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Original Article

Comparative Diagnostic Accuracy of Different Measures of Preclinical Atherosclerosis for Detection of Atherosclerotic Coronary Artery Disease

Volume 3, Apr 2014

Ravi R Kasliwal MD, DM, Manish Bansal MD, DNB, Rahul Mehrotra MD, DNB, Kulbir Ahlawat, MD, Naresh Trehan MD, Gurgaon, India

Background: The relative diagnostic accuracy of different measures of preclinical atherosclerosis such as carotid intima media thickness (CIMT), pulse wave velocity (PWV), and coronary calcium score (CCS) for detection of incident coronary artery disease (CAD) is not well known in Indians.
Methods: 219 subjects with or without preexisting cardiovascular disease (CVD) were included in the study and subjected to clinical assessment, biochemical investigations and assessment of preclinical atherosclerosis (CIMT, PWV and CCS). Angiographic (conventional or computed tomographic) evidence of coronary atherosclerosis was used to divide the patients into non-CAD (n=124) and CAD (n=95) groups.
Results: As compared to the non-CAD patients, those with CAD had increased CIMT (right side 0.66 ± 0.19 vs. 0.74 ± 0.13 mm; left side 0.67 ± 0.19 vs. 0.79 ± 0.26 mm, and average 0.67 ± 0.18 vs. 0.77 ± 0.18 mm; all P values <0.01), left brachial-ankle PWV (baPWV, 1414.8 ± 399.0 vs. 1603.9 ± 381.1 cm/sec, P = 0.0009) and CCS (6.4 ± 28.3 vs. 137.3 ± 214.2, P <0.001). On ROC curve analysis, CCS was found to have the best diagnostic accuracy among all the three measures (areas-under-the-curve 0.89 for CCS, 0.69 for average CIMT and 0.68 for left baPWV, P <0.01). However, combining CIMT and baPWV resulted in significant improvement in their individual diagnostic abilities. Presence of abnormality in at least one of these two parameters had a sensitivity of 91% for diagnosing CAD whereas a normal value of both average CIMT and left baPWV could exclude coronary atherosclerosis with 91% certainty.
Conclusions: The present study shows that among different measures of preclinical atherosclerosis, CCS has the best diagnostic accuracy for the presence of coronary atherosclerosis. However, the combination of CIMT and baPWV has an excellent negative predictive value for atherosclerotic coronary vascular disease and can, therefore, be used as a simple, noninvasive, less-expensive and radiation-free approach to initial CV risk stratification of the individuals. (J Clin Prev Cardiol. 2014;3(2):36-42)
Keywords: arterial stiffness; augmentation index; cardiovascular disease; hypertension; pulse wave velocity

Volume 3, Number 2, Pages: 36-42

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