Abstract 4141098: Prognostic value of Achilles tendon assessment by ultrasonography to predict complexity of coronary artery disease in patients with acute coronary syndrome

Background: One of the major causes of atherosclerotic cardiovascular diseases is high low-density lipoprotein cholesterol (LDL-C) levels and prolonged exposure to high LDL-C can lead to the formation of atheromatous lesion. Achilles tendon thickening (ATT) is also known to be due to exposure to high LDL-C from the childhood in familial hypercholesterolemia (FH) and is one of the criteria for the diagnosis of FH in Japan. We have reported that ATT can be measured more accurately by ultrasonography（US-ATT）than X-ray（Xp-ATT）. The US-ATT in FH patients correlate with the severity of coronary artery disease; however, it is unknown whether the US-ATT correlates with the severity of coronary artery disease in non-FH patients. In this study, we investigated whether the evaluation of US-ATT could serve as a predictive indicator for the severity of coronary artery disease in non-FH patients. Methods: We investigated 95 consecutive patients who presented with acute coronary syndrome (ACS) at Osaka Medical and Pharmaceutical University Hospital from April 2023 to May 2024. ATT was measured by ultrasonography and radiography. The complexity of coronary artery disease was evaluated using the Syntax score and the number of coronary artery lesions with >50% diameter stenosis. FH diagnosis was based on clinical findings. Excluding FH patients, the relationship between the complexity of coronary artery disease and the mean of the right and left US-ATT as the mean US-ATT was evaluated. Results: The mean age of the patients was 67.7 years, and 81.9% were male. There were 10 patients with FH and 85 patients with non-FH. The mean US-ATT was 5.1 ± 0.6 mm. The mean US-ATT was associated with coronary multiple vessel disease in non-FH patients (p = 0.029). The association between the mean US-ATT and Syntax score was observed in non-FH patients (p = 0.031). The correlation between ATT and Syntax score was found to be stronger for US-ATT than Xp-ATT (p < 0.001 and p = 0.009). Multivariate analysis adjusting for age, gender, smoking, and HbA1c revealed that the mean US-ATT was an independent predictor of severe coronary artery disease (OR: 5.4, 95% CI: 1.45-20.2, p = 0.001). Conclusions: Even in non-FH patients, US-ATT was significantly associated with the complexity of CAD and showed a significant correlation. Given its greater accuracy, simplicity, and lack of radiation exposure, US-ATT could serve as an alternative method to predict severe CAD.