Research Article
Volume 7 Issue 5 - 2020
Usefulness of Carotid Ultrasound in Patients with Intermediate Pretest Probability of Coronary Artery Disease
Ahmad Abdelaziz1, Ragab A Mahfouz2 and Ghada A Kazamel1*
1Cardiology Department, National Heart Institute, Egypt
1Cardiology Department, Zagazig University Hospital, Egypt
*Corresponding Author: Ghada A Kazamel, Cardiology Department, National Heart Institute, Egypt.
Received: April 13, 2020; Published: April 30, 2020


Objective: We aimed to investigate the clinical significance of carotid ultrasound in subjects with chest pain had intermediate pretest probability of CAD.

Methods: Eighty consecutive patients presented with chest pain and had intermediate pretest probability for CAD were subjected to carotid intima media thickness (CIMT) and carotid plaque evaluation with the use of carotid ultrasound. The presence and evaluation of CAD was performed with CCTA.

Results: 37% of the study cohort had CCTA documented. Of patients with CCTA documented coronary stenosis > 50%, the CIMT was significantly higher (p < 0.001). Furthermore, the calcium score was significantly higher in those with obstructive CAD (p < 0.005). Multivariate analysis demonstrated that increased CIMT was associated with an increased risk of coronary stenosis > 50% (odds 1.56 [1.22 - 1.93], p < 0.03), whilst carotid plaque thickness was associated with coronary stenosis (odds ratio 2.85 [1.25 - 3.72], p < 0.001) after adjusting for traditional risk factors. ROC analysis showed that the best cutoff CIMT value for predicting CAD was 0.89 mm, while the cutoff value of plaque thickness was 1.95 mm.

Conclusion: Carotid plaque and CIMT were significantly associated with coronary plaque burden in subjects presented with chest pain and had intermediate pretest probability of CAD. Thus, we suggest that carotid ultrasound might provide a useful noninvasive tool for risk stratification of subjects presented with acute chest pain and deemed to have intermediate pretest probability of CAD.

Keywords: Carotid Ultrasound; Coronary Plaque Burden; Coronary CT Angiography


  1. Fihn SD., et al. “American College of Cardiology Foundation. 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS guideline for the diagnosis and management of patients with stable ischemic heart disease: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, and the American College of Physicians, American Association for Thoracic Surgery, Preventive Cardiovascular Nurses Association, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons”. Circulation25 (2012): 3097-3137.
  2. Hachamovitch R., et al. “Exercise myocardial perfusion SPECT in patients without known coronary artery disease: incremental prognostic value and use in risk stratification”. Circulation 5 (1996): 905-914.
  3. Bangalore S., et al. “Risk stratification using stress echocardiography: incremental prognostic value over historic, clinical, and stress electrocardiographic variables across a wide spectrum of Bayesian pretest probabilities for coronary artery disease”. Journal of the American Society of Echocardiography 3 (2007): 244-252.
  4. Mudrick DW., et al. “Downstream procedures and outcomes after stress testing for chest pain without known coronary artery disease in the United States”. American Heart Journal 3 (2012): 454-461.
  5. Rozanski A., et al. “Temporal trends in the frequency of inducible myocardial ischemia during cardiac stress testing: 1991 to 2009”. Journal of the American College of Cardiology 10 (2013): 1054-1065.
  6. Holaj R., et al. “Intima-media thickness of the common carotid artery is the significant predictor of angiographically proven coronary artery disease”. The Canadian Journal of Cardiology 19 (2003): 670-676.
  7. Calmarza P., et al. “Lack of association between carotid intima-media thickness and apolipoprotein (a) isoforms in a sample of Spanish general population”. Journal of Cardiology 61 (2013): 372-377.
  8. Altekin ER., et al. “Determination of subclinical atherosclerosis in plaque type psoriasis patients without traditional risk factors for atherosclerosis”. Turk Kardiyol Dern Ars 40 (2012): 574-580.
  9. Bernard S., et al. “Incremental predictive value of carotid ultrasonography in the assessment of coronary risk in a cohort of asymptomatic type 2 diabetic subjects”. Diabetes Care 28 (2005): 1158-1162.
  10. Craven TE., et al. “Evaluation of the associations between carotid artery atherosclerosis and coronary artery stenosis. A case-control study”. Circulation 82 (1990): 1230-1242.
  11. Akosah KO., et al. “Carotid ultrasound for risk clarification in young to middle-aged adults undergoing elective coronary angiography”. American Journal of Hypertension 19 (2006): 1256-1261.
  12. Arad Y., et al. “Correlations between vascular calcification and atherosclerosis: a comparative electron beam CT study of the coronary and carotid arteries”. Journal of Computer Assisted Tomography 22 (1998): 207-211.
  13. Gibbons RJ., et al. “ACC/AHA/ACP-ASIM guidelines for the management of patients with chronic stable angina: executive summary and recommendations. A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on Management of Patients with Chronic Stable Angina)”. Circulation 99 (1999): 2829-2848.
  14. Stein JH., et al. “Use of carotid ultrasound to identify subclinical vascular disease and evaluate cardiovascular disease risk: A consensus statement from the American Society of Echocardiography Carotid Intima‐Media Thickness Task Force. Endorsed by the Society for Vascular Medicine”. Journal of the American Society of Echocardiography 21 (2008): 93-111.
  15. Agatston AS., et al. “Quantification of coronary artery calcium using ultrafast computed tomography”. Journal of the American College of Cardiology 15 (1990): 827-832.
  16. Min JK., et al. “Prognostic value of multidetector coronary computed tomographic angiography for prediction of all-cause mortality”. Journal of the American College of Cardiology 50 (2007): 1161e70.
  17. Johnson KM., et al. “Traditional clinical risk assessment tools do not accurately predict coronary atherosclerotic plaque burden: a CT angiography study”. The American Journal of Roentgenology 192 (2009): 235e43.
  18. Min JK., et al. “Age- and sex-related differences in all-cause mortality risk based on coronary computed tomography angiography findings results from the International Multicenter CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter Registry) of 23,854 patients without known coronary artery disease”. Journal of the American College of Cardiology 58 (2011): 849-860.
  19. Goldstein JA., et al. “The CT-STAT (Coronary Computed Tomographic Angiography for Systematic Triage of Acute Chest Pain Patients to Treatment) trial”. Journal of the American College of Cardiology 58 (2011): 1414-1422.
  20. Kumar A and Cannon CP. “Acute coronary syndromes: diagnosis and management”. Mayo Clinic Proceedings 10 (2009): 917-938.
  21. Cassar A., et al. “Chronic coronary artery disease: diagnosis and management”. Mayo Clinic Proceedings 12 (2009):1130-1146.
  22. Russo V., et al. “Incremental prognostic value of coronary CT angiography in patients with suspected coronary artery disease”. Circulation 3 (2010): 351-359.
  23. Dedic A., et al. “Value of cardiac CT and exercise testing in stable angina pectoris”. Radiology 261 (2011): 428-436.
  24. Douglas PS., et al. “PROMISE Investigators. Outcomes of anatomical versus functional testing for coronary artery disease”. The New England Journal of Medicine 14 (2015): 1291-1300.
  25. Christopher B Fordyce., et al. “Identification of Patients With Stable Chest Pain Deriving Minimal Value From Noninvasive Testing The PROMISE Minimal-Risk Tool, A Secondary Analysis of a Randomized Clinical Trial”. JAMA Cardiology 4 (2017): 400-408.
  26. M Kanwar., et al. “Usefulness of carotid ultrasound to improve the ability of stress testing to predict coronary artery disease”. The American Journal of Cardiology 99 (2007): 1196-1200.
Citation: Ghada A Kazamel., et al. “Usefulness of Carotid Ultrasound in Patients with Intermediate Pretest Probability of Coronary Artery Disease”. EC Cardiology 7.5 (2020): 82-91.

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