From the Karolinska Institute, Departments of Clinical Physiology (J.N.,
T.J.), Radiology (T.N.), and Cardiology (C.S.), Huddinge University Hospital,
Stockholm, Sweden.
Correspondence to Jacek Nowak, MD, PhD, Department of Clinical Physiology, Huddinge University Hospital, S-141 86 Huddinge, Sweden. E-mail jano{at}fysd01.hs.sll.se
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
mm2 for ultrasonography; (1) ST depression
Results—Coronary angiography revealed the presence of CAD
(
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.
© 1998 American Heart Association, Inc.
Original Contributions
Potential of Carotid Ultrasonography in the Diagnosis of Coronary Artery Disease
A Comparison With Exercise Test and Variance ECG
0.1 mV and
0.2 mV with and (2) without chest pain for exercise test; and
electrical variability index from 50 to 100 for variance ECG. 50% 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
(P<.001 and P<.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
(P<.05). However, at the chosen cut points, carotid
plaque identification offered higher sensitivity than exercise test
with either criterion (P<.01 and
P<.001, respectively).
Key Words: carotid artery disease • coronary artery disease • duplex scanning • electrocardiography
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