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Signal Acquisition, Score Interpretation, and Economics of a Non-Invasive Point-of-Care Test for Coronary Artery Disease
Published on: August 9, 2024
Comparison of non-invasive methods for the detection of coronary atherosclerosis
Angela Bacelar Albuquerque Bampi1, Carlos Eduardo Rochitte, Desiderio Favarato
1Clinical Atherosclerosis Unit, Heart Institute (InCor), Hospital das Clinicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo/SP, Brazil.
Insights
Non-invasive methods like calcium scoring and HDL-c levels can help determine the extent of coronary artery disease (CAD). These indicators, along with the TG/HDL-c ratio, offer a reliable way to assess cardiovascular health without invasive procedures.
Area of Science:
- Cardiology
- Preventive Medicine
- Diagnostic Imaging
Background:
- Non-invasive detection of atherosclerosis is crucial for disease prevention.
- Early identification of coronary artery disease (CAD) aids in timely intervention.
- Assessing atherosclerosis risk factors non-invasively improves patient outcomes.
Purpose of the Study:
- To correlate non-invasively detectable indicators of coronary atherosclerosis with the extent of disease.
- To evaluate the effectiveness of various non-invasive markers in predicting coronary artery disease severity.
- To compare non-invasive findings with coronary angiography results using the Friesinger index.
Main Methods:
- Prospective study of 100 patients undergoing coronary angiography.
- Assessed classical risk factors, hs-CRP, carotid intima-media thickness (IMT), endothelial function, ankle-brachial index, and coronary artery calcium score.
- Calculated non-HDL cholesterol and TG/HDL-c ratio; evaluated endothelial function via ultrasound.
Main Results:
- Calcium score, HDL-c, TG/HDL ratio, and IMT showed univariate correlation with CAD extent.
- Multivariate analysis revealed calcium score and low HDL-c levels as significant predictors of CAD extension.
- Calcium score, HDL-c, and TG-HDL ratio accurately predicted extensive CAD via ROC analysis.
Conclusions:
- Non-invasive methods, particularly calcium score and HDL-c assays, can approximate CAD presence and extent.
- TG/HDL-c ratio is a valuable non-invasive marker for assessing coronary artery disease.
- These non-invasive indicators provide a feasible approach for evaluating cardiovascular disease risk.
Background:
Non-invasive detection of atherosclerosis is critical for its prevention.
Objective:
To correlate non-invasively detectable indicators of coronary atherosclerosis, or Coronary Artery Disease (i.e., classical risk factors, hs-CRP test results, carotid intima-media thickness, endothelial function, ankle-brachial index and calcium score by computed tomography) with the extent of coronary disease assessed by the Friesinger index from conventional coronary angiography.
Methods:
We conducted a prospective study of 100 consecutive patients, mean age 55.1 +/- 10.7 years, 55% men and 45% women. Patients with acute coronary syndrome, renal dialytic insufficiency, collagen disease and cancer were not included. All patients were subjected to clinical evaluation and laboratory tests. Endothelial function of the brachial artery and carotid artery were evaluated by high-resolution ultrasound; ankle-brachial index and computed tomography for coronary determination of calcium score were also performed, and non-HDL cholesterol and TG/HDL-c ratio were calculated. All patients were subjected to coronary angiography at the request of the assistant physician. We considered patients without an obstructive lesion (< 29% stenosis) demonstrated by coronary angiography to be normal.
Results:
Univariate analysis showed that calcium score, HDL-c, TG/HDL ratio and IMT were significantly correlated with the Friesinger index. However, multivariate analysis indicated that only calcium score and low HDL-c levels correlated significantly with the extension of CAD. On the other hand, hs-CRP, LDL-c, flow-mediated dilation, and Framingham score did not correlate with the Friesinger index. ROC analysis showed that calcium score, HDL-c and TG-HDL ratio accurately predicted extensive CAD in a statistically significant manner.
Conclusion:
It is possible to approximately determine the presence and extent of CAD by non-invasive methods, especially by calcium score, HDL-c and TG/HDL-c ratio assays.
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