Spiral CT detection of coronary artery calcification and increased carotid intimal-medial thickness by carotid ultrasonography: valuable non invasive methods for detecting early coronary artery diseases and atherosclerosis

ABSTRACT

Currently available non invasive techniques can identify only patients with advanced coronary artery disease [CAD] who manifest myocardial ischemia. Also, the gold standard invasive coronary angiography provides no information on plaque burden other than the extent of luminal obstruction and vascular remodeling phenomenon results in disparity between plaque burden and angiographic stenosis. To evaluate detection of coronary artery calcification [CAC] by spiral CT and increased carotid intimal-medial thickness [IMT] by B-mode ultrasound as non-invasive tools for detection of early atherosclerotic process, so that preventive measures may be instituted before occlusive vascular diseases occurs. 70 subjects with their age 51.68 +/- 10.1 years, divided into group A include 31 patients with CAD 12 patients have already done coronary angiography, and group B include 39 subjects without evidence of CAD, were subjected to clinical evaluation, some laboratory investigations. E.C.G., X-ray chest, echocardiography, carotid ultrasonography for measurement of carotid IMT and spiral CT scan of heart for coronary calcium scorings [CCS]. Both increased carotid IMT and CAC were detected in 55.7% of total 70 individuals, 83.9% of group A and 33.3% of group B. Significant increase of Carotid IMT and high CCS was detected in patients with angiographyically documented CAD than those with normal coronary angiography. There was a significant positive association between both increased carotid IMT and CAC and some risk factors for CAD e.g. age, male sex, smoking, diabetes mellitus, hypertension, serum cholesterol level and also with ECG evidence of CAD. Detection of coronary artery calcification by spiral CT and increased carotid intima media thickness by ultrasound may represent a valuable non invasive methods for identification of early atherosclerotic process. Spiral CT scan has on advantage over invasive coronary angiography via giving information about plaque burden and vascular remodeling phenomen that does not affect its specificity