Is the lumen diameter of peripheral arteries a good marker of the extent of coronary atherosclerosis?

BACKGROUND: The lumen diameter (LD) of the extracranial carotid arteries determined by B-mode ultrasound has been provedto be associated with most atherosclerotic risk factors and cardiovascular events. This raises the question as to whether LDmay also predict coronary artery disease.

AIM: To elucidate whether LD of the common carotid and/or femoral artery could be a clinically useful marker of the extentof coronary atherosclerosis.

METHODS: A duplex ultrasonography and a quantitative coronary angiography were used to assess carotid, femoral and coronary atherosclerosis for 204 patients with angina pectoris. Intima-media thickness (IMT) and LD assessments were performed in peripheral arteries. We used three coronary angiographic scores: Vessel, Gensini and Extent. The following parameterswere recorded: gender, age, diagnoses of arterial hypertension and diabetes, history of myocardial infarction (MI) and stroke, smoking status, body mass index (BMI) and body surface area (BSA).

RESULTS: Significant correlations between LD, IMT and coronary scores were found, but the strongest correlations were betweenLD of the common carotid arteries and angiographic scores. In the case of LD in all investigated arteries, and IMT ofthe right carotid and left femoral arteries, significantly higher values were observed for patients with three-vessel disease (3VD) than for patients without it. Univariate analysis showed the important role played by LD of the carotid arteries in predicting 3VD (OR = 2.7). We obtained two multivariate logistic regression models which could estimate the probability P of 3VD. The first model:logit P = 0.05 age + 0.94 RCCALD + 0.70 MI - 9.1; AUC=0.80 (0.03) is based on the value of the right common carotid artery lumen diameter (RCCALD), age and history of MI; the second oneis based on LD of the left common carotid artery, gender, age and previous MI. ROC analysis indicated the optimal cut-offvalue for prediction of 3VD (P = 0.36), with high sensitivity (80%) and specificity (70%) for the first model.

CONCLUSIONS: According to our results, LD of the common carotid artery appears to be an independent predictor of 3VD. RCCLD turned out to be a basic prognostic variable (called 'risk variable') of the extent of coronary atherosclerosis afteradjustment for age and prior MI. Measurements of common carotid artery LD, together with age, history of MI (and gender in the case of the left common carotid artery LD), could estimate the probability of 3VD. Other studies will be necessary to confirm our results before the obtained method can be used in clinical practice as a simple non-invasive diagnostic tool for a specific group of patients.