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

• Chung H
• Jung YH
• Kim KH
• Kim JY
• Min PK
• Yoon YW
• Lee BK
• Hong BK
• Rim SJ
• Kwon HM
• Choi EY

• KMID: 2223772
• DOI: http://doi.org/10.4070/kcj.2016.46.1.72

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

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

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

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  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.

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  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.

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