B – Flow assessment of femoral artery as predictor of coronary artery disease in patients evaluated for chest pain by radionuclide myocardial perfusion scintigraphy

Petar Avramovski; Maja Avramovska; Zaklina Servini; Zorica Nikleski; Keti Veljanovska; Snezana Mihajlova; Kosta Sotiroski; Aleksandar Sikole

doi:10.4103/wjnm.WJNM_74_18

World Journal of Nuclear Medicine, Table of Contents

CC BY-NC-ND 4.0 · World J Nucl Med 2019; 18(04): 396-405
DOI: 10.4103/wjnm.WJNM_74_18

Original Article

B – Flow assessment of femoral artery as predictor of coronary artery disease in patients evaluated for chest pain by radionuclide myocardial perfusion scintigraphy

Authors

Petar Avramovski

Department of Internal Medicine, High Medical School, Clinical Hospital, University St. Kliment Ohridski, Bitola
Maja Avramovska

¹Department of Gynecology, Clinical Hospital, Bitola
Zaklina Servini

²Department of Nuclear Medicine, Clinical Hospital, Bitola
Zorica Nikleski

³Advanced Torrens University, Australia
Keti Veljanovska

²Department of Nuclear Medicine, Clinical Hospital, Bitola
Snezana Mihajlova

²Department of Nuclear Medicine, Clinical Hospital, Bitola
Kosta Sotiroski

⁴Department of Economic Statistics, Faculty of Economics, Prilep, Bitola

⁵Department of Statistics, University St. Kliment Ohridski, Bitola
Aleksandar Sikole

⁶Department of Nephrology, Medical Faculty, University St. Curil and Methodius, Skopje, Macedonia

Abstract

In the evaluation of patients with suspected coronary artery disease (CAD), the presence of the superficial femoral artery (SFA) plaque is more informative than a carotid plaque and at least as informative as coronary plaque in the identification of coronary death individuals. In 60 patients with chest pain with a normal electrocardiogram, B-flow ultrasound estimation of SFA plaque and radionuclide myocardial perfusion scintigraphy (MPS) estimation for CAD was performed. We found significant positive correlations between age and SFA plaque score (PS) (P = 0.0084), myocardial ischemia in rest and SFA PS (P < 0.0001), and between transient ischemic dilation (TID) and SFA PS (P = 0.0069), too. The TID correlates only with myocardial ischemia in rest (P = 0.0022) and SFA PS (P = 0.0069). The results we got by the receiver operating characteristics (ROC) curve analysis with TID/without TID were the area under curve (0.704, P = 0.0038). The multiple regression analysis showed standardized coefficient β coefficients for SFA PS and TID (3.4577 and 1.9903, P < 0.001 and P = 0.0021), respectively. By proven correlative relationship of SFA atherosclerotic plaques and CAD, we can use B-flow as a screening method for triage of patients with chest pain before being sent to the assessment of coronary circulation with radionuclide MPS.

Keywords

Atherosclerotic plaque - B-flow - coronary artery disease - myocardial perfusion scintigraphy - superficial femoral artery

Full Text

References

References
1 Naghavi M, Falk E, Hecht HS, Jamieson MJ, Kaul S, Berman D, et al. From vulnerable plaque to vulnerable patient – Part III: Executive summary of the Screening for Heart Attack Prevention and Education (SHAPE) Task Force report. Am J Cardiol 2006;98:2H-15H.
2 Kallikazaros I, Tsioufis C, Sideris S, Stefanadis C, Toutouzas P. Carotid artery disease as a marker for the presence of severe coronary artery disease in patients evaluated for chest pain. Stroke 1999;30:1002-7.
3 Geroulakos G, O'Gorman DJ, Kalodiki E, Sheridan DJ, Nicolaides AN. The carotid intima-media thickness as a marker of the presence of severe symptomatic coronary artery disease. Eur Heart J 1994;15:781-5.
4 Siljanovski S, Avramovski P. Carotid artery wall changes as a prognostic indicator of coronary artery disease. Maced J of Med Sci 2009;2:137-40.
5 Dalager S, Falk E, Kristensen IB, Paaske WP. Plaque in superficial femoral arteries indicates generalized atherosclerosis and vulnerability to coronary death: An autopsy study. J Vasc Surg 2008;47:296-302.
6 Avramovski P, Avramovska M, Sikole A. B-flow imaging estimation of carotid and femoral atherosclerotic plaques: Vessel walls rheological damage or strong predictor of cardiovascular mortality in chronic dialysis patients. Int Urol Nephrol 2016;48:1713-20.
7 Blankstein R, Di Carli MF. Integration of coronary anatomy and myocardial perfusion imaging. Nat Rev Cardiol 2010;7:226-36.
8 Underwood SR, Anagnostopoulos C, Cerqueira M, Ell PJ, Flint EJ, Harbinson M, et al. Myocardial perfusion scintigraphy: The evidence. Eur J Nucl Med Mol Imaging 2004;31:261-91.
9 Machecourt J, Vanzetto G. Myocardial perfusion imaging for the detection of coronary artery disease in patients with known or suspected disease. Eur Heart J Suppl 2001;3 Suppl F: F2-4.
10 Weskott HP. B-flow – A new method for detecting blood flow. Ultraschall Med 2000;21:59-65.
11 Tola M, Yurdakul M, Cumhur T. Combined use of color duplex ultrasonography and B-flow imaging for evaluation of patients with carotid artery stenosis. AJNR Am J Neuroradiol 2004;25:1856-60.
12 Henri P, Tranquart F. B-flow ultrasonographic imaging of circulating blood. J Radiol 2000;81:465-7.
13 Salonen JT, Salonen R. Ultrasonographically assessed carotid morphology and the risk of coronary heart disease. Arterioscler Thromb 1991;11:1245-9.
14 Held C, Hjemdahl P, Eriksson SV, Björkander I, Forslund L, Rehnqvist N, et al. Prognostic implications of intima-media thickness and plaques in the carotid and femoral arteries in patients with stable angina pectoris. Eur Heart J 2001;22:62-72.
15 Hyvärinen S. Arteriographic findings of claudication patients. Ann Clin Res 1984;16 Suppl 41:1-45. Ikeda N, Kogame N, Iijima R, Nakamura M, Sugi K. Carotid artery intima-media thickness and plaque score can predict the SYNTAX score. Eur Heart J 2012;33:113-9.
16 Elhendy A, Bax JJ, Poldermans D. Dobutamine stress myocardial perfusion imaging in coronary artery disease. J Nucl Med 2002;43:1634-46.
17 Strauss HW, Miller DD, Wittry MD, Cerqueira MD, Garcia EV, Iskandrian AS, et al. Procedure guideline for myocardial perfusion imaging 3.3. J Nucl Med Technol 2008;36:155-61.
18 Weiss AT, Berman DS, Lew AS, Nielsen J, Potkin B, Swan HJ, et al. Transient ischemic dilation of the left ventricle on stress thallium-201 scintigraphy: A marker of severe and extensive coronary artery disease. J Am Coll Cardiol 1987;9:752-9.
19 Heston TF, Sigg DM. Quantifying transient ischemic dilation using gated SPECT. J Nucl Med 2005;46:1990-6.
20 Halligan WT, Morris PB, Schoepf UJ, Mischen BT, Spearman JV, Spears JR, et al. Transient ischemic dilation of the left ventricle on SPECT: Correlation with findings at coronary CT angiography. J Nucl Med 2014;55:917-22.
21 Jani B, Rajkumar C. Ageing and vascular ageing. Postgrad Med J 2006;82:357-62.
22 Päivänsalo MJ, Merikanto J, Jerkkola T, Savolainen MJ, Rantala AO, Kauma H, et al. Effect of hypertension and risk factors on diameters of abdominal aorta and common iliac and femoral arteries in middle-aged hypertensive and control subjects: A cross-sectional systematic study with duplex ultrasound. Atherosclerosis 2000;153:99-106.
23 Rajala U, Laakso M, Päivänsalo M, Suramo I, Keinänen-Kiukaanniemi S. Blood pressure and atherosclerotic plaques in carotid, aortic and femoral arteries in elderly finns with diabetes mellitus or impaired glucose tolerance. J Hum Hypertens 2005;19:85-91.
24 Kinoshita N, Sugihara H, Adachi Y, Nakamura T, Azuma A, Kohno Y, et al. Assessment of transient left ventricular dilatation on rest and exercise on tc-99m tetrofosmin myocardial SPECT. Clin Nucl Med 2002;27:34-9.
25 Marcassa C, Galli M, Baroffio C, Campini R, Giannuzzi P. Transient left ventricular dilation at quantitative stress-rest sestamibi tomography: Clinical, electrocardiographic, and angiographic correlates. J Nucl Cardiol 1999;6:397-405.
26 Bertomeu V, Morillas P, Gonzalez-Juanatey JR, Quiles J, Guindo J, Soria F, et al. Prevalence and prognostic influence of peripheral arterial disease in patients ≥40 years old admitted into hospital following an acute coronary event. Eur J Vasc Endovasc Surg 2008;36:189-96.
27 Schiano V, Sirico G, Giugliano G, Laurenzano E, Brevetti L, Perrino C, et al. Femoral plaque echogenicity and cardiovascular risk in claudicants. JACC Cardiovasc Imaging 2012;5:348-57.
28 Katz JS, Ruisi M, Giedd KN, Rachko M. Assessment of transient ischemic dilation (TID) ratio in gated SPECT myocardial perfusion imaging (MPI) using regadenoson, a new agent for pharmacologic stress testing. J Nucl Cardiol 2012;19:727-34.
29 Ogata T, Yasaka M, Yamagishi M, Seguchi O, Nagatsuka K, Minematsu K, et al. Atherosclerosis found on carotid ultrasonography is associated with atherosclerosis on coronary intravascular ultrasonography. J Ultrasound Med 2005;24:469-74.
30 Blacher J, Pannier B, Guerin AP, Marchais SJ, Safar ME, London GM, et al. Carotid arterial stiffness as a predictor of cardiovascular and all-cause mortality in end-stage renal disease. Hypertension 1998;32:570-4.