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CLINICAL STUDY: ARTHEROSCLEROSIS

Evaluation of carotid artery and aortic intima-media thickness measurements for exclusion of significant coronary atherosclerosis in patients scheduled for heart valve surgery

Laurent Belhassen, MD, PhD^*, Claudine Carville, MD^*, Gabriel Pelle, PhD^*, Jean Luc Monin, MD, Emmanuel Teiger, MD, PhD^*, Anne-Marie Duval-Moulin, MD, Patrick Dupouy, MD, Jean Luc Dubois Rande, MD, PhD and Pascal Gueret, MD, FACC^,*

^* Service de Physiologie-Explorations Fonctionnelles, Henri-Mondor University Hospital, APHP, Créteil, France
Fédération de Cardiologie, Henri-Mondor University Hospital, APHP, Créteil, France
Service de Cardiologie, Hôpital Privé d’Antony, Antony, France

Manuscript received June 11, 2001; revised manuscript received January 3, 2002, accepted January 16, 2002.

^* Reprint requests and correspondence: Dr. Pascal Gueret, Fédération de Cardiologie, Hôpital Henri-Mondor, 51 Avenue du Maréchal De Lattre de Tassigny, 94010 Créteil, France.
pascal.gueret{at}hmn.ap-hop-paris.fr

OBJECTIVES: We assessed the value of carotid intima-media thickness (CIMT) and thoracic aorta intima-media thickness (AoIMT) in ruling out significant coronary artery disease (CAD) in patients scheduled for heart valve surgery.

BACKGROUND: Evaluation of CAD is needed in most patients undergoing heart valve surgery because of the high surgical morbidity in patients with significant CAD, raising the need for sensitive tests to exclude CAD. Coronary angiography is the reference standard, but this invasive procedure is not cost-effective, because more than two-thirds of these patients do not have significant CAD.

METHODS: In a pilot study, CIMT and AoIMT cutoff values separating low- from high-risk groups were determined in 96 patients by using receiver-operating characteristic curves. Then, a prospective study was conducted in 152 patients to determine the statistical power of these cutoff values used alone or in combination. In both studies, carotid artery ultrasonography and transesophageal echocardiography were performed before coronary angiography and valve surgery.

RESULTS: In the pilot study, CIMT <0.55 mm and AoIMT <3 mm were excellent predictors of the absence of CAD. In the prospective study, CIMT and AoIMT criteria were independent predictors of significant CAD in these patients, as assessed by logistic regression analysis. Carotid IMT criterion had 100% sensitivity and 100% negative predictive value. For the AoIMT criterion, sensitivity was 98%, and negative predictive value 99%. Combining the two criteria did not change sensitivity and negative predictive value but increased specificity to 78%.

CONCLUSIONS: Measurements of CIMT and AoIMT may be useful in selecting patients who do not require coronary angiography before heart valve surgery.

Abbreviations and Acronyms   AoIMT   aortic intima-media thickness   CAD   coronary artery disease   CIMT   carotid intima-media thickness   IMT   intima-media thickness   NPV   negative predictive value   ROC   receiving operating characteristic   TEE   transesophageal echocardiography

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