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| ORIGINAL ARTICLE |
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| Year : 2011 | Volume
: 12
| Issue : 4 | Page : 157-160 |
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A study to correlate carotid intima thickness by B-mode ultrasonography in patients documented with coronary artery disease
Shiran Shetty, Peter George, BM Venkatesha, Jayaprakash Alva
Department of Medicine, Fr Muller Medical College, Mangalore, Karnataka, India
| Date of Web Publication | 15-Dec-2011 |
Correspondence Address:
Shiran Shetty
Department of Medicine, Fr Muller Medical College, Mangalore - 575 002, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/1995-705X.90902
 Abstract | | |
Aim of the study: To study the IMT of the common carotid arteries and correlate with documented coronary artery disease.
Patients and Methods: The study was conducted in subjects with history of coronary artery disease in the past and who presented with acute coronary syndrome. After detailed history and examination, investigations were carried out as per our protocol. The sample size was 100, with 70 in the case group and 30 in the control group (matched).B-mode ultrasonography scanning of the carotid arteries was performed and measurements were made at proximal, middle and distal segments of the common carotid arteries. Univariate analysis was used to confirm the significance of the variables and multiple regressions were used to predict the risk, based on significant variables.
Results: The total study sample consisted of 100 subjects, of whom 70 were cases and 30 were controls. The case group comprised of a total of 70 patients with a mean age of 58.72 years. In the control group of 30 patients, the mean age was 62.73 years. In the study group, 77.1% (n=54) were males and 22.9% (n=16) were females. In the study group, 51.4% (n=36) were smokers compared with 13.3% (n=4) among the control group (P=0.001 vhs). In the study group, 20% (n=14) had diabetes while this was 13.3% (n=4) among the control group. In the study group, 52.96% (n=37) had hypertension while 16.7% (n=5) had hypertension in the control group (P=0.001 vhs). The mean total cholesterol among the study group was 197.4mg/dl while in the control group it was 175.9 mg/dl. Thirty-two percent of the patients with CAD had anterior lateral wall ischemia, 21% had anterior wall, 21% lateral wall, 19% inferior wall and 7% unstable angina. The mean carotid IMT in the study group was 0.923 ± 0.123 and in control group it was 0.689 ± 0.051 (P=0.001). The mean carotid intima thickness was significantly high in the case group as compared with the control, and the P-value was highly significant.
Conclusion: The carotid IMT was found to be higher in patients with coronary artery disease, and there was a statistically significant difference between cases and controls. Thus, our study shows that carotid IMT is a marker of atherosclerosis that is strongly associated with risk factors and can be used as a surrogate marker in the prediction of atherosclerosis in coronary artery disease. As it is easily reproducible, carotid B-mode ultrasonography is a safe, non-invasive and reproducible procedure that helps in the early identification of clinical coronary artery disease. Keywords: B-mode carotid ultrasonography, CAD, carotid intima media thickness, coronary artery disease, IMT
How to cite this article:
Shetty S, George P, Venkatesha B M, Alva J. A study to correlate carotid intima thickness by B-mode ultrasonography in patients documented with coronary artery disease. Heart Views 2011;12:157-60 |
How to cite this URL:
Shetty S, George P, Venkatesha B M, Alva J. A study to correlate carotid intima thickness by B-mode ultrasonography in patients documented with coronary artery disease. Heart Views [serial online] 2011 [cited 2023 Dec 8];12:157-60. Available from: https://www.heartviews.org/text.asp?2011/12/4/157/90902 |
| Introduction | |  |
India is on an epidemiological threshold of experiencing significant increase in cardiovascular diseases. [1] Of all the ethnic groups, people of Indian origin have one of the highest incidences of coronary artery disease (CAD). [2],[3]
Atherosclerosis is one of the underlying factors. It has been suggested by the International Atherosclerosis Project that the atherosclerosis process occurs at the same time in the carotid, cerebral and coronary arteries. [4] Recent evidence has emerged that generalized atherosclerosis is reflected by carotid atherosclerosis. [5] Assessment of the carotid artery by measuring the common carotid Intima Media Thickness (IMT) could be used as a marker for atherosclerosis. [6] The Intima thickness of the common carotid artery can be detected accurately by B-mode ultrasonography. [7] It is reliable and, has a high degree of accuracy and reproducibility in estimating the arterial wall thickness. [8],[9]
The value of carotid IMT as a marker for atherosclerosis is well documented by various non- invasive imaging methods. Arterial IMT measurement by B-mode ultrasonography is currently recommended as a relatively safe, inexpensive and non-invasive method of assessing subclinical atherosclerosis by the American Heart Association. [7] Arterial IMT measurement is an independent predictor of atherosclerotic events. [10] The progression of common carotid IMT is a useful surrogate marker for coronary and other atherosclerotic events. [10],[11]
The present study was undertaken to relate common carotid IMT with documented coronary artery disease.
