Utility of both carotid intima–media thickness and endothelial function for cardiovascular risk stratification in patients with angina-like symptoms. (1st July 2015)

• Record Type: Journal Article
• Authors: Matsuzawa, Yasushi; Svedlund, Sara; Aoki, Tatsuo; Guddeti, Raviteja R.; Kwon, Taek-Geun; Cilluffo, Rebecca; Widmer, R.Jay.; Nelson, Rebecca E.; Lennon, Ryan J.; Lerman, Lilach O.; Gao, Sinsia; Ganz, Peter; Gan, Li-Ming; Lerman, Amir
• Is Part Of: International journal of cardiology. Volume 190(2015)
• Page Start: 90
• Page End: 98
• Publication Date: 2015-07-01
• Subjects: ASCVD atherosclerotic cardiovascular disease -- CI confidence interval -- CIMT carotid intima–media thickness -- FCVRS Framingham Cardiovascular Risk Score -- MPS stress myocardial perfusion scintigraphy -- RHI reactive hyperemia-peripheral arterial tonometry index -- RH-PAT reactive hyperemia-peripheral arterial tonometry; Cardiovascular disease -- Framingham Cardiovascular Risk Score -- Myocardial perfusion -- Noninvasive -- Endothelial function -- Carotid intima–media thickness; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2015.04.124
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: 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 5.3 years (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.