Insight into Coro-Carotid atherosclerotic disease in patients with acute coronary syndrome

Abstract: Background: the arterial tree branches in different parts of human body are sharing the histological and physiological features. Atherosclerosis is a systemic arterial disease, hence is expected to affect to affect more than one arterial system with similar pathologic manifestations.Aim: the aim of this thesis is to highlight the relationship between the two arterial systems involved in common acute ischemia, the carotid and coronary arteries, and to focus on the diagnostic tools that could be of help in estabilishing accurate diagnosis.Methods: we conducted five studies, the first three looked into the acute coronary syndrome and the different echocardiographic imaging modalities, including 2-Dimentional wall motion abnormalities, M-mode measurments, and myocardial deformation parameters measurment (Strain and Strain rate) in identifying the culprit coronary lesion (study 1), early recovery of left ventricular function after acute coronary syndrome (study 2) and  the third study is a comparison between conventional 2-D dobutamine stress echocardiography and dobutamine stress echocardiography analysis using speckle tracking technique. The fourth and fifth studies are analyzing the relationship between the carotid  calcifications measured by conventional computed tomogaphy based on Agatston calcium scoring and that of the coronary arteries (study 4) and the fifth study looked at the carotid and coronary atherosclerosis manifestation in a systematic review and mata-analysis.Results: Left ventricular myocardial strain rate was the most sensetive peridictor of the culprit artery lesion in the setting of acute coronary syndrome, measurment of deformation parameters are more sensetive than those of conventional echo in detecting early recovery of left ventricular function after acute coronary syndrome. Myocardial deformation parameters messured by speckle traching technique during dobutamine stress echo cardiography are more senstive than convetional 2-D measurments in detecting the stenosed arteries. Coronary calcifications is 10 times higher than carotid calcifications in acute coronary syndrome patients. There was moderate relationship between Carotid intima media thickness and the degree of stenosis of the coronary arteries.Conclusions: resting echocardiographic measurments are accurate in predicting the culprit coronary artery lesions in patients presenting with acute coronary syndrome. myocardial deformation measurments are the most accurate parameter that identify culprit lesion and left venticular segmental recovery and also are more sensetive than conventioal 2-D dobutamine stress echo in redicting stenosed coronaries in patients post acute coronary syndrome and with low ejection fraction. atherosclerosis parameters of the carotid arteriescorrelates with those of the coronary circulation, despite different phenotypic presentation. this finding highlights the importance of measuring the carotid intima media thickness in suspected high risk patients with acute coronary syndrome.