Usefulness of carotid plaque (sum and maximum of plaque thickness) in combination with intima‐media thickness for the detection of coronary artery disease in asymptomatic patients with diabetes

Abstract

Aims/IntroductionThe usefulness of markers of carotid plaque, such as sum (PS) and maximum (P‐max) of the plaque thickness, in combination with intima‐media thickness in the common carotid artery (CIMT) for the detection of obstructive coronary artery disease (CAD) was investigated in patients with type 2 diabetes without known CAD.Materials and MethodsB‐mode ultrasonographic scanning of the carotid artery and multislice computed tomography coronary angiography were carried out in 332 asymptomatic patients with type 2 diabetes.ResultsFor the presence of obstructive CAD when incorporating PS or P‐max to standard risk factors in a multiple logistic regression model, the classification ability in PS and P‐max increased greatly (area under the curve [AUC] 0.827 vs 0.720 [net reclassification index {NRI} = 0.652, P < 0.01] and AUC 0.820 vs 0.720 [NRI = 0.775, P < 0.01], respectively), and it in CIMT increased slightly (AUC 0.740 vs 0.720, NRI = 0.230, P = 0.041). Furthermore, the classification abilities for a model with interaction terms between PS* or P‐max* and CIMT were statistically larger than those for a model without interaction terms (AUC 0.833 vs 0.827 [NRI = 0.411, P < 0.01] and 0.823 vs 0.820 [NRI = 0.269, P < 0.05], respectively). Partitioning showed the patients in the values of the PS <2.6 mm and CIMT <0.725 mm (100%), or in P‐max <2.1 mm and CIMT <0.725 mm (95.4%), did not have obstructive CAD, whereas those in the values of PS ≧2.6 mm, presence of hyperlipidemia and CIMT ≧0.675 mm (84%) or those in the value of P‐max ≧2.1 mm and body mass index ≧24 (91.7%) had obstructive CAD.ConclusionsAlthough the P‐max and PS in the carotid artery were useful as detectors of CAD, combining them with CIMT provided a much superior first‐line screening method in detecting CAD in asymptomatic patients with diabetes.

Predicting obstructive coronary artery disease using carotid ultrasound parameters: A nomogram from a large real‐world clinical data

“…These modalities reflect different aspects of atherosclerosis. 8,22 In our study, the addition of CIMT did not improve the discrimination and reclassification of obstructive CAD, which was consistent with previous studies. However, previous studies found that the CIMT had slight or no significant incremental value over Framingham Risk Score.…”

“…9,11,12,22 A meta-analysis of 11 studies also supported this finding. 9,11,12,22 A meta-analysis of 11 studies also supported this finding.…”

“…These findings indicate CIMT may be biologically distinct from plaque. 22 We have conducted a preliminary study with 515 patients who had the data of maximum plaque height. 24 Plaque is more related to atherosclerotic processes.…”

Differences in optic nerve head microcirculation between evening and morning in patients with coronary artery disease

“…FBS, UAC, mean IMT, and plaque score were identified as risk factors for CAD in previous studies, and those reports may support our present findings. Under antihypertensive medication, the morning pulse pressure was higher in our CAD patients.…”

“…General physiological methods to predict the onset of CAD have been described. IMT obtained by carotid ultrasonography has been reported to be an important surrogate marker for the prediction of CAD and stroke in general populations, and increased carotid plaque was shown to be an independent predictor of the presence and severity of CAD . However, due to difficulties in studying the coronary microcirculation directly, it is still unclear whether aspects of coronary microcirculation could be used to predict CAD.…”