Copyright © 1994 by the European Society of Cardiology.
© 1994 The European Society of Cardiology
The carotid intima-media thickness as a marker of the presence of severe symptomatic coronary artery disease
Vascular Section of the Academic Surgical Unit and Academic Cardiology Unit, St Mary's Hospital Medical School QEQM Wing, South Wharf Road, London W2, U.K.
Received 1 December 1992; revised 1 February 1994; .
Correspondence: Mr. G. Geroulakos, Vascular Section of the Academic Surgical Unit, St Mary's Hospital Medical School, QEQM Wing, South Wharf Road, London W2, U.K.
Abstract
High resolution ultrasound can be used for the accurate measurement of intima-media thickness (IMT). The within-observer coefficient of variation of the IMT of two carotids measured seven times each on different days by two different observers was between 4% and 8%, and the mean absolute difference of the IMT of 68 carotids measured independently by two observers was 0.11 ± 0.11 mm (mean value ± SD).
Seventy-five consecutive male patients who underwent coronary angiography for assessment of chest pain and 40 normal controls matched for age and sex, were examined with high resolution B-mode ultrasound. The IMT of the common carotid artery for the controls was 0.71 ± 0.16 mm and for the patients 0.91 ± 0.18 mm (P<0.005). In patients with normal coronary angiogram the IMT was 0.73 ± 0.1 mm, and this increased in each of the subgroups with coronary stenosis compared to patients who had a normal coronary angiogram. In the group with one-vessel disease it was 0.9± 0.17 mm (P<005, ANOVA), in the group with two-vessel disease it was 0.96 ± 0.17 mm (P<0.01), and in the group with three-vessel disease it was 0.99 ± 0.21 mm (P<0.01). There was a significant linear trend between IMT and the number of involved vessels (P<0.0001, r=0.44). An IMT>0.85 mm was derived from the studied population of 75 patients as a criterion for the prediction of coronary artery disease (CAD). This criterion was prospectively evaluated in a further group of 32 consecutive patients, in whom it could predict the presence of CAD with a specificity of 77%, a sensitivity of 43% and a positive predictive value of 83%.
Thus, an increased carotid IMT is a marker of coronary vascular disease which can be measured non-invasively and may be used as a biological marker of CAD in observational studies and clinical trials. In addition, an increased IMT may have considerable importance as a screening tool for coronary atheroma.
Key Words: Intima-media thickness • coronary artery disease
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