Utility of both carotid intima-media thickness and endothelial function for cardiovascular risk stratification in patients with angina-like symptoms
| Autor: | Sinsia Gao, Rebecca Cilluffo, Lilach O. Lerman, Raviteja R. Guddeti, R. Jay Widmer, Rebecca E. Nelson, Yasushi Matsuzawa, Taek Geun Kwon, Ryan J. Lennon, Peter Ganz, Sara Svedlund, Li-Ming Gan, Tatsuo Aoki, Amir Lerman |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Male
medicine.medical_specialty Chest pain Carotid Intima-Media Thickness Risk Assessment Article Angina Risk Factors Internal medicine medicine Humans Single-Blind Method cardiovascular diseases Myocardial infarction Angina Stable Prospective Studies Stroke Aged Framingham Risk Score business.industry Hazard ratio Middle Aged medicine.disease Confidence interval Intima-media thickness Cardiology Female Endothelium Vascular medicine.symptom Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | International journal of cardiology. 190 |
| ISSN: | 1874-1754 |
| Popis: | Background Myocardial perfusion scintigraphy (MPS) is used widely to assess cardiovascular risk in patients with chest pain. The utility of carotid intima–media thickness (CIMT) and endothelial function as assessed by reactive hyperemia-peripheral arterial tonometry index (RHI) in risk stratifying patients with angina-like symptoms needs to be defined. We investigated whether the addition of CIMT and RHI to Framingham Cardiovascular Risk Score (FCVRS) and MPS improves comprehensive cardiovascular risk prediction in patients presenting with angina-like symptoms. Methods We enrolled 343 consecutive patients with angina-like symptoms suspected of having stable angina. MPS, CIMT, and RHI were performed and patients were followed for cardiovascular events for a median of 5.3years (range 4.4–6.2). Patients were stratified by FCVRS and MPS. Results During the follow-up, 57 patients (16.6%) had cardiovascular events. Among patients without perfusion defect, low RHI was significantly associated with cardiovascular events in the intermediate and high FCVRS groups (hazard ratio (HR) [95% confidence interval (CI)] of RHI≤2.11 was 6.99 [1.34–128] in the intermediate FCVRS group and 6.08 [1.08–114] in the high FCVRS group). Furthermore, although MPS did not predict, only RHI predicted hard cardiovascular events (cardiovascular death, myocardial infarction, and stroke) independent from FCVRS, and adding RHI to FCVRS improved net reclassification index (20.9%, 95% CI 0.8–41.1, p=0.04). Especially, RHI was significantly associated with hard cardiovascular events in the high FCVRS group (HR [95% CI] of RHI≤1.93 was 5.66 [1.54–36.4], p=0.007). Conclusions Peripheral endothelial function may improve discrimination in identifying at-risk patients for future cardiovascular events when added to FCVRS–MPS-based risk stratification. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|
Full Text from ScienceDirect