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Canadian Journal of Cardiology

Early Atherosclerosis Detection in Asymptomatic Patients: A Comparison of Carotid Ultrasound, Coronary Artery Calcium Score, and Coronary Computed Tomography Angiography

Published:October 28, 2013DOI:https://doi.org/10.1016/j.cjca.2013.10.003

      Abstract

      Background

      Detailed multimodality assessment of subclinical atherosclerosis in asymptomatic subjects referred for risk stratification has not been performed. We analyzed the detection of early atherosclerosis using 3 imaging modalities: coronary artery calcium (CAC) scoring, carotid ultrasound (US), and coronary computed tomography angiography (CCTA).

      Methods

      Asymptomatic subjects free of known vascular disease scheduled to undergo a carotid US for risk stratification were invited to undergo CCTA/CAC. Subjects taking lipid-lowering medication were excluded. All images were assessed by experienced core laboratory personnel. Carotid intima media thickness ≥ 75th percentile for age and sex, CAC > 0, and detection of either carotid or coronary artery plaque were indicators of atherosclerosis.

      Results

      Fifty patients were included with a median age of 53 years. Atherosclerosis was observed in 28%, 78%, and 90% of subjects using CAC, CCTA, and carotid US, respectively. All subjects showed atherosclerosis on at least 1 modality. In 36 patients with a CAC score = 0, 69% and 86% had atherosclerosis on CCTA and carotid US, respectively.

      Conclusions

      In this detailed analysis, all subjects identified to warrant further risk stratification had subclinical atherosclerosis on at least 1 imaging modality. Concordance between modalities was highly variable, dependent on the specific definition of atherosclerosis used. Carotid US and CCTA detection of plaque were significantly more sensitive than CAC > 0 in this middle-aged population. Considering the prevalence of subclinical disease on carotid US and CCTA, the threshold at which to treat warrants further research.

      Résumé

      Introduction

      L’évaluation détaillée de l’imagerie multimodale de l’athérosclérose subclinique chez les sujets asymptomatiques orientés pour la stratification du risque n’a pas été réalisée. Nous avons analysé la détection de l’athérosclérose précoce en utilisant 3 modalités d’imagerie : le score calcique des artères coronaires (CAC), l’échographie (EG) carotidienne et la coronarographie par tomodensitométrie (Coro-TDM).

      Méthodes

      Les sujets asymptomatiques sans maladie vasculaire connue inscrits pour subir une EG carotidienne en vue de la stratification du risque ont été invités à subir la Coro-TDM/CAC. Les sujets prenant un hypolipidémiant ont été exclus. Toutes les images ont été évaluées par le personnel expérimenté du laboratoire central. L’épaisseur de l’intima-média de la carotide ≥ 75e percentile de l’âge et du sexe, le CAC > 0 et la détection de plaque carotidienne ou de plaque de l’artère coronaire ont été des indicateurs d’athérosclérose.

      Résultats

      Cinquante (50) patients dont l’âge moyen était de 53 ans ont été inclus. L’athérosclérose a été observée chez 28 %, 78 % et 90 % des sujets à l’aide de la CAC, la Coro-TDM et l’EG carotidienne, respectivement. Tous les sujets ont montré de l’athérosclérose dans au moins 1 modalité. Chez 36 patients ayant un score de CAC = 0,69 % et 86 % ont montré de l’athérosclérose à la Coro-TDM et l’EG carotidienne, respectivement.

      Conclusions

      Dans cette analyse détaillée, tous les sujets identifiés pour justifier une stratification du risque plus poussée ont montré de l’athérosclérose subclinique dans au moins 1 modalité d’imagerie. La concordance entre les modalités a été très variable, dépendamment de la définition de l’athérosclérose utilisée. La détection de la plaque à l’EG carotidienne et à la Coro-TDM a été significativement plus sensible qu’à la CAC > 0 chez cette population d’âge moyen. Si l’on considère la prévalence de la maladie subclinique à l’EG carotidienne et à la Coro-TDM, le seuil auquel traiter justifie d’autres recherches.
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