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European Heart Journal Advance Access originally published online on June 27, 2007
European Heart Journal 2007 28(17):2094-2101; doi:10.1093/eurheartj/ehm244
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© The European Society of Cardiology 2007. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Carotid intima-media thickness by B-mode ultrasound as surrogate of coronary atherosclerosis: correlation with quantitative coronary angiography and coronary intravascular ultrasound findings

Mauro Amato1, Piero Montorsi1,2, Alessio Ravani1, Elisa Oldani1, Stefano Galli1,2, Paolo M. Ravagnani1,2, Elena Tremoli1,3 and Damiano Baldassarre1,3,*

1 Centro Cardiologico Monzino, IRCCS, Via Parea 4, 20138 Milan, Italy
2 Institute of Cardiology, School of Medicine, University of Milan, Milan, Italy
3 Department of Pharmacological Sciences, University of Milan, Via Balzaretti 9, 20133 Milan, Italy

Received 6 February 2007; revised 4 May 2007; accepted 22 May 2007; online publish-ahead-of-print 27 June 2007.

* Corresponding author. Tel: +39 02 58002253; fax: +39 02 58002623. E-mail address: damiano.baldassarre{at}unimi.it

See page 2049 for the editorial comment on this article (doi:10.1093/eurheartj/ehm320)

Aims: Although well supported by postmortem studies, the reliability of carotid atherosclerosis as surrogate marker of coronary atherosclerosis has been put in doubt by in vivo studies showing a poor correlation between carotid intima-media thickness (IMT) detected by external carotid ultrasound (ECU) and coronary stenosis assessed by quantitative coronary angiography (QCA). In the present study, we have investigated whether a stronger in vivo correlation between the two arteries can be obtained by using homogeneous variables such as carotid and coronary IMT, detected by ECU and intravascular ultrasound (IVUS), respectively.

Methods and results: ECU, QCA, and IVUS measurements were made in 48 patients. Carotid IMT was correlated with both angiographic and IVUS findings. A significant but weak correlation was observed between ECU and QCA variables (r {approx} 0.35, P < 0.05); the correlation between ECU and IVUS measurements of IMT was higher, with correlation coefficients ranging from 0.49 to 0.55. In patients with a QCA diagnosis of normal/intermediate coronary atherosclerosis, the presence of a carotid-IMTmean > 1 mm was associated with an 18-fold increase in risk of having a positive IVUS test (OR = 17.99, 95% CI 1.83–177.14, P= 0.013) and with a seven-fold increased risk of having a significant IVUS coronary stenosis (OR = 7.4, 95% CI 1.27–44.0, P = 0.028).

Conclusion: Carotid atherosclerosis correlates better with coronary atherosclerosis when both circulations are investigated by the same technique (ultrasound) using the same parameter (IMT). This supports the concept that carotid IMT is a good surrogate marker of coronary atherosclerosis.

Key Words: Angiography • IVUS • Ultrasound • Carotid • Coronary


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