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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

View larger version (15K): [in a new window]   Figure 1 Receiver operating characteristic curve for carotid intima-media thickness (CIMT) (A), aortic intima-media thickness (AoIMT) (B) and the combination of CIMT and AoIMT (C). Arrows indicate the position of cutoff values on these graphs.

View larger version (20K): [in a new window]   Figure 2 Carotid intima-media thickness (CIMT) versus coronary stenosis. Each diamond represents a patient. The thin horizontal and vertical lines represent a CIMT cutoff value of 0.55 mm and 70% coronary stenosis, respectively. The bold line represents the linear regression curve, with its equation and r value at the top.

View larger version (19K): [in a new window]   Figure 3 Aortic intima-media thickness (AoIMT) versus coronary stenosis. Each diamond represents a patient. The thin horizontal and vertical lines represent an AoIMT cutoff value of 3 mm and 70% coronary stenosis, respectively. The bold line represents the linear regression curve, with its equation and r value at the top.

View larger version (24K): [in a new window]   Figure 4 Proposed stepwise strategy for exclusion of coronary artery disease in patients undergoing heart valve surgery. Carotid ultrasonography is performed to measure carotid intima-media thickness (CIMT). Transesophageal echocardiography (TEE) is performed to measure aortic intima-media thickness (AoIMT).