Abstract 693: Can Coronary Artery Disease Severity Be Predicted Using Flow-mediated Dilatation of Brachial Artery and/or Intima-media Thickness of Carotid Artery
Background: It has been reported that the flow-mediated dilatation (FMD) of the brachial artery and carotid intima-media thickness (IMT) correlate with the presence of coronary artery disease (CAD). However, it is not clear whether CAD severity can be detected using these parameters. Therefore, we examined whether the severity of CAD can be detected by FMD of the brachial artery and/or IMT using carotid ultrasonography.
Methods: One thousand two hundred and twenty-seven patients who underwent coronary angiography during the evaluation of CAD were enrolled. In each patient, brachial artery diameter responses to FMD and nitroglycerin spray administration and carotid IMT were measured using high-resolution ultrasound (10 MHz) in the morning before coronary angiography. CAD was defined as >50% stenosis of a major coronary artery. Multivessel disease was defined as the presence of stenosis of two or more major vessels.
Results: There were 100 patients without CAD, 250 with single-vessel disease, and 375 with multivessel disease. There were significant differences in age (p < 0.0001), gender (p = 0.015), presence of hypertension (p = 0.0009), HDL cholesterol level (p < 0.0001), LDL cholesterol level (p = 0.0042), fasting blood sugar (p = 0.0001), and HbA1c (p < 0.0001), and ejection fraction on echocardiography (UCG) (p < 0.0001) among the three groups. FMD and nitroglycerin-induced dilatation (NTG-D) were significantly lower (p < 0.0001, p = 0.0001, respectively) and IMT was significantly higher (p < 0.0001) in patients with multivessel disease. Logistic regression analysis demonstrated that FMD (p = 0.0003) and IMT (p < 0.0001), levels of HDL-C and HbA1c, and ejection fraction on UCG were predictors of the presence of severe CAD. Receiver operating characteristic curve analysis showed cut-off values for detecting multivessel disease of 4.4% for FMD and 1.12 mm for IMT. Using these cut-off values of FMD and IMT, sensitivity and specificity were 0.37 and 0.84 for the presence of multivessel disease.
Conclusions: These findings suggest that FMD in brachial ultrasound and IMT in the carotid ultrasound were significant factors associated with the presence of multivessel disease. These ultrasonographic indices may provide important diagnostic information.