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


BACKGROUND
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.


METHODS
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.


RESULTS
In the pilot study, CIMT < 0.55 mm and AoIMT < 3 mm were excellent predictors of the absence of CAD. In the prospective study, CIMT and AoIMT criteria were independent predictors of significant CAD in these patients, as assessed by logistic regression analysis. Carotid IMT criterion had 100% sensitivity and 100% negative predictive value. For the AoIMT criterion, sensitivity was 98%, and negative predictive value 99%. Combining the two criteria did not change sensitivity and negative predictive value but increased specificity to 78%.


CONCLUSIONS
Measurements of CIMT and AoIMT may be useful in selecting patients who do not require coronary angiography before heart valve surgery.
Belhassen
Laurent
L
Service de Physiologie-Explorations Fonctionnelles, Henri-Mondor University Hospital, APHP, Créteil, France.
Carville
Claudine
C
Pelle
Gabriel
G
Monin
Jean Luc
JL
Teiger
Emmanuel
E
Duval-Moulin
Anne Marie
AM
Dupouy
Patrick
P
Dubois Rande
Jean Luc
JL
Gueret
Pascal
P
D000368:Aged; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging* / Q000473:pathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology; D017548:Echocardiography, Transesophageal; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D016015:Logistic Models; D008297:Male; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011300:Preoperative Care; D011446:Prospective Studies; D012372:ROC Curve; D012680:Sensitivity and Specificity; D017539:Tunica Intima / Q000473:pathology; D017540:Tunica Media / Q000473:pathology; D017585:Ultrasonography, Doppler, Transcranial