Haberka M, et al. - This study intended to offer a complete evaluation of the links between single or combined cardiovascular ultrasound indexes and the complexity of coronary artery disease (CAD) in high and very-high risk patients. For the first time, it was demonstrated that there existed an association of a combination of ultrasound indexes related to periarterial fat and vascular wall (PATIMA index) with more complex CAD in high and very-high risk patients. Notably, PATIMA index versus other single ultrasound indexes and clinical risk assessment revealed improved predictive value.

Methods

• This study included a total of 215 patients scheduled for elective coronary angiography (F/M: 80/135 pts; age: 61.8 ± 7.9 years).
• Detailed clinical characteristics, including several obesity parameters, and the following ultrasound indexes were obtained: carotid intima-media thickness (IMT) and extra-media thickness (EMT), epicardial fat thickness (EFT) and intra-abdominal fat thickness (IAT).
• Researchers assessed CAD severity and complexity based on the well-evidenced SYNTAX score (SS) algorithm.

Results

• Data reported that study participants (79% with a very high CV risk) had central obesity (77%), and arterial hypertension (81%), one-third (37%) had diabetes and most of the individuals (74%) were current or previous smokers.
• In the study group, significantly higher SS (p < 0.05) was related to male sex, higher number of CV risk factors, diabetes and increased carotid vascular indexes (IMT or EMT ≥ 900 μm), respectively.
• A significantly lower SS was exhibited by obese patients compared to non-obese individuals (3.65 ± 6.66 vs. 5.93 ± 8.8; p < 0.01), which was not explained by the number of CV risk factors or age.
• Researchers noted that all the ultrasound indexes (except for visceral fat – IAT) revealed significant associations with the SS and the highest correlation coefficient was found for PATIMA combined index (r = 0.45; p < 0.01).
• Hence, none of the obesity-related clinical indexes demonstrated any associations with CAD complexity.
• It was evident in multivariate regression analysis that male sex, chronic kidney disease and the PATIMA index were independently associated with the Syntax Score.
• Additionally, the ROC analysis showed that the highest sensitivity (71% and 82%) and specificity (77% and 72%) in prediction of either SS > 1 or SS > 7 were found for the combined PATIMA index (negative predictive value = 92% for SS > 7).