[The importance of carotid ultrasound in the risk stratification of patients with ischaemic heart disease].
The stratification of cardiovascular risk is important both in primary and secondary prevention. In the clinical evaluation, besides the well-known risk factors, the European Guide of Cardiovascular Prevention recommends the identification of additional markers of risk, one of them being the detection of atherosclerotic alterations by carotid ultrasound examination. The objectives of this study were: assessment of carotid ultrasound alterations in patients with known cardiovascular disease; their relation with the other risk factors, the clinical status and echocardiography.


METHODS
The study included 144 patients, aged 41-80 (84 males, 60 women) with cardiovascular disease (stable angina, myocardial infarction, peripheral arterial disease, arterial hypertension). Risk factors as smoking, hypercholesterolemia, diabetes mellitus, obesity have been determined, followed by a clinical assessment and echocardiographic examination. Ultrasound of the extracranial carotid arteries included measurement of IMT of the common carotid arteries, the identification of atherosclerotic plaques and the presence of stenoses. The plaques were considered if the IMT was more than 1.3 mm.


RESULTS
Patients with IMT > 0.8 are older (61.5 +/- 8.2 vs. 56.1 +/- 8.2 years, p = 0.001); the prevalence of arterial hypertension is greater (63.8% vs. 21.6%, p = 0.05), and at an IMT of more than 1.1 mm all were hypertensive; the association with peripheral arterial disease is significant at the IMT = 0.8 mm (23.6% vs. 4.8%, p = 0.01). The relationship with echocardiographic markers of left ventricular hypertrophy is present at an IMT of 0.8 mm and is evident at IMT = 1 mm (interventricular septum 13.2 +/- 3 vs. 12 +/- 2.3, p = 0.05; left ventricular wall 14 +/- 5.4 vs. 12 +/- 1.7, p = 0.01; left ventricular mass 323 +/- 94 vs. 282 +/- 68, p = 0.03), and also the relation with the degree of diastolic dysfunction expressed by E/A ratio (0.71 +/- 0.24 vs. 0.99 +/- 0.39, p = 0.001). The presence of atherosclerotic plaques correlates with gender (45.1% at male vs. 24.3%, p = 0.01) and older age (61.7 +/- 8.6 vs. 56.2 +/- 8.5 years, p = 0.001). IMT and carotid plaques are not significantly correlated either with such risk factors as smoking, hypercholesterolemia, diabetes mellitus or clinical conditions as myocardial infarction and angina.


CONCLUSIONS
IMT greater than 0.8 mm is a marker of increased cardiovascular risk, associated with age, presence of peripheral arterial disease, arterial hypertension, left ventricular hypertrophy, and diastolic dysfunction. IMT seems to be a more reliable index of cardiovascular risk than carotid plaques. Measurement of IMT is easy to be done in clinical practice, and is recommended for more accurate risk stratification in patients with atherosclerotic cardiovascular disease.
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Universitatea de Medicină si Farmacie Gr T Popa, Iaşi, Facultatea de Medicină, Clinica a VI Medicală, Spitalul Clinic de Recuperare Iaşi.
Mitu
Magda
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Turiceanu
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Caliap
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Leatu
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D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D050197:Atherosclerosis / Q000000981:diagnostic imaging; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging*; D004452:Echocardiography; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012383:Romania / Q000453:epidemiology; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D017540:Tunica Media / Q000000981:diagnostic imaging