title: Multiparametric carotid and cardiac ultrasound compared with clinical risk scores for the prediction of angiographic coronary artery disease: a multicenter prospective study.
abstract: OBJECTIVE
  Cardiovascular risk prediction is deemed fundamental and the assessment of organ damage is emerging as a potentially 'downstream' picture of individual risk. Our aim was to assess the feasibility and value of prediction of coronaropathy [coronary artery disease (CAD)] of integrated cardiovascular ultrasound examination.
  
  
  METHODS
  This multicenter study involved eight cardiology centers that enrolled 457 consecutive patients. Blood pressures, carotid intima-media thickness (cIMT), carotid pulse wave velocity (cPWV), semiquantitative score of cardiac calcifications, global myocardial longitudinal strain (GLS), and rest Doppler flow velocity on the left anterior descending (LAD) coronary artery were measured. After coronary angiography, patients were divided in CAD, n = 273, at least one coronary stenosis higher than 50%, and no CAD, n = 184.
  
  
  RESULTS
  CAD were older (65.9 ± 10.7 versus 63.1 ± 11.2 years, mean ± standard deviation, P = 0.01), and had higher blood pressure (137.0 ± 18.8/77.5 ± 11.1 versus 130.2 ± 17.4/75.1 ± 9.7 mmHg, P < 0.02), cIMT (791.4 ± 165.5 versus 712.0 ± 141.5 mcm, P < 0.0001), cPWV (median: 9 versus 8.1 m/s, P < 0.01), score of calcium (median, 2 versus 1, P < 0.0001), LAD velocity (median, 38 versus 36, P < 0.07), and lower GLS (-17.6 ± 4.3 versus -19.3 ± 5.1, P < 0.05) than no CAD. Score of calcium was feasible in the totality of patients, cIMT in 97%, cPWV in 86%, GLS in 88%, and LAD in 84%. A combination of at least three variables was measurable in 80% of the patients. All ultrasound parameters significantly predicted CAD. However, in a stepwise logistic regression, the only combined predictors of obstructive CAD were score of calcium, cIMT, and LAD velocity.
  
  
  CONCLUSIONS
  In Echo-Lab, Rome, Italy, the integrated cardiovascular ultrasound study is feasible in a high percentage of patients. The combination of three parameters, that is, score of calcium, cIMT, and LAD velocity, has incremental predictive value for obstructive CAD.
authors.affiliation: aCardiology IV, Department 'A De Gasperis', Ospedale Niguarda Ca'Granda, Milano bDepartment of Health Science, University of Milano-Bicocca, Milano cDepartment of Cardiology, Parma University Hospital, Parma dDivision of Cardiology, Spedali Civili, University of Brescia, Brescia eDepartment of Cardiology, Clinical and Experimental Medicine, University of Messina, Messina fEcho-Lab and Cardiovascular Prevention Unit, San Giovanni-Addolorata Hospital, Roma gDepartment of Clinical and Experimental Sciences, Medicina Spedali Civili, and University of Brescia, Brescia hDepartment of Cardiology, dell'Angelo Hospital, Mestre-Venice, Italy.
authors.forename: Antonella
authors.initials: A
authors.lastname: Moreo
authors.forename: Nicola
authors.initials: N
authors.lastname: Gaibazzi
authors.forename: Pompilio
authors.initials: P
authors.lastname: Faggiano
authors.forename: Moemen
authors.initials: M
authors.lastname: Mohammed
authors.forename: Scipione
authors.initials: S
authors.lastname: Carerj
authors.forename: Gianfrancesco
authors.initials: G
authors.lastname: Mureddu
authors.forename: Filippo
authors.initials: F
authors.lastname: Pigazzani
authors.forename: Lorenza
authors.initials: L
authors.lastname: Muiesan
authors.forename: Massimo
authors.initials: M
authors.lastname: Salvetti
authors.forename: Francesca
authors.initials: F
authors.lastname: Cesana
authors.forename: Giacomo
authors.initials: G
authors.lastname: Faden
authors.forename: Rita
authors.initials: R
authors.lastname: Facchetti
authors.forename: Cristina
authors.initials: C
authors.lastname: Giannattasio
authors.forename: Fausto
authors.initials: F
authors.lastname: Rigo
mesh_terms: D000368:Aged; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D059168:Carotid Intima-Media Thickness; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D023921:Coronary Stenosis / Q000000981:diagnostic imaging*; D015150:Echocardiography, Doppler; D005260:Female; D006801:Humans; D006973:Hypertension / Q000000981:diagnostic imaging; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000648:ultrastructure*; D011379:Prognosis; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D012307:Risk Factors