Carotid artery ultrasound for evaluating the degree of stenosis and plaque composition in patients with coronary heart disease

Background: Early screening, diagnosis, risk assessment, and intervention of intima-media thickness (IMT) and carotid plaques is critical for assessing the risk of coronary heart disease (CHD). The current study aimed to assess carotid IMT and atherosclerotic plaque composition in patients with CHD by carotid artery ultrasound and to determine the associations of various factors with CHD. Methods: 480 patients with suspected CHD underwent a duplex ultrasound of the carotid arteries and coronary angiography or coronary CT. Then, the patients were investigated and evaluated to identify both personal and medical histories of clinical evaluations, and divided into the CHD (n=325) and control (n=155) groups based on clinical symptoms and vessel lesions. Associations of clinical characteristics with ischemic lesions determined by coronary angiography or CT were examined. Screening by B-mode carotid artery ultrasonography was performed the morning after admission prior to any treatment, coronary angiography or CT. Results: Cardiac diagnostic testing was performed in 134 subjects by CT coronary angiography, while the remaining 346 patients underwent coronary angiography. Carotid plaques were mainly distributed in the common carotid artery, with a significant difference between the CHD and control groups. Plaque incidence (80%) and IMT thickness (0.84±0.21) were significantly higher in the CHD group compared with control patients (P=8.92e-12 and P=0.012 respectively). The factors significantly associated with CHD were selected into the multivariate regression model. Male subject (OR=1.569, 95%CI 1.004-2.453; P=0.048) and plaque level (OR=0.457, 95%CI 0.210-0.993; P=0.048) were significant for CHD occurrence. The carotid plaque performed significantly better than IMT and the Framingham CHD risk score for predicting CHD risk (DeLong's correlated AUC test P=5.84e-4 and P=2.52e-5, respectively). Conclusions: The present study demonstrated that carotid artery ultrasound could be an effective method for early detection of atherosclerosis, which would help prevent CHD in asymptomatic patients with advanced atherosclerosis of the carotid artery. Incorporating carotid artery ultrasound plaque composition into screen practice may perform significantly better than the Framingham CHD risk factors for predicting CHD risk.