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Carotid ultrasound with intima-media thickness measurement (IMT) can help rule out coronary artery disease as a cause of left ventricular systolic dysfunction (LVSD), new research shows. Identifying whether patients with LVSD have coronary artery disease is crucial for determining medical therapy, as well as whether revascularization is warranted, Dr. Harmony R. Reynolds of New York University School of Medicine and colleagues note in the June issue of the American Heart Journal.

However, they add, using angiography to diagnose coronary artery disease is risky and expensive, and many of the non-invasive studies still expose patients to considerable radiation doses. Given that carotid IMT is strongly associated with coronary artery disease, Dr. Reynolds and colleagues tested whether carotid ultrasound -- reproducible, relatively inexpensive, and not requiring radiation or contrast -- could be an alternative approach for diagnosing ischemia as a potential etiology of LVSD.

To investigate, they performed carotid ultrasound studies in 150 patients, all with ejection fractions of 40% or less, who were scheduled to undergo coronary angiography.

Carotid ultrasound revealed plaque in 95 patients (63.3%). Sixty-nine patients (46.0%) had mean common carotid artery IMT of 0.9 mm or greater. Ninety-eight patients (65.3%) either had plaque or a common carotid IMT > 0.9 mm.

Forty patients (26.7%) had ischemic LVSD, defined as stenosis of 75% or greater in the left main and/or the proximal left anterior descending coronary artery, or at least two major epicardial coronary arteries with at least 75% stenosis.

Sixty-four patients had significant coronary artery disease (at least 50% stenosis in any major epicardial vessel), including 24 who didn't meet criteria for ischemic LVSD.

"The absence of plaque and/or a common carotid artery IMT >/= 0.9 mm had a negative predictive value of 98%," the researchers found.

"Carotid ultrasound with IMT measurement appears to be a valuable screening tool for the exclusion of an ischemic etiology of LVSD in patients without known CAD or history of MI," Dr. Reynolds and colleagues write. "Further research is needed to determine whether carotid ultrasound with IMT measurement may be used as an initial screening test to exclude CAD as the etiology of LVSD."

Source: Reuters Health