title: The utility of carotid ultrasonography in identifying severe coronary artery disease in asymptomatic type 2 diabetic patients without history of coronary artery disease.
abstract: OBJECTIVE
  Although many studies have shown that carotid intima-media thickness (IMT) is associated with coronary artery disease (CAD), it remains inconclusive whether assessment of carotid IMT is useful as a screening test for asymptomatic but severe CAD in diabetic patients.
  
  
  METHODS
  A total of 333 asymptomatic type 2 diabetic patients without history of CAD underwent exercise electrocardiogram or myocardial perfusion scintigraphy for detection of silent myocardial ischemia, and those whose test results were positive were subjected to coronary computed tomography angiography or coronary angiography. The ability of carotid IMT to identify severe CAD corresponding to treatment with revascularization was examined by receiver-operating characteristic (ROC) curve analyses.
  
  
  RESULTS
  Among the 333 subjects, 17 were treated with revascularization. A multiple logistic regression analysis showed that maximum IMT was an independent predictor of severe CAD even after adjustment for conventional risk factors. ROC curve analyses revealed that the addition of maximum IMT to conventional risk factors significantly improved the prediction ability for severe CAD (from area under the curve, 0.67 to 0.79; P = 0.039). The greatest sensitivity and specificity were obtained when the cut-off value of maximum IMT was set at 2.45 mm (pretest probability, 5%; posttest probability, 11%; sensitivity, 71%). When we applied age-specific cut-off values, the sensitivity of screening further increased in both the nonelderly (pretest probability, 6%; posttest probability, 10%; sensitivity, 100%) and the elderly subjects (pretest probability, 5%; posttest probability, 15%; sensitivity, 100%).
  
  
  CONCLUSIONS
  Our study suggests that carotid maximum IMT is useful for screening asymptomatic type 2 diabetic patients with severe CAD equivalent to revascularization.
authors: Department of Metabolic Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.
authors: Yoko
authors: Y
authors: Irie
authors: Naoto
authors: N
authors: Katakami
authors: Hideaki
authors: H
authors: Kaneto
authors: Mayu
authors: M
authors: Nishio
authors: Ryuichi
authors: R
authors: Kasami
authors: Ken'ya
authors: K
authors: Sakamoto
authors: Yutaka
authors: Y
authors: Umayahara
authors: Satoru
authors: S
authors: Sumitsuji
authors: Yasunori
authors: Y
authors: Ueda
authors: Keisuke
authors: K
authors: Kosugi
authors: Iichiro
authors: I
authors: Shimomura
mesh_terms: D000368:Aged; D044466:Asian People; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000000981:diagnostic imaging; D014463:Ultrasonography
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