Common Carotid Artery Intima-Media Thickness and Intracranial Pulsatility Index in Non-ST-Elevation Acute Coronary Syndromes

Abstract

Background: Common carotid intima-media thickness (CIMT) has been related to cardiovascular risk factors, coronary atherosclerosis and a higher risk of myocardial infarction. Evaluation of intracranial arteries by transcranial Doppler explores the presence of vascular dysfunction at this level. We tested the hypothesis that CIMT and Doppler Pulsatility Index (DPI) can be related to the Thrombolysis in Myocardial Infarction (TIMI) risk score for non-ST-elevation acute coronary syndrome (nST-ACS). The relation to the prognosis after an acute event was also assessed. Methods: We recruited 126 consecutive patients (80 males; mean age: 66.6 ± 13.1 years) admitted with nST-ACS. A carotid assessment with bidimensional mode, measuring the CIMT in the posterior wall of the common carotid artery, and a transcranial Doppler assessment of the middle cerebral artery, with measurement of the Pulsatility Index were carried out. Clinical follow-up at 6 months was performed for endpoints (cardiovascular death, recurrent ACS or revascularization). Results: Fifty-nine patients had an abnormal (≧0.8 mm) CIMT, whilst 70 patients had an abnormal DPI (≧1.2). CIMT was correlated with TIMI risk score (Pearson r: 0.26; p = 0.004), whilst abnormal DPI was associated with TIMI risk scale (p < 0.001). Using a logistic regression analysis, the presence of an abnormal CIMT was only related to age ≧65 (p = 0.0012) and diabetes mellitus (p = 0.0028). Abnormal DPI was also associated with age ≧65 (p < 0.0001) and diabetes mellitus (p = 0.0466). Neither CIMT nor DPI were related to 6 months’ clinical outcome. Conclusions: Patients with nST-ACS have a high prevalence of dates of abnormal DPI, which was associated with increased CIMT. Both variables were related to age and diabetes but not with clinical outcomes.

Pre-Eclampsia Is a Risk Factor of Carotid Artery Atherosclerosis

“…Therefore, in a representative population sample, we examined whether women with previous PE or pregnancy-induced hypertension (PIH) without proteinuria have an increased carotid intima-media thickness (IMT) and a higher incidence of atherosclerotic plaques compared with women who had been healthy during pregnancy and women who had never given birth. It has previously been shown that the IMT of carotid arteries and detection of plaques are useful measures of preclinical atherosclerosis and progression of atherosclerotic disease [14,15,16,17,18,19,20]. …”

Valor prognóstico da espessura médio-intimal da artéria carótida na mortalidade de curto e longo prazo na estratégia de registro de síndrome coronariana aguda (ERICO)

“…No que diz respeito ao valor prognóstico da EMIC e SCA, dois estudos anteriores avaliaram a mortalidade (Held et al, 2001;Tello-Montoliu et al, 2007 (Tello-Montoliu et al, 2007). Independentemente de diferenças na metodologia e características da amostra comparando estes estudos prévios (Held et al, 2001;Tello-Montoliu et al, 2007) com o nosso, sugere-se que não há nenhuma relação entre EMIC e mortalidade em pacientes pós-SCA.…”

“…Independentemente de diferenças na metodologia e características da amostra comparando estes estudos prévios (Held et al, 2001;Tello-Montoliu et al, 2007) com o nosso, sugere-se que não há nenhuma relação entre EMIC e mortalidade em pacientes pós-SCA. Algumas hipóteses que talvez justifiquem estes resultados nulos, incluindo aqueles apresentados no nosso estudo, deve ser devido a EMIC ser um melhor marcador de aterosclerose subclínica em estágios iniciais da doença coronariana e, portanto, é um preditor fraco de mortalidade neste grupo de pacientes, mesmo nos valores mais elevados em comparação com indivíduos com DAC mais estável (Demircan et al, 2005, Ciccone et al, 2013, Rosa et al, 2003.…”

“…Apesar de muitos estudos anteriores descreverem EMIC relacionada com FRCV e o valor da EMIC para prever o risco cardiovascular em indivíduos com risco assintomático intermediário, o papel da EMIC ainda não está claramente definido na mortalidade em SCA (Held et al, 2001;Tello-Montoliu et al, 2007 (Held et al, 2001;Tello-Montoliu et al, 2007).…”

“…Na verdade, há uma escassez de publicações que avaliam o valor prognóstico da EMIC de carótida e mortalidade pós-SCA (Held et al, 2001;Tello-Montoliu et al, 2007).…”