Multiterritory Arterial Ultrasound before Coronary CT Angiography: A 2-Step Triage Model
Łukasz Artyszuk1, Ewelina Błażejowska2, Zuzanna Danielecka1
1Department of Internal Medicine, Hypertension and Vascular Diseases, Medical University of Warsaw, Warsaw, Poland.
Insights
Non-coronary arterial ultrasound effectively identifies high-grade coronary stenosis, improving patient selection for coronary computed tomography angiography (CCTA). This method enhances diagnostic accuracy beyond clinical assessment alone.
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.
Objectives:
Coronary artery disease (CAD) and peripheral artery disease share common pathophysiological mechanisms and risk factors. Early identification of individuals at risk for CAD is essential for timely diagnosis and intervention. This study evaluated whether non-coronary arterial ultrasound can improve preselection for coronary computed tomography angiography (CCTA) and provide diagnostic information beyond simplified clinical assessment.
Methods:
Seventy-two patients underwent both CCTA and standardized ultrasonographic assessment of multiterritory non-coronary arterial ultrasound, including the carotid, aortoiliac, and lower-extremity arteries. The primary endpoint was CCTA-defined high-grade coronary stenosis. Atherosclerotic plaques were evaluated using a plaque-counting quantitative score, referred to as plaque score (PS), and a semi-quantitative morphology-based classification, referred to as so-called ultrasonic biopsy (UB). To explore incremental diagnostic value beyond routine clinical assessment, a simplified clinical model was compared with a multiterritory ultrasound plaque score and with a combined clinical and ultrasound model.
Results:
Ultrasound models demonstrated high diagnostic accuracy for identifying CCTA-defined high-grade coronary stenosis, with area under the curve (AUC) values ranging from 0.87 to 0.90. Models incorporating the aortoiliac territory showed the highest sensitivity (up to 90%), whereas UB carotid (CAR) + lower extremity arteries (LEA) achieved the highest specificity (92%). In an exploratory incremental analysis, the simplified clinical model achieved an AUC of 0.864, the multiterritory plaque score alone an AUC of 0.887, and the combined model an AUC of 0.929. Addition of the ultrasound score significantly improved model fit (likelihood-ratio p < .001).
Conclusions:
In this exploratory cohort, ultrasound assessment of multiterritory non-coronary arterial atherosclerosis may complement routine clinical assessment and help refine patient selection for CCTA by identifying patients with a higher likelihood of high-grade coronary stenosis on CCTA.
Related Concept Videos
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:28Imaging Studies for Cardiovascular System V: CT
01:30Acute Coronary Syndrome I: Introduction
01:25Imaging Studies for Cardiovascular System VI: Calcium -Scoring CT
01:21Aneurysm II: Clinical Manifestations and Diagnostic Studies