Korean Circ J.  2016 Jan;46(1):72-78. 10.4070/kcj.2016.46.1.72.

Carotid Artery End-Diastolic Velocity and Future Cerebro-Cardiovascular Events in Asymptomatic High Risk Patients

Affiliations
  • 1Division of Cardiology, Heart Center, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea. choi0928@yuhs.ac

Abstract

BACKGROUND AND OBJECTIVES
Prognostic value of additional carotid Doppler evaluations to carotid intima-media thickness (IMT) and plaque has not been completely evaluated.
SUBJECTS AND METHODS
A total of 1119 patients with risk factors for, but without, overt coronary artery disease (CAD), who underwent both carotid ultrasound and Doppler examination were included in the present study. Parameters of interest included peak systolic and end-diastolic velocities, resistive indices of the carotid arteries, IMT, and plaque measurements. The primary end-point was all-cause cerebro-cardiovascular events (CVEs) including acute myocardial infarction, coronary revascularization therapy, heart failure admission, stroke, and cardiovascular death. Model 1 covariates comprised age and sex; Model 2 also included hypertension, diabetes and smoking; Model 3 also had use of aspirin and statin; and Model 4 also included IMT and plaque.
RESULTS
The mean follow-up duration was 1386+/-461 days and the mean age of the study population was 60+/-12 years. Amongst 1119 participants, 43% were women, 57% had a history of hypertension, and 23% had diabetes. During follow-up, 6.6% of patients experienced CVEs. Among carotid Doppler parameters, average common carotid artery end-diastolic velocity was the independent predictor for future CVEs after adjustments for all models variables (HR 0.95 per cm/s, 95% confident interval 0.91-0.99, p=0.034 in Model 4) and significantly increased the predictive value of Model 4 (global chi2=59.0 vs. 62.8, p=0.029).
CONCLUSION
Carotid Doppler measurements in addition to IMT and plaque evaluation are independently associated with future CVEs in asymptomatic patients at risk for CAD.

Keyword

Carotid arteries; Doppler; Events

MeSH Terms

Aspirin
Carotid Arteries
Carotid Artery, Common
Carotid Intima-Media Thickness
Coronary Artery Disease
Female
Follow-Up Studies
Heart Failure
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hypertension
Myocardial Infarction
Risk Factors
Smoke
Smoking
Stroke
Ultrasonography
Aspirin
Smoke

Figure

  • Fig. 1 Schematic presentation of study population. ECHO: echocardiography, CAD: coronary artery disease, CVA: cerebrovascular accident, US: ultrasound.

  • Fig. 2 Schematic presentation of Doppler findings of common carotid artery. PSV: peak systolic velocity, EDV: end-diastolic velocity.

  • Fig. 3 Kaplan-Meier survival curve. The group with lower CCA-EDV (<15.9 cm/s) has higher cerebro-cardiovascular events. CCA: common carotid artery, EDV: end-diastolic velocity.

  • Fig. 4 Incremental prognostic value of CCA-EDV for cerebro-cardiovascular events. Model 1 included age and sex (demographics); Model 2 included history of hypertension, diabetes, and smoking status (risk factors) in addition to Model 1 variables; Model 3 included aspirin use and statin use (medications) in addition to Model 2 variables; and Model 4 included IMT and presence of plaque (imaging markers) in addition to Model 3 variables. CCA: common carotid artery, EDV: end-diastolic velocity, IMT: intima-media thickness.


Cited by  1 articles

Carotid Atherosclerosis and Electrocardiographic Left Ventricular Hypertrophy in the General Population: The Namwon Study
Nam-Ho Kim, Min-Ho Shin, Sun-Seog Kweon, Jum Suk Ko, Young-Hoon Lee
Chonnam Med J. 2017;53(2):153-160.    doi: 10.4068/cmj.2017.53.2.153.


Reference

1. Polak JF, Pencina MJ, Pencina KM, O'Donnell CJ, Wolf PA, D'Agostino RB Sr. Carotid-wall intima-media thickness and cardiovascular events. N Engl J Med. 2011; 365:213–221.
2. O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular Health Study Collaborative Research Group. N Engl J Med. 1999; 340:14–22.
3. Yuk HB, Park HW, Jung IJ, et al. Analysis of carotid ultrasound findings on cardiovascular events in patients with coronary artery disease during seven-year follow-up. Korean Circ J. 2015; 45:28–37.
4. Grant EG, Benson CB, Moneta GL, et al. Carotid artery stenosis: gray-scale and Doppler US diagnosis--Society of Radiologists in Ultrasound Consensus Conference. Radiology. 2003; 229:340–346.
5. Bai CH, Chen JR, Chiu HC, Pan WH. Lower blood flow velocity, higher resistance index, and larger diameter of extracranial carotid arteries are associated with ischemic stroke independently of carotid atherosclerosis and cardiovascular risk factors. J Clin Ultrasound. 2007; 35:322–330.
6. Wolff T, Guirguis-Blake J, Miller T, Gillespie M, Harris R. Screening for carotid artery stenosis: an update of the evidence for the U.S. Preventive Services Task Force. Ann Intern Med. 2007; 147:860–870.
7. Stein JH, Korcarz CE, Hurst RT, et al. Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: a consensus statement from the American Society of Echocardiography Carotid Intima-Media Thickness Task Force. Endorsed by the Society for Vascular Medicine. J Am Soc Echocardiogr. 2008; 21:93–111. quiz 189-90.
8. Beach KW, Leotta DF, Zierler RE. Carotid Doppler velocity measurements and anatomic stenosis: correlation is futile. Vasc Endovascular Surg. 2012; 46:466–474.
9. Pickett CA, Jackson JL, Hemann BA, Atwood JE. Carotid bruits as a prognostic indicator of cardiovascular death and myocardial infarction: a meta-analysis. Lancet. 2008; 371:1587–1594.
10. Chuang SY, Bai CH, Chen JR, et al. Common carotid end-diastolic velocity and intima-media thickness jointly predict ischemic stroke in Taiwan. Stroke. 2011; 42:1338–1344.
11. Dijk JM, Algra A, van der Graaf Y, Grobbee DE, Bots ML. SMART study group. Carotid stiffness and the risk of new vascular events in patients with manifest cardiovascular disease. The SMART study. Eur Heart J. 2005; 26:1213–1220.
12. Janzen J. The microscopic transitional zone between elastic and muscular arteries. Arch Mal Coeur Vaiss. 2004; 97:909–914.
13. Barutcu I, Esen AM, Degirmenci B, et al. Acute cigarette smoking-induced hemodynamic alterations in the common carotid artery--a transcranial Doppler study--. Circ J. 2004; 68:1127–1131.
14. Manabe S, Okura T, Watanabe S, Higaki J. Association between carotid haemodynamics and inflammation in patients with essential hypertension. J Hum Hypertens. 2005; 19:787–791.
Full Text Links
  • KCJ
Actions
Cited
CITED
export Copy
Close
Share
  • Twitter
  • Facebook
Similar articles
Copyright © 2024 by Korean Association of Medical Journal Editors. All rights reserved.     E-mail: koreamed@kamje.or.kr