Early Atherosclerosis Detection in Asymptomatic Patients: A Comparison of Carotid Ultrasound, Coronary Artery Calcium Score, and Coronary Computed Tomography Angiography

• Published in: Canadian journal of cardiology 2013-12, Vol.29 (12), p.1687-1694
• Main Authors: Schroeder, Benjamin, MD, Francis, Gordon, MD, Leipsic, Jonathon, MD, Heilbron, Brett, MD, John Mancini, G.B., MD, Taylor, Carolyn M., MD, MPH
• Format: Article
• Language: English
• Subjects: Adult; Aged; British Columbia; Calcinosis - classification; Calcinosis - diagnosis; Cardiovascular; Carotid Stenosis - classification; Carotid Stenosis - diagnosis; Coronary Angiography; Coronary Artery Disease - classification; Coronary Artery Disease - diagnosis; Early Diagnosis; Female; Humans; Male; Middle Aged; Reference Values; Risk Assessment; Tomography, X-Ray Computed; Ultrasonography
• ISSN: 0828-282X; 1916-7075
• DOI: 10.1016/j.cjca.2013.10.003

Abstract Background Detailed multimodality assessment of subclinical atherosclerosis in asymptomatic subjects referred for risk stratification has not been performed. We analyzed the detection of early atherosclerosis using 3 imaging modalities: coronary artery calcium (CAC) scoring, carotid ultrasound (US), and coronary computed tomography angiography (CCTA). Methods Asymptomatic subjects free of known vascular disease scheduled to undergo a carotid US for risk stratification were invited to undergo CCTA/CAC. Subjects taking lipid-lowering medication were excluded. All images were assessed by experienced core laboratory personnel. Carotid intima media thickness ≥ 75th percentile for age and sex, CAC > 0, and detection of either carotid or coronary artery plaque were indicators of atherosclerosis. Results Fifty patients were included with a median age of 53 years. Atherosclerosis was observed in 28%, 78%, and 90% of subjects using CAC, CCTA, and carotid US, respectively. All subjects showed atherosclerosis on at least 1 modality. In 36 patients with a CAC score = 0, 69% and 86% had atherosclerosis on CCTA and carotid US, respectively. Conclusions In this detailed analysis, all subjects identified to warrant further risk stratification had subclinical atherosclerosis on at least 1 imaging modality. Concordance between modalities was highly variable, dependent on the specific definition of atherosclerosis used. Carotid US and CCTA detection of plaque were significantly more sensitive than CAC > 0 in this middle-aged population. Considering the prevalence of subclinical disease on carotid US and CCTA, the threshold at which to treat warrants further research.