Utility of both carotid intima-media thickness and endothelial function for cardiovascular risk stratification in patients with angina-like symptoms

Yasushi Matsuzawa, Sara Svedlund, Tatsuo Aoki, Raviteja R. Guddeti, Taek Geun Kwon, Rebecca Cilluffo, R. Jay Widmer, Rebecca E. Nelson, Ryan J. Lennon, Lilach O Lerman, Sinsia Gao, Peter Ganz, Li Ming Gan, Amir Lerman

Research output: Contribution to journalArticle

1 Citation (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)90-98
Number of pages9
JournalInternational Journal of Cardiology
Volume190
Issue number1
DOIs
StatePublished - Aug 1 2015

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Carotid Intima-Media Thickness
Myocardial Perfusion Imaging
Perfusion Imaging
Confidence Intervals
Stable Angina
Hyperemia
Manometry
Chest Pain

Keywords

  • Cardiovascular disease
  • Carotid intima-media thickness
  • Endothelial function
  • Framingham cardiovascular risk score
  • Myocardial perfusion
  • Noninvasive

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Utility of both carotid intima-media thickness and endothelial function for cardiovascular risk stratification in patients with angina-like symptoms. / 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.

In: International Journal of Cardiology, Vol. 190, No. 1, 01.08.2015, p. 90-98.

Research output: Contribution to journalArticle

Matsuzawa, Y, Svedlund, S, Aoki, T, Guddeti, RR, Kwon, TG, Cilluffo, R, Widmer, RJ, Nelson, RE, Lennon, RJ, Lerman, LO, Gao, S, Ganz, P, Gan, LM & Lerman, A 2015, 'Utility of both carotid intima-media thickness and endothelial function for cardiovascular risk stratification in patients with angina-like symptoms', International Journal of Cardiology, vol. 190, no. 1, pp. 90-98. https://doi.org/10.1016/j.ijcard.2015.04.124
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. / Utility of both carotid intima-media thickness and endothelial function for cardiovascular risk stratification in patients with angina-like symptoms. In: International Journal of Cardiology. 2015 ; Vol. 190, No. 1. pp. 90-98.
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AU - Matsuzawa, Yasushi

AU - Svedlund, Sara

AU - Aoki, Tatsuo

AU - Guddeti, Raviteja R.

AU - Kwon, Taek Geun

AU - Cilluffo, Rebecca

AU - Widmer, R. Jay

AU - Nelson, Rebecca E.

AU - Lennon, Ryan J.

AU - Lerman, Lilach O

AU - Gao, Sinsia

AU - Ganz, Peter

AU - Gan, Li Ming

AU - Lerman, Amir

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Y1 - 2015/8/1

N2 - 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.

AB - 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.

KW - Cardiovascular disease

KW - Carotid intima-media thickness

KW - Endothelial function

KW - Framingham cardiovascular risk score

KW - Myocardial perfusion

KW - Noninvasive

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