| Aim of the Study | | |
- To study the IMT of the common carotid arteries.
- To correlate IMT of common carotid arteries with documented coronary artery disease.
| Patients and Methods | | |
The study was conducted in Father Muller Medical College Hospital, Mangalore. It was conducted in a total of 100 subjects, of whom 70 were documented cases of coronary artery disease and 30 were controls.
Source of data
Patients with documented coronary artery disease admitted to the Father Muller Medical College Hospital.
Method of collection of data
Each case was studied as per the format prepared.
Subjects with history of coronary artery disease in the past and who presented with acute coronary syndromes were selected. After detailed history and examination, investigations were carried out. As per our protocol, Hb, TC, DC, ESR, RBS (FBS/PPBS if required), serum urea, creatinine, CKMB, Troponin-I (strip method), Fasting lipid profile, ECG and 2D echo, coronary angiogram was carried out. Carotid Doppler and IMT were performed using the 7.5 mHz probe. The sample size was 100, with 70 in the case group and 30 in the control group (matched).
B-mode ultrasonography scanning of the carotid arteries was performed on subjects while supine, with the neck in extension, using a high-frequency imaging probe (7.5 mHz) with a Toshibha SSH-140A scanner. The carotid vessels are followed from the clavicular head to their bifurcation. Both axial and sagital images of the common carotid artery will be obtained. Measurements were made at proximal, middle and distal segments of the common carotid arteries.
Univariate analysis was used to confirm the significance of the variables and multiple regressions were used to predict the risk, based on significant variables.
Inclusion criteria
Patients admitted to the Father Muller Medical College Hospital with acute coronary syndromes or an inpatient with documented history of coronary artery disease.
Exclusion criteria
Patients with renal failure on dialysis and lipid-lowering drugs were excluded.
| Results | | |
The total study sample consisted of 100 subjects, of whom 70 were cases and 30 were controls.
The case group comprised of a total of 70 patients with a mean age of 58.72 years. In the control group of 30 patients, the mean age was 62.73 years. In the case group, majority were in the age group of 60-69 years (n=27) and in the control group, this was 50-59 years.
In the study group, 77.1% (n=54) were males and 22.9% (n=16) were females. A male preponderance of 77.1% was seen. In the control group, 60% (n=18) were male and 40% (n=12) were females.
In the study group, 51.4% (n=36) were smokers compared with 13.3% (n=4) among the control group (P=0.001 vhs). In the study group, 20% (n=14) had diabetes while this was 13.3% (n=4) among the control group. In the study group, 52.96% (n=37) had hypertension while 16.7% (n=5) had hypertension in the control group (P=0.001 vhs).
The mean total cholesterol among the study group was 197.4mg/dl while in the control group it was 175.9 mg/dl. There was a significant difference documented in the study and control group with total cholesterol and triglyceride levels. But high-density lipoprotein and low-density lipoprotein (LDL) levels did not show a significant difference among the study and control groups.
Thirty-two percent of the patients with CAD had anterior lateral wall ischemia, 21% had anterior wall, 21% lateral wall, 19% inferior wall and 7% unstable angina.
The carotid IMT in the case group was significantly higher than that in the control group. But, there was no significant difference between the right side and the left side carotid intima thickness.
The mean carotid IMT in the study group was 0.923 ± 0.123 and in control group it was 0.689 ± 0.051 (P=0.001). The mean carotid intima thickness was significantly high in the case group as compared with the control, and the P-value was highly significant.
| Discussion | | |
Coronary artery disease is major cause of mortality and morbidity in the developed and in developing countries. The incidence is rising. Atherosclerosis is the major cause of CAD. Atherosclerosis can be detected at an early stage by measuring the carotid IMT. Ultrasonography is a reliable and accurate technique to determine IMT. B-mode ultrasonography of carotid IMT is of clinical value in the screening of patients with CAD. In this study, we have compared 70 cases with 30 controls that were age and sex matched.
The mean age in the study group was 58.73 ± 10.88 years, and males constituted 77.1% and females 22.9% of this population. The mean age in the study conducted by Jadhava et al. [12] was 52.8 ± 8.1 years, and males constituted 65% and females 35%. In the ARIC study, [13],[14] the mean age was 56 ± 6 years, where as in the Rotterdam study, [14] the mean age was 70.6 years.
In our study, 51.4% of the patients with coronary artery disease were smokers. In the Rotterdam study, [14] the incidence of smoking was 26.5% and in the cardiovascular health study, [15] it was 12.2%. Jadhav and colleagues [12] noted that the smoking incidence was 31.3% in the CAD group.
In our study, 20% of the patients with CAD had diabetes. The incidence of diabetes mellitus was 51.5% in the study, conducted by Jadhav [12] but in the Rotterdam study [14] it was 10.5% and in the ARIC [13] studies it was 9%.
In our study, 52.9% of patients with CAD and hypertension were encountered. In the Rotterdam study, [14] hypertension was noted in 32% of the cases, whereas in the cardiovascular health study, [15] hypertension was noted in 39.9% of the cases. But, in the study conducted by Jadhav and colleagues, [12] it was 18.2%. In the ARIC study, [13],[14] it was noted that 27% of the patients were hypertensive. In view of the low sample size, we encountered a high percentage of patients having hypertension compared with other studies.
In our study, the mean total cholesterol in the cases was 197.44 mg/dl and in the controls it was 170.90 mg/dl. In the study conducted by Jadhav and colleagues, [12] the total serum cholesterol was 208.4 ±43.49 mg/dl. The mean LDL cholesterol in the cases with CAD was 129.30 mg/dl, whereas in the controls it was 122.73 mg/dl. In the ARIC study, [13],[14] The the LDL level was 140 ± 37 mg/dl. The mean triglyceride in our study in the cases with CAD was 150.51 mg/dl while in the controls it was 119.63 mg/dl. In the study conducted by Jadhav and colleagues, [12] the triglyceride level was 167.6 mg/dl.
Intima media thickness
In our study, the mean carotid IMT in patients with coronary artery disease was 0.923 mm and in the controls it was 0.689 mm. In the cases, carotid IMT was significantly higher than that in the controls (P=0.001). In the cardiovascular health study, the mean IMT was 1.03 ± 0.2 mm. Jadhav and colleagues [12] noted a high carotid IMT level among coronary artery disease patients. Salonen and Salonen [16] reported that each 0.1 mm increases in IMT increased the risk of CAD by 11%, and maximal IMT remained a statistically significant predictor of acute myocardial infarction. The ARIC study [13] reported that carotid IMT was 10% greater in patients with coronary artery disease.
The Rotterdam study, [14] showed the higher the base line IMT, the greater is the myocardial infarction risk. The CUPS study [17] showed that carotid IMT >1.1 mm was seen in diabetics rather than in non non-diabetics.
| Summary | | |
The current study is an observational case control study with 70 cases and 30 controls. A male preponderance was observed. Hypertension was more common in cases with coronary artery disease. Higher level of total cholesterol and triglyceride levels were seen in patients with coronary artery disease. Carotid IMT was significantly higher in patients with coronary artery disease than in controls.
| Conclusion | | |
The carotid IMT was found to be higher in patients with coronary artery disease, and there was a statistically significant difference between cases and controls. No significant differences were observed between the left and right side of the carotid IMT. Thus, our study shows that carotid IMT is a marker of atherosclerosis that is strongly associated with risk factors and can be used as a surrogate marker in the prediction of atherosclerosis in coronary artery disease. As it is easily reproducible, carotid B-mode ultrasonography is a safe, non-invasive and reproducible procedure that helps in the early identification of clinical coronary artery disease.
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