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Cardiovasc Ultrasound ; 16(1): 26, 2018 Oct 09.
Article in English | MEDLINE | ID: mdl-30296943

ABSTRACT

BACKGROUND: Relationship between carotid and coronary artery disease (CAD) in patients undergoing invasive and non-invasive test is unclear. The aim of the study is to evaluate whether carotid disease is associated with CAD in patients submitted to exercise echocardiography (EE) and if it improves the EE ability to predict CAD. METHODS: We retrospectively studied 156 subjects without previous vascular disease who underwent EE, carotid ultrasonography and coronary angiography between 2002 and 2013. Positive EE was defined as exercise induced wall motion abnormalities, carotid disease according to Manheim and American Society of Echocardiography Consensus and significant CAD as stenosis ≥50%. RESULTS: Eighty-nine (57.1%) subjects had significant CAD. Factors associated with CAD in multivariate analysis were fasting plasma glucose (odds ratio [OR] 1.02, p = 0.031), pre-test probability of CAD > 65% (OR 3.71, p < 0.001), positive EE (OR 10.51, p < 0.001) and carotid plaque (CP) presence (OR 2.95, p = 0.013). There was neither statistical significant difference in area under the curve after addition of CP to EE results (0.77 versus 0.81, p = 0.525) nor sensitivity, specificity, predictive values or efficiency. CP presence reclassified as very high-risk according to Systematic COronary Risk Evaluation 13 patients (34.2%) with negative EE and 22 (33.3%) without CAD. CONCLUSION: CP is associated with CAD in patients undergoing EE, however its addition to EE does not improve CAD prediction, probably due to insufficient statistical power. CP reclassified one third of patients to very high-risk category despite negative EE or CAD absence, these subjects benefit from aggressive primary prevention interventions.


Subject(s)
Carotid Stenosis/diagnostic imaging , Carotid Stenosis/epidemiology , Coronary Stenosis/diagnostic imaging , Coronary Stenosis/epidemiology , Echocardiography, Stress/methods , Ultrasonography, Doppler/methods , Age Factors , Aged , Area Under Curve , Cohort Studies , Comorbidity , Coronary Angiography/methods , Female , Humans , Male , Middle Aged , Multivariate Analysis , Plaque, Atherosclerotic/diagnostic imaging , Plaque, Atherosclerotic/epidemiology , Predictive Value of Tests , Prevalence , Retrospective Studies , Risk Assessment , Sensitivity and Specificity , Severity of Illness Index , Sex Factors
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