Evaluation Of Carotid Stiffness In Predicting The Risk Of Coronary Artery Diseaseusing Shear Wave Elastography And Ultrafast Pulse Wave Velocity

Objective:To evaluate the risk prediction value of carotid atherosclerosis degree on severity of coronary heart disease and coronary artery disease by shear wave elastography(SWE)and ultrafast pulse wave velocity technology(UF-PWV).Methods:Patients who were going to receive coronary angiography(CAG)in our hospital were selected as subjects.A total of 135 patients were enrolled,including 97 males and 38 females,aged 41-71 years,with an average age of 57.92±7.13 years.According to the results of CAG,they were divided into CAD group and non-CAD group.There were 90 cases in CAD group and 45 cases in non-CAD group.Coronary artery severity was assessed by the Gensini score of coronary angiography.Patients were divided into 3 groups according to Gensini score:low score group(score≤5,n=47);Median score group(5<score≤35,n=34);High score group(score>35,n=54).Carotid hemodynamics parameters(PSV,MDV,EDV,RI,PI,Slope),carotid intima-media thickness(IMT),carotid elastic modulus(Emean,Emin,Emax)and carotid pulse wave(PWV-BS,PWV-ES)were measured by conventional high-frequency ultrasound,SWE and UF-PWV were statistically analyzed.Results:The elastic modulus(Emean,Emin,Emax),carotid pulse wave velocity(PWV-BS,PWV-ES)and IMT of carotid artery in CAD group were higher than those in non-CAD group.Gensini score was used to evaluate the severity of coronary artery disease.Carotid elastic modulus(Emean,Emin,Emax),carotid pulse wave velocity(PWV-BS,PWV-ES),carotid IMT were positively correlated with Gensini score.In multivariate analysis,carotid elastic modulus(Emean,Emin,Emax),PWV-BS,PWV-ES were still independent predictors of CAD and high score group after controlling for traditional risk factors(TRF).TRF included age,gender,body mass index,hypertension,diabetes mellitus,smoker,total cholesterol,low-density lipoprotein cholesterol,high-density lipoprotein cholesterol,fasting blood glucose,homocysteine and creatinine.Emean(AUC:0.902),Emax(AUC:0.904)and PWV-ES(AUC:0.907)had better predictive ability for CAD,with sensitivities of78.8%,82.2%and 92%,respectively.The specificity was 95.6%,95.5%and 80%,respectively.In addition,Emax and PWV-ES were added into the TRF model,and the predictive ability of the model for CAD increased significantly,with AUC of 0.927and 0.92,respectively.Conclusions:1.Measurement of local carotid stiffness using SWE and UF-PWV techniques is more valuable than IMT in predicting the presence and severity of CAD and helps to identify patients at high risk of CAD.2.SWE,UF-PWV technique and IMT have a higher predictive value in predicting CAD and its severity than TRF and contribute to the risk stratification of CAD.