Key result
An abnormal vascular elasticity response to sublingual nitroglycerin in the common carotid artery was associated with a significantly higher prevalence of coronary artery disease (80% vs 33%, p<0.01).
Why the study?
Does sublingual nitroglycerin improve vascular elasticity of the common carotid artery in patients with suspected coronary artery disease?
Cross-Sectional (n=61)
Does sublingual nitroglycerin improve vascular elasticity of the common carotid artery in patients with suspected coronary artery disease?
Absolute Event Rate: 80% vs 33%
p-value: p=<0.01
The vascular elasticity response of the common carotid artery to nitroglycerin can differentiate patients with and without significant coronary and carotid atherosclerosis, offering a noninvasive method for early detection.
May support noninvasive carotid testing for CAD risk; hypothesis-generating from cross-sectional data and needs prospective validation.
The purpose of this study was to determine whether the early stages of arterial atherosclerosis could be evaluated by the vascular response to nitroglycerin (NTG). The vascular elasticity of the common carotid artery (CCA) was evaluated at sites without atheromatous plaque using high-resolution ultrasonography before and after sublingular NTG administration. The vascular elasticity was expressed by vascular strain (VS) and pressure-strain elastic modulus (Ep). The study was performed in 9 normal young males (group N) and 52 patients who were suspected to have coronary artery disease (CAD). In group N, VS of the CCA increased from 9+/-2 to 13+/-4%, Ep decreased from 80+/-18 to 42+/-14 kPa (p<0.01) and systolic blood pressure (SBP) decreased from 116+/-8 to 109+/-8 mmHg (p<0.05) after NTG administration. Two different responses were observed in the patients. One group of patients (group A, n=27) showed similar responses to NTG as those of group N; that is, VS increased from 8+/-4 to 14+/-8%, Ep decreased from 115+/-64 to 57+/-31 kPa (p<0.01) and SBP decreased from 121+/-15 to 110+/-16 mmHg (p<0.05). In the other group (group B, n=25), in spite of SBP decreasing from 124+/-21 to 111+/-21 mmHg (p<0.05), VS decreased from 11+/-4 to 7+/-3% and Ep increased from 76+/-29 to 113+/-53 kPa (p<0.01). The prevalence and severity of CAD were lower in group A than in group B (33 vs 80%, 11 vs 60%, p<0.01, respectively). The prevalence of atheromatous plaque of the CCA was also lower in group A than in group B (4 vs 22%, p<0.01). These results revealed that the prevalence of carotid atheromatous plaque was highly correlated with that of CAD (p=0.001) and suggested that the vascular elasticity response of the CCA to NTG is highly associated with atherosclerotic changes of the artery and may be a useful method for detecting the early stages of atherosclerosis.
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Lai et al. (1998) conducted a cross-sectional in Suspected coronary artery disease (n=61). Sublingual nitroglycerin vs. Normal vascular response group (Group A) was evaluated on Prevalence of coronary artery disease in patients with an abnormal vascular response (Group B) versus a normal vascular response (Group A) to nitroglycerin (p=<0.01). An abnormal vascular elasticity response to sublingual nitroglycerin in the common carotid artery was associated with a significantly higher prevalence of coronary artery disease (80% vs 33%, p<0.01).
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