Utility of both carotid intima-media thickness and endothelial function for cardiovascular risk stratification in patients with angina-like symptoms

Yasushi Matsuzawa, Sara Svedlund, Tatsuo Aoki, Raviteja R. Guddeti, Taek Geun Kwon, Rebecca Cilluffo, R. Jay Widmer, Rebecca E. Nelson, Ryan J. Lennon, Lilach O. Lerman, Sinsia Gao, Peter Ganz, Li Ming Gan, Amir Lerman

Research output: Contribution to journalArticlepeer-review

4 Citations (Scopus)


Background: Myocardial perfusion scintigraphy (MPS) is used widely to assess cardiovascular risk in patients with chest pain. The utility of carotid intima-media thickness (CIMT) and endothelial function as assessed by reactive hyperemia-peripheral arterial tonometry index (RHI) in risk stratifying patients with angina-like symptoms needs to be defined. We investigated whether the addition of CIMT and RHI to Framingham Cardiovascular Risk Score (FCVRS) and MPS improves comprehensive cardiovascular risk prediction in patients presenting with angina-like symptoms. Methods: We enrolled 343 consecutive patients with angina-like symptoms suspected of having stable angina. MPS, CIMT, and RHI were performed and patients were followed for cardiovascular events for a median of 5.3 years (range 4.4-6.2). Patients were stratified by FCVRS and MPS. Results: During the follow-up, 57 patients (16.6%) had cardiovascular events. Among patients without perfusion defect, low RHI was significantly associated with cardiovascular events in the intermediate and high FCVRS groups (hazard ratio (HR) [95% confidence interval (CI)] of RHI ≤ 2.11 was 6.99 [1.34-128] in the intermediate FCVRS group and 6.08 [1.08-114] in the high FCVRS group). Furthermore, although MPS did not predict, only RHI predicted hard cardiovascular events (cardiovascular death, myocardial infarction, and stroke) independent from FCVRS, and adding RHI to FCVRS improved net reclassification index (20.9%, 95% CI 0.8-41.1, p = 0.04). Especially, RHI was significantly associated with hard cardiovascular events in the high FCVRS group (HR [95% CI] of RHI ≤ 1.93 was 5.66 [1.54-36.4], p = 0.007). Conclusions: Peripheral endothelial function may improve discrimination in identifying at-risk patients for future cardiovascular events when added to FCVRS-MPS-based risk stratification.

Original languageEnglish
Pages (from-to)90-98
Number of pages9
JournalInternational Journal of Cardiology
Issue number1
Publication statusPublished - 2015 Aug 1


  • Cardiovascular disease
  • Carotid intima-media thickness
  • Endothelial function
  • Framingham cardiovascular risk score
  • Myocardial perfusion
  • Noninvasive

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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