title: Role of simultaneous carotid ultrasound in patients undergoing stress echocardiography for assessment of chest pain with no previous history of coronary artery disease.
abstract: BACKGROUND
  We prospectively explored prevalence of carotid disease (CD), its independent association with coronary artery disease (CAD) and outcome as well as potential impact on management, in patients undergoing stress echocardiography (SE) for new onset chest pain without known CAD.
  
  
  METHODS
  Accordingly, 591 consecutive patients referred for SE underwent carotid ultrasound. Carotid disease was defined as carotid intima-media thickness (C-IMT) >75th percentile for age and sex and/or presence of plaque.
  
  
  RESULTS
  Myocardial ischemia was demonstrated in only a minority (11%), but there was a high prevalence of CD (70%). Incidence of CD was similar in patients with and without ischemia (76% versus 69%, P = .26). Carotid data led to reclassification of Framingham risk score categories in 65% of patients as well as more than a third of negative SE patients potentially benefitting from primary prevention therapy. Of the 83 patients undergoing coronary arteriography, 59 (71%) demonstrated coronary atherosclerosis (any atheroma) and 33 (40%) CAD. Positive predictive value of SE for CAD was 56%, but presence of carotid plaque improved it to 70%. Although both CD and plaque showed association with CAD and revascularization, after adjustment for conventional risk factors, only carotid plaque maintained significant association (P = .024 and P = .023, respectively).
  
  
  CONCLUSIONS
  There is significantly higher prevalence of CD compared with myocardial ischemia in patients undergoing SE and carotid ultrasound for suspected CAD. This can lead to significant Framingham risk score reclassification with important primary prevention implications. Carotid plaque is superior to clinical assessment for the prediction of CAD and improves positive predictive value of SE for CAD in these patients.
authors: Department of Cardiovascular Medicine and Institute for Medical Research, Northwick Park Hospital, Harrow, London, United Kingdom.
authors: Shahram
authors: S
authors: Ahmadvazir
authors: Department of Cardiovascular Medicine and Institute for Medical Research, Northwick Park Hospital, Harrow, London, United Kingdom.
authors: Konstantinos
authors: K
authors: Zacharias
authors: Cardiovascular, Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom.
authors: Benoy N
authors: BN
authors: Shah
authors: Department of Cardiovascular Medicine and Institute for Medical Research, Northwick Park Hospital, Harrow, London, United Kingdom.
authors: Jatinder S
authors: JS
authors: Pabla
authors: Department of Cardiovascular Medicine and Institute for Medical Research, Northwick Park Hospital, Harrow, London, United Kingdom; Cardiovascular, Biomedical Research Unit, Royal Brompton Hospital, London, United Kingdom. Electronic address: roxysenior@cardiac-research.org.
authors: Roxy
authors: R
authors: Senior
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002637:Chest Pain / Q000000981:diagnostic imaging*; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia; D058226:Plaque, Atherosclerotic / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors