Multiterritory Arterial Ultrasound before Coronary CT Angiography: A 2-Step Triage Model

Area of Science:

• Cardiovascular Imaging
• Vascular Ultrasound
• Atherosclerosis Research

Background:

• Coronary artery disease (CAD) and peripheral artery disease share common risk factors.
• Early identification of CAD risk is crucial for timely intervention.
• Non-coronary arterial ultrasound may aid in risk stratification for CAD.

Purpose of the Study:

• To evaluate if non-coronary arterial ultrasound improves preselection for coronary computed tomography angiography (CCTA).
• To assess if ultrasound provides diagnostic information beyond simplified clinical assessment for CAD risk.
• To determine the diagnostic accuracy of multiterritory ultrasound in identifying high-grade coronary stenosis.

Main Methods:

• Seventy-two patients underwent CCTA and ultrasound of carotid, aortoiliac, and lower-extremity arteries.
• Atherosclerotic plaques were quantified using a plaque score (PS) and ultrasonic biopsy (UB).
• Clinical models were compared with ultrasound plaque score and combined models for diagnostic value.

Main Results:

• Ultrasound models showed high accuracy (AUC 0.87-0.90) for detecting high-grade coronary stenosis.
• Aortoiliac ultrasound demonstrated the highest sensitivity (90%), while carotid + lower extremity UB had the highest specificity (92%).
• The combined clinical and ultrasound model achieved the highest AUC (0.929), significantly improving upon clinical assessment alone (AUC 0.864).

Conclusions:

• Multiterritory non-coronary arterial ultrasound assessment can complement clinical evaluation for CAD risk.
• Ultrasound helps refine patient selection for CCTA by identifying individuals with higher likelihood of significant coronary stenosis.
• This approach offers potential for improved diagnostic yield in cardiovascular risk assessment.