UMEM Educational Pearls

Early Atherosclerosis Detection

50 middle-aged asymptomatic subjects free of vascular disease underwent carotid ultrasound (CUS) for risk stratification were also invited to undergo coronary computed tomography angiography (CCTA) or coronary artery calcium score (CAC) to identify which of the 3 imaging modalities was best at identification of early atherosclerosis

Atherosclerosis was observed in 28%, 78%, and 90% of subjects using CAC, CCTA, and CUS, respectively

36 patients with a CAC score = 0, 69% and 86% had atherosclerosis on CCTA and CUS, respectively

Concordance between modalities was highly variable

CUS and CCTA detection of plaque were significantly more sensitive than CAC 

Considering the prevalence of subclinical disease on CUS and CCTA, the threshold at which to treat warrants further research

References

Schroeder B, Francis G, et al. Early Atherosclerosis Detection in Asymptomatic Patients: A Comparison of Carotid Ultrasound, Coronary Artery Calcium Score, and Coronary Computed Tomography Angiography. Canadian Journal of Cardiology, 2013-12-01, Volume 29, Issue 12, Pages 1687-1694