Potential of Carotid Ultrasonography in the Diagnosis of Coronary Artery Disease

Abstract

Background and Purpose-Carotid artery atherosclerosis has been shown to correlate with coronary artery disease (CAD).This study evaluates the capacity of duplex ultrasonography of the carotid arteries as a tool in the diagnosis of CAD in comparison with exercise stress test and variance ECG. Methods-Carotid ultrasonography, exercise stress test, and variance ECG were performed in 184 symptomatic patients evaluated with coronary angiography. The diagnostic capacity of the studied noninvasive methods was assessed by use of receiver operating characteristic (ROC) curves constructed by successive consideration of several cut points, such as (1) the presence of unilateral/bilateral plaques and (2) cross-sectional common carotid artery (CCA) intima-media (IM) area from 10 to 30 mm 2 for ultrasonography; (1) ST depression Ն0.1 mV and Ն0.2 mV with and (2) without chest pain for exercise test; and electrical variability index from 50 to 100 for variance ECG. Results-Coronary angiography revealed the presence of CAD (Ն50% luminal stenosis in 1 or more major epicardial arteries) in 147 patients (80%). Identification of carotid plaques on one or both sides and calculation of the left-sided (but not right-sided) CCA IM area provided a significant discrimination (PϽ.001 and PϽ.01, respectively) of patients with CAD. The discriminating capacity of the ultrasound procedures was equal to that of variance ECG and exercise test with ST depression criterion only but somewhat lower than that of exercise test with the combined chest pain and ST depression criterion (PϽ.05). However, at the chosen cut points, carotid plaque identification offered higher sensitivity than exercise test with either criterion (PϽ.01 and PϽ.001, respectively). Conclusions-Carotid ultrasonography is a useful diagnostic method that is comparable to exercise test and variance ECG for detection of CAD in a high-prevalence population. (Stroke. 1998;29:439-446.)

Prevalence of Asymptomatic Coronary Artery Disease in Ischemic Stroke Patients

“…27,28 In patients with suspected CAD scheduled for conventional coronary angiography, CAD was found to be more common in those with carotid artery disease. 30,31 Finally, cohort studies have shown that asymptomatic carotid stenosis is an independent risk factor for myocardial infarction 32 and that patients with bilateral carotid atherosclerosis are more likely to have previous myocardial infarction and to die as a consequence of myocardial infarction. 33 Our results, taken together with those previous findings, therefore support the need for a thorough assessment of cervical and intracranial atherosclerosis to identify stroke/TIA patients with a high risk of asymptomatic CAD.…”

Carotid artery wall hypertrophy in children with metabolic syndrome

“…[8][9][10][11] The cross-sectional area of the intima-media complex (CSA-IMC) has been found to be a good indicator of arterial wall mass, closely related to cardiac left ventricular mass, and has been demonstrated to be another accurate predictor of coronary atherosclerosis. 12,13 Risk factors for cardiovascular disease frequently cluster within individuals in both children and adults. In a recent survey on Italian school-aged children, high blood pressure (BP) was strictly associated with overweight 14 and in another study BP levels in obese children were independently associated with hyperglycaemia.…”

Estenose de carótida extracraniana

“…7 , ainda, salientando a importância da relação entre estenose de carótida extracraniana e doença arterial coronariana, avaliaram a sensibilidade e especificidade do uso da ultrasonografia de estenose de carótida extracraniana como método diagnóstico de doença arterial coronariana, em 184 pacientes (tab. I), concluindo que a ultra-sonografia de carótida é um método útil e comparável ao teste de esforço para detecção da doença arterial coronariana 7 .…”