopoulos AS, Angelopoulos A, Tsioufis K, Antoniades C, Tousoulis D. Cardiovascular risk stratification by coronary computed tomography angiography imaging: current state-of-the-art. Eur J Prev Cardiol 2022;29:608-624.
• van Velzen JE, Schuijf JD, de Graaf FR, et al. Diagnostic performance of non-invasive multidetector computed tomography coronary angiography to detect coronary artery disease using different endpoints: detection of significant stenosis vs. detection of atherosclerosis. Eur Heart J 2011;32:637-645.
• Zielinski T, Dzielinska Z, Januszewicz A, et al. Carotid intima-media thickness as a marker of cardiovascular risk in hypertensive patients with coronary artery disease. Am J Hypertens 2007;20:1058-64.
• Mack WJ, LaBree L, Liu C, Selzer RH, Hodis HN. Correlations between measures of atherosclerosis change using carotid ultrasonography and coronary angiography. Atherosclerosis 2000;150:371-379.
• Rampidis G, Rafailidis V, Kouskouras K, et al. Relationship between Coronary Arterial Geometry and the Presence and Extend of Atherosclerotic Plaque Burden: A Review Discussing Methodology and Findings in the Era of Cardiac Computed Tomography Angiography. Diagnostics (Basel) 2022;1:2178.
• Nakazato R, Shalev A, Doh JH, et al. Aggregate plaque volume by coronary computed tomography angiography is superior and incremental to luminal narrowing for diagnosis of ischemic lesions of intermediate stenosis severity. J Am Coll Cardiol 2013;62:460-467.
• Blaha MJ, Mortensen MB, Kianoush S, Tota-Maharaj R, Cainzos-Achirica M. Coronary Artery Calcium Scoring: Is It Time for a Change in Methodology? JACC Cardiovasc Imaging 2017;10:923-937.
• Pathakota SR, Durgaprasad R, Velam V, Ay L, Kasala L. Correlation of coronary artery calcium score and carotid artery intima-media thickness with severity of coronary artery disease. J Cardiovasc Thorac Res 2020;12:78-83.
• Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 2000;20:1262-75.
• Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008;358(13):1336-1345
• Alexopoulos N, Raggi P. Calcification in atherosclerosis. Nat Rev Cardiol 2009; 6 :681-688.
• Okan T, Topaloglu C. Association of ratios of monocyte/high-density lipoprotein cholesterol and neutrophil/high-density lipoprotein cholesterol with atherosclerotic plaque type on coronary computed tomography. Cardiovasc J Afr 2024;34:1-6.
• Blaha MJ, Cainzos-Achirica M, Greenland P, et al. Role of Coronary Artery Calcium Score of Zero and Other Negative Risk Markers for Cardiovascular Disease: The Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 2016;133:849-58.
• Hussain A, Ballantyne CM, Nambi V. Zero Coronary Artery Calcium Score: Desirable, but Enough? Circulation 2020;142:917-919.
• Lester SJ, Eleid MF, Khandheria BK, Hurst RT. Carotid intima-media thickness and coronary artery calcium score as indications of subclinical atherosclerosis. Mayo Clin Proc 2009;84:229-233.
• Wolski C, Rotkiewicz A, Grzelak P, Elgalal M, Stefańczyk L. Comparison of tomographic coronary artery calcification index (calcium score) and ultrasonographic measurement of intima-media complex thickness in diabetic subjects. Pol J Radiol 2011;76:15-20.
• Schroeder B, Francis G, Leipsic J, Heilbron B, John Mancini GB, Taylor CM. Early atherosclerosis detection in asymptomatic patients: a comparison of carotid ultrasound, coronary artery calcium score, and coronary computed tomography angiography. Can J Cardiol 2013;29:1687-1694.
• Dokumaci DS, Oztürk C, Ergun E, Kosar P. The relationship of intima-media thickness, coronary calcium score and coronary artery disease. Harran Üniversitesi Tıp Fakültesi Dergisi 2015; 12: 211-219.
• Cohen GI, Aboufakher R, Bess R, et al. Relationship between carotid disease on ultrasound and coronary disease on CT angiography. JACC Cardiovasc Imaging 2013;6(11):1160-1167.
• Kablak-Ziembicka A, Tracz W, Przewlocki T, Pieniazek P, Sokolowski A, Konieczynska M. Association of increased carotid intima-media thickness with the extent of coronary artery disease. Heart 2004;90:1286-1290.
• Wada S, Iwanaga Y, Nakai M, et al. Significance of coronary artery calcification for predicting major adverse cardiovascular events: results from the NADESICO study in Japan. J Cardiol 2023;82:172-178.
• Matangi MF, Hétu MF, Armstrong DWJ, et al. Carotid Plaque Score is Associated with 10-year Major Adverse Cardiovascular Events in Low-Intermediate Risk Patients Referred to a General Cardiology Community Clinic. Eur Heart J Cardiovasc Imaging 2024:jeae153.
• Adams MR, Nakagomi A, Keech A, et al: Carotid intima-media thickness is only weakly correlated with the extent and severity of coronary artery disease. Circulation 1995;92:2127-2134.
• Takashi W, Tsutomu F, Kentaro F: Ultrasonic correlates of common carotid atherosclerosis in patients with coronary artery disease. Angiology 2002;53:177-183.
• Kanadaşi M, Cayli M, San M, et al. The presence of a calcific plaque in the common carotid artery as a predictor of coronary atherosclerosis. Angiology 2006;57:585-592.
• Hulthe J, Wikstrand J, Emanuelsson H, Wiklund O, de Feyter PJ, Wendelhag I. Atherosclerotic changes in the carotid artery bulb as measured by B-mode ultrasound are associated with the extent of coronary atherosclerosis. Stroke 1997 ;28:1189-1194.
• Hodis HN, Mack WJ, LaBree L, et al: The role of carotid arterial intima-media thickness in predicting clinical coronary events. Ann Intern Med 1998;128: 262-269.
• Lisowska A, Musiał WJ, Lisowski P, Knapp M, Małyszko J, Dobrzycki S. Intima-media thickness is a useful marker of the extent of coronary artery disease in patients with impaired renal function. Atherosclerosis 2009;202:470-475.
• Belhassen L, Carville C, Pelle G, et al. Evaluation of carotid artery and aortic intima-media thickness measurements for exclusion of significant coronary atherosclerosis in patients scheduled for heart valve surgery. J Am Coll Cardiol 2002;39:1139-1144.
• Zhang Y, Guallar E, Qiao Y, Wasserman BA. Is carotid intima-media thickness as predictive as other noninvasive techniques for the detection of coronary artery disease? Arterioscler Thromb Vasc Biol 2014;34:1341-1345.