Role of Neck Vessel Doppler in Correlation with Coronary CT Angiography for Assessing Coronary Artery Disease Burden in Diabetic Women and Men

Abstract

With an incidence of 4.1 for women and 6.4 for men/1000 person-years, cardiovascular disease is the primary cause of morbidity and mortality for both men and women worldwide.[1] In asymptomatic patients, subclinical atherosclerosis has been detected utilising several non-invasive methods, such as computed tomography (CT) coronary angiography and Neck Vessel Doppler (NVD) to test coronary calcification. The goal of the present study was to assess the role of NVD in correlation with coronary CT angiography (CCTA) in assessing the coronary artery disease (CAD) burden in diabetic women and men patients. This study was conducted on 30 female patients and 30 male patients aged 40–60 years, who are referred for CCTA for suspected CAD at Nizam’s Institute of Medical Sciences Hospital, Hyderabad. This study was an observational and prospective study of diabetes mellitus patients. All subjects underwent NVD and CCTA scan on the same day. Carotid intimal media thickness (CIMT) was considered the largest of the two separate values (left and right CIMT). The analysis examined factors associated with coronary artery calcification defined as a coronary artery calcium (CAC) score >0. The mean age at assessment was 52.6 years in the diabetic male group and 53.7 in the diabetic female group. 63% of the study population was also hypertensive in the male group and 77% of the study population was also hypertensive in the female group. Mean CIMT was 1.01 mm in the diabetic male group and 1.02 mm in the diabetic female group. Twenty-two (73.3%) patients in the diabetic male group had a CAC score >0, of which 4 (18.18%) had severe coronary artery calcification (CAC score >400 Au), 7 (31.81%) had moderate coronary artery calcification (CAC score 100–400 Au), 11 (50%) had mild coronary artery calcification (CAC score 1-99 Au), and 8 out of 30 (26.67%) had no coronary artery calcification (CAC score <0 Au). Twenty (66.67%) patients in the diabetic female group had a CAC score >0, of which 2 (10%) had severe coronary artery calcification (CAC score >400 Au), 7 (35%) had moderate coronary artery calcification (CAC score 100–400 Au), 11 (55%) had mild coronary artery calcification (CAC score 1-99Au) and 10 out of 30 (33.33%) had no coronary artery calcification (CAC score <0 Au). Mean CIMT and carotid plaque were significantly associated with CAC (P = 0.046 and P = 0.026, respectively, in the diabetic male’s group and P = 0.008 and P = 0.011, respectively, in the diabetic female’s group). The significance was more profound in the diabetic female group when compared to the diabetic male group. NVD giving various surrogate parameters such as CIMT and plaque, in correlation with CCTA (CAC score), can play a significant role in assessing the CAD burden in men and women with diabetes and hypertension, thereby helping the clinician to assess the future risk for stroke or myocardial ischemic events to take active interventions.