Utilidad de la ecografía carotidea en el diagnostico de la enfermedad arterial coronaria y su posible valor pronóstico en pacientes con dolor torácico sometidos a ecocardiografía de esfuerzo

Abstract

Background: There are few data regarding carotid echography usefulness in the diagnosis or assessment of coronary artery disease (CAD) extension in patients undergoing non-invasive cardiac test. Moreover there are also few data regarding carotid echography as a marker of adverse cardiovascular events after a coronary angiography. Methods: observational and retrospective study of patients submitted to coronary angiography after the performance of a treadmill exercise echocardiography (EE) and carotid ultrasonography. Patients with previous vascular disease were excluded in the assessment of the relationship between CAD and carotid ultrasound. Positive EE was defined as exercise induced wall motion abnormalities. Carotid intima media thickness (CIMT) and CP were performed and defined according to international consensus. Significant CAD was defined as stenosis greater than or equal to 50 % and CAD extension as number of vessels affected. Adverse event was defined as myocardial infarction, stroke or cardiovascular death. Results: CP was associated with CAD presence (odds ratio [OR] = 2,95; 95 % confidence interval [CI] 1,25 - 6,93; p = 0,013) and CAD extension (OR = 1,75; 95 % CI 1,20 - 2,55; p = 0004) in the 156 patients without vascular disease. CP addition to EE results did not improve CAD prediction. CP predicted adverse events in the 390 subjects submitted to a coronary angiography (Hazard ratio = 2,36; 95 % CI 1,02 - 5,44; p = 0,044). CIMT results were not significant. Conclusions: carotid ultrasonography provides additional diagnostic information in patients submitted to EE and additional prognosis information in subjects undergoing coronary angiography.