P410Correlation between carotid ultrasound and exercise stress test for assessing the sublinical vascular deseases in asymptomatic patients


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Abstract

Aim: The relationship between carotid pathology and exercise stress – test in patients with new onset symptoms for cardiovascular disease (CVD) as predictor for cardiovascular events.Material and methods: Exercise stress-test(EST)and echocardiography exams were performed in 503 patients(mean age54±17,5y,men64%) with typical and untypical symptoms for CVD, and without previously history for CVD in two cardiological centers. After EST patients were classified in three groups- with positive,negative and questionable results. Color duplex sonography of rigth and left carotid arteries was performed in transverse and longitudinal planes and intima media thickness (IMT) of the common carotid (CCA) and the internal carotid arteries was measured. No modifiable (age and sex) and some modifiable (hypertension, diabetes, atrial fibrillation, dyslipidemia (Chol,Tg,HDL), carotid artery stenosis, obesity,hemorheological variables –leucocytes (Leuc), hemoglobin(Hb), hematocrit (Ht), FR for CVD were evaluated.The patients with positive EST were on PTCA undergone.The patients with questionable EST, the decision for PTCA was taken after severity of carotid pathology and clinical exam.Results: AH was the most common RF in all groups–75 %,dyslipidemia-64 %,diabetes-28 %. A symmetrical hypertrophy of the left ventricle and a decrease of its contractility, as E/E“>15 was found as typical diastolic dysfunction.Mild stenosis of ICA(35%) predominated in all groups while moderate(36-55%)or severe(>60%)carotid stenoses were relatively rare, especially with positive EST.Symptomatic thromboses ofICA were seen in4,5 %pts with positive EST.IMT of the ICA correlated positively with the arterial blood pressure (r=+0.60,p<0.05). A positive corelation was established between CCA, diastolic blood flow and EF in all patients groups (r=0.45;p<0.01). In group with postive EST (32%) were found significant carotid disease (28%)and significant coronary anatomy– one, two or multivessel coronary disease.The multivariable analysis confirms that AH, positive ESTs and questionable ESTs correlated very fair with moderate and mild carotid pathology and significant coronary diseases in pts with positive ESTs (beta 0.31;p<0.001).There were fewer subjects with signifcant plaques in lower risk group (2%) and more subjects with plaques in the high risk group (60%).Conclusion: The study confirms clinical impact of carotid pathology alone or its association with other RF is under consideration. Noninvasive carotid sonography in patients with CVD is sensitive method for assessment of coronary pathology.

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