Introduction : Coronary artery calcium score (CACS) and carotid artery intima-media thickness (CIMT) are the markers of atherosclerosis. An association between CACS and CIMT with presence of atherosclerotic coronary artery disease (CAD) is well established. However relationship between severity of CAD with CACS and CIMT is less clear. This study aimed to investigate the correlation between severity of CAD assessed by SYNTAX and Gensini scores with CACS and CIMT. Methods: This prospective study was conducted on 351 patients with CAD between June 2015 to December 2016. CACS was obtained using AGATSTON algorithm with 128 slice multidetector computer tomography (MDCT) before conventional coronary angiography (CCA). CIMT was measured by using Philips IE33 Echo machine. The severity of CAD was assessed by SYNTAX score (SS) and Gensini score on CCA. Correlation between severity of CAD with CACS and CIMT was analysed. Results: Mean CACS was 241.5±463.7, and this was positively correlated with over all SS (r=0.417, P<0.0001) and Gensini score (r=0.405, P<0.0001). Mean CIMT was 0.80±0.18 mm and this was also significantly correlated with SS (r=0.450, P<0.0001) and Gensini score (r=0.459,<0.0001). Multivariate analysis showed that CACS was independently associated with diabetes mellitus (β:0.11, P=0.021), SS (β:0.251, P=0.010) and mean CIMT (β:0.128, P=0.028). Receiver-operating characteristic (ROC) curve analysis revealed a cut off CACS of >493 for SS≥33 (high-SS tertile). Conclusion: Our study confirmed a significant correlation between CACS and CIMT with the severity of CAD assessed by SS and Gensini scores. CACS and CIMT may be considered as important noninvasive diagnostic modalities in the assessment of the severity of CAD.

Aortic stenosis (AS) is characterized by gradual thickening, fibrosis, and calcification leading to reduced opening of aortic valve leaflets. Aortic valve narrowing increases the afterload on left ventricle (LV), which consequently leads to hypertrophy and myocardial fibrosis which over a period of time leads to diastolic dysfunction. LV diastolic dysfunction is an independent predictor of heart failure rehospitalization and mortality in post-aortic valve replacement patients. Chronic pressure overload leads to development of systolic dysfunction due to afterload mismatch. Patients with severe symptomatic AS and depressed LV function without significant myocardial scarring will derive maximum benefit after percutaneous valve replacement and thus show immediate improvement after reduction of LV afterload. We report two such cases which had good LV function recovery immediately after transcatheter aortic valve replacement (TAVR).

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