title: A carotid extra-media thickness, PATIMA combined index and coronary artery disease: Comparison with well-established indexes of carotid artery and fat depots.
abstract: BACKGROUND
  The clinical utility of traditional cardiovascular (CV) risk factors to predict coronary artery disease (CAD) is insufficient and limited. Our aim was to evaluate the association between a novel ultrasound index of periarterial fat and adventitia (carotid extra-media thickness; EMT) and the severity of CAD and to compare this with well-known vascular indexes in patients with high and very high CV risk.
  
  
  RESULTS
  Four hundred twenty two patients scheduled for elective coronary angiography were included in the study (age: 61.3 ± 7.4 years; males 65%). Several clinical parameters of obesity were obtained as well as the following ultrasound indexes: carotid EMT and intima-media thickness (IMT), epicardial and pericardial fat thickness (EFT and PFT), and intra-abdominal fat thickness (IAT). These were then related to CAD severity in all individuals. Our study patients had a very high estimated CV risk (82%), and most (60%) fulfilled the MS criteria. Most individuals (71%) had CAD (≥50% stenosis) with equal rates of one, two, or three-vessel disease, and critical (≥70%) coronary stenosis was found in 40% of patients. Carotid EMT was significantly increased in patients with CAD (812 ± 116 vs 746 ± 131 μm) and patients with critical coronary stenosis (829 ± 119 vs 769 ± 122 μm) compared to the appropriate control groups. Moreover, carotid EMT was significantly associated with the severity of CAD. Carotid IMT and EFT (but not PFT and IAT) also revealed significant relations to the number of diseased vessels. Carotid EMT and the new proposed combined index (PATIMA = EMT/BMIx35 + IMT + EFTx60) were predictive for CAD (AUC: 686 ± 304 and 755 ± 260, sensitivity: 60 and 62%, specificity: 76 and 81% for 772 μm and 2015u).
  
  
  CONCLUSIONS
  We present the first study showing that the new vascular index (carotid EMT) and the proposed combined index PATIMA are associated with the presence and the severity of CAD.
authors.affiliation: School of Health Sciences, Medical University of Silesia, Department of Cardiology, Katowice, Poland. Electronic address: mhaberka@op.pl.
authors.forename: Maciej
authors.initials: M
authors.lastname: Haberka
authors.affiliation: School of Health Sciences, Medical University of Silesia, Department of Cardiology, Katowice, Poland.
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Gąsior
mesh_terms: D000273:Adipose Tissue / Q000473:pathology; D000368:Aged; D000369:Aged, 80 and over; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000473:pathology*; D059168:Carotid Intima-Media Thickness; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000473:pathology*; D023921:Coronary Stenosis / Q000473:pathology; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D024821:Metabolic Syndrome / Q000473:pathology; D008875:Middle Aged; D009765:Obesity; D012372:ROC Curve; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index
keywords: Adventitia; Coronary artery disease; Extra-media thickness; Intima-media thickness; Metabolic syndrome; Obesity; Perivascular fat