Evaluation of carotid artery and aortic intima-media thickness measurements for exclusion of significant coronary atherosclerosis in patients scheduled for heart valve surgery

• Published in: Journal of the American College of Cardiology 2002-04, Vol.39 (7), p.1139-1144
• Main Authors: Belhassen, Laurent, Carville, Claudine, Pelle, Gabriel, Monin, Jean Luc, Teiger, Emmanuel, Duval-Moulin, Anne-Marie, Dupouy, Patrick, Dubois Rande, Jean Luc, Gueret, Pascal
• Format: Article
• Language: English
• Subjects: Aged; Aorta, Thoracic - diagnostic imaging; Aorta, Thoracic - pathology; Atherosclerosis; Biological and medical sciences; Blood pressure; Cardiology; Cardiology. Vascular system; Cardiovascular disease; Carotid Arteries - diagnostic imaging; Carotid Arteries - pathology; Confidence intervals; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - epidemiology; Coronary heart disease; Coronary vessels; Diabetes; Echocardiography, Transesophageal; Female; Gender; Heart; Heart attacks; Heart Valve Diseases - surgery; Humans; Hypertension; Intubation; Logistic Models; Male; Medical imaging; Medical sciences; Multivariate analysis; Pilot Projects; Predictive Value of Tests; Preoperative Care; Prospective Studies; ROC Curve; Sensitivity and Specificity; Studies; Surgery; Tunica Intima - pathology; Tunica Media - pathology; Ultrasonic imaging; Ultrasonography, Doppler, Transcranial; Variables
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(02)01748-5

We assessed the value of carotid intima-media thickness (CIMT) and thoracic aorta intima-media thickness (AoIMT) in ruling out significant coronary artery disease (CAD) in patients scheduled for heart valve surgery. Evaluation of CAD is needed in most patients undergoing heart valve surgery because of the high surgical morbidity in patients with significant CAD, raising the need for sensitive tests to exclude CAD. Coronary angiography is the reference standard, but this invasive procedure is not cost-effective, because more than two-thirds of these patients do not have significant CAD. In a pilot study, CIMT and AoIMT cutoff values separating low- from high-risk groups were determined in 96 patients by using receiver-operating characteristic curves. Then, a prospective study was conducted in 152 patients to determine the statistical power of these cutoff values used alone or in combination. In both studies, carotid artery ultrasonography and transesophageal echocardiography were performed before coronary angiography and valve surgery. In the pilot study, CIMT