The Predictive Value Of Coronary Heart Disease Via Carotid Ultrasound And High Sensitive C-reactive Protein

ObjectiveThrough the detection of the IMT(Intima-media thickness) in the carotid artery.the stability of the plague and serum hs-CRP(high sensitivity C-reactive protein)levels, discuss the relationship between these factors and the Coronary Atherosclerotic Heart Disease(CAD)and clear whether they were the risk factors in predicting CAD. Furthermore, Receiver operating characteristic (ROC) curve were used to acquire appropriate sensitivity and specificity of IMT and serum hs-CRP for the concurrent CAD.MethodsThe study population included 116 patients(63.90±8.89 years old,70 men)who had suffered from chest pain.chest distress and were clinically suspected CAD. After admission, all patients had undergone coronary angiography, according to the results of the coronary angiography, the patients could be divided to the control group and CAD group. Considering the different level of disease, we made the further classification as one-vessel group,two-vessel group and three-vessel group. Also, all patients had been detected carotid artery IMT and the carotid plagues using high-frequency Ultrasound and measured serum hs-CRP level, blood total cholesterol(TC), blood triglyceride(TG), low density lipoprotein cholesterol(LDL), high density lipoprotein cholesterol(HDL), Finally, do the Statistic analysis of results.Result1.87 patients definitely were diagnosed as CAD according coronary angiography, including 33 patients of one-vessel group,27 patients of two-vessel group,27 patients of three-vessel group and 29 patients were the control group.2. The results showed that the carotid artery IMT in CAD group was obviously higher than in the control group (t=6.504,P<0.001),and there was significant different between one-vessel group and two-vessel group, also was between two-vessel group and three-vessel group (t1.2=-4.681,P1.2<0.001;t2.3=-3.131, P2.3=0.003).3. The detection rate of the plagues were also high in CAD group and the control group, there was no significant different between them (P=0.511). In CAD group,32 out 54 patients had instability plaques, while 2 out 16 patients in the control group, there was significant different between them(P=0.008).The percentage of the instability plaques increased with group category, and there was significant different between one-vessel group and two-vessel group(P=0.037),also was between two-vessel group and three-vessel group(P=0.028). The carotid artery plaques Crouse in CAD group was higher than the control group(P<0.001).There was significant different between one-vessel group and the control group (P=0.000), also was between one-vessel group and two-vessel group(P=0.002),and two-vessel group and there-vessel group(P=0.001).4. Patients with CAD tended to have higher the serum hs-CRP level (t=4.855,P <0.001). and as the carotid artery IMT and the percentage of the instability plaques increased, the hs-CRP level increased. There was significant different between one-vessel group and two-vessel group(t=-0.348,P=0.001),also was two-vessel group and there-vessel group(t=2.140,P=0.037).5. Multiple logistic regression analysis was performing to identify the independent variables for predicting CAD. Carotid artery IMT, hs-CRP were the risk factors.6.The cut-off level determined by ROC curve analysis for the great sensitivity and specificity for IMT was 0.78mm(sensitivity 96.6%, specificity41.0%) and that for hs-CRP was 2.15mg/L (sensitivity 85.1%, specificity 72.3%).7. Excellent correlation were found between IMT and hypertension, smoking, diabetes, TC, and no correlation with HDL,LDL,TG, age. We also found hs-CRP has excellent correlation with hypertension, diabetes, but no correlation with age, smoking, TG, TC, HDL, LDL. Conclusion1.With the augment of carotid artery IMT, the mount of the instability plaques and Crouse score, the pathological branches of coronary arteries were increasing.2. The character of carotid atherosclerosis and Coronary heart disease has a positive correlation.the pathological branches of coronary arteries were not relation to the mount of plaques, but were close related to character of carotid atherosclerosis.3.Excel lent correlation were found between CIMT. the instability plaques and hs-CRP. With the increasing of the hs-CRP, the pathological change of the coronary was more severe.4. Smoking, hypertension, TC, diabetes were associated with carotid artery intima-media thickness, they were risk factors for carotid intima-media thickness. and hs-CRP has excellent correlation with hypertension, diabetes, they were risk factors for hs-CRP.5. Carotid artery intima-media thickness, hs-CRP were the independent variables for predicting CAD.