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ORIGINAL ARTICLE
Year : 2011  |  Volume : 12  |  Issue : 4  |  Page : 157-160  

A study to correlate carotid intima thickness by B-mode ultrasonography in patients documented with coronary artery disease


Department of Medicine, Fr Muller Medical College, Mangalore, Karnataka, India

Date of Web Publication15-Dec-2011

Correspondence Address:
Shiran Shetty
Department of Medicine, Fr Muller Medical College, Mangalore - 575 002, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1995-705X.90902

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   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 2019 Jun 26];12:157-60. Available from: http://www.heartviews.org/text.asp?2011/12/4/157/90902


   Introduction Top


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 Top


  1. To study the IMT of the common carotid arteries.
  2. To correlate IMT of common carotid arteries with documented coronary artery disease.



   Patients and Methods Top


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 Top


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 Top


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 Top


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 Top


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.

 
   References Top

1.Chadu SL, Radha Krishnan S, Ramachandran K, Kaul U, Gopinath M. Epidemiological study of coronary artery disease in urban population of Delhi. Indian J Med Res 1990;92:424-30.   Back to cited text no. 1
    
2.International Atherosclerosis Project. McGill HC et al. General findings of the International Atherosclerosis Project. Lab Invest 1968;18:498-502.   Back to cited text no. 2
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3.Grobbee DE, Bots ML. Carotid artery intima-media thickness as an indicator of generalized atherosclerosis. J Intern Med 1994;236:567-73.   Back to cited text no. 3
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4.Taylor AJ. Atherosclerosis imaging to detect and monitor cardiovascular risk. Am J Cardiol. 2002;90(10C):8L-11L.  Back to cited text no. 4
    
5.Pignoli P, Tremoli E, Poli A, Oreste P, Paoletti R. Intimal plus medial thickness of the arterial wall. A direct measurement with ultrasound imaging. Circulation 1986;74:1399-406.   Back to cited text no. 5
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6.Crouse JR 3 rd , Thompson CJ. An evaluation of methods for imaging and quantifying coronary and carotid lumen stenosis and atherosclerosis. Circulation 1993;87(3 Suppl):II17-33.   Back to cited text no. 6
    
7.Smith SC Jr, Greenland P, Grundy SM. AHA Conference Proceedings prevention conference V Beyond Secondary prevention: Identifying the high risk patient for primary prevention: Executive summary. American Heart Association. Circulation 2000;101:111-6.   Back to cited text no. 7
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8.Hodis HN, Mack WJ, LaBree L, Selzer RH, Liu CR, Liu CH, et al. The role of carotid Intima Media Thickness in predicting clinical coronary events. Ann intern Med 1998;128:262-9.   Back to cited text no. 8
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9.O' Leary DH, Polak JF. Intima Media Thickness. A Tool for Atherosclerosis imaging and Event Prediction. Am J Cardiol 2002;90(10C):18L-21L.   Back to cited text no. 9
    
10.Mohan V, Deepa R, Ravi Kumar R. Role of carotid IMT in assessment of preclinical atherosclerosis. Indian Heart J 2000;52:395-9.  Back to cited text no. 10
    
11.Ridker PM. Evaluating novel cardiovascular risk factors. Ann Intern Med 1999;130:933-7.   Back to cited text no. 11
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12.Jadhav UM, Kadam NN. Carotid intima-media thickness as an independent predictor of coronary artery disease. Indian Heart J 2001;53:458-62.   Back to cited text no. 12
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13.Burke GL, Evans GW, Riley WA, Sharrett AR, Howard G, Barnes RW, et al. Arterial wall thickness is associated with prevalent cardiovascular disease in middle aged adults. The Atherosclerosis Risk in Communities (ARIC) study. Stroke 1995;26:386-91.   Back to cited text no. 13
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14.Bots L, Hoes W, Koudstall J, Hofman A, Grobbee E. Common Carotid Intima Media Thickness and risk of stroke and myocardial infarction. Circulation 1997;96:1432-7.  Back to cited text no. 14
    
15.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.   Back to cited text no. 15
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16.Salonen JT, Salonen R. Ultrasound B-mode imaging in observational studies of atherosclerotic progression. Circulation 1993;87(3 Suppl):56-65.   Back to cited text no. 16
    
17.Mohan V, Ravikumar R, Shanthi Rani S, Deepa R. Intimal medial thickness of carotid artery in south Indian diabetic and non diabetic subjects. The Chennai Urban Population Study (CUPS) Diabetologia 2000;43:494-9.  Back to cited text no. 17
    



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