Clinical InvestigationImaging and Diagnostic TestingRole of simultaneous carotid ultrasound in patients undergoing stress echocardiography for assessment of chest pain with no previous history of coronary artery disease
Section snippets
Participants
Consecutive consenting patients with recent onset chest pain who were referred for a clinically indicated SE underwent carotid ultrasonography. The principal exclusion criteria were age <35 or >85 years, known CAD (history of myocardial infarction or coronary revascularization), presence of resting wall motion abnormality, significant valve disease or hypertrophic cardiomyopathy, and prior carotid artery intervention (stenting or surgical endarterectomy). Chest pain character, cardiovascular
Results
A total of 591 patients with a mean age of 59 ± 11 years (range 35-85), 46% men, and no history of cardiovascular disease participated in the study. Their demographic and clinical characteristics are depicted in Table I. Most patients (74%) had an intermediate pretest probability of CAD; similarly higher proportion of patients (53%) had intermediate FRS.
Myocardial ischemia was demonstrated in 67 (11%) patients. A higher number of patients underwent exercise (62%) compared with pharmacologic SE (
Discussion
This is the first large prospective study to assess the prevalence of CD in symptomatic patients without a history of cardiovascular disease, undergoing SE for evaluation of myocardial ischemia and its implication on primary preventive therapy. The study demonstrated that, in this population with a pretest probability of CAD of 40%, the prevalence of CD was 70%, whereas the prevalence of myocardial ischemia was only 11%.
In the subset of patients who underwent CA, in which the pretest
Conclusion
This prospective study revealed that carotid ultrasound in symptomatic patients referred for clinically indicated SE can identify early atherosclerosis that may necessitate primary preventive therapy despite reassuring SE result. Simultaneous carotid ultrasound further improved the prediction of CAD by SE and identified patients at high risk of revascularization. Thus, carotid ultrasonography is a simple, rapid, and accurate bedside method for enhancing the diagnostic value with potential for
Disclosures
None.
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Cited by (9)
Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk: From the American Society of Echocardiography
2020, Journal of the American Society of EchocardiographyLong-Term Prognostic Value of Simultaneous Assessment of Atherosclerosis and Ischemia in Patients with Suspected Angina: Implications for Routine Use of Carotid Ultrasound during Stress Echocardiography
2020, Journal of the American Society of EchocardiographyCitation Excerpt :Stress echocardiography was reported as “abnormal” in the presence of wall thickening abnormality in at least two contiguous segments. After SE, bilateral carotid arteries were imaged in longitudinal and cross-sectional views, interrogating the proximal, mid, and distal common carotid artery (CCA), as well as the bifurcation and proximal portions of the internal carotid arteries (ICAs).11 This was performed using a high-resolution, nonharmonic B-mode ultrasound system (Philips iE33; Philips Medical Systems, Best, Holland) with a linear array (3-11 MHz) transducer.
Incremental Prognostic Value of Stress Echocardiography With Carotid Ultrasound for Suspected CAD
2018, JACC: Cardiovascular ImagingCitation Excerpt :In another study that combined coronary CTA with SPECT in a predominantly asymptomatic population, in whom stress SPECT was carried out appropriately, the authors demonstrated superior prognostication by atherosclerosis assessment over perfusion (17). Both the present study and previously published data (5) suggest that simultaneous assessment of myocardial ischemia and atherosclerosis in patients presenting with suspected stable angina provide incremental prognostic information. Detection of CP is likely to have therapeutic implications.
Relationship Between Carotid Intima-media Thickness and the Results of Exercise Echocardiography in Patients With Suspected Coronary Disease
2017, Revista Espanola de Cardiologia