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Sex-based impact of carotid plaque in patients with chest pain undergoing stress echocardiography.
- Source :
- Heart; Dec2020, Vol. 106 Issue 23, p1819-1823, 5p
- Publication Year :
- 2020
-
Abstract
- <bold>Objective: </bold>Women with suspected angina without history of coronary artery disease (CAD) less frequently have flow-limiting stenosis (FL-CAD) and more often have microvascular disease, affecting predictive accuracy of stress echocardiography (SE) for detection of FL-CAD. We postulated that carotid plaque burden (CPB) assessment would improve detection of FL-CAD and risk stratification.<bold>Methods: </bold>Consecutive consenting patients assessed by SE on clinical grounds for new-onset chest pain also underwent simultaneous carotid ultrasound. Patients were followed for major adverse events (MAE): all-cause mortality, non-fatal myocardial infarction and unplanned revascularisation. Carotid plaque presence and burden (CPB) were assessed.<bold>Results: </bold>After a mean of 2617±469 days (range 17-3740), of 591 recruited patients, 573 (97%) outcome data (314 females) were obtainable. Despite lower pretest probability of CAD in females versus males (14.9±0.8 vs 20.5±1.3, respectively, p<0.0001), prevalence of myocardial ischaemia was similar (p=0.08). Females also had lower prevalence of both carotid plaque (p<0.0001) and FL-CAD (p<0.05). CPB improved the positive predictive value of SE for detection of FL-CAD (from 34.5% to 60%) in females but not in males. Absence of CPB in females with myocardial ischaemia ruled out FL-CAD in 93% versus 57% in males. CPB was the only independent predictor of MAE (p=0.012) in females, whereas in males both SE (p<0.0001) and CPB (p=0.003) remained significant.<bold>Conclusion: </bold>In females with new-onset stable angina without a history of cardiovascular disease, CPB improved the predictive accuracy of myocardial ischaemia for flow-limiting CAD. However, CPB provided incremental risk stratification in both sexes. [ABSTRACT FROM AUTHOR]
- Subjects :
- STRESS echocardiography
CHEST pain
CAROTID intima-media thickness
ATHEROSCLEROTIC plaque
CORONARY disease
SEX factors in disease
PROGNOSIS
INTERNAL carotid artery
MYOCARDIAL infarction treatment
ECHOCARDIOGRAPHY
RESEARCH
CAROTID artery diseases
PREDICTIVE tests
RESEARCH methodology
MYOCARDIAL infarction
ANGINA pectoris
MEDICAL cooperation
EVALUATION research
ATHEROSCLEROSIS
SEX distribution
RISK assessment
COMPARATIVE studies
CORONARY artery disease
MYOCARDIAL revascularization
KAPLAN-Meier estimator
DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 13556037
- Volume :
- 106
- Issue :
- 23
- Database :
- Complementary Index
- Journal :
- Heart
- Publication Type :
- Academic Journal
- Accession number :
- 147009454
- Full Text :
- https://doi.org/10.1136/heartjnl-2019-316507