Prognostic value of carotid intima-media thickness in detection of coronary atherosclerosis in patients with calcified aortic valve stenosis.

OBJECTIVE: Aortic stenosis (AS) coexists with coronary artery disease (CAD) in at least 30% of patients. Patients with concomitant CAD may benefit from simultaneous coronary bypass grafting. This study aimed to evaluate the prognostic value of carotid intima-media thickness (IMT) in patients with AS in assessing concomitant CAD.

METHODS: Group I consisted of 33 patients (mean age +/- SD, 61.0 +/- 8.2 years; 18 men and 15 women) with AS but without CAD on angiograms. Group II consisted of 34 patients (64.4 +/- 8.0 years; 25 men and 9 women) with AS and CAD confirmed angiographically. A control group included 36 patients (61.2 +/- 4.9 years; 18 men and 18 women) with normal coronary arteries and no AS. Maximal IMT was assessed in all patients at the common carotid artery, bulb, and internal carotid artery and expressed as a mean value.

RESULTS: There were no differences among the respective groups with regard to age, sex, frequency of hypertension, diabetes, and smoking habit, although patients with CAD were more often hyperlipemic (P = .038). The IMT of the common carotid artery, bulb, and internal carotid artery was significantly higher in patients with AS and CAD compared with both the control group and patients with AS only. The multivariable regression model revealed that CAD (P < .001), AS (P = .006), male sex (P = .034), age (P < .001), and diabetes mellitus (P = .047) were independent risk factors for IMT thickening. A mean IMT value of greater than 1.2 mm was predictive (sensitivity, 73.5%; specificity, 72.7%) of concomitant CAD in patients with AS.

CONCLUSIONS: Intima-media thickness increases in patients with AS. The greatest IMT values are observed in patients with both AS and CAD. Patients with AS might be suspected of having CAD when the IMT value exceeds 1.2 mm.