K. Hristova 1, L. Vladimirova 2, F. Nikolov 2, P. Nikolov 2, Tz. Katova 1
1 National Heart Hospital – Sofia,
2 Medical University – Sofia, Bulgaria
Objective: To study the relationship between carotid pathology and exercise stress-test in patients with new onset symptoms for cardiovascular diseases (CVDs).
Material and Methods: Exercise stress-test (EST) and echocardiography were performed in 503 patients (mean age 54±17 years) with symptoms for CVD in two cardiological centers. Based on EST the patients were classified in three groups - with positive, negative or questionable results. Color duplex sonography of both carotid arteries was performed in transverse and longitudinal planes and intima media thickness (IMT) of the common carotid (CCA) and internal carotid (ICA) arteries was measured. No modifiable (age and sex) and some modifiable (hypertension, diabetes, atrial fibrillation, dyslipidemia, carotid stenosis, obesity, hemorheological variables – leucocytes (Leuc) hemoglobin (Hb), hematocrit (Ht), FR for CVD were evaluated. The pts with positive EST were on PTCA undergone and pts with questionable EST the decision for PTCA was taken after severity of carotid pathology and clinical exam.
Results: Arterial hypertension (AH) was the most common risk factor (RF) in 75% of all patients, dyslipidemia - in 64% and diabetes mellitus - in 28%. A symmetrical hypertrophy of the left ventricle and a decrease of its contractility was found as typical diastolic dysfunction. Mild ICA stenoses predominated in all groups while the moderate or severe carotid stenoses were relatively rare, especially with positive EST. ICA symptomatic thromboses were seen in 4,5% with positive EST. The IMT of the ICA correlated positively with the AH (r=+0.60,p<0.05). In the group with positive 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 and questionable ESTs correlated very fair with moderate and mild carotid pathology and significant coronary diseases in pts with positive ESTs.There were fewer subjects with signifcant plaques in lower risk group (2%) and more subjects with plaques in the high risk group (60%).
Discussion: The study confirms the clinical impact of carotid pathology alone and its association with other RF. The application of carotid ultrasound in CVD is sensitive method for assessment of coronary pathology.
Key words: intima-media thickness, stress test.