Additional value of inflammatory biomarkers and carotid artery disease in prediction of significant coronary artery disease as assessed by coronary computed tomography angiography

Abstract

Among asymptomatic intermediate-risk patients, the presence of increased IL6 levels in addition to traditional risk factors (male gender with diabetes) and carotid artery disease predicts higher rates of obstructive CAD and it could be of help to identify which subset of asymptomatic patients could be referred to CCTA for screening.

Prognostic relevance of subclinical coronary and carotid atherosclerosis in a diabetic and nondiabetic asymptomatic population

“…The unique ability of CCTA to identify adverse plaque features such as low‐density noncalcified plaque and positive remodeling of the vessel is of great clinical value . Despite the power of coronary stenosis information in predicting event occurrence and correctly reclassifying most patients, the present analysis shows that the characterization of plaque and, specifically, the presence of positive remodeling, are able to further improve risk stratification, particularly lowering the risk of patients who do not show this feature.…”

Usefulness of carotid ultrasonography in the assessment of coronary artery disease extension in patients undergoing exercise echocardiography

“…Subjects were younger than our population, nearly 50% of them were women, and cardiovascular risk factors prevalence was different with more hypertension and dyslipidemia and less diabetes mellitus and smoking habit. Finally, just as Cohen's study and ours, they considered the number of affected vessels and not angiographic scoring systems . Studies performed with invasive coronary angiography found a relationship between CAD extension, defined by the number of affected vessels or by angiographic scoring systems, and carotid disease, mostly CIMT, in patients suffering stable angina and/or acute coronary syndrome.…”

“…Carotid disease, defined as carotid intima‐media thickness (CIMT) and/or the presence of plaques, has been associated in epidemiological studies with myocardial infarction, stroke, and death, and its study improves the ability of risk functions to predict cardiovascular events . It has also showed its utility for coronary artery disease (CAD) diagnosis in patients with ischemic heart disease suspicion scheduled for invasive and noninvasive diagnostic testing . In that sense, American and European guidelines on the management of stable CAD agree that a history of cerebrovascular or peripheral artery disease increases the likelihood of CAD and ultrasound assessment of the carotid arteries in patients with suspected CAD without known atherosclerotic disease is a grade IIa level C recommendation for diagnosis and preventive purposes in the European guidelines .…”

“…Although there is a correlation between carotid disease and CAD presence and extension in post‐mortem and invasive and noninvasive coronary angiography studies, there are no data in the scientific literature about the relation between CAD extension and carotid disease in patients undergoing noninvasive stress testing such as treadmill exercise stress echocardiography (EE). Moreover, although the American guidelines for the diagnosis and management of patients with stable ischemic heart disease mention peripheral artery disease as a prognostic risk factor for mortality in patients with stable CAD, there is no clear recommendation regarding carotid ultrasound assessment for CAD prognosis or CAD extension in any of these guidelines…”

Advanced imaging techniques (CT and MR): Gender-based diagnostic work-up in ischemic heart disease?

“…Inspired by a renewed awareness of this issue the matter, the researchers have been now reanalysing old data and developing conceiving focused prospective studies based on modern and thrilling technology such as computed tomography angiography (CTA) and cardiac magnetic resonance (CMR). In the light of the dramatic technological advances, CTA and CMR have been giving the possibility offer the ability to characterize both the coronary artery disease (CAD) and the myocardium to at a very high level of detail [4][5][6]. This could allow the imaging modality armamentarium to differentiate the pathophysiology of the IHD and other major heart diseases within each gender.…”