BACKGROUND It remains difficult to assess cardiovascular risk in symptomatic women. The development of femoral plaque precedes adverse cardiovascular events. However, associations of femoral plaque burden with coronary artery disease (CAD) severity and extent are unknown. The aim of this study was to determine sex-specific plaque quantification markers by vascular ultrasound for identifying significant, obstructive CAD. METHODS In this cross-sectional study, 500 participants (34% women) underwent carotid and femoral ultrasound following coronary angiography. Maximal plaque height and total plaque area were quantified. Logistic regression was used to determine associations of plaque burden with significant, obstructive CAD (≥50% stenosis), when adjusted for age and cardiac risk factors. CAD prediction was evaluated using receiver operating characteristic areas under the curve (AUCs). RESULTS Two hundred thirty-one men (70%) and 78 women (46%) had significant CAD. A combined assessment of femoral bifurcation and carotid maximal plaque height was the most accurate identifier of CAD in men (AUC = 0.773, cutoff ≥ 2.7 mm, 87% sensitivity, 53% specificity) but a poorer indicator of CAD in women (AUC = 0.659, P < .01). In contrast, the strongest identification of CAD in women was achieved by a combined analysis of common femoral and carotid total plaque area (AUC = 0.764, cutoff ≥ 42.0 mm2, 86% sensitivity, 53% specificity). At this value, more than half of women with false-positive stress test results were correctly identified as having no significant CAD. CONCLUSION Combined femoral and carotid plaque burden assessments effectively ruled out significant disease in both sexes. Vascular ultrasound may have particular value for cardiovascular risk stratification in women, in whom traditional screening tools are less effective.

中文翻译：

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合并股动脉和颈动脉斑块负担可确定女性的阻塞性冠状动脉疾病。

背景技术在有症状的女性中评估心血管风险仍然很困难。股动脉粥样硬化斑块的发展先于不良心血管事件。但是，股动脉粥样斑块负担与冠状动脉疾病（CAD）的严重程度和程度之间的关联尚不清楚。这项研究的目的是通过血管超声确定性别特异性的斑块定量标志物，以鉴定出明显的阻塞性CAD。方法在这项横断面研究中，在冠状动脉造影后对500名参与者（34％的女性）进行了颈动脉和股骨超声检查。定量最大菌斑高度和总菌斑面积。经年龄和心脏危险因素调整后，采用逻辑回归分析确定斑块负荷与严重阻塞性CAD（≥50％狭窄）的相关性。使用曲线下的接收器工作特征区域（AUC）评估CAD预测。结果231名男性（70％）和78名女性（46％）患有明显的CAD。股骨分叉和颈动脉最大斑块高度的综合评估是男性CAD的最准确标识符（AUC = 0.773，临界值≥2.7 mm，敏感性87％，特异度53％），但女性CAD指标较差（AUC = 0.659） ，P <.01）。相比之下，女性的CAD最强识别是通过共同的股骨和颈总斑块面积的综合分析获得的（AUC = 0.764，临界值≥42.0 mm2，敏感性86％，特异性53％）。在此值下，正确识别出虚假压力测试结果的女性中有超过一半的人没有明显的CAD。结论结合股骨和颈动脉斑块负荷评估有效排除了男女之间的重大疾病。血管超声检查对于传统心血管筛查工具效果较差的女性心血管风险分层可能具有特殊价值。