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Author Block D Patton, A Dillon, D Brouillard, A Johri, M Matangi

Kingston, Ontario

BACKGROUND: Carotid Doppler imaging is a simple non-invasive method of assessing the presence or absence of atherosclerosis. The purpose of our investigation was to determine the prevalence of high-risk carotid disease in a series of consecutive patients referred for stress echocardiography.
METHODS: Males aged 40-65 years and females aged 50-65 years referred for either dobutamine or treadmill stress echocardiography also underwent carotid Doppler imaging. Patients were also excluded if they had any history of vascular disease. Two images were performed on each carotid artery. One of the common carotid artery (CCA) and one of the carotid bulb and the internal carotid artery. Maximal CCA intimal medial thickness (IMT) was performed offline using an automated edge detection program. The presence of carotid plaque was defined using the ARIC (Atherosclerosis Risk in Communities Study) criteria. Patients were considered to have high-risk carotid disease if there was either the presence of carotid plaque or the maximal CCA IMT was ≥1.20mm.
RESULTS: Between October 3, 2011 and March 24, 2012, 653 patients were referred for stress echocardiography, 449 underwent treadmill exercise ECHO and 204 dobutamine ECHO. The main findings are seen in Table 1.
CONCLUSION: The prevalence of high-risk carotid disease in patients presenting for stress echocardiography is 52.7% for treadmill and 63.5% for dobutamine. While the patient is in the ECHO laboratory the opportunity to obtain important prognostic information regarding vascular health should not be overlooked.

Table 1.
  Exercise ECHO Dobutamine ECHO
Number 449 204
Exclusions 248 152
Screened (F/M) 201 (145/56) 52 (26/26)
Mean age (years) 57.0 ± 5.1 56.3 ± 5.6
Maximal CCAIMT (mm) 1.01 ± 0.25 1.05 ± 0.22
Plaque (%) 47.3 61.5
Plaque or CCA IMT ≥1.20mm 52.7 63.5
Of the 400 exclusions, 344 were excluded due to age criteria, 37 due to known vascular disease and in 19 patients the reason for not screening was not stated.