A 5 years follow-up for ischemic cardiac outcomes in patients with carotid artery calcification on panoramic radiographs confirmed by doppler ultrasonography in Turkish population

Abstract

Objective: To evaluate the diagnostic accuracy of digital panoramic radiograph (DPR) for detection of carotid artery calcification (CAC) confirmed by Doppler Ultrasonography (DUSG) and to clarify the relationship between between CAC identified by DPR and cardiovascular events through a 5 year follow-up period.

Methods: Of 3600 consecutive patients examined, 158 patients presented with CAC as detected by DPR. The final study group was composed of 96 patients who had CAC confirmed by DUSG or CT angiogram. The control group was composed of 62 patients who has normal DUSG. The end point of the study was the occurrence of any cardiovascular event.

Results: 72 (75%) of the 96 patients with CAC confirmed by DUSG (16 patients had significant stenosis) had bilateral and 24 (25%) had unilateral CAS as detected by DUSG. There was a low agreement between the examination results with a κ value of 0.488 (p < 0.005) for calcification. Study data revealed that smoking, chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM) and diastolic hypertension were significantly more common in patients with CAC than the control group (p < 0.05). During the follow-up period, 13 subjects had myocardial infarction and 1 subject died; in the control group, 1 patient died after MI and 1 patient died of a non-cardiac event.

Conclusion: Patients with CAC detectable by DPR concomitant with COPD, DM, smoking or diastolic hypertension are more likely to suffer from vascular events. Therefore, patients with detectable carotid plaque in DPR require referral to a cardiovascular surgery clinic for further investigations.

Keywords: Carotid artery calcification; Panoramic radiography; Ultrasonography; cardiovascular events.

Figure 1.

Study Flow-chart and the follow-up report of the patients. CABG, coronary artery bypass grafting; CAS, carotid artery stenosis; DM, diabetes mellitus; DPR, digital panoramic radiography; DUSG, Doppler ultrasonography; ICA, internal carotid artery; IHD, ischemic heart disease; MI, myocardial infarction; PAH, pulmonary arterial hypertension; PCI, percutaneous coronary intervention.

Figure 2.

(A) The panoramic radiograph of 71-year-old male revealing bilateral radiopaque masses suggestive of CAC superimposed on the hyoid bone. (White arrow) (B) Color Doppler image and (C) Carotid CT angiography of right common carotid and internal carotid artery of the same patient demonstrates calcified plaques (black arrow) with 70% narrowing. (D) Operative photograph of the right carotid artery and calcific and stenotic lesion (white asterix). (E) Dissected carotid plaque after endarterectomy. CAC, carotid artery calcification.

Figure 3.

(A) The panoramic radiograph of 67-year-old male revealing bilateral radiopaque masses suggestive of CAC superimposed on the hyoid bone. (white arrow) (B) Carotid CT angiography of right common and internal carotid artery of the same patient demonstrates calcified plaques (white arrow) with 70% narrowing. 3D reconstruction of the CT images. (C) Operative photograph of the right carotid artery (White arrow). (D) Calcific and ulcerated stenotic plaque after endarterectomy. 3D, three-dimensional; CAC, carotid artery calcification.