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Detection of subclinical coronary atherosclerosis using two-dimensional, high-resolution transthoracic
I Gradus-Pizlo1, S G Sawada, D Wright
1Krannert Institute of Cardiology, Indiana University School of Medicine, Indianapolis 46202, USA. igradus@iupui.edu
Insights
High-resolution echocardiography detects arterial wall thickening and enlargement in patients with coronary artery disease (CAD). This imaging technique is sensitive enough to identify early signs of atherosclerosis, even in subclinical cases.
Area of Science:
- Cardiovascular imaging
- Medical diagnostics
- Arterial wall mechanics
Background:
- Subclinical atherosclerosis is characterized by arterial wall thickening and compensatory enlargement with a preserved lumen.
- Early detection of these changes in asymptomatic coronary artery disease (CAD) patients can enable timely intervention.
- Preventing acute coronary events is a key goal in managing subclinical atherosclerosis.
Purpose of the Study:
- To evaluate the capability of two-dimensional high-resolution transthoracic echocardiography (HR-2DTTE) in detecting arterial wall thickness and size changes.
- To assess if HR-2DTTE can identify alterations associated with subclinical coronary artery disease (CAD).
Main Methods:
- HR-2DTTE was performed on 26 patients with proven CAD and 29 healthy volunteers.
- The left anterior descending coronary artery (LAD) was assessed using an ATL 5000 echograph with a 4 to 7 MHz transducer.
- Measurements included LAD wall thickness, maximal luminal diameter, and external diameter.
Main Results:
- Patients with CAD exhibited significantly greater LAD wall thickness (1.9 mm vs. 0.9 mm) and external diameter (6.0 mm vs. 3.9 mm) compared to volunteers (p < 0.001).
- No significant difference in luminal diameter was observed between patients and volunteers (2.2 mm vs. 2.1 mm, p = NS).
- Similar increases in wall thickness and external diameter were found in patients with obstructive (>70%) and subclinical (<70%) LAD stenosis.
Conclusions:
- HR-2DTTE is a sensitive method for detecting increased LAD wall thickness and external diameter in patients with CAD.
- These arterial changes are significantly more pronounced in CAD patients compared to normal subjects.
- Obstructive and subclinical LAD disease show comparable increases in wall thickness and external diameter.
Objectives:
We evaluated whether two-dimensional high-resolution transthoracic echocardiography (HR-2DTTE) can detect changes in arterial wall thickness and size associated with subclinical coronary artery disease (CAD).
Background:
Arterial wall thickening, compensatory arterial enlargement and a preserved arterial lumen characterize subclinical atherosclerosis. Detection of these changes during the asymptomatic stage of CAD may allow early treatment and prevention of acute coronary events.
Methods:
Twenty-six patients with angiographically proven CAD and 29 normal volunteers underwent HR-2DTTE evaluation of the left anterior descending coronary artery (LAD) using an ATL 5000 echograph (Advanced Technology Laboratories, Bothell, Washington) with a 4 to 7 MHz transducer. Significant (>70%) LAD stenosis was present in 15 patients (mean 82%); 11 patients did not have significant LAD stenosis (mean 26%) and represented a surrogate for subclinical LAD disease. Wall thickness, maximal luminal diameter and external diameter of the LAD were measured.
Results:
Left anterior descending coronary artery wall thickness was larger in patients (1.9 +/- 0.4 mm) than it was in volunteers (0.9 +/- 0.1 mm, p < 0.001). The external diameter of the LAD was (6.0 +/- 1.1 mm) in patients and (3.9 +/- 0.7 mm) in volunteers (p < 0.001). Luminal diameter was 2.2 +/- 0.5 mm in patients and 2.1 +/- 0.6 mm in volunteers (p = NS). There was no difference in wall thickness (1.9 +/- 0.4 mm vs. 2.0 +/- 0.4 mm), luminal diameter (2.2 +/- 0.5 mm vs. 2.2 +/- 0.4 mm) and external diameter (5.9 +/- 1.0 mm vs. 6.2 +/- 1.2 mm) between the patients with <70% and >70% LAD stenosis.
Conclusions:
Left anterior descending coronary artery wall thickness and external diameter are significantly increased in patients with CAD as compared with normal subjects, and HR-2DTTE is sensitive enough to detect these differences. Wall thickness and external diameter are increased to the same extent in patients with obstructive and subclinical LAD disease.
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