Department of Medicine, New York University School of Medicine, New York, NY, USA.
Am Heart J. 2010 Jun;159(6):1059-66. doi: 10.1016/j.ahj.2010.03.026.
Coronary artery disease (CAD) is the most common cause of left ventricular systolic dysfunction (LVSD). Patients with ischemia as the cause of LVSD may warrant revascularization. Angiography is the most accurate method of CAD diagnosis but is invasive, expensive, and associated with some risk. Noninvasive imaging for CAD often involves expensive equipment, radiation exposure, medication, and/or contrast administration. Carotid ultrasound with measurement of intima-media thickness (IMT) is safe and inexpensive. Carotid IMT is well correlated with the presence of CAD. We assessed the accuracy of carotid ultrasound for identification of CAD as a potential etiology of LVSD.
Patients with LVSD (ejection fraction < or =40%) of uncertain etiology referred for angiography underwent carotid ultrasound. Patients with history of myocardial infarction were excluded. Two experienced cardiologists blinded to CAD status determined common carotid artery (CCA) IMT and plaque. Significant CAD was defined as > or =50% stenosis of any major artery. Ischemic LVSD was defined as (1) left main and/or proximal left anterior descending coronary artery > or =75% or (2) > or =2 major arteries with > or =75% stenosis.
Mean ejection fraction was 27% +/- 10% in 150 patients. Significant CAD was found in 64 (42.7%) and ischemic LVSD in 40 (26.7%). Carotid plaque was seen in 95 (63.3%). Mean CCA IMT was > or =0.9 mm in 69 (46.0%). The combination of mean CCA IMT <0.9 mm and no plaque had negative predictive value for ischemic LVSD of 98%.
Carotid ultrasound with IMT measurement is a valuable screening tool for excluding an ischemic etiology of LVSD when CAD is suspected.
冠心病（CAD）是左心室收缩功能障碍（LVSD）最常见的原因。由于缺血导致 LVSD 的患者可能需要血运重建。血管造影是 CAD 诊断最准确的方法，但具有侵入性、昂贵且存在一定风险。用于 CAD 的非侵入性成像通常涉及昂贵的设备、辐射暴露、药物和/或造影剂给药。颈动脉超声测量内膜中层厚度（IMT）既安全又经济。颈动脉 IMT 与 CAD 的存在密切相关。我们评估了颈动脉超声识别 CAD 作为 LVSD 潜在病因的准确性。
LVSD（射血分数<=40%）病因不明的患者行血管造影术，并接受颈动脉超声检查。排除有心肌梗死病史的患者。两名经验丰富的心脏病专家在不知道 CAD 状态的情况下，确定颈总动脉（CCA）IMT 和斑块。显著 CAD 定义为任何主要动脉的> =50%狭窄。缺血性 LVSD 定义为（1）左主干和/或近端左前降支> =75%或（2）> =2 条主要动脉，> =75%狭窄。
150 例患者的平均射血分数为 27% +/- 10%。64 例（42.7%）存在显著 CAD，40 例（26.7%）存在缺血性 LVSD。95 例（63.3%）可见颈动脉斑块。69 例（46.0%）CCA IMT> =0.9mm。当怀疑 CAD 时，CCA IMT<0.9mm 且无斑块的组合对缺血性 LVSD 的阴性预测值为 98%。
当怀疑 CAD 时，颈动脉超声联合 IMT 测量是排除 LVSD 缺血性病因的有价值的筛查工具。